Maybe a section on preventing health problems eg obesity via food nutrition knowledge and food preparation skills, opportunities for exercise, monitoring progress?
I would agree on this. Many illnesses have a trajectory that worsens over time because of the way we live our lives reaching an acute emergency stage that could have been avoided or significantly delayed.
Although I’m not a fan of what is often called the nanny state, I think linked to this is something around food formulation. Excess sugars are being better understood but they are hidden in ‘cheap’ food under the various names that is invisible to people. I’m not talking about a sugar tax here. Cheap food in reality isn’t cheap, the cost has just been displaced.
I do wonder if it's not a bad idea to levy a processed food tax in order to incentivise buying raw foods. I hate to put the finger on the scales this way but the costs of bad health are socialised in the absence of an insurance system
From my experience of having been a hospital patient for 7 consecutive days last year may I suggest a way in which the NHS could be re-organised to improve efficiency
If my case was fairly typical, the consultants’ routine is to go around with their entourage each day, in my case each late morning, visiting the patients they oversee. They decide on what testing (often including blood tests) should be done within the next 24 hours and whether the patient is ready for discharge. The following day on their rounds, if known, they report the findings of testing. The findings may prompt further testing and so on.
Not being well-versed in hospital routine, when it came to midday on the Saturday and the consultant and his entourage hadn’t arrived, I made enquiries and was informed the doctors didn’t work week-ends.
On the Monday after the consultant’s visit, I was discharged. I could have been discharged on the Saturday as it happened. In effect I had been blocking a bed over the week-end. And a lot of patients must effectively have been bed-blocking to greater and lesser extents.
Meanwhile, over the week-end, a lot of hospital equipment had been lying dormant, except for emergency use.
I believe it to be the case that the nursing staff’s work schedule more or less provides the same daily care 7-days a week; whereas the equivalent situation with doctors and others is 5-days a week. Doctors and others, excepting those whose turn it is to be on week-end duty, all take their 2 days a week leave off together at the week-end.
My suggestion to improve efficiency is for said doctors and others to work rotas akin to those worked by nursing staff. Such a reorganisation would not only reduce bed-blocking but also make better use of hospital facilities such as scanners, etc.
You are quite right that administrators and managers are necessary. However their function should be to support front line staff, not control and micromanage them. I suspect that all bureaucracies tend to take expand their role until the actual workers are totally swamped in red tape. You get the situation where nurses are more likely to be censured for incompetent form filling than for incompetent treatment.
How you keep a public sector administration firmly in it’s box,I don’t really have an answer to. Judging by the little I have seen of hospitals, it looks like no-one else knows either.
Just a quick note regarding pandemics. The pandemic industrial complex is building rapidly and is incentivised to find the next bug du jour. As such the corporatisation together with the supra national decision making in design, means that an unacceptable budget will be dedicated to surveillance and prevention in the name of preventing lockdowns.
This article gives a summary and links to work going on at Leeds University showing how the industry is built on aberration rather than fact.
Maybe worth in any summary something along the lines of the party does not believe that any debate about funding / delivery should be boiled down to a simple comparison of the existing UK model v the US model. This is a deliberate polarising tactic to ensure a status quo is maintained and avoids the debate that must be had. There are multiple other models in nations that allow for the introduction of patient insurance whilst ensuring that the most vulnerable are provided for to the same standard.
Thank you for understanding taking this massive task. There are many good points you make. I keep coming back to:
1) who actually runs the NHS? It’s isn’t the government. There is an overall CEO (for NHS England) and also CEOs for the various regions. Each will have an SLT and a board. These are the people who run the NHS: day to day, week to week, month to month and year to year. With that in mind. What are their incentives? I always start from the first principle (from Munger), “Show me the incentives and I will show you the behaviour/outcomes.” Are they being held accountable? We rarely (if ever) hear about these leadership teams, their performance (absolute and relative to each other), which region is doing better than the other etc.
2) The NHS is vast. It has become an institution (Bridges - Organisational life cycle) that is inward focused, as it has lost its way, prefers to maintain the status quo, and (like the BBC) exists for itself rather than its customers. So it doesn’t make sense (to me) looking at it as one whole unit. Transparent reporting comparing the regions (focused on the top x priorities). I am assuming that each region is ran as a silo. Likely the regions run themselves largely as silos because (coming back to incentives) status, power, prestige could be at play.
3) The book “The hard thing about hard things” is a must read for managers and leaders. We are in wartime and should be running the NHS through that lens. Peacetime activities (and spending) are only suitable for when things are going well. The same view could be applied to the civil service. As you say the managers and administrators are important. Middle managers get incredibly bad press. We need these managers and the SLT to be ran under wartime conditions. Another big assumption, these top executive teams may not know how to do it.
Some initial thoughts from me. #1 incentives and #2 wartime versus peacetime thinking could be applied to all your manifesto sections.
One suggestion to consider is that other policy areas under development have a health component written into them. Many chronic illnesses are a consequence of the life we have led unaware of what is happening to us under the surface. T
So for example house building, land and planning should have mixed use programmed into it to increase pockets of resources to be accessed on foot or safely by bike to reduce sedentary behaviour. Policing as you have already noted should have more community focus so that people feel increasingly safe to walk.
+1 for something on the importance of prevention. IMO everyone should be offered an annual check that covers all the major diseases causing death in the UK, so breast, prostate, lung, bowel, pancreatic etc cancers, and whatever else is high on the list. Clearly a huge and costly undertaking that would take a great deal of time - I’m imagining a hospital/clinic visit of something in the region of half a day per person. But I think in the long term, early detection, with the reduction in treatment complexity that that implies, would end up reducing costs and improving outcomes.
“For political purposes, virtually all parties will declare ....part of the problem.”
I don't agree that many health problems are not due to simply variable management but the delivery model itself: we should look at what we can learn from France, Germany, and other medical delivery models. This is particularly the case when referrals to primary health care/GPs are made.
There is also an issue of culture. The view that profit has no place in health care tends to be married with the notice that a not-for-profit system in some way makes the operational staff virtuous and therefore managers evil. There is no pressure on staff to improve because the patient has not autonomy or financial pressure in the relationship. The old vocational deeply Christian influenced conservative models of nursing have disappeared.
As the generations pass through the system, the old incalcitrant independent minded, locale based, even bloody minded GPs have retired, the next generation are integrated into the commissioning and contractual obligations to the changing administrative health commissioning structure. Health Authorities gave wave to Primacy care Trusts, they were replaced by commissioning care groups and now integrative care boards. With each reform they are separated from the communities they were a part of. Whether in medical care, nursing homes or even social care, people are not inclined to shop around. So there is seldom a pressure on these services. The focal point of hospital discharge were the a independent person is converted into a patient and then into a “bed blocker” the pressure is on to get them out of the medical system at the exact point when the patients next decision should be cautious and informed as the next move into transitional care options back in to the community, back home with support or into institutional care is those most life-changing. The Hospital serves itself not the patient. The only KPI that matters is waiting lists and the power of health care staff, nurses, and doctors, as well as managers coalescing into the new class interest politically connected and dominating. The patients are the inconvenience.
“The reason is as much to do with ... a comprehensive review.”
Any review needs to have presuppositions otherwise, the healthcare blob will take it over:
Presupposition one: the NHS, like many public sector bodies, is overly bureaucratic and far too large, leading to a stifling top-down culture with no innovation. We should look at how to promote independence, innovation, and creativity of response, particularly at middle management and local level.
“Usually, the best recovery space is in the home. Our policy will be to restore healthcare to the district level. Many regions are served by one or two large hospitals, often far away from where people live. A journey across a UK city can take at least an hour by car, incurring parking costs, and longer by public transport. We must return to the model of district hospitals and specialist clinics geared for care in the home, with improved interoperability between organisations.”
I agree, but it is probably too late now as the hospital estate is rather set and consolidated into mega hospitals, starting in the eighties. Diversifying would require a ten-year, multi-billion-dollar program. There may be more opportunities in rural areas. Green impact on transport will be a serious problem, the decline of the ambulance capacity relative to the population is also something we should examine.
“There has been ... recommendations for improvement.”
There has to be tension between the health medical model and social care wellbeing model; integrated boards were, in my opinion, a health takeover of social care mainly due to the far weakened state of local government post-austerity. Again, I would not trust a royal commission to think constructively on this.
“We note that discharging people ... domiciliary care.”
I think discharge is invariably based on freeing up beds – based on the notion of medically fit for discharge – to work out what kind of future placement is required for the patient - either intermediate care, re-enablement care, a care home or nursing home - or back to the individual’s home or a family home with a spouse or family member requires careful consideration that seldom happens, and the discharge process is rushed. Premature discharge resulting in readmission does not lead to a financial or performance punishment for the hospital. This is why market pressure for care home placements that would drive up standards does not operate in practice. Added is the downward pressure on costs exercised by councils with limited budgets. Solutions? I think I would need to reflect upon this.
That is true, but discharge must also be planned, and the “Bed Blocking” paradigm prevents this. I think the scarcity of supply on both sides of the discharge is becoming a greater challenge, particularly with an ageing population and the sacking of tens of thousands of low-paid experienced care workers from care homes due to the vaccine mandate.
“On an average day in July 2023, ... and intermediate care.”
Community nurses are particularly vital because they are community-based. Note that austerity cuts in administration and staffing led to a vacating and consolidation of office and health centre spaces into large hospitals or larger under-occupied units.
“Meanwhile, the care home sector is a mess. ... career progression.”
Hold on, you have to distinguish between care assistants (mainly in care homes) and care assistants “supervised by nursing staff in nursing homes”. Also, care work in homes, cleaning, toileting, bathing, laundry, and low-level friendliness and attentiveness, dare I say kindness – is more an attitudinal thing than a skill training thing and flows from the culture of the care manager/owner and the availability of labour. Many modestly educated woman workers went into ancillary, shop assisting, cleaning our factory work and now work in the care sector. The real skill issues should be addressed in the care home alongside experienced and capable workers; increasing access to college off-the-job training invites the individual to leave for...
...better, less arduous work or hours. Training of care managers is vital in setting the culture in the home. Isolated, often attractive-looking care homes in rural areas struggle with care quality due to the availability of labour pulled from a small local community.
“To that end, we propose a ... part of the community.”
I assume you are thinking of places like London. Either way, this will be very expensive and will set off a ripple effect with nursing staff and even some doctors wanting access to the same provision. Not sure this is practical and will inevitably have to be picked up in council houses.
“This will be ...nursing.”
I think you are confusing care in the home with medical interventions that generally would be delivered by a contracted local GP, the nursing staff in a nursing home, an ambulance or via unfortunate accident and emergency or hospital admission. If, in fact, you are talking about home care, then the point about low-level personal care work comes in again, this time in the individual’s home; as soon as you professionals this work, people will leave for better statutes and pay alternatives.
“Though coming ... from taxation.”
I will need to ponder this. Over 80 seems too high; most individuals die between 82 and 83 in a nursing home. I assume we are looking at unpaid family carers, a spouse or other family member. This would be a high cost, and most carers do this for free, so you would not release any extra capacity.
General Practice
“The Party believes ... casualty departments.”
District hospital aside, I agree; I think if the non-emergency non-accident cases were taken away for accident and emergency, they would bounce back into life. My guess is that two-thirds of the people who attend A&E are directed there by GP surgeries or even walk-in centres that need to be incentivised to provide slots.
“It has suited the British medical profession ... and speciality training places.”
One of the problems seldom acknowledged has been the push for female doctors in the UK. Due to female doctors wanting to eventually go part-time, the cost of training female doctors versus what they contribute once trained is much higher than that of male doctors. Also, I think the radicalisation of the Health Sector unions is a direct result of a higher proportion of female members, crippled with university fee debt and keen to settle and start a family.
Nurse recruitment
“To qualify as State Enrolled Nurses, students completed a 2-year course. The entry criteria being ‘O’ levels and an interview in the 1980’s. This training fitted easily into most lifestyles and family commitments.”
There is a leap here. Most nursing accommodation was phased out by Ken Clarke in the eighties – my first girlfriend trained as a nurse and Occupational therapist in London after the nursing accommodation had gone, and it was really hard to find somewhere to live back then mid eighties -this was decades ago. Most nursing training is at university hospitals, with less time on the wards.
“Today ... on the wards.”
Leadership and personal management skills would be beneficial for training.
Covid aftermath
COVID lockdowns would never have been possible without the deleterious centralisation and delocalisation of health and social care, the denuding of local government, and the politicisation of public health into panicky health security overlords.
I would generally agree with you. My main experience has been over the last 5 years or so and looking back at some of the other occasions made me realise that there have always been issues, but that it has got worse in recent years. I am now 64.
It took the NHS doctors and specialists 1.5 years to come up with a diagnosis of cancer at start of 2020 and then giving me immunotherapy for 9 sessions before I realised that my facial palsy which occurred in 2018 was caused by my diet. The useless doctors never once asked about diet. If you should be interested I wrote something about it.
I understand the therapy was very expensive and from what little information is available toxic to a degree and added to my issues, probably affecting my pituitary and thyroid balance.
The NHS has to a large extent been taken over by big pharma and toxic drugs which are invariably the resort of the pharma indoctrinated doctors.
Much of the NHS is not necessary and as a nation we have relied on the State to look after our health at which it is incompetent at best.
I consider the NHS should be essentially demolished as an organisation and rebuilt using whatever is worth saving. As you say provide a safety net for emergency treatment and not much more.
Many thanks David. Interesting comment from that GP. Family doctor, what are they nowadays?! In my surgery they have a pharmacy which I understand was owned by one of the GP's. A clear conflict of interest if so.
Maybe a section on preventing health problems eg obesity via food nutrition knowledge and food preparation skills, opportunities for exercise, monitoring progress?
Good on you taking this on, by the way
I would agree on this. Many illnesses have a trajectory that worsens over time because of the way we live our lives reaching an acute emergency stage that could have been avoided or significantly delayed.
Although I’m not a fan of what is often called the nanny state, I think linked to this is something around food formulation. Excess sugars are being better understood but they are hidden in ‘cheap’ food under the various names that is invisible to people. I’m not talking about a sugar tax here. Cheap food in reality isn’t cheap, the cost has just been displaced.
I do wonder if it's not a bad idea to levy a processed food tax in order to incentivise buying raw foods. I hate to put the finger on the scales this way but the costs of bad health are socialised in the absence of an insurance system
Some brilliant, creative ideas here Pete, but pragmatism too. Keep up the good work!
From my experience of having been a hospital patient for 7 consecutive days last year may I suggest a way in which the NHS could be re-organised to improve efficiency
If my case was fairly typical, the consultants’ routine is to go around with their entourage each day, in my case each late morning, visiting the patients they oversee. They decide on what testing (often including blood tests) should be done within the next 24 hours and whether the patient is ready for discharge. The following day on their rounds, if known, they report the findings of testing. The findings may prompt further testing and so on.
Not being well-versed in hospital routine, when it came to midday on the Saturday and the consultant and his entourage hadn’t arrived, I made enquiries and was informed the doctors didn’t work week-ends.
On the Monday after the consultant’s visit, I was discharged. I could have been discharged on the Saturday as it happened. In effect I had been blocking a bed over the week-end. And a lot of patients must effectively have been bed-blocking to greater and lesser extents.
Meanwhile, over the week-end, a lot of hospital equipment had been lying dormant, except for emergency use.
I believe it to be the case that the nursing staff’s work schedule more or less provides the same daily care 7-days a week; whereas the equivalent situation with doctors and others is 5-days a week. Doctors and others, excepting those whose turn it is to be on week-end duty, all take their 2 days a week leave off together at the week-end.
My suggestion to improve efficiency is for said doctors and others to work rotas akin to those worked by nursing staff. Such a reorganisation would not only reduce bed-blocking but also make better use of hospital facilities such as scanners, etc.
You are quite right that administrators and managers are necessary. However their function should be to support front line staff, not control and micromanage them. I suspect that all bureaucracies tend to take expand their role until the actual workers are totally swamped in red tape. You get the situation where nurses are more likely to be censured for incompetent form filling than for incompetent treatment.
How you keep a public sector administration firmly in it’s box,I don’t really have an answer to. Judging by the little I have seen of hospitals, it looks like no-one else knows either.
Food for thought.
Just a quick note regarding pandemics. The pandemic industrial complex is building rapidly and is incentivised to find the next bug du jour. As such the corporatisation together with the supra national decision making in design, means that an unacceptable budget will be dedicated to surveillance and prevention in the name of preventing lockdowns.
This article gives a summary and links to work going on at Leeds University showing how the industry is built on aberration rather than fact.
https://brownstone.org/articles/the-fairy-tale-of-pandemic-risk/
Maybe worth in any summary something along the lines of the party does not believe that any debate about funding / delivery should be boiled down to a simple comparison of the existing UK model v the US model. This is a deliberate polarising tactic to ensure a status quo is maintained and avoids the debate that must be had. There are multiple other models in nations that allow for the introduction of patient insurance whilst ensuring that the most vulnerable are provided for to the same standard.
Thank you for understanding taking this massive task. There are many good points you make. I keep coming back to:
1) who actually runs the NHS? It’s isn’t the government. There is an overall CEO (for NHS England) and also CEOs for the various regions. Each will have an SLT and a board. These are the people who run the NHS: day to day, week to week, month to month and year to year. With that in mind. What are their incentives? I always start from the first principle (from Munger), “Show me the incentives and I will show you the behaviour/outcomes.” Are they being held accountable? We rarely (if ever) hear about these leadership teams, their performance (absolute and relative to each other), which region is doing better than the other etc.
2) The NHS is vast. It has become an institution (Bridges - Organisational life cycle) that is inward focused, as it has lost its way, prefers to maintain the status quo, and (like the BBC) exists for itself rather than its customers. So it doesn’t make sense (to me) looking at it as one whole unit. Transparent reporting comparing the regions (focused on the top x priorities). I am assuming that each region is ran as a silo. Likely the regions run themselves largely as silos because (coming back to incentives) status, power, prestige could be at play.
3) The book “The hard thing about hard things” is a must read for managers and leaders. We are in wartime and should be running the NHS through that lens. Peacetime activities (and spending) are only suitable for when things are going well. The same view could be applied to the civil service. As you say the managers and administrators are important. Middle managers get incredibly bad press. We need these managers and the SLT to be ran under wartime conditions. Another big assumption, these top executive teams may not know how to do it.
Some initial thoughts from me. #1 incentives and #2 wartime versus peacetime thinking could be applied to all your manifesto sections.
Good luck.
One suggestion to consider is that other policy areas under development have a health component written into them. Many chronic illnesses are a consequence of the life we have led unaware of what is happening to us under the surface. T
So for example house building, land and planning should have mixed use programmed into it to increase pockets of resources to be accessed on foot or safely by bike to reduce sedentary behaviour. Policing as you have already noted should have more community focus so that people feel increasingly safe to walk.
+1 for something on the importance of prevention. IMO everyone should be offered an annual check that covers all the major diseases causing death in the UK, so breast, prostate, lung, bowel, pancreatic etc cancers, and whatever else is high on the list. Clearly a huge and costly undertaking that would take a great deal of time - I’m imagining a hospital/clinic visit of something in the region of half a day per person. But I think in the long term, early detection, with the reduction in treatment complexity that that implies, would end up reducing costs and improving outcomes.
Some observations:
“For political purposes, virtually all parties will declare ....part of the problem.”
I don't agree that many health problems are not due to simply variable management but the delivery model itself: we should look at what we can learn from France, Germany, and other medical delivery models. This is particularly the case when referrals to primary health care/GPs are made.
There is also an issue of culture. The view that profit has no place in health care tends to be married with the notice that a not-for-profit system in some way makes the operational staff virtuous and therefore managers evil. There is no pressure on staff to improve because the patient has not autonomy or financial pressure in the relationship. The old vocational deeply Christian influenced conservative models of nursing have disappeared.
As the generations pass through the system, the old incalcitrant independent minded, locale based, even bloody minded GPs have retired, the next generation are integrated into the commissioning and contractual obligations to the changing administrative health commissioning structure. Health Authorities gave wave to Primacy care Trusts, they were replaced by commissioning care groups and now integrative care boards. With each reform they are separated from the communities they were a part of. Whether in medical care, nursing homes or even social care, people are not inclined to shop around. So there is seldom a pressure on these services. The focal point of hospital discharge were the a independent person is converted into a patient and then into a “bed blocker” the pressure is on to get them out of the medical system at the exact point when the patients next decision should be cautious and informed as the next move into transitional care options back in to the community, back home with support or into institutional care is those most life-changing. The Hospital serves itself not the patient. The only KPI that matters is waiting lists and the power of health care staff, nurses, and doctors, as well as managers coalescing into the new class interest politically connected and dominating. The patients are the inconvenience.
“The reason is as much to do with ... a comprehensive review.”
Any review needs to have presuppositions otherwise, the healthcare blob will take it over:
Presupposition one: the NHS, like many public sector bodies, is overly bureaucratic and far too large, leading to a stifling top-down culture with no innovation. We should look at how to promote independence, innovation, and creativity of response, particularly at middle management and local level.
“In terms of care ... cure them.”
I think you are overlooking and may be duplicating step-down and step-up intermediate care from health and reablement care from social care. https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/understanding-intermediate-care
“Usually, the best recovery space is in the home. Our policy will be to restore healthcare to the district level. Many regions are served by one or two large hospitals, often far away from where people live. A journey across a UK city can take at least an hour by car, incurring parking costs, and longer by public transport. We must return to the model of district hospitals and specialist clinics geared for care in the home, with improved interoperability between organisations.”
I agree, but it is probably too late now as the hospital estate is rather set and consolidated into mega hospitals, starting in the eighties. Diversifying would require a ten-year, multi-billion-dollar program. There may be more opportunities in rural areas. Green impact on transport will be a serious problem, the decline of the ambulance capacity relative to the population is also something we should examine.
“There has been ... recommendations for improvement.”
There has to be tension between the health medical model and social care wellbeing model; integrated boards were, in my opinion, a health takeover of social care mainly due to the far weakened state of local government post-austerity. Again, I would not trust a royal commission to think constructively on this.
“We note that discharging people ... domiciliary care.”
I think discharge is invariably based on freeing up beds – based on the notion of medically fit for discharge – to work out what kind of future placement is required for the patient - either intermediate care, re-enablement care, a care home or nursing home - or back to the individual’s home or a family home with a spouse or family member requires careful consideration that seldom happens, and the discharge process is rushed. Premature discharge resulting in readmission does not lead to a financial or performance punishment for the hospital. This is why market pressure for care home placements that would drive up standards does not operate in practice. Added is the downward pressure on costs exercised by councils with limited budgets. Solutions? I think I would need to reflect upon this.
http://www.profdevjournal.org/articles/103032.pdf
Performance-based contracting might be a model.
“Pressure on services ... they leave hospital.”
That is true, but discharge must also be planned, and the “Bed Blocking” paradigm prevents this. I think the scarcity of supply on both sides of the discharge is becoming a greater challenge, particularly with an ageing population and the sacking of tens of thousands of low-paid experienced care workers from care homes due to the vaccine mandate.
“On an average day in July 2023, ... and intermediate care.”
Community nurses are particularly vital because they are community-based. Note that austerity cuts in administration and staffing led to a vacating and consolidation of office and health centre spaces into large hospitals or larger under-occupied units.
“Meanwhile, the care home sector is a mess. ... career progression.”
Hold on, you have to distinguish between care assistants (mainly in care homes) and care assistants “supervised by nursing staff in nursing homes”. Also, care work in homes, cleaning, toileting, bathing, laundry, and low-level friendliness and attentiveness, dare I say kindness – is more an attitudinal thing than a skill training thing and flows from the culture of the care manager/owner and the availability of labour. Many modestly educated woman workers went into ancillary, shop assisting, cleaning our factory work and now work in the care sector. The real skill issues should be addressed in the care home alongside experienced and capable workers; increasing access to college off-the-job training invites the individual to leave for...
...better, less arduous work or hours. Training of care managers is vital in setting the culture in the home. Isolated, often attractive-looking care homes in rural areas struggle with care quality due to the availability of labour pulled from a small local community.
“To that end, we propose a ... part of the community.”
I assume you are thinking of places like London. Either way, this will be very expensive and will set off a ripple effect with nursing staff and even some doctors wanting access to the same provision. Not sure this is practical and will inevitably have to be picked up in council houses.
“This will be ...nursing.”
I think you are confusing care in the home with medical interventions that generally would be delivered by a contracted local GP, the nursing staff in a nursing home, an ambulance or via unfortunate accident and emergency or hospital admission. If, in fact, you are talking about home care, then the point about low-level personal care work comes in again, this time in the individual’s home; as soon as you professionals this work, people will leave for better statutes and pay alternatives.
“Though coming ... from taxation.”
I will need to ponder this. Over 80 seems too high; most individuals die between 82 and 83 in a nursing home. I assume we are looking at unpaid family carers, a spouse or other family member. This would be a high cost, and most carers do this for free, so you would not release any extra capacity.
General Practice
“The Party believes ... casualty departments.”
District hospital aside, I agree; I think if the non-emergency non-accident cases were taken away for accident and emergency, they would bounce back into life. My guess is that two-thirds of the people who attend A&E are directed there by GP surgeries or even walk-in centres that need to be incentivised to provide slots.
“It has suited the British medical profession ... and speciality training places.”
One of the problems seldom acknowledged has been the push for female doctors in the UK. Due to female doctors wanting to eventually go part-time, the cost of training female doctors versus what they contribute once trained is much higher than that of male doctors. Also, I think the radicalisation of the Health Sector unions is a direct result of a higher proportion of female members, crippled with university fee debt and keen to settle and start a family.
Nurse recruitment
“To qualify as State Enrolled Nurses, students completed a 2-year course. The entry criteria being ‘O’ levels and an interview in the 1980’s. This training fitted easily into most lifestyles and family commitments.”
There is a leap here. Most nursing accommodation was phased out by Ken Clarke in the eighties – my first girlfriend trained as a nurse and Occupational therapist in London after the nursing accommodation had gone, and it was really hard to find somewhere to live back then mid eighties -this was decades ago. Most nursing training is at university hospitals, with less time on the wards.
“Today ... on the wards.”
Leadership and personal management skills would be beneficial for training.
Covid aftermath
COVID lockdowns would never have been possible without the deleterious centralisation and delocalisation of health and social care, the denuding of local government, and the politicisation of public health into panicky health security overlords.
I will give your thoughts some consideration. Thank you.
I would generally agree with you. My main experience has been over the last 5 years or so and looking back at some of the other occasions made me realise that there have always been issues, but that it has got worse in recent years. I am now 64.
It took the NHS doctors and specialists 1.5 years to come up with a diagnosis of cancer at start of 2020 and then giving me immunotherapy for 9 sessions before I realised that my facial palsy which occurred in 2018 was caused by my diet. The useless doctors never once asked about diet. If you should be interested I wrote something about it.
https://baldmichael.substack.com/p/sodium-nitrite-e250-the-poison-in?utm_source=publication-search
I understand the therapy was very expensive and from what little information is available toxic to a degree and added to my issues, probably affecting my pituitary and thyroid balance.
The NHS has to a large extent been taken over by big pharma and toxic drugs which are invariably the resort of the pharma indoctrinated doctors.
Much of the NHS is not necessary and as a nation we have relied on the State to look after our health at which it is incompetent at best.
I consider the NHS should be essentially demolished as an organisation and rebuilt using whatever is worth saving. As you say provide a safety net for emergency treatment and not much more.
Many thanks David. Interesting comment from that GP. Family doctor, what are they nowadays?! In my surgery they have a pharmacy which I understand was owned by one of the GP's. A clear conflict of interest if so.