Category Archives: Guest

Assessment of differences of survival between countries. We have rationed anaesthetists, and ventilators, as well as hospital beds, for decades..

This is courtesy of a friend. His analysis betrays the British Politicians and Ministers of Health over decades. His Assessment of the differences of survival between countries may be superficial but its worth considering and reflecting.. We have rationed anaesthetists, and ventilators, as well as hospital beds, for decades.. Successive ministers of health should be in the dock giving evidence to the retrospective enquiry. (See below) Remember that in 2015: David Iacobucci reports on the opinion of David Nicholson. We have had at least 5 years warning, and done nothing.

All main political parties’ pledges for NHS will prove inadequate, says former chief executive: BMJ 2015;350:h2081

I’ve been asked why the death rate in Germany is relatively so much lower than the UK and Italy. I think that this might explain it to some extent.

Country Intensive Care beds Care beds with Ventilators Critical care beds per 100,000 population
Germany 28,000 25,000 30.0
France 12,429 5,065 12.0
Italy 7,560 15,000 12.5
UK 4,123 5,000 6.6
US 160,000 34.2

The 5,000 count of UK ventilators includes all of those use in the operating theatres which is why it exceeds the number of Intensive Care beds. Apparently the NHS has just requisitioned 1,200 more from the private sector.

The much lower death rate in Germany might be explained by their far higher availability of Intensive Care Beds and ventilators.

Age alone cannot explain the difference, as the median age of the population in Italy is 45.5 years compared with 47.1 years in Germany!

The other reason for Germany’s lower death rate (to date) seems to be “Test, test, test”.  They have been doing about 23,000 per day. That means that the people in the denominator include far more mildly affected people than in the UK (and I believe in Italy) where the only people being tested have turned up at hospitals with severe symptoms.

Let’s hope all of those companies which have been asked to help make ventilators are pulling out all of the stops.

We know that our scientists and medics are.

Many governments and many ministers of health have made mistakes… They should be candid.

Successive ministers of health are responsible for the nursing shortage. And they are not accountable!!

NHSreality wants scapegoats – and suggests the successive ministers of health (for England). Allyson Pollock might agree..

A 150% increase in patients going private is an indictment of the UK Health Services… Successive health ministers have ensured a thriving private system.


Poor state of Welsh health. The experiment with devolution has failed….

Poor state of Welsh health Letter in the Sunday Times 17th December 2019
Labour has announced it will outspend the Tories on the NHS and reduce waiting times. Here in Wales the NHS has been devolved to the Labour–led Welsh assembly since 1999. Waiting-time targets for most elective surgery are twice those in England (36 weeks as opposed to 18) and even then are often exceeded.

The Welsh NHS also performs considerably worse in A&E waiting times, with some health boards even allowing 12-hour waits.
Eleanor London, Penarth, Vale of Glamorgan

Devolution of health to Wales was a mistake?

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

The advantages of mutuality are being shunned. Purchasing power in small regions is little. Choices are disappearing.. Hammond is unlikely to help ..

Less talk more action on General Practitioners

LESS TALK, MORE ACTION ON GPs – The Sunday Times 17th November 2019
You report that “Tories make more ‘empty promises’ on extra GPs” (News, last week). These will do nothing for the millions of patients who are unable to see their GP because of the recruitment and retention crisis. This is a government that has proven its inability to deliver on its 2015 commitment of recruiting an extra 5,000 GPs.

As GP numbers are falling, we need more than just election soundbites — we need investment in the working conditions and retention of our existing GPs, who have been neglected for the past decade.
Dr Rinesh Parmar, chairman, The Doctors’ Association UK

Reality check-up
While election pledges to deliver more family doctors are encouraging, we must not forget that previous promises have fallen far short and GP numbers have continued to decline. We need meaningful action to keep experienced GPs in the NHS, not least the scrapping of absurd pension regulations that punish doctors for staying in work.

Both main parties say extra GPs will provide millions more appointments, but thousands more doctors are needed just to meet present demands. Politicians owe it to patients to be realistic about what can be delivered.
Dr Richard Vautrey, chairman, BMA GP committee

Those “halcyon” days…


Sir, Dr Andrew Bamji (letter, Nov 2) asserts that the Blair and Brown Labour governments were truly awful in their handling of the NHS. I wholly concur with his withering assessment but the past nine years of Conservative government have not been the answer. From catastrophic cuts in funding (as a percentage of GDP) to top-down reorganisations of the NHS that we were promised would not happen by David Cameron, we have witnessed a systematic destruction of the NHS by the Conservative Party. The disdain with which Labour treated junior doctors during the modernising medical careers (MMC) fiasco of 2007 was dwarfed by the contempt shown by Jeremy Hunt during 2015-16 and which prompted the first junior doctors’ strike in a generation. Consultants and GPs have not fared better, with brutal taxation policies from 2016 onwards that have prompted mass retirement, decimation of overtime and the worst waiting lists since John Major’s premiership. Many patients are now waiting in more than a year for planned surgery, suffering pain and disability as a direct consequence of this government’s mismanagement. When this is coupled to the abolition of nursing bursaries, perilously low staffing on wards, mental health crisis, and the effects of Brexit on a multicultural and multinational NHS workforce, one can see that this is the worst of times. Dr Bamji should be grateful that he is retired as many of us of left working in the NHS now look back at the Blair-Brown years as halcyon days.
Professor Neil Smart

Consultant colorectal surgeon, Royal Devon & Exeter Hospital

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The Market for health

In a letter to the Times 25th Feb 2019 a consultant exposes the weaknesses of the Internal Market:

Sir, The abolition of competition among NHS hospitals is long overdue (News, Feb 22). The “internal market” introduced within the NHS in 1991 was intended to drive down costs and increase choice, among other things. In fact it was inefficient, costly, resulted in a proliferation of managers and was potentially harmful to patients, as well as many other problems.

Smaller hospitals wanted to introduce money-raising procedures for which they had neither the staff nor equipment, procedures usually performed by larger, more experienced tertiary centres. This resulted in duplication of expensive equipment, inexperienced staff doing procedures for which they did not have enough training and ultimately a risk of patient harm. A few years ago I recall a local colleague telling me that his hospital needed to start a cardiology procedure “to balance the books”.

Fortunately, it has been realised that collaboration is highly preferable to competition. At last the damage started by the internal market is being undone. Patients can be directed to centres that are best at the task in hand, not the cheapest.
Dr David E Ward

Consultant cardiologist (ret’d)
London SE22

NHS plan ‘ends public right to choose hospital’ – A form of rationing well known to Wales

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Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns


Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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Thank god the Welsh were wise enough to avoid PFI

The collapse of Carillion was foreseen. In May 2013 there was a campaign not to use PFI in Liverpool. The BMJ summarises the history of a tempting short-termism idea, which has made some parts of the country even less well served. It has led to great wealth for the directors and officers of PFI companies as well.

Richard Smith in an editorial in the BMJ opines (BMJ 2018;360:k311 ):  Failure of the private finance initiative

Was predictable and predicted

In 1999 TheBMJ called the private finance initiative (PFI) “perfidious financial idiocy,”1 and in 2017 the Office for Budget Responsibility described it as a “fiscal illusion.”2 Now a data driven report from the National Audit Office shows that PFIs have been more expensive than the use of public financing for the building of hospitals, schools, and other public buildings and has mostly not realised the benefits hoped for.3 Published in the same week as the collapse of Carillion, a large company fulfilling PFI contracts, the report has helped propel private financing and provision of public services high on the political agenda.

The difference between conventional public procurement of new buildings and PFIs lies in the financing. In both cases private contractors do the work, but with PFIs the money comes from the private sector. The public sector then pays back the private sector over some 25-30 years from when the building is delivered. The UK has over 700 PFI projects with a capital value of around £60bn (€68bn; $83bn). Annual charges were £10.3bn in 2016-17, and even without any new projects charges will continue into the 2040s and cost £199bn. It’s important to note, however, that over the past 20 years the contribution of PFI, at around £3bn a year, is relatively small compared with public capital investment of around £50bn a year.3

The main attraction of PFI to the government is that privately raised capital does not add to national debt. Nevertheless, it is paid for from the public purse in the form of annual charges, and the Treasury knew when it launched PFI in 1989 that it would be more expensive because privately raised capital is more expensive than publicly raised capital and carries other costs (insurance and management costs). It hoped, however, that it would achieve value for money through efficiencies and better outcomes. The National Audit Office report dashes those hopes.

Even the National Audit Office does not have access to all the government’s PFI contracts, but its study of a group of schools found that PFI costs are about 40% higher than funding with public money. A study in 2011 by the House of Commons Treasury Committee found that a PFI hospital cost 70% more than a publicly financed one.4 The Treasury disputes these findings.

Save now, pay later

PFI is also attractive to government ministers because there are savings in the early years: the costs come later. The National Audit Office’s study of the schools showed that despite the overall costs being higher, costs were lower for the first 15 years. The Department of Health had greater flexibility in its budget between 1997 and 2009 because the capital investment was greater than the charges, but by 2015 charges were almost £2bn greater than capital investment. This lack of flexibility is much more severe in some NHS trusts, with one trust paying 20% of its turnover in PFI charges.3

The National Audit Office analysed the hoped for benefits to see if they outweighed the extra costs. It found that PFI projects are more often delivered on time and within budget than non-PFI projects but did not find any savings in construction costs. Similarly, it found no evidence of operational efficiencies, and there were higher maintenance costs in PFI hospitals but also higher standards.

Lack of flexibility may prove to be one of the biggest problems with PFI projects lasting 25-30 years. The report describes how Liverpool City Council is paying £4m a year for a school that is empty; overall it will pay £47m for a school that cost £24m to build. Most observers of the NHS recognise the need to shift services from hospitals to the community.5 Inflexible, long term PFIs preserve the domination of hospitals at the expense of community services.

Health authorities and local authorities have, however, now recognised the idiocy and seen through the illusion: between 2002 and 2007 there were an average of 55 PFI deals a year, whereas there was only one in 2016-17. Nevertheless, the public sector will be paying average charges of £7.7bn over the next 25 years, and the National Audit Office concludes that it is difficult to reduce the costs.

Despite the criticism of PFI since its inception, the overall performance of PFI has never been quantified. In the face of higher financing costs and continuing criticism, the Treasury relaunched PFI as PF2 in 2012, but the National Audit Office concludes that it’s not much different—hence the low uptake. Yet the poor state of the nation’s finances means that there may have to be some continuing use of PF2.

The combination of the National Audit Office report and the collapse of Carillion has led to calls to end all use of the private sector for providing public services, but this would probably be a mistake. The Financial Times points out that if there is a market in the service, performance can be easily measured, and the service isn’t integral to the purpose and reputation of government, then outsourcing to the private sector can work.6 Catering meets all three criteria, whereas probation services meet none of them.

The public sector should be smart rather than ideological and avoid the illusion of a “free lunch,” as The BMJ said in 1999.1


  • Competing interest. RS wrote the 1999 editorial on PFI, when he was editor of The BMJ. He worked for UnitedHealth Group, a private company supplying services to the NHS from 2004 to 2015 and still has shares in the company. He is also the chair of Patients Know Best, a private company selling into the NHS. This position is unpaid but RS owns share options (about 1% equity) in the company. He is also a paid consultant for an artificial intelligence company Medial EarlySign, which hopes to sell into the NHS.




English Health Service to reject more PFI – but not the hedge funds!

NHS ‘leaking millions’ in PFI contracts. No PFIs in Wales…. unless GP premises count.

Ending the Blair/Brown short term mania for PFI Hospital Builds

Campaigners urge bosses not to use PFI to build new Royal Liverpool Hospital