Gordon Brown is facing a cash crunch and the NHS budget has been so badly mismanaged that many hospitals are under threat of closure…
…is there a better explanation for this massacre of hospitals? It is quite unbelievable that government ministers can agonise in public about the appointment of a few dodgy teachers, and yet refuse to offer any public comment or justification for the irreversible extinction of dozens of hospitals, hiding resolutely behind civil servants who are themselves anonymous.
Forget the ‘porno sirs’ – the real scandal is going on in the NHS
Many years ago I had a short and happy reign as comment editor of these pages, during which it was my chief joy to sign the expenses of a brilliant but heroically under-productive colleague, whose tactic was to wait until I was full of the benignity that follows lunch and present his stapled dockets, a masterpiece of Tolstoyan length and creativity.
With mock reverence he would approach my desk, and flatten the top sheet in such a way as to conceal the bottom line. “Just sign here, minister,” he would say, in the manner of Sir Humphrey; and because I believed that this was exactly how our then proprietor would have wanted me to spend his money (or whoever’s money it was; there seems to be some confusion on that point these days), I would unhesitatingly authenticate his claim.
Like tens of thousands of people set in authority, I had no time to check the detail of his assertions. I couldn’t confirm that he had indeed had lunch with Mossad or the CIA – where did I phone them? – and there was no point: the sums were tiny, and in any case I had no reason whatever to doubt his word.
He was merely playing with that sense of mild anxiety (“sign here, minister”) that afflicts any low-grade administrator, when we are asked to put our name to something, and when we know in our hearts that we do not have the resources to check it out to our perfect satisfaction. But that is how it works in every office hierarchy; that is how business works; and that is how government works.
If you look at the number of papers to which a secretary of state must affix his or her name, you will soon realise that 90 per cent of these signatures are given on trust: in the expectation that the civil servants have got it right, and that these power-squiggles of the pen are not accidentally releasing swarms of sex fiends into the community or causing a rash of superstores in the green belt. But no matter how fast we scan and we squiggle, there is a common principle accepted by all of us in positions of nominal authority. If it is your name at the bottom of the operative letter, then you carry the can.
Yours was the hand that signed the paper; your five sovereign fingers put a king to death, or authorised the new runway, or gave a teaching job to a well-known pervert. This is the abiding doctrine of ministerial responsibility, and it is the one good thing to come out of the whole sorry business of Ruth Kelly and the “porno sirs”, as we must call them in deference to the Sun.
We may wonder how on earth relatively sensible men such as Kim Howells, the minister concerned, could have decided that a sex offender was an ideal fellow to have in the changing-rooms of the school gym. What I find wholly admirable, on the other hand, is that Kim admits that he consecrated several agonising hours to the decision, and that Miss Kelly continues to protest to anyone who will listen that she bears complete responsibility for the decisions taken in her name, and the meltdown of her department.
We have an extraordinary picture of senior ministers hugging “responsibility” like lovers, and spending most of their waking hours deciding whether this or that person should be employed in this or that school; and yet there are decisions taken every day by government that are far more important, frankly, than a handful of playground perverts, that do far more damage to people’s lives, and for which ministers take no responsibility.
I do not wish in any way to deprecate the current anti-paedophile hysteria, and if Kim sends some sex offender to our school gym, then I will be mighty peeved. But I urge you, if you can, to drag your boggling eyes away from the sex offenders, and consider the NHS. I bet I am not the only MP to have noticed a sharp and recent uptick in the number of complaints about the cancellation of operations.
Last week, it was a woman who came to see me about her osteo-arthritic elbow, and the operation that was scrubbed four times in the space of a month. This morning, I heard from a hernia patient who was told, a month ago, that his condition needed urgent attention, and who received a puzzling letter last week saying that medical thinking had undergone an evolution; he was in fact right as rain, and the operation was cancelled. In so far as his hernia permits it, he is hopping mad.
Across the country, we are seeing what happens when you fire-hose cash at the NHS without properly reforming it, and then decide to turn the tap off; and it is not just operations that are being scrubbed. This week, delegates arrived in Westminster from all over the country to attend the latest meeting of Chant (Community Hospitals Acting Nationally Together), and I am afraid the tone was one of mounting desperation. There are now 80 community hospitals under threat of closure, most of them places much loved and valued by local people, founded by them, and funded by local communities until 1948.
Many readers will already know the arguments in favour of keeping such places going: that they are especially important in rural areas, where general hospitals can be hard to reach, and above all they help to relieve pressure on the acute sector. Why are the poor NHS trusts obliged to tell patients that they are, in fact, in the pink of health, and axe their operations? Because the beds in the acute sector – where they eventually perform hernia operations – are full of people who shouldn’t be there.
And why are the beds full of bed-blockers? Because there are not enough step-down beds in community hospitals. And why are they closing even more community hospitals? Because Gordon is facing a cash crunch and the NHS budget has been so badly mismanaged.
Or is there a better explanation for this massacre of hospitals? It is quite unbelievable that government ministers can agonise in public about the appointment of a few dodgy teachers, and yet refuse to offer any public comment or justification for the irreversible extinction of dozens of hospitals, hiding resolutely behind civil servants who are themselves anonymous.
I do not say that we should lay off Ruth Kelly; just that the inquisition she faces is nothing compared with that which ought to be directed at Health Secretary Patricia Hewitt.
Boris refers repeatedly ” the NHS ” . A point which does not appear to be appreciated is that – since 1998 -the old British NHS has been dismantled and replaced with four separate NHS’s – one each for England , Scotland , Ulster and Wales .
Health in Scotland , Wales and Ulster are devolved issues and the responsibility of their parliaments /assemblies . Only the English NHS – now an entirely separate organisation from the others -is run directly by the British government – because we do not have our own parliament . That same British government takes great care to see that health spending in England on a per head per annum basis lags far behind it favoured Scotland and Wales .
British governemnt funding of Scotland is about£2200 per head per annum greater than in England and a large chunk of that extra spending is on health .
If England were so favoured , instead of being discriminated against , most of the problems of the English NHS could be resolved .
Never trust a people who, in a country renowned for high winds and thistles, adopts the kilt as their national dress.
It could,Psi, just as easily, be said that one should never trust someone who would shoot a sitting bird.
The NHS , as John said, is not as financially favoured in England as in the other places, but then , what is? There appears to be but one side of the coin:they rule us: the reverse is not true.
It is , however , interesting to note that the average life span of those, living , for example , in parts of Glasgow , is markedly less than the average in England, even including the Pielands of the North-west.
Are extra funds in this area not necessary?
Trust is good, but checking is better.
It seems to me that the persons ultimately answerable to the endless questions about the prevailing rules , governing whichever area of governmental responsibility, be it Health or Education , are not taking enough time to check on their subordinates’ advice about the available” facts”.
The rules change so quickly, particularly with regard to the operation of the NHS machine, that added vigilance is the only answer.
Never mind merely flying the Union Flag to signify a oneness of spirit , let us see that EACH , and EVERY,member of the Union has equal shares in the National Income,to be spent on a per capita basis..
Words are cheap: actions are not.
I can tell you that Canada’s gone through something very much like this, and that mortality went UP as a direct result, to the point where some community hospitals were reopened. I realize it’s not quite as difficult to get from Henley to London as it is to get from Bella Coola to Vancouver, but still, how many months of life expectancy is the British government willing to sacrifice to economic goal-setting?
There are also a number of attitude studies, and every one of which I am aware shows overwhelming support for increased fees to maintain access to existing medical facilities, if that is what is required. If the problem is lack of money, and the public is willing to pay more, aggressive and lifethreatening cost-cutting measures are not merely unneccessary but malevolent.
So what’s the Tory position on that?
How much money could have been spent on the NHS if we hadn’t wasted so much killing civilians for the yanks?
Can I make a controversial suggestion:
IS primary health care really cost-effective or indeed just simply effective?
I’ve tried to look up some of the figures on the internet but haven’t made much progress. But I think we must have something like
20,000 GPs (plus ancillary nurses, office staff etc), The GPs these days get about £70,000 per annum. So we are already into mega figures with their salaries alone – £1.4b. Add in the cost of ancillary staff, buildings etc and one must be talking about huge amounts.
I seriously question whether is a very effective service. GPs necessarily have only a very hazy notion of how particular syptoms relate to particular disease processes.
Furthermore, individuals can get a lot of information now from other sources such as the internet.
It seems to me that the government like primary care because they think it is a financial “gatekeeper”. But is it? Or is it a really inefficient way of distributing resources. Wouldn’t it be better if we
(a) encouraged people to access health information over the net (b) if we advised healthy people aged between 18 and 40 not to hassle the health service with minor ailments but to self-medicate (c) if we developed speicalist services for the children and elderly.
The way the NHS was set up was to use the available resources in the most effective way possible, both medically and financially.
Ideally it should be relatively simple : the patient sees the GP, who takes note of any symptoms, and in the case of something of a relatively serious nature, outside his competence, or requiring specialist treatment;refer the patient to a hospital , with the necessary expertise , not too far away.
In general the public seems to think that the GP has abundant time to listen to tales of woe about even the slightest cough ,cold and snivel. Surely this cannot be right!
If patients were required to pay an appointment deposit, say £5.00, repayable in the event of a real illness or condition being diagnosed , the surgeries would not be so crowded,. and more time would be available for those who really are ill.
Of course this will not happen, more’s the pity, because it would be seen, by innumerable organisations, as not PC.
Treatment, if really required , would still be free, but there would be many less , lightly made and then not kept, appointments , thus freeing time and effort of the doctor and the whole surgery staff.
There is are serious problems with each of these suggestions.
Doctors, while neither omniscient nor without personal failings, are well-trained to spot, diagnose and treat health problems. Lay people are not. I had Hodgkin’s Disease; if I’d had to rely on self-diagnosis, I’d have thought I had a flu, and I would have died within eight months. This is not in question. I had access to the net. I have an IQ that beats out not a few GPs. I had an exhaustive list of the symptoms. What I did not have was any inkling that those added up to cancer, nor did the Net help me in any way, nor would it now. It’d probably tell me to eat more organic broccoli while sitting in a crystal pyramid. And many people are the stiff upper lip type, saying “oh, it’s nothing, it’ll pass” till long after it’s too late. If their spouses couldn’t bug them into going to the doctor, they’d drop dead at a much greater rate than they do now.
We must also remember that unless the goverment is willing to commit to 100% net access for its citizens (computers for those without access to community computers, and who cannot afford them themselves, a perfect 100% English literacy rate,even in immigrants, etc) we are essentially making this a two-tiered system, with the bottom tier recieving no health care at all.
Honestly, have YOU heard of Hodgkin’s disease? You’d have died, too.
British Columbia has also put in “user fees” at ten Canadian dollars a visit; the result was an epidemic rate of TB among the poorest, who simply don’t walk around with ten dollars in their pockets all the time. It did prevent me from visiting my doctor once, for which he gave me hell later.
While these suggestions sound sensible, and are well-meant, the ultimate effect of implimentation would be to reduce life expectancy among immigrants, the un-self-absorbed and the poor.
Now, if we could develop a program which would increase mortality among people who wear t-shirts to dinner parties, I’d be in favour!
Oh yes, and user fees had no impact whatsoever on GP or hospital visits by actual hypochondriacs or narcissists. None. Eventually, the government dropped them.
Raincoaster: the suggestion for a REFUNDABLE deposit is not quite the same as charging a fee per visit. The number of appointments which are not kept , thereby denying those in real need getting to the doctors in a timely manner are , we are assured at epic proportions .
Because medical attention is free at the point of delivery, it is being massively abused,and not just by the odd hypochondriac either. This state of affairs is slowly bringing our NHS , once the envy of half the World, to its knees. It is a limited, expensive resource ,with no chance of it ever getting cheaper: it should be respected and used only when needed.
I like Macarnie’s idea of imposing a small charge for GP consultation.
Free medical advice on demand, as often as you want it, is an anachronism in an age when it can cost you £5 or more just to park the car.
People generally swallow the prescription charge (pun unintended!) so why not a similar sum for the consultation? Much as I hate the ever-increasing tax burden, this would at least be a service where you’d pay the money and actually see the goods.
Of course it’s unlikely to happen because of offence to the holy cow of “free at the point of delivery”.
I agree with raincoasters comments on self-diagnosis. There is no way that an individual could pick up certain more serious ailments without the proper training. I was in a similar boat, it turned out that I had a type of cancer called a Seminoma which just threw up a raft of un-related symptoms. I would not have had a cat-in-hells chance of picking it up without my GP. Also he was able to send me to a consultant who was able to narrow it down and send me to the relevant hospital for specialist treatment. I’d have truly been in the proverbial without his advice/help.
Macarnie’s idea about a refundable deposit sounds good, however I’d add a twist that each patient should perhaps have an account (linked to a bank account) with their surgery, if they fail to keep the appointment then the £5 is deducted from their account. Most appointments are made over the phone so this would be one way of guaranteeing the payment if the appointment is missed. I think that most people have bank/post office accounts these days.
I’ve worked in a doctor’s office, and we had no-shows. In fact, we counted on them. The doctors (at least here) aren’t paid for patients they don’t see, so no-shows don’t cost the system anything. I’d be shocked if your system was different, as it would encourage doctors to make up imaginary patients and bill for their bookings. We allowed a 25% no-show rate, and the only difficulty we encountered was that sometimes everyone showed up, putting us well behind schedule.
As for the refundable deposit; well, it won’t help people whose medical difficulties go undiagnosed for years, a not unsubstantial number of the legitimately ill. And as I said, even nonrefundable fees didn’t reduce visits from those who are not actually sick, ie the system abusers. If the problem is that the system is being abused, and fees, refundable or not, don’t reduce this abuse, then what is the justification for the fees? And, as I said, there is a segment of the population that doesn’t run around with ten bucks in its pockets, and the entire principle of socialized medicine is to provide medical care for those who cannot pay for it at the point of delivery.
Hey everyone! I’m back! Ever conclude that debate over my gender? Well, Mr Johnson, as a friend of Mz Angus’, I have to say that I feel an extraodinary amount of pride that you are taking an interest in everything Scooortish. Not that she’s Scottish. Or a she. Because she’s not. DON’T HOLD ME TO ANYTHING!!!
The NHS has long passed its use by date. The biggest beneficiaries are the BMA, RCN and Unison. The reason – truly awful management. Why truly awful management – no competition.
It abounds with Spanish practices and always will do so as long as doctors can moonlight. There is a 4 months queue, but it can be done tomorrow (using exactly the same reasources) if you bung the consultant a few quid. As in France, they should be either in or out.
GPs are handsomely rewarded for making it difficult to get an appointment.
British doctors and nurses are the best paid in Europe (according to the Economist) and yet it is one of the worst health care systems in Europe.
In 1947 a system based on Soviet principles might have made sense. NHS targets admirably reflect the Gosplan-thinking. The collapse of the Soviet Union ought to have made someone think.
It isn’t as though it was rocket-science. Just copy the French model. Knowing the British, hell will freeze over first.
It looks as though eddie reader might have something there. This A.M. a report on the steam wireless tells of a radiographer being suspended , due, either to incompetence; carelessness or both .
Women with symptoms of breast cancer were wrongly given the all clear , thereby prejudicing their chances of a cure..
Much criticism is made of the NHS and illustrated above.
I, however, await the day when British public spending on healthcare per head matches that of America (and that’s the United States of America, not Canada).
The triumph of the NHS isn’t that it’s superb – it’s that it does pretty well despite being run on a shoestring.
How to miss a point.
” I , however, await the day when British public spending on healthcare per head matches that of America (and that’s the United States of America, not Canada). ”
Spending by the British government on healthcare per head , per annum , in Scotland ( via the Scottish parliament ) is already well in excess of that of the US government in the US and of total US spend per head per annum in the US.
The British government is , as ever , besotted with the celtic fringe and is endemically anti English . Their spend on healthcare per head per annum ( as it is for every other category of governmental expenditure eg transport , education , housing etc ) in England is massively less than for Scotland or Wales and the trend is becoming even worse year by year .
– typical British government bias against the English .
When we English have our own English parliament we can deal with our own problems ouselves ( equitably and fairly ) – it is simply ridiculous to suppose that the British government which occupies England will ever deal fairly with the English – they have had enough chances , time for them to get lost and for the English to rule themselves .
That’s horrifying. The Americans aren’t paying for medical service or medicines: they are paying for a vast, boondoggle-choked bureaucracy of HMO’s, insurance schemes, and government departments. Something less than 40% of “healthcare costs” in the US are actually used to provide health care itself. The rest is used to keep paper pushers and lobbyists employed. This is NO-ONE’s idea of a system to be emulated.
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Spending by the British government on healthcare per head , per annum , in Scotland ( via the Scottish parliament ) is already well in excess of that of the US government in the US and of total US spend per head per annum in the US.
The former I can easily believe – but the latter really surprises me. Public healthcare spending is only 45% of the total in the US as opposed to 85% in the UK (and it is those figures that are getting compared). Could you source the claim that the total healthcare spending in Scotland is higher please?
Using OECD figures for 2003 ( the latest and published in 2005) healthcare spend , both public and private , for the UK is 7.7% ( despite the British govt’s attempt to fix the figs upwards )
US is 15%
of GDP .
I agree with your fig of 85% of the UK spend being public – about right
ie 6.545% of GDP
US public healthcare spend if at 45% of the total would make it 6.75% of US GDP ie ahead of ours . In fact , I had thought that the US public spend was about 8.6% of US GDP . US spend is bound to be more evenly spread than in th UK – they are a federal state and each state fights its corner – no one over there would put up with the gross disparity in health spend which we have in the “United Kingdom ” for 5 minutes .