Mi A&E sobrevive a la muerte

Dr Emma Jones is an A&E consultant based in the Midlands.

October 12, 2022

A few nights ago, during the graveyard shift in A&E, a colleague sent me a clip from the classic BBC sitcom, Yes, Prime Minister. “The Smoking Ban” episode shows PM Jim Hacker vowing to take on the tobacco lobby — something his Cabinet Secretary, Sir Humphrey Appleby, says “no man in his right mind could possibly contemplate”. When Hacker, quoting from a medical report, explains that smoking-related diseases cost the NHS £165 million a year, Sir Humphrey puts forward the case for tobacco tax revenue:

“It has been shown that if those extra 100,000 people had lived to a ripe old age, they would’ve cost us even more in pensions and social security than they did in medical treatment. So financially speaking, it’s unquestionably better that they continue to die at about the present rate!”

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Anyone who’s worked in the National Health Service for more than a few months would, depressingly, recognise this kind of equation.

Those episodes were first broadcast in 1986, when the tobacco tax generated £4 billion in revenue for the government and smoking-related diseases did indeed cost the NHS £165 million a year. Last year, the tobacco tax raised £8.7 billion for the government — but smoking-related illnesses cost the UK healthcare system £2.5 billion per annum. Nevertheless, a smoking ban has never been seriously considered. Behind the gallows humour at the heart of Yes, Prime Minister lies a bleak fact: the state is happy to kill off the weak to balance the books, or even make a profit.

This cavalier attitude to death rather defined the Government’s attitude to the pandemic, as it spread through hospitals and was encouraged into care homes, pushing the NHS to breaking point. In hospitals, we’re battling it still. When Omicron started spreading at the end of last year, we were told it wasn’t as dangerous as previous variants — but that might just have been because patients and the public were more vigilant. Now, vigilance has waned. With most Covid mitigation measures nothing but a memory, hospitalisations could spiral out of control again. And it’s now predicted that, because of a lack of exposure during lockdown, flu deaths will be very high this year. This winter, according to The Lancet the return of influenza as a major public health issue appears “inevitable”.

Then factor in the cost of living crisis. People are not going to be able to heat their homes. People are not going to be able to put food on their tables. People are not going to be able to put fuel in their vehicles to go to work to earn money. People are not able to afford prescriptions. People are going to have to choose whether to feed themselves or their children. Isolated, vulnerable people are going to be more isolated and more vulnerable. Abused people are going to be more abused.

Emergency departments throughout the country are starting to seem Dickensian. I routinely see patients admitted with combinations of multiple problems: severe respiratory illness, loss of sphincteric function, terrible hygiene and general self-neglect. Paramedics are having to wear specialist kit to cope with lice, scabies and faecal matter — and incinerate patient property in keeping with protocols.

All of this will put immense pressure on the NHS — which is in a terrible position to deal with any of it. After a recent bout of Covid (yes, even doctors get it) left me utterly drained, I dragged myself into my department because — like the rest of the NHS — it is suffering from unprecedented staff shortages. A staggering 40,000 nurses have quit in the past year, many due to stress and poor pay. (Those remaining are deciding whether to strike.) Resignation rates far outstrip recruitment. Sick leave, meanwhile, is running at an all-time high, with some 60,000 healthcare and social care staff suffering from Long Covid. Working conditions for those working are verging on untenable.

The A&E department where I work is representative, in that it is falling apart. Ambulances get stuck outside for hours. There is no patient flow, and therefore no capacity; there are not enough GP appointments, so problems aren’t treated early and people show up on our doorstep far more seriously ill; and there is a dearth of community services. In the past two years — since before the second lockdown — I have seen more severe cases than in the rest of my career. Recently, I had a patient who had telephoned his GP complaining of a sore arm, which was thought to be a muscular or skeletal problem. In fact, the man had been suffering from angina, and the sore arm was referred pain. The situation soon escalated: he had a massive heart attack. We worked on him in A&E, but to no avail. Had the patient had a face-to-face consultation with his GP, things may well have been different.

This summer, we experienced “excess” non-Covid deaths in the region of 1,000 a week in England and Wales — in other words, far more deaths than would usually be expected for the period. Many of them, it seems, were related to lung, heart and circulatory diseases. Research by The Kings Fund healthcare charity revealed that the pandemic era has seen life expectancy in the UK fall by a magnitude that “has not been seen since World War II”. Second only to the US, the UK’s pre-pandemic life expectancy was lower than in many comparative countries for males, lowest for females. In the first 12 months of the pandemic, it fell by over a year for the former, and just under a year for the latter.

If deaths this summer were way beyond the average, the prognosis for this winter is bleak, given this lethal cocktail of health and socio-economic issues. According to the Government’s own research, for yet another week, “statistically significant excess all-cause mortality by week of death was observed overall in England” — and autumn has only just begun. The nation is about to be plunged into a winter during which people can’t protect themselves, comfort themselves, warm themselves or feed themselves.

Our hopes rest on a new Health and Social Care Minister, Thérèse Coffey. She is, it’s said, in “listening mode”. She has already made remarks that sound great. Everyone is going to be able to see a GP within two weeks, she says, without explaining exactly how she’ll achieve this. (Currently, some people are unable to see a GP at all.) Coffey has also said that nurses won’t get a pay rise. In fact, she’s advocated working for no money at all, unabashedly calling for a “national endeavour” to support the NHS, which “includes encouraging more volunteering across the health service”.

Coffey has proposed tweaks to the NHS pension rules to “allow” retired staff (who are probably well shot of the health service) to return to work if they want to (why would they?). But why the focus on clinicians at the end of their careers? The General Medical Council (GMC) is reporting that two-thirds of junior doctors are “worn out” at the end of a working day and morale among trainee nurses is at an all-time low. Coffey’s plan should throw them a lifeline; instead, it doesn’t mention them. Our healthcare system is dreadful and dilapidated because of this government’s failure to invest — not only financially but also in terms of the time and brainpower needed to sort out the situation — and the same Government is still failing to do anything meaningful about it.

The cherry on top is the fact that Coffey seems poised to bin its plan to tackle smoking. It is no coincidence, perhaps, that she herself smokes. We live in a world in which “optics” matter — particularly in the socio-political sphere — and Coffey, like Jim Hacker’s chain-smoking, tobacco-lobbying health minister, aren’t good. She’s obese. She drinks. She’s known to be cosy with the tobacco industry. And she’s anti-abortion.

Still, there are signs that somebody, somewhere in Coffey’s department, understands the most pressing challenge facing departments like mine: one of the priorities in what has been titled “Our plan for patients” is the Adult Social Care Discharge Fund, the aim of which is essentially to free up beds. In my region, we can’t seem to get any patients out the hospital and into social care — because there is no social care. If Mrs Smith on ward seven has her pneumonia treated quickly, and she turns the corner beautifully, and she’s off supplemental oxygen and on oral antibiotics, and all the paperwork has been filled out by the junior doctors for the social care assessment — all that happens is she gets into the queue for social care quicker. The queue gets ever-longer. Mrs Smith remains in hospital.

It is hard for hospital managers and clinicians to remain motivated in the face of this absurdity. Making things more efficient within the hospital doesn’t actually speed up the process of getting patients out of hospital. It just gets them onto these waiting lists quicker.

Even the best British satirists might struggle to lampoon it, so dark is our current situation. The other night, while I was on call, the sister in charge let slip that only one or two beds in the emergency department would free up that evening. This is a continual problem where I work: the number of beds available in any given 24-hour period is always far outnumbered by the number of patients requiring clinical admission. Allocation is a simple mathematical equation. On this occasion, the sister followed up her update with another: “We’re expecting a couple of deaths…”

In other words, the only way we can get new patients into our emergency department — and the only way we can get existing patients into the community — is if people die. This health “target” unsurprisingly doesn’t get openly discussed. But it’s there, nonetheless, in the back of management’s collective mind, reminiscent of Sir Humphrey declaring, “it’s unquestionably better that they continue to die!”

If this is the NHS’s new normal, and the Secretary for Health and Social Care is happy to accept it, then that’s a sad indictment of her stewardship. But her party sets the tone. We’ve been here before with this government: in April 2021, Boris Johnson said he would rather see “bodies pile high” than take the UK into a third lockdown. The UK currently has a body count of 205,000 Covid-19 deaths, and the Tories seem all too comfortable with this — which doesn’t bode well for the coming winter.

Without adequate support from the Government, the NHS will be forced to keep relying on a shameful, unofficial “beds for death” policy. Staff shortages will snowball. The new generation of clinicians is already battling with severe financial and mental health issues. And they’re not stupid: they know exactly what their employers are depending on, to free up beds. That these young people are trained, pressurised, and ultimately programmed to operate within an NHS that relies on human misery to create capacity is yet another sign of a healthcare system at breaking point. To make a dent in these systemic problems, the service urgently needs money and personnel — not a spate of excess deaths.

“Dr Emma Jones ?is an A&E Consultant…”

Is that a Freudian typo?

There’s a lot i’d be ‘querying’ of Dr Emma Jones too. During my own 35-year career in the NHS i too could’ve produced plenty of examples of inefficiencies, human error and professional hubris which made patient care suboptimal, and i don’t doubt that Covid has exacerbated the inherent problems. But what is this article meant to do, apart from thrash out in every available direction? This isn’t Emma’s first article along these lines.

So yes, the problems of the NHS may be manifold, but the biggest healthcare problem is the lifestyle choices made by iindividuals, resulting in obesity, diabetes, heart disease and yes, mental illness. The stresses and strains we all face are only worsened by the refusal of many to take responsibility for their own well-being which puts enormous pressure on finite healthcare resources. Thus, those in genuine need find themselves in one of the queues Emma refers to, behind those with self-inflicted illness. No reference to this though. Instead, it’s the fault of the government, despite record amounts being allocated.

Maybe Emma thinks she’s engaging in a form of “whistleblowing”. Perhaps she’d care to write about her ideas for possible solutions? What she’s doing with these articles is the equivalent of standing at the bedside wailing and gnashing her teeth. I fail to see how that’s helping anyone.

But you’re doing exactly the same thing you’re accusing her of! How do you know it’s the patients’ fault? Before COVID I could get a GP appointment same day. Now it’s 6 weeks. Wtf has happened? Pesky proles not looking after themselves…

No one needs a GP appointment to realise that a healthy diet, exercise and giving up smoking is a good thing.

I’m doing nothing of the sort. And you’ve answered your own question, regarding the ‘before’ and ‘after’ of Covid. GPs manage their own services, contingent on their meeting the needs of the population. They’re failing to do that, hence the new Health Secretary having to intervene to reduce appointment times, which of course won’t happen overnight. Patients aren’t “proles” either, however you care to label them on my behalf.My point remains. If more people took greater responsibility for maintaining their well-being, through eating inexpensive and nutritious food, taking more exercise, cutting down or stopping smoking (the most malignant habit imaginable, of zero benefit to anyone) and drinking enjoyably but moderately, waiting times for GPs and all health services would melt away. Do you disagree?

I’m 82 with diabetes, I do my own cooking avoiding factory food, I cycle every day and get plenty of exercise, I have never smoked tobacco or anything else, and my last drink was on New Years Eve – just to be sociable, and I’ve not been able to see a GP since before Covid. And I am of course – a prole.

Good to hear that you’re taking measures to keep as fit and healthy as possible. Diabetes can obviously occur through reasons other than not doing, and i wish you many more years of active life.

What would you say to the argument that unhealthy living actually saves the NHS money, in hurrying people to sudden, premature deaths, saving the expenses required for extended palliative care? If this is so then this crisis is on the governemnt, not people. https://www.adamsmith.org/blog/healthcare/fatties-and-smokers-save-the-nhs-money

Jeff, how is responding to a not very good article with sensible comments ‘doing exactly the same thing’ as Dr. Emma?And your question, ‘How do you know it’s the patients’ fault’ could be answered in any number of ways: because I’ve worked in the NHS for 35 years; because I read articles in the Lancet which give statistics about the unhealthy lifestyles of many Brits; because I’ve stood in a queue at Tescos and marveled at the fat arses of those around me; because I never claimed it was ALL the patients’ fault, just that if some people ate and smoked less there would be less pressure on a health service we all pay for.The truth is that with a population like the Japanese the NHS budget would be more than enough. There would even be money over to buy some nice floral curtains for the wards. But when a country has a large minority of people who insist on living unhealthily and irresponsibly then the government could tip the whole of the UK’s GDP down the NHS’s gullet and that still wouldn’t be enough.

I agree that perhaps the majority of degenerative diseases, incuding cardiovascular, diabetes, liver disease and cancer are to do with appalling lifestyles. But, I don’t believe it is all the ‘proles’ fault. I saw Hugh Fearnly-Whittingstall’s documentary about trying to change eating habits in England. He went to towns in the midlands. As someone who is relatively affluent living in the South East I was shocked at the lack of healthly food available. There were numerous fast food outlets and shops selling junk food; fresh veg and fruit was hard to come by. Generations of people are brought up to believe that this way of life is normal. Hugh went to the Conservative Party conference to seek out the then Health Secretary Jeremy Hunt whom had thus far been elusive. The lanyards for the conference badges were all supplied by Tate & Lyle!

Helen please, I live in the Midlands (Leicester) and we have the same shops you have down south. Or do you really believe ‘the north’ is some kind of cultural and economic backwater? We have Sainsbury’s, Waitrose and Marks and Spencers which sell the same products you buy in Kent and for the same prices. 4 Braeburn apples cost £1.50. A cabbage costs 80p. We can afford it. Those who claim healthy food is too expensive are those who buy ready meals that cost twice as much as meals you prepare yourself. What they mean is that they can’t be arsed to cook. Yes, there are plenty of junk food outlets here, just as there are in all places in England. Luckily we aren’t forced to use them; even in the north it’s still a choice.

even in the north !!! What a bigoted, loathsome statement. I’m from the northeast and have worked since I was 18 following high school. I have children and grandchildren who have been brought up to be healthy, happy, considerate human beings. A very far cry from the knife, gun wielding, drug dealing gangsters of the south.

Joyce, you misunderstood. The person I was replying to referred to the Midlands as though it were the Third World. I’m sure she believes that everywhere north of the Watford Gap is ‘The North’. She was suggesting that those people who don’t live in the affluent south have it hard. I was trying to put her right and then you sailed in, all righteous anger and no idea what the conversation was about. I think that’s why you’ve got an approval rate of minus 1.

-11 now, and well deserved.

The problem in these areas you speak of is the absence of demand. If there was demand for fruit and vegetables then market forces would make them appear almost instantly.The myth of “healthy food deserts” has a long history, but there is no evidence that they exist because nasty capitalists and MPs want poor people to be fat and unhealthy.It’s a classic correlation-causation fallacy.

We have ezperienced these calls for more and more money by the NHS and when they get it what has improved. Something is not working and I think it is much bogger than not enough money.

JB. Here’s a question for the benefit of the gringos: Do you have ideas about how easy and costly it would be to secure a routine appointment with a physician operating outside of the NHS? Is there a robust market for private (non-NHS) care?

You don’t have to be rich and well educated to look after yourself, avoid eating processed shit and not drink yourself into a stupor! Kind of commonsense really.

There is some truth in it though. There is something in our culture that says the world owes me a living. People are brought up to think that way.

The best thing that happened to the NHS after Covid was that patients only got through to their GP on the telephone and thus s(he) would weed out those who were just wasting their time. Most medicines to cope with feverish colds, etc., are obtainable at the Chemist...

And people have died because of misdiagnosis due to to “phone call appointments “. Have you let anyone ?

“Perhaps she’d care to write about her ideas for possible solutions? ”Indeed. Her solution (at the end of her rant) is more money and more staff. Well we’ve had 70 years of that and it still fails the country. Time for a new insurance based system.

Without the additional funding I don’t think it matters what system you use. If the cash isn’t there for enough beds and staff, and you’ve nowhere to discharge vulnerable patients to you’re always going to have queues

The queues are long because the product is “free” and so has to be rationed.

The NHS has had a huge dollop of “additional” funding in the past two years and this resulted in front-line capacity actually decreasing. The problem, very obviously, isn’t simply the amount of money the NHS gets.

In the past two years it’s been dealing with a pandemic in case you’d forgotten. And that “huge dollop of additional funding” still doesn’t bring it up to the level of the German model.I’m not arguing that the NHS is perfect, reform is definitely needed. I just don’t believe that privatising parts of it is going to be a magic bullet

Not True. The UK is spending the same %oif GDP as Germany.

Excuses, excuses, excuses, and more excuses piled high on a hill of excuses. It has been thus for 70-odd years. Time for a clearout of the failed management classes. The Health Sec should start with a big, sharp hatchet.

It isn’t just managerial classes, there is plenty of inefficiency on the hospital wards and clinics

Private health works much better but the problem is it is too expensive. I found the best nurses were the Phillipinos. Perhaps put them in charge? Around my way they have two houses one to live in and one to rent out so they know about economy.

The German model is a public/private taxation and insurance subscription model. I will take German levels of spending if we have their setup in the UK otherwise pointless comparing to very different systems. People always seem to quote the German spending on their healthcare but always seem to be dead set against their model of payment, I don’t get it. One system works and one clearly doesn’t. We need change and we need it now.

We are spending more GDP % than Switzerland on health. The NHS model costs a fortune for a poor service.

it does matter Billy Bob. It’s precisely because of the insane way that the NHS operates that we have these problems when comparable developed European nations don’t. If the money followed the patient via a universal health insurance scheme, then you would see a radical difference. Take GPs for example. If as in most European countries, the money followed the patient then you would find GPs much keener to see patients. No patient, no fee. Suddenly seeing patients would be prioritised. They’d be available to visit, if necessary, work weekends open early or late. They wouldn’t tell patients they could have a phone consultation in 2 weeks. Why? Because the patient would find another doctor to see them, and that doctor would pick up the fee. That’s why my French colleagues can’t believe that you can’t phone up and see a GP that very day. And if referred for any kind of testing that you would have to wait. Why? Because the money follows the patient. So diagnostic centres can go ahead and set up in business to do the work, buy those scanners and fund those labs because they have patients coming their way armed with their universal insurance funding. No bureaucrats are needed. No committees convened, no time wasted on internal politics. And what about the employees? Well, they no longer have a monopoly employer. If they’re not being paid enough by one employer, then they can go to another. in one fell swoop you’d have a proper labour market rewarding health workers properly. And the GPs and the diagnostic centres would have no time for waste. Their income is the fee. They don’t allow their profit to be frittered away on diversity and inclusion officers or employing people still struggling to master the use of a telephone.So yes it does matter how it’s organised.

Who would have thought that a centralised, top down management system, that changes the leadership and strategy every 3 or 4 years would struggle. Governments are usually great at running things.

Governments are not very good at running things. The knack is to use the best people for the job. Nationalisation was always inefficient and ate up the countries taxes like a raving dinosaur. It’s things like police, parliament and armed forces etc. that is nationalised not things which the private sector can do far better.

Best answer so far I think.

The debate is confused by the structure of our NHS. Take A&E: it is a monopoly supplier funded by an unavoidable tax. As a resident of the UK if my lifestyle choices are poor then I have no choice but to use A&E if they come home to bite. Banning lifestyle choices is outrageous because I cannot opt out of the taxation nor find an alternative A&E.

If the State insists on universal insurance with a ‘premium’ not reflecting my personal lifestyle so be it. Educating and lecturing people about these poor choices is also fine. Suggesting such people should be penalised for the cost they inflict is morally wrong.

Best comment so far. Human beings respond to incentives. Nearly all the incentives in our system are perverse.

GP practices are effectively private clinics though, they contract to the NHS they’re not employed by them. So by complaining about GPs you’re saying that the private model isn’t always better surely?

Succinctly put Samuel. Even after reading your comments there will be still quite a sizeable amount of people screaming from the rooftops that no change is needed within the NHS just more money required. To me these people and cowardly politicians who dare not act and are not willing to accept another method of running the NHS are a massive part of the problem

Nonsense on steroids.The cash is there. Its been supplied in astonishing amounts for 70 years yet the service gets worse and people get unhealthier.The NHS problem is that the plentiful cash is spent on the wrong things, as we have seen recently with the Bart’s Trust video of plush City offices equipped with well-rooms for staff unwilling to work and £1000 coffee machines. While Emma’s colleagues at the sharp end get diddly squat.

Isn’t there is a paradox that critics of the NHS struggle with – life expectancy has markedly increased in the last few decades pre-Covid. The ability to be mobile, to see well, to have a better chance of surviving cancer, to get to enjoy retirement and some parts of old age, have all been successes. Arguably were Newspaper headlines only written once every 40yrs the headline would be – ‘Amazing Improvement in Life expectancy’.

Now if we assume the NHS has had nothing much to do with that – despite significant improvements in things like Stroke and Cardiac care – it begs a question what is causing the improvement? If one then lambasts the personal choices of a minority how is the aggregated improvement also squared? The fact is it’s much more complicated and simplistic point scoring been part of the problem for too long.On other facts – there is a lag on data but most recent puts us 1-2% behind France and Germany on % of GDP spent on health. That is alot of money. Nonetheless it is also true how you spend is vital. But fundamentally both those countries have matched better funding with long term health care workforce plans. HM Treasury has repeatedly blocked the same in the UK. So now the demand/supply imbalance is causing serious pay inflation for agency/temp staff, without the skills and experience to boot, and without covering the gaps. All v foreseeable and repeatedly raised, but somehow for 12 years having a long term workforce plan contrary to neoliberal/’market will provide’ doctrine. And here is where we end up.

Our funding is currently at the top end of the European table but our results are still mediocre. I know from my own frequent hospital visits how inefficient the NHS s

Insurance is the biggest scam going.

The real issue is that the main purpose of the NHS is to serve the interests of the people who work in it. Providing healthcare has effectively become just the pretext.

Unfortunately, that was also my experience in the decades i spent working alongside some great people, but also a whole raft of others who thought they were doing patients a favour by simply turning up.

You sound just like someone I used to work with. !! He was an ar*e as well.

Joyce… you’ve already made a fool of yourself by misinterpreting the post by Keith Merrick, who was standing up for the North rather than putting it down.

Only superficially so. NHS employees are miserable – hence the staff retention problems. Health employees are happier in just about all other health systems in the West.

It is because the purpose of the NHS is to serve the interests of the employees that they are miserable

Eh? Shurely a self-contradictory statement…or are you doing something clever?

Not to say there are not principled people who work there but it is very easy to drift for those who want to as in most nationalised industries.

Isn’t that similar in all nationalised industries?

Do you have more than 1 brain cell?? The people who work for the NHS are burnt out, demoralised and depressed. Comes from having to look after and save the lives of mor**s such as yourself.

I have worked in the NHS, and such was the level of thieving, skiving and could not give a tossisum that I was ashamed to do so. I have subsequently had other offers to work in the public sector but have so far had too much pride to accept. I know where of what I speak.Form your attitude and complete lack of self awareness I assume that you work for the NHS

Ask yourself why the people who work for the NHS are burnt out, demoralised and depressed. Not enough frontline staff but plenty of managers and non jobbers ? Funds not going to where they are needed. But lets just keep on heading in the same direction for another 75 years with our heads in the sand

It is a cushioned profession and very safe, unlike the risks in private business which keeps one sharp and efficient.

Now here’s a contrary thought: if the success of the NHS was so important how come governments of various colours have not fixed it yet?My suggestion is that fixing a long running so-so service is nowhere as politically rewarding as building a new railway, bridge, power station, new benefit regime, or tax cuts. Politicians do what will benefit their careers and the NHS isn’t in that category – indeed ‘messing’ with the Holy NHS is seen to be career suicide.So there you have it, the NHS is a problem that no-one dare solve.

I agree. Structural reform of the NHS is the issue that dare not speak its name.

But the whole idea of the NHS, that a person should be responsible to the State for their (legal) behaviours and health conditions, is ludicrous.The fact is that the NHS has failed to lessen ‘harmful’ behaviours, whereas in insured medicine the more harmful the behaviour the less likely becomes the granting of insurance. This acts as an strong incentive to the individual to live more healthily (or increase the premiums if they can’t).By contrast our Scottish leader wants the State to fund heroin abusers.

Or no one knows how to solve.

There are other Health Services overseas that are said to be better and more effective. We could copy the French arrangements for instance. But the switchover could be difficult and it would need great moral strength to press ahead against ingrained practices.It would perhaps take two Parliaments to implement, so it’s probably never going to happen unless the NHS implodes.

It’s much simpler. Attempts by a party of any colour to reform the NHS guarantee that party a massive loss of votes. Why the Brits so love their NHS is one of the great mysteries of the last 70 years.

All very true. We must encourage people to look after their health.While we’re at it we must encourage them to be nice to reduce crime.

Talking about crime it is a fact that the police in the last year have only sorted 5% of burglaries. The priority has been political correctness for some reason, not solving crime. Good on Suella Braverman telling them to get back to their priority of solving and preventing crime.

When my mother was alive in 2019 I visited the hospital with her for her numerous appointments to keep her alive. It was the Great Western in Swindon and I was genuinely shocked.There was a Tsunami of elderly people and a peppering of fit and healthy people who needed mending and then sent on their way.This Tsunami could not walk properly, or see properly many were Obese. When a new respiratory illness came along what happens it wipes a good percentage of these people out who have no resistance and nothing left to fight with. This was portrayed as a national tragedy it was not and until the West focus on allowing people to die with grace and dignity naturally rather than promoting arrangements where they are reduced to squalor before they die matters will decline.My mother bed blocked all the way through the Lockdown of 2020/21 and when I returned home to the UK to oversee her care package after she was released from the hospital, she was a cackling old woman who was living in her own home in squalor with the support of NHS care workers.On the 25th of June 2021 back in the hospital for yet another UTI infection, her Urologist phoned me and said I have been to see your mother to gain consent for another stent change. She thinks she is in a garage I really think it’s time to call it a day and let her go peacefully. We should not put her through any more of this. As I cried down the phone I said you are the first person I have spoken to who is treating my beloved mother as a person who needs her dignity back, thank god.She died peacefully between clean sheets all her sores were cleansed on the 29th of June. The nightmare was over and now I go back to 2015 when she was still reasonably fit and talk to her.The combination of thinking which kept my mother alive in her own personal lockdown for five years and the high levels of Obesity which only increased in the UK during 2020/21 is the only place you need to look. 8% of the NHS budget is spent treating Type 2 Diabetes, make them pay! Chris Patton talked about this ten years ago.

Thankyou for this insight. Your point about being allowed to die with dignity instead of unnecessary and often cruel interventions is very well made, and i’m sure it’ll speak to many other readers.

People should read ‘Being Mortal’ by Atul Gawande. Very, very interesting on the modern focus on keeping people alive rather than allowing them to die with dignity.

I wonder how this would differ if the elderly still lived with their families instead of being left to fend for themselves after a certain age.

My mother would never have wanted to live with us, and I know my father doesn’t want to.

You can’t speak for all the elderly though. Some are so lonely they just give up because they don’t have family support.

Anti abortion is spoken of as a person’s big problem. With a decreasing birthrate in the UK apart from those from other countries who are producing big healthy families pro abortion isn’t really working and is only reducing the families of the natives of this land.

That is the intention, to outnumber the British born people. When will the hairy shirt hand wringers admit to this.

I cannot believe you have worked in the NHS for 35 years and have the audacity to include mental illness as a lifestyle choice. My clinical OCD began age 23, I’m now 40 and I have recently been house and bed bound for 3 years due to a relapse in pregnancy and postpartum. It’s like locked in syndrome. I could barely crawl to the bathroom. Completely catatonic. Had electro convulsive therapy. Couldn’t care for baby so distressing. I am totally shocked to hear you say this is a lifestyle choice. I had no life! Death was better, but I survived. My aunt is currently an inpatient with schizophrenia and psychosis relapse. 5 years she’s been unwell. No life whatsoever, outside her flat. Malnourished. She cannot feed or look after herself, and nearly set herself, and her flats alight and severely burned herself in the kitchen. She puts clothes in the toilet. Her life is in danger and also others’ lives. I wouldn’t call that a lifestyle choice. Please in future make clear you are referring to mental health (lifestyle), not clinical mental illness. Gosh no wonder the NHS left me to die. Honestly, it’s like saying cancer is a lifestyle choice. Dispatches on Channel 4 the other night says it all about NHS care for the extremely vulnerable mentally ill.

I have no such audacity. I’m afraid you’ve misinterpreted my comment.

Let me explain, with just one comparison.

Those who don’t exercise enough are likely to gain weight with associated health problems. Those are physical probabilities, i.e. not always, but more likely.

Those who during their teens and twenties decide to regularly use recreational drugs for pleasure such as cannabis or ecstasy are more likely to develop mental health issues; not always, but more likely, through changes in their neuro-chemistry.

Both are lifestyle choices. Both can be avoided, or limited.

I’m sorry that you and your aunt have suffered severe problems, but its important to understand the difference between avoidable health problems and those which occur despite our best efforts to stay healthy.

Good for you for speaking up, well said

I am sorry about your predicament – but what were you thinking having kids with it ??? Did you not think that you had enough on your plate ?? And how will those kids cope ?? Definitely a lifestyle choice ……

A significant cause of what you attribute to the public is that the NHS is free and paid for by the shrinking minority who are net contributors to the public purse. Health care is not valued. It’s just something the state provides so expectations are low and individual patients have negligible influence on the way funds flow and on what they are spent or invested in. I emigrated to Australia where individual patient choice directly decides who is paid for what, where and by whom. Total spend per capita is only slightly more than in the UK but it is spent much more effectively.The resulting points most relevant to your comments are:a) patients are aware of the cost of medical care because they get a bill, even if they don’t pay it themselvesb) medical staff work in a much more effective and efficient system so morale is higher even under the stress of the pandemic.c) I believe the patient-doctor relationship is stronger because the culture is more customer oriented if you’ll excuse the marketing speak.I don’t enjoy getting sick or injured but a great compensation is that getting repaired is actually something to look forward to because I’m in the hands of a system that works with great people doing a great job without having to fight the system.

To which i’d add: great analysis. I had quite a few valuable colleagues emigrate Down Under. I can understand why, even though it wasn’t for me.

Your comments should be sent to the new Secretary of State for Health.

I agree. Good analysis.My sister works as an anaesthetist in Australia. Her work life balance far better than that of my other sister, an anaesthetist in this country. The latter has retired early due to the cavalier and appalling way management saw fit to deal with her at the end of a 40 year career in the NHS.My youngest daughter is a junior doctor yet to specialise, currently working as an ED(emergency department, essentially A &E) doctor in NZ. The respect given to doctors over there is apparently, as in Australia, far greater than here and she may not come back. If she does, her time spent and experience gained over there will not count on her pay scale here as she is not ‘in training’ I.e has not yet decided on her field and therefore not in a recognised training programme. It did not used to be like this, (pay grade also reflected experience however gained) but this must surely be a disincentive to returning. Morale amongst her contemporaries here is very low.

NZ needs more healthcare workers esp nurses – plz come on over – it is a great lifestyle !!

I disagree … Dr. Jones is pointing out that the currency of NIH isn’t healthcare duty or compassion, it’s … well …. currency. The same calculations go on in the great state of California with Kaiser Permanente Healthcare. It’s socialized medicine at its finest … and I mean FINEST ! My son, now deceased by his own hand and forever 33, was admitted for suicidal planning and ideation more than 10 times in one year, was a victim of the callous California system. He was never kept more than a few days or a week. He did cost California and KP a lot of money because he had money and insurance. Now he is no longer a financial burden to the Great State of California. F*** California and socialized medicine.

i am sorry for your loss Gayle – I too have a son whom I will outlive (30 yo at present) – but that is because he lives in a very harsh world with little true humanity and is depressed about what humans are doing to animals and to each other – no amount of medical input will change that – and the bleakness seems to be getting steadily worse. Unless your son had a biologically based depression that can be helped with drugs he was in the same situation. Many young people are in this existentially depressed state – and counselling them to try to get more balance and that there is still wonder and goodness out there mostly fails. Unfortunately we did not notice while the forces of greed and exploitation took over the world and became so powerfully entrenched that they are unassailable. And social media brings this to the kids daily so what chance do they have for balance. Best not to have kids now and live in a peaceful place – and keep talking to your son and listen for those whispers that might just be him (check out Michael Newton’s work….)

Have you considered the possibility that ‘free’ healthcare itself may be a part of the reason so many people make poor choices.

“Our healthcare system is dreadful and dilapidated because of this government’s failure to invest” is not the problem. The problem is that your healthcare system is a government owned and operated system. Unfortunately, the U.S. healthcare system is being pushed in the same direction with programs like Obamacare and Medicare for All. Doomed to fail and already failing. The disastrous response to Covid by politicians and governments worldwide, aided by “scientists” and “doctors” who went along to get along, should be sufficient proof that politicians and governments have no business running healthcare systems. But your Commonwealth country Canada is moving faster than the UK in saving money by reducing the number of dependent patients by providing euthanasia for people who do not have terminal or even life threatening medical conditions. https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867

Smoking-related diseases cost the NHS £165 million a year in 1986. That’s just over £500 million in 2022 money. Yet today smoking-related illnesses are said to cost the UK healthcare system £2.5 billion per annum, despite a massive fall off in smoking rates in the interim. No country could sustain a decent health care system where costs outstrip the capacity of the economy to fund it to that extent. The author seems to think society should change to meet the requirements of the health care system rather than vice versa. She objects to smoking, drinking and obesity, and favours Covid lockdowns and “vigilance”. Yet the current problems of healthcare backlogs and inflation are the direct result of lockdown policies in 2020-21, which saw the medical profession put more barriers between themselves and the public, while goading the government to impose more restrictions, all funded by Quantitative Easing, ultimately fuelling inflation. Isolated, vulnerable people became more isolated and more vulnerable. Abused people were more abused.

We need to train more doctors for a rising and aging population, and keep the ones we train through a combination of carrot (more pay), and stick (long term contracts for trainees, bans on medical schools auctioning off places to foreigners). More doctors – rather than more support staff – will reduce existing doctors’ bargaining power and social cache, which is perhaps why Dr. Jones doesn’t mention the issue. Beyond that, we need to reverse 80 years of failed socialist medicine, and open up the healthcare system to competition and private sector investment. If the grocery sector was run like the NHS, it too would rely on rationing and waiting lists.

Why would opening up the healthcare system to the private sector lead to better outcomes? In my opinion it hasn’t done so within other industries such as public transport or the utilities, so why would it be a magic bullet for healthcare?When people compare the NHS to systems used in Germany or France they always neglect to mention that those systems received much more funding per capita for decades, and they often don’t cover things such as doctors visits.In my opinion we expect too much from the NHS for the level of funding it receives. It either needs vastly more funding, or to cut back on the services it provides

If you don’t think privatisation of the railways and the utilities has not dramatically improved efficiency, lowered costs, and increased responsiveness you must be a rabid socialist, or very young.

They are not perfect, but they are so much better than when in public ownership and control.

The tragedy is Tory governments who just cannot keep from interfering (especially with the shiny train sets,) and making things worse.

Unfortunately the left wing unions interfere with a smooth running of the railways.

Maggie thatcher ruined this country for most. The people with money will still hail her as a hero. The less fortunate will have their day. “Let them eat cake “.

“Ruin” as in create more wealth for all, a more open society, a pride in ourselves and way of life, beating extremism, improving conditions for all, taking us from being the sick man of Europe to one of the most successful, her policies emulated round the world; cake for all indeed? I suppose she did. Back to your dry bread and dripping!

The system in France is not nationalised but is privatised through insurance. The service has to follow the patient because of insurance as someone has already pointe out. No service no money. Why wouldn’t that bring service to patients rather than doctors hiding like the police?

I think there is already a very large and successful private healthcare system in the UK that is in direct competition with the NHS. It covers everything from minor problems that require physiotherapy to major illnesses such as cancer. Furthermore, its benefits extensively from the subsidised training and facilities provided by the NHS.I also note that the NHS benefits from the use of private facilities. For example I recently had an MRI under the NHS, which was provided by a private company working within an NHS hospital. The whole process was absolutely superb and I had the MRI at 10am on a Sunday morning. I also noted at the time that every other outpatient facility at the hospital was closed. I assume they were all all owned and managed directly by the NHS.

I couldn’t get any phsiotherapy from the hospital. They farm it out to private providers now and you get seen straight away, but you have to pay. Your tax is not reduced though.

But if the NHS was run like the grocery business it woud be putting pu its prices so that the disadvantaged could no longer afford it… Otherwise I agree with most of your comments.

But they haven’t…in fact most groceries are cheaper in real terms than they were in 1986, not five times more expensive.

If the grocery sector was run like the NHS…..and a loaf of bread would be £20

Wrong.. Smoking more than pays for itself- see above?

indeed it would cure the country’s financial problem if smoking could be introduced in schools

If they encouraged smoking again the NHS would be rolling in £££ through the taxes imposed.

And the reduction in life expectancy would reduce the burden on the state in terms of pensions and long term medical costs.is a win win scenario

Yeah because of the high tax on tobacco.

Privatization is working a treat here in the U.S. I had to quit my vocation and move to care for elderly parents in a rural part of the U.S. (No social services for a 90 year old crippled mother and blind stepfather). I took a local, low paying job that miraculously provided health insurance (most jobs here don’t). My pay would be docked 479.00 a month for it; roughly 1/4 my monthly pay. After 2 weeks Mom caught Covid and had a fall so I had to quit that job to give them more aid. I’m now getting letters from that former employer about my health insurance options. The US has a program – COBRA-wherein you can pay out of pocket for your previously employer-based health insurance. And note also that co-pays and “out of network costs” means the average American can easily pay thousands per year more in any average year. If a serious illness or accident happens we can face bills in the hundreds of thousands. Inability to pay medical bills is the #1 reason for bankruptcy here. Oh, and my COBRA cost? 1,200.00 a month. Might as well be a million.

The US health system is not “privatised” It’s a highly regulated, crony capitalist, disaster. One built, regulated and operated according to the needs of corrupt politicians and their donors. In both cases patients become little more than an annoying irritant.

The US system sits at one end of the spectrum, the monolithic NHS at the other. No country in the world has copied either. Most successful countries mandate universal, compulsory insurance. The money follows the patient and services are provided by a combination of private for-profit, charitable non-profit and government run services.

No system is ever perfect, but for entirely political reasons, the UK/US seem determined to cling to the worst possible solutions.

Wait until you need emergency surgery and someone is asking, “how will you pay for this ?”

So Obama care didn’t work then.

In a word, no.As a physician in the US system, Obamacare (aka “Affordable Care Act”) was a dog’s breakfast of rewards to insurers, Big Pharma, and the healthcare administration industry. The “increased coverage” it promised was accomplished mostly through Medicaid, which is better than no insurance but hardly reimburses for care; ask any MD. Even then, it grossly over-promised and under-delivered on that selling point. As far as its impact on clinical care, it’s meant tons more Federal mandates for hospitals and MDs to deal with, without commensurate funding. If anything, it just accelerated the demise of private practice MDs and drove them into the willing arms of big hospital systems looking to secure ever-larger pools of guaranteed patients, and has accelerated the use of non-MDs, some of whom are good, others who “don’t know what they don’t know.” Physicians aren’t cheap, but there are very good reasons why we go through as much schooling and training as we do.

The author seems to think society should change to meet the requirements of the health care system rather than vice versa.

Could not agree more – like all public services its organised around the benefit of the providers not the users / consumers.

That has always been true for decades. A drop of mercy is not strained it falleth like a drop of rain. Would that it were so.

Here’s the elephant in this room: the NHS is now funded at its greatest ever level. The idea therefore that we can solve these problems with even more money is basically absurd.

I’m not dismissing the arguments in the article generally: healthcare in the UK is a fiasco, a brutally bureaucratised statist system that is wholly indifferent to the needs of what would be its customers if there was any hope of getting the NHS to actually accept that it owes people a service for the vast torrents of money it receives. It’s just that we are not about to solve this problem with even more money.

It seems to have been the cry for the last thirty years. More money more money and everything will be solved but it rarely is.

Sounds like the public education system here in the States. The knee jerk response to its manifold problems is always “MORE MONEY!”

It’s the expectation that just about every ailment must be treated by prescription drugs that means that the more money poured into the NHS is then sucked out by the pharmaceutical industry. When a service is apparently “free” it will be abused and few people consider what is really happening. I was shocked to find out the sheer number of drugs being dished out to my peers (70 year olds). No wonder the elderly are susceptible to respiratory diseases after what amounts to having their bodies natural processes overwhelmed by medication over many years.

Yes! With healthcare as with housing and education and policing and energy and so many other issues, Britain has more than than enough resources to take care of the British. The problem is that Britain does not have enough resources to take care of Pakistan and Albania and sub-Saharan Africa etc. And in the queue for British resources the British are told to give up their place and watch others go first. This can’t go on.

I genuinely do not understand why, with the continued massive increase in spending on the NHS, the improvement in our diets and lifestyles and the general reduction in hazards at work and in the environment, the number of patients and problems in the health of the population continue to soar. Is it because we live longer and so the number of long term health issues (cancer, heart disease, diabetes etc) become more prevalent? Is it because we can now manage serious illness, rather than allowing it to kill the patient? Is it because people now demand treatment for ever more trivial matters (tattoo removal to improve mental health). Is it a combination of these factors? Is it other things?I also note that articles such as this one never advocate any solutions, other than more money, they simply outline horrific, seemingly insurmountable, problems. What are the authors top three suggestions for change that do not include “more money”?For what it’s worth, my very recent experience of the NHS both personally, and in end of life care at home for my father in law, has been excellent.

After a short period of increasing difficulty swallowing I phoned the surgery on Monday morning. I was 6th in the queue, the phone told me. It took 32 mins to be answered but that’s ok, I had speakerphone n and did the washing up. I was phoned back by a doctor that Monday morning, told she wanted me to have an endoscopy and lo and behold on Tuesday at 08.00 I was phoned with an appointment on Friday at the hospital. On Wednesday all the relevant details and a form to complete arrived in the post. On Friday I attended the endoscopy department at 10.00 and I left after it at 12.30 complete with photos of my throat and stomach, and having had a thorough explanation by a staff member – I have a hiatus hernia.

I fail to see how this could have been any better. Derriford is a big teaching hospital serving a large and disparate area but there was only one ambulance waiting outside as I walked past their reception with my husband after my procedure.

I believe the mess is largely due to excess management and not enough doctors. Why for instance would the NHS which already employs 70 nationalities at last count, need to pay a “manager” to encourage diversity? And pay her £200k? A well-run hospital can perform well in the NHS and can keep morale high.

Rather than more money, more thought is required – how about a gym, a swimming pool, a lounge etc. for the use of staff . Their place of work should do it’s best to offset the high level of stress they work at, which is saving lives.

I recently read of the private Nuffield group using an entity called NES to woo foreign doctors from poorer, mainly African countries – in particular Nigeria – to work in U.K. under terrible and impoverishing conditions. The doctors are required to work unbelievable hours. It’s obvious that private healthcare, in this case anyway, isn’t the answer. They all wish they could work in the NHS.

The NHS is the same age as I am and I do not want to lose it! It has saved the lives of many of my family. But the way it’s run, and the need for nurses to get degrees are two things that need attention – young nurses are best as apprentices learning as they used to while working.

I abhor this style of useless, destructive and denigratory article.

Since 2016 there have been Nursing Apprenticeships available for anyone who would prefer that route to a degree.

Is that similar to becoming a junior nurse in the old system? Thanks for the info.

Not sure, but as far as I know it’s the same as becoming a student nurse at university, but the training takes a couple of years longer, and you receive the minimum wage.

But they remain at the bottom of the pile. Degrees speak volumes in the nhs with the the possessors being promoted because of this, despite many more people being overwhelmingly more suitable for the promotion.

The Insurance system works perfectly well in most other countries, and must be extended here,,in addition and complimentary to an NHS, and the NHS admin overspend needs carving up.

I used to work at Derriford. It was a joy when I was called in at the weekend, because I could park without trouble. Unlike during the week, when the car park was packed with the cars of the administration staff. And this was back in the early 90s!

Well the NHS Tavistock centre received millions which they used to cut up children to turn them into another sex. Thank goodness this was closed down by Liz Truss. We do need people like her around.

Much of the increase in difficulties is caused by the ideology which means that although we happily kill unborn babies, we don’t think people should actually die. We therefore do all sorts of mad things to keep people alive, merely existing, instead of allowing them to die in a dignified manner.

Thank you from an nhs worker dedicating 30 + years to doing my best for the population.

Monolithic systems always fail. Not sometimes. Not usually. Always.

100% correct

NHS staff have been moaning about the same issues for decades now, there’s enough of them, why don’t they fix their problems?

This woman is a classic lefty, expecting humans to somehow become perfect beings through government and not the messy malfunctioning things we will always be.

If she would prefer her patients to look like they are attending a non smoking spa she should work for a private hospital.

Good suggestion!

The Uk is spending around 12% GDP on the NHS. This is much the same as France and Germany and more than Switzerland, Sweden ,Denmark etc.They all have more doctors and beds per capita, few waiting lists and better outcomes. Medics not politicians run the services. Patients are all insured. Doctors are largely private.So why do the medical profession not ask the UK to move to their far better systems ? Why do they cling to the out of date, NHS model that starves doctors and patients of resources while it pays for Departments of Health, Commissioning bodies, NHS providers, Diversity officials, etc – none of which are needed in European countries. . – In Europe they spend the money instead on patients who get better treatment.Under European systems patients have insurance. Doctors see patients as an income and want to see them and the paying patient has real choice. Here the NHS view patients as a cost.

The UK spends 12% of GDP on OCD defined “healthcare” which includes private provision of services (which includes much of what we call “social care”).

The NHS costs about 8% of GDP but a significant element is diverted to continu to pay for the “private finance initiative” provision of buildings arranged by the then labour government.

There isn’t much left to pay for medical services I’m afraid.

If France is privatised why would any part of the GDP be apportioned to them?

In 1948 that paragon of socialist virtue and ‘founder’ of the NHS, one Aneurin Bevan, boasted that he was able to accomplish his goal “by stuffing the doctors’ mouths with gold.”

So what possibly could have gone wrong?

Perhaps he should have used a different orifice?

An outrageous yet apposite suggestion!

No one forcesanyone to become a doctor? If they dont like it, do something else, like being a traffic warden?

That’s not necessarily true. I came across plenty of junior doctors who readily admitted that their family had a tradition of being doctors and they were almost shoe-horned into the profession from their early years. Some made great doctors, others didn’t. There certainly used to be an “old boys network” which not only helped their offspring get into medical school but then helped them climb the ladder by pulling strings.I’m not sure how much that still applies; less so i hope, since many of those cajoled into the profession were unhappy people.

My eldest cousin has been severely mentally and physically handicapped since birth due to a problem during delivery. As he is now in a care home he is now ‘owned’ by the state. His parents (now in their 80s) have fought tooth and nail to improve his care through better nutrition and a functional medicine approach. Turns out the powers that be would rather drug him up so that he simply lies in bed semi-comatose than accept a team approach with very invested parties. The family, if allowed to contribute, would take pressure off the carers and the budget. It is arrogant and cruel in the extreme that, despite having another son who is a barrister, they have been unable to make sufficient headway to provide meaningful help to their eldest child. There is SO much more that could be done to take pressure off clinical staff.

I see mental patients in the community walking around clearly stocked up with drugs. It is sad to see them detiorate gradually physically which is I suspect due to the drugs they are stocked up with.

“The UK currently has a body count of 205,000 Covid-19 deaths”Plus an unknown, but probably greater, number caused by the lockdowns.

And the vax? The bit that has been covered up?

“Last year, the tobacco tax raised £8.7 billion for the government — but smoking-related illnesses cost the UK healthcare system £2.5 billion per annum. Nevertheless, a smoking ban has never been seriously considered.”

Why is that ‘nevertheless’ in there? If I made £6bn a year from a product other people had to produce, sell and consume, I’d be in no rush to ban it either.

Proposed new gov’t slogan for this winter:Have a tab -> Fund the NHS -> Save Lives

actually nearer £21 bn, of all revenues are taken into account, plus the added benefit of killing us smokers… job done?!

I’d be interested to learn to what extent the same is true of alcohol – I’m plodding through a sober October and if the gov’t is profiting off my drinking habit, that might just give me the motivation I need to persevere.

I’ve often said that if you want to solve the NHS crisis, we should offer free fags for the over 40’s. The crisis is real, and we all know about it. This article achieves nothing. The NHS is run by a criminal cartel of CEO’s and others who move around from job to job, getting payoffs whenever their incompetence is discovered and then moving on to cause mayhem in the next job. Stop going on about money

Chris Hopson comes to mind!

‘Our healthcare system is dreadful and dilapidated because of this government’s failure to invest’. Er, actually not the case.The benighted NHS is a socialist endeavour and as has been proven, time after time after time, socialism (for all its lofty ideals) never, ever works.Every comparable country has universal healthcare (not the US ) and they all work better than the NHS. Best cancer survival rates in the world: Belgium; percentage of Dutch hospitals owned or run by the state: 0%; none of these comparators is experiencing anything like the UK. The NHS is proof positive of my #1 rule: if you really want to screw it up, nationalise it.It’s not that the NHS has problems, the NHS is the problem… socialism doesn’t work.

I’d add a British favourite – the football analogy: the government should be the referee/Football Association; not hiring players, or managing teams, just making sure the rules are fair, elevate the game, and are followed.

Very good idea. Nationalised industries do not work but the police, armed forces etc. cannot be privatised.

According to the BMJ in the UK in 1960 there were 0.85 doctors per 1000 people.

In 2017 there were 2.8 doctors per 1000 people.

These figures suggest to me that the problem is not the amount of doctors but that there is more illness. If over twice the number of doctors are not enough for our population today, again that suggests there are well over twice, three times? four times? the number of ill people there were back in 1960.

Why are we so ill ?

Numerous answers: overcrowding in cities, unhealthy housing, keeping people alive for longer because without any belief in an afterlife death must be kept at bay at all costs, abundant cheap carbohydrate and high sugar food on offer combined with advertising, the disintegration of family life with both man and wife working outside the home, loneliness and stress, and I’m sure there are more.

It is overwhelming and I don’t blame “Dr Emma Jones” for her distress. All I can suggest to her is to view the situation coolly, she cannot fix it, perhaps it cannot be fixed, she can only get on with the job as best she can while taking good care of herself.

Some good questions but it seems hard to believe there is more illness in the population today than in 1960. Back then bronchial disease was rife because of poor air quality arising from coal fires. Far more people did hard manual labour, in dangerous workplaces like coal mines, steelworks and factories. Even domestic work for housewives was more physical than today. Much housing was old and damp and there was no central heating. Everyone smoked huge quantities of cigarettes. I think your point about expectations of healthcare being radically different is the one that gets to the heart of it.

Interesting point. The illnesses of today seem to come out of our more comfortable, indulgent lifestyles. In 1960 the illnesses you describe came about out of necessity – hard, dangerous physical work and poor housing, really poor housing. Now in 2022 we are more safe and have more choices, but many of our diseases are down to those lifestyle choices, overeating, lack of exercise, drink and drugs.

Poor humans, we get ill either way.

Please don’t forget that life expectancy is now about 11 years longer. This increase in life expectancy has not been accompanied by a concurrent increase in disability-free years.

And yet there are populations, such as in Japan, where the health of centurions is impressively good, so it can be done and is not just down to income, rather education and lifestyle choices. The government need to inform the public about the dangers of sugar and ultra processed foods, as they have done with the tobacco industry. Then we might finally get somewhere.

We have a choice to read the labels and knowledge has increased through the internet. Why does it have to be government to spoon feed us?

Advertising, as per the covid fear campaign is extremely powerful no? Why else do advertisers spend the equivalent of a feature film budget on a 30 second ad?

Add Big Pharma to the equation, and everything becomes even more warped!

Big Pharma has a lot to answer for not least deaths and injuries through vax, but you cannot say that of course as you will get cancelled by mass media.

Tell me about it, Tony! Even before I learnt about those particular injuries and deaths, I was already cautioning people not to rush themselves or others to get it because I’ve always fully aware that are almost always certain people who could get quite intense side effects with any pharmaceutical product, and feared that more people would be prone to such dangers amidst this mad vax rush. I openly urged people to check with their trusted medical professionals before making that decision(not knowing at the time that many were intimidated into submission), but I got largely cold-shouldered. Eventually my warnings weren’t only vindicated, but I in fact underestimated how bad the outcome was.PS On similar principles I’ve been loudly against lockdowns from the very start (in fact even more fiercely than the vax apart from the mandates themselves), and I sure did get half-cancelled by the mob!

Kindly enlarge on these dire consequences and enlighten us on what these trusted practitioners would say. It would also help if you could explain what qualifies you to push your advice onto people.

Our minds are polluted as well as our bodies these days. Righteousness exalts a nation but sin is a reproach to any people.

Its not that there’s an absolute rise in the number of illnesses, rather more that there’s a exponential rise in the number of diagnosis and the potential treatmentsFor example, in the 60’s you had cancer plain and simple and then you died of it – in to 2020s you can have one of hundreds of forms of cancer, undergo multiple forms of scan and tests and receive an endless list of drugs and other interventions – each step requiring its own specialistsO, and each doctor has to fill out 100s more forms than they ever used to – and thanks to Dr. Shipman they all practice defensive medicine which costs more, takes longer and involves more tests with their accompanying specialists and administrators 🙂

Perhaps they were healthier because of more physical work?

Exactly. One problem is that we now have effective treatments for many more conditions than we did then. Don’t forget that all those cigarettes stopped people living into old age and becoming massive consumers of healthcare. Physical work probably prolongs life, but may increase the risk of disability.

These figures are a bit misleading.

About 15 years ago doctors working conditions changed. Many had worked (or been on call) 50 or even 80 hours a week (sometimes more for House Officers). Now 40 hours would be normal full time but many now work part time and offer only 25 or 30. So the number of hours worked by doctors is now greatly reduced (but pay per hour increased).

The irony is that many doctors have become unhappy under the new regime. The have lost autonomy and control, fell undervalued and attacked and many have work stress (like the author of this article – probably).

It is the fault of the Department of Health and the “working time directive” introduced by the EU. I don’t think it will ever be changed back. It’s a very sad story of unintended consequences which will inevitably lead to a slow privatisation of the service.

.. but don’t get ill on Saturday or Sunday?

Thank you, yes, that’s a good point and it leads on to something else. My grandfather was a doctor and in those days it was understood that if a woman married a doctor, you played a vital role in supporting him; running the home, looking after the children etc, because the job was an important, highly respected vocation and it needed a lot of his attention

I believe medicine is now about 60% women/40% men* and the idea that the spouse of either should become a full-time integral support in the old-fashioned way is seen as . . .well old-fashioned. But it worked, a doctor with a devoted wife coped with the longer hours which you refer to. It was their career, their enterprise together, rather than just his or hers.

The other problem you shy away from mentioning, and I don’t blame you, is that many of those 60%* of women doctors today, when they become mothers, perfectly understandably, want to work part-time rather than full-time and so more doctor hours are lost.

*correction: 47.5% women/52.5% men (statista)

What’s the answer then ? More doctors with understanding, self-sacrificing spouses ? More male doctors ?I don’t know.A rethink anyway.

So you are partly correct but if you look at the stats ALL want to work part time or retire early and the sex difference is less than you assume.

What to do? Allow retired docs to work a bit by abolishing their loss of a “licence to practice”, tell med students their debt will be canceled after 10 year equivalent full-time work and fine those who fail to do their share. Double medical school places. Let nurses retrain to become doctors.

Vested interests would block all these reforms.

Not sure which stats you’re referring to but according to The King’s Fund studies of trainee drs done most years, it definitely is’nt ALL wanting to work part-time, it is less than a third, 27%, wanting to work full-time. Their studies vary from 840 responses in 2018 to only 341 in 2022.

I cannot find anything more up to date on the sex differential than 2016, when 42% of female doctors worked LTFT (less than full-time) compared to only 7% of male doctors.

I’d be pleased to see any more up to date viable studies you know of.

According to David Oliver (a senior doctor writing in the BMJ), four in five salaried GPs work part-time, and nineteen in twenty GP trainees intend to work part-time. Up to half of hospital consultants work part-time (depending on the speciality); for instance, almost half of female consultant physicians were part-time. “Reducing hours is often a reaction to stress, burnout, or unsustainable workloads, or it’s a practical necessity owing to parenting or caring responsibilities…. many NHS doctors report burnout or moral distress from unsafe workloads.”Part-time work is a reaction to burnout and is by no means an exclusive female preference.https://doi.org/10.1136/bmj.n2794

Thanks. David Oliver is there quoting from the same King’s Fund study that I referred to if you check.

I did not say in any of my comments that part-time work was exclusively a female preference, but according to the article above and the one I refer to, before the pandemic, the levels of female part-time preference were significantly higher than male. You’ve just written one example yourself, “almost half of female consultant physicians were part-time.”

I am not attacking female doctors, this is just an observable fact that is relevant to the argument.

If women doctors are much more likely to work part-time, for whatever reason, then surely that needs to be taken into consideration when calculating how many doctors are required in the future, and the consequent sex ratio there should be in recruitment.

Men and women are different, we have different needs and we behave differently, trying to pretend we are exactly the same does none of us any favours.

Of course you are correct that women with caring responsibilities often prefer part-time hours, but this has been true for the past 25 years. My point is that men now want the same arrangement because of recent changes in their NHS working conditions. Doctors are choosing to reduce their hours. We should all be concerned.

I think you are right. My daughter in law is a doctor and with five children has spent most of the time on maternity leave at the expense of the hospital. She is still working but her poor husband trying to work at home has to cope with the children on top of his work and she was the one who wanted all those children.

The NHS costs each taxpayer ca £5,000/year, my private health insurance is £1,000/year. We cannot see a GP, we have to wait 12+ hours in A&E, 12 months for an operation, most trusts are in special measures, luckily I am a man so do not have to suffer the perils of childbirth in an NHS hospital. The NHS is a complete failure and should be completely scrapped and a new model based on the best European/Australian systems introduced. Unfortunately our politicians are too weak and cowardly to admit the NHS has failed and until they do this the NHS will continue to fail the public.

Too many socialists see it against them for some reason and mount polical pressure on any government that even thinks about it.

Sorry Emma, most of the population know NHS care is rationed by death. Has been for fifty years.Surive everything the NHS can throw at you and they might eventually ‘care’ for you. Or not.

Today a leading story was an NHS suggestion that all women are summoned for a “menopause check”.It seems to me it can’t think of enough ways to waste money fast enough!A novel idea would be that women experiencing symptoms could access a fit for purpose consultation, rather than a “chat” with a generic nurse.

The NHS is unreformable. Trying to do so is like flogging a dead horse.

Dr. Emma had my attention until she wrote, ‘People are going to have to choose whether to feed themselves or their children’. That’s when I knew that one of us, she or I, is out of touch with reality.Even the main thrust of her argument i.e. that the government is cynically willing to let smokers smoke themselves into an early grave, thereby saving the NHS billions in hospital costs made me ask, so what? Why is letting people do what they want while adding to the state coffers a bad thing? I didn’t get any further with the damn thing.

I can understand Emma Jones’ frustration but – I speak having qualified in 1973, and lived with two GP parents through the 50s and 60s – it was ever thus. One has to make uncomfortable choices if the money is insufficient, and as the opportunity to prolong life increases, it is at a cost. The older the population the more medical conditions they accrue while getting frailer and frailer. Treat some diseases with drugs that cost £200k or more if extra survival is measured in weeks or months? Resuscitate, or operate on an elderly patient only to return them to a life of incontinence and dementia in a care home after weeks in ICU? Keep a brain-dead child on a ventilator indefinitely? Is that kind? Indeed is it right? The list of things doctors should not do is endless but one cannot just ignore the cost.This is brilliantly laid out in David Haslam’s recent book “Side Effects: How Our Healthcare Lost Its Way – And How We Fix It”. I suggest that Emma Clarke reads it if she has not already done so.

Many thanks for the recommendation. Dr Haslam’s book is presently available from the usual online ebook emporiums at an unbelievably irresistible price! I’m off to acquire my copy now.

I suggest that the government subsidize medical education for those able and willing to undertake it. Exams can exclude those who are not capable of being medical professionals, but this needs to be addressed from both ends: supply and demand. Say, for example, that your medical education will be free IF you work for the NHS for the next 10 years or so, otherwise you’ll be on the hook for the cost.

Also, we need to make working conditions bearable for those doctors and nurses who show up to work every day. Either do this, or else privatize health care in the UK.

Poor things have to show up every day.

Gubmint health care. What could go wrong?

We Americans kept hearing how great NHS is. Health care is a right, they scream. It didn’t handle a real health emergency very well now, did it? Here in America the health care system looks more and more like NHS. The poor and elderly has suffered the most from SC2 Pandemic, but no one reports on it because the news industry is now controlled by a cartel after Bill Clinton signed the Telecommunications Act that regulated out of existence small ISPs and allowed television stations to be rolled up across State lines. We now have Big Brother and he’s a Big Bro with a Big Boot.

We have noticed the decline of America but I suspect there is a remnant ready to reverse the greed and the government corruption. Canada seems to be heading the same way under Trudeau who seems to want to destroy his country or does he just believe a lie?

As an American you Brits seriously have no idea what a predatory, greedy, failed healthcare system looks like.

I thought America had a good system?

The excess deaths: “Many of them, it seems, were related to lung, heart and circulatory diseases”. Now, what could have caused those?

Nobody really knows. Could be a collapsing health service, unintended consequences of lockdown, our financial difficulties or, of course, the side effects of the vaxxxine. In Denmark they have restricted access because of this last worry.

The vax?

A differential diagnosis: Governments don’t impose a smoking ban as it would infringe civil liberties and laws suppressing addictive substances don’t work.

What? this government ” Infringe civil liberties?”… NO?… surely not?

The question is why people who have paid for the NHS for decades, and are probably still paying tax on their workplace pensions, suffer in later life to fund treatment for those who have never worked, who are obese, who smoke, and are riddled with lice? The hint that those of us who work to fund the NHS should be subjected to masks and other ‘Covid’ controls when we are not the people that it is likely to kill is particularly egregious. The answer is ‘No’.Social care is clearly an issue and must be properly funded and the staff paid decent wages. The training of doctors and nurses is also a major issue and anyone entering a British university from a British school should receive their training free of charge and an allowance for their living costs which would be held over as an interest-free loan until they had completed an agreed number of years service in the NHS, at which point it would be written off. Brexit and Covid removed many foreign staff from the NHS and social care and policies to mitigate the effects of that, and train and employ British people on decent wages, do not appear to have been considered. That was foolish.

Move to Australia. We are always looking for well trained medics and nurses, the weathers better, and the combined public/ private system, despite the occasional issues, works very well.

My father (surgeon) was alarmed by how many of his colleagues abandoned ship in the NHS and flew off to Oz for exactly these reasons. That was 1958-60. Nothing changes in the NHS.

I think they pay more there as well.

I can vouch for that having lived for 18 years in Oz and the past 14 in the U.K.

I would like to invite Dr Jones to consider the possibility that the elevated excess death numbers this summer – which have been especially pronounced amongst the working age population – might, just might, have been caused, at least in part, by well intentioned but ultimately misguided non-pharmaceutical and pharmaceutical interventions.

If that turns out to be at least partially true, Dr Jones might ponder whether implicitly calling for more restrictions and interventions to be reintroduced is the most sensible thing to be doing right now. She and her overstretched, undervalued, and exhausted colleagues battling with health service bureaucracy have all of my sympathy. As people with a medical vocation who have entered into a career of public service it must be incredibly frustrating. They just want to use their incredible expertise and experience to help people love healthy, happy lives.

But equally, I would invite Dr Jones to consider whether the paradigm in which she appears to operate – that is, one that is predisposed to favour intervention to try and “correct” health problems – might be blinding her to the possibility that sometimes expert, experienced doctors can do more harm than good, especially when operating in a highly politicised and commercialised environment in which they have to accept scientific and medical information “on trust” from others. That she wants only the best for her patients, sadly, doesn’t mean that such a noble impulse is shared by execs in biotech companies interested in the value of their share options or by power-drunk politicians & technocrats interested in “resetting” and “reimagining” society in the name of the “common good” – even if that does result in some collateral damage on the way to their utopian fantasy world.

It’s hard enough for anyone working a demanding, stressful more than full-time job to find the time and space to step back, set aside their prior assumptions, and to challenge themselves to really try and understand what might be going on and how their worldview need serious revision. It’s even harder if to do so could, potentially, lead one to the conclusion that one might have been duped into advocating or even implementing interventions that history might come to judge as doing much more harm than good. It’s easier just to keep going within your existing paradigm, in which one’s sense of self is preserved and in which you have pretty strong views of who the goodies and the baddies are, and in which all of the things you learnt at medical school are the whole truth and nothing but the truth. But the world is more complex than that, and such naive simplifications only make us vulnerable to those who would manipulate our good natures and trust.

Good people in the medical profession and outside of it now need to somehow find the headspace to pause, listen, think, speak and act with courage. We cannot carry on like this.

Hear, hear!

Make assisted suicide legal.An epidemic of Dementia is coming and if i am one of victims i am off to Switzerland to have my life terminated

All free! The Swiss and their country will bore you to death before you have even been through passport control at the airport!!

I’m changing my name to Hugh Then Asia..

Actually to ‘top yourself’ in Switzerland costs about £5,000, about the same as a UK taxpayer contributes to the NHS.There is obviously room for competition here.

As an American I have read over and over how proud the British are of their healthcare system. This is what you are proud of? I could see my GP this morning if I wished. But I don’t need to. I am a diabetic prole who takes pretty good care of himself.

Ah yes, but could 25m non-insured others also say the same? (or is it 40m?) And do you not have to stress over copious forms and smallprint to just check what is and is not covered? And is not the proportion of GDP expended almost double the UK too?There is no doubt the US has some of the most fabulous health care for those who can afford it. But arguably almost the most rotten for those who can’t. An average life expectancy the same as Cuba I understand? How the heck does that happen?At a micro level we can and should borrow much. At a Macro level we don’t do so bad, and we control costs much bette whilst having universal cover. Govt incompetency and dogma the last decade has weakened the system but it hasn’t broken just yet..Our systems in part reflect where power lies and has lain for decades. We’re close cousins but not the same in all our values and can respect that.

We have dire problems, Prof, badly exacerbated by the appalling mismanagement, pretty much worldwide, of Covid-19. I mention Covid because the writer of this article does, but we’ll leave that aspect aside because the problems it created appear simply to have brought a long brewing and ignored situation to a head.I should declare my mother was a Yank, met and married my father during WW2, and resided in UK with him for the rest of her life (apart from a five year spell when we lived in Canada). I have first cousins in both Canada and New England, and friends elsewhere in North America, with whom I am in regular contact. I therefore have some comprehension and a large soft spot for your country.I have been retired 15 years, but worked as a qualified nurse in a variety of specialties and latterly as a qualified midwife in a senior role, by choice always at the practical end, and never in management. This involved close work with medics of all grades from students to consultants, most of them deeply rewarding as colleagues.The writer seems typical of a number of young medics in the profession who, like many young people today, have been primed by the educational system over several decades to assume that the individual is unable, and probably should not be permitted, to take personal responsibility. In her case she is also one of a contingent of young medics who really do believe there is no alternative option to our present “precious” NHS. She is clearly under great stress, as is the NHS genuinely at present. It needs root and branch reform, and many of us hope the present crisis might bring about the necessary examination and action, though I am not confident of that. More money is not the answer.Now here’s the other side. There are times when the sheer brilliance of what our health system is supposed to be shines through. I was hospitalised for 8 weeks in the summer of 2019. They quite rightly kick you out the minute you are remotely capable of being wheeled out the door by your husband in a chair these days, so you may conclude that for most of those 8 weeks I was in dire need of the care I was given. I had an acute abdominal problem requiring major surgery, which in my younger nursing days I know would have resulted ultimately in my death or permanent invalidity, but I survived and am now pretty fit.The thing which still stuns and overwhelms me, even as a retiree who knows how good and how disfunctional the system can be, is the huge number of utterly dedicated and skilled staff at all levels who worked tirelessly, literally 24/7 to ensure I, and the many sick people around me, were patched up and sent home more or less fully functional.I’m not so naive, as some are, to assume that this sense of unity and dedication cannot be transposed into a partially privatised system which will give equitable health care to all citizens, regardless of their financial status. It is possible, it happens in most European countries, and the really sad aspect of the whole thing is that neither the UK nor the USA seem able to achieve, after all these years, something similar. Why not for goodness sake?

Let’s assume the most appropriate comparison is with France, Germany and Benelux countries. They have social insurance systems. It’s certainly not private insurance led. They’ve then consistently spent a good bit more on healthcare than the UK as proportion of GDP. We got up to their level in the noughties but drifted back last 10yrs. They have national long-term workforce plans linking education placement capacity, funding and modelling. They do have aging population/social care issues but not to the level or extent of crisis we’ve allowed in the UK, hence their health system ‘flows’ better.

Excuse me but it was the NHS during the pandemic, not the Government, that threw out its vulnerable elderly patients,without even a test for coronavirus, to die in nursing homes or at home instead of using the Nightingale wards provided by the Army at the behest of the Government. It was the NHS that failed to order enough PPE. It was the NHS that was shown by Exercise Cygnus to be unprepared for any pandemic and did nothing about it. It was the NHS that tried to block the use of non NHS labs, ie., private and university labs from making PCR test standards (is assays the correct term?). The Government arranged for the Chemical Weapons Establishment at Porton Down to undertake the task. It was the NHS that failed to procure enough ventilators. Instead we had the PM on the steps of Downing street and in TV studios Boris pleading for anyone in private industry to design and manufacture them. It was the inability of the NHS to cope with Coronavirus that drove the government to attempt severe and lengthy lockdowns in order to keep the load on the NHS down to within its pathetically low capacity. We the patients were exhorted to save the NHS and clap for it. Che?And no that was not because of Tory cuts. Spending on the NHS has risen every year for a very long time.

You might be best to wait for public inquiry before being quite so definitive.Furthermore this general use of the term ‘NHS’ you fail to define – do you mean the DoH, the SoS, NHSE, or the 1.2m working within.As regards use of private labs etc – the NHS logo and brand was insisted upon by numerous providers of lab and covid related services. In part because it provided reassurance to the public, but also as a firewall for those companies. It is true that some in NHSE and the DoH objected to that, esp given the sums lavished on Test & Trace without proper procurement. The evident subsequent waste gets attributed to the NHS yet it did not control the decision-making.This will all come out though. Just have to reserve some judgment and give it a bit of time.

Holy moly, this is not up to the usual standards of UnHerd. I’m a Canadian doctor, and co-founder of freespeechinmedicine.com Dr. Jones says a few whoppers here (Hanlon’s razor applies).First, she trots out the trope that because we have become “complacent” (read: ” have decided that COVID isn’t the black plague, and want to go back to our normal lives”), that somehow the hospitals will be overwhelmed with COVID again. I’m not sure if she knows much about natural immunity, or how benign Omicron is. Or perhaps, like me, she thinks that the vaccines don’t help very much?Second, she talks about “Long COVID” as if it’s established fact. What is fact is that Long COVID correlates to pre-existing anxiety disorder much better than it correlates to actually having had COVID. It is the new fibromyalgia, or sick building syndrome, or chronic lyme or chronic yeast infection. Since the time of Galen or Hippocrates we have recognized a subset of patients who complain chronically about fatigue, poor sleep, aches and pains, and “brain fog”, but for whom we cannot find anything objectively wrong. It doesn’t mean they don’t feel well. It means there is nothing objectively wrong with them. Medical history is a serial history of new attempst to explain these patients in some objective way. They were hysterical. They were repressing childhood trauma. They had sick building syndrome. Multiple chemical sensitivity. COVID is the perfect explanation for something that we’ll never be able to explain.Long COVID also pours fuel on the COVID-zero fire for COVIDians who have been forced to admit that COVID just isn’t that dangerous now. Omicron infection fatality rate is 0.006, less than the flu by a good bit, and probably the same as most previous coronaviruses – read “colds” which is what we used to call coronaviruses back before the COVID brain worm had rendered us incapable of rational thought. But COVID-zero can still be pushed based on the idea that long-COVID threatens us in some serious way, even though COVID itself is now benign for the vast majority.I read articles like this with despair. Here is a physician, presumably educated, presumably thinking about COVID (since she wrote an article about it) who still arrives at conclusions which are hysterical and unsupported by fact or science.

The service always needs money and personnel.

It needs a lot more than that! When NHS got their hands on my very old father – first they dropped him causing vascular dementia, then would not release him to us because they said he had to have professional care! So we had to have amazingly useless and expensive in-home care – and all paid by us – and if we did not use them the NHS would remove him to a care-home at £10,000 a month and take it from any estate!

F-that – I just took him back to USA and we cared for him at my place his last 6 months, at home, like one should do. It was good how it went. (I happen to also have a little medical background, so that helped – but anyone can do end-of-life care)

NHS are like leeches – they suck onto anyone with money and suck it out of them by care costs at home, or in a home. They have 100% authority over you and your dependent in your own care – they think they are little Gods – F- the NHS is what I thought of them.

At least you escaped from them to America.

Emma Jones writes vividly of her first hand experience of a collapsing NHS but her diagnosis of the cause of this catastrophe is not correct.

We spend about the average of comparative countries on “healthcare” (as defined by the OCD). The problem is where and how the money is spent.

We waist much on inefficient small poorly staffed “nursing homes” which have very limited medical input and make no attempt to rehabilitate or discharge patients. In most countries, these units would be regarded as small hospitals and run accordingly.

Beds are therefore blocked and not available to those who could be transferred from “acute wards” and so money is wasted.

These wards are themselves denuded of medical staff and access to diagnostic and other equipment.

Money instead goes to pay for the hospital fabric under PFI; a stupid wasteful system used by both types of government.

We train sufficient doctors but they don’t like working in our system so leave, retire or go part-time. We are all suffering as a result. Don’t blame them. Listen to their distress – well described here

Most in care homes have sold their houses and have nowhere to go whilst the profits of the sale are gradually eaten up by the rent and care they receive. That’s what they chose and that’s what they expect. They judged that it would be better lving there than by tryng to survive at home.

We spend about the average of comparative countries on “healthcare” You are ignoring the 30% of spending on health care that is treat now pay later. That’s the pensions. Then on top there’s the debts the NHS is accumulating. So what’s the cost of PFI versus the alternative? Stump up the numbers. ie. Cost of borrowing by the state against cost of PFI

I remember a think tank report a while back that said 650,000 applications to train in nursing have been turned down in the last 20 years. I voted to remain in the EU (not sure I would vote that way again ) but I would (as I’m sure many leave voters would) expect to see the obvious reliance on foreign trained healthcare workers replaced with our own young people being given the opportunity to take their place. Otherwise what was it for?

180k nurse (and midwife) training places between 2012-18. HEE estimated drop out rate would result in c70% completing. Nursing is tough and many find it isn’t for them. Not all then choose to stay in nursing for long and Covid certainly exacerbated that.Of course not everyone who applies gets accepted either. We could drop the entrance requirements. But nursing is increasingly a highly technical job so a clear balance to be struck.Now of course as we know a junior nurse salary gives no chance of a mortgage in vast majority of the country. Subsidised accommodation has evaporated. Furthermore, and utterly bonkers, this Govt abolished the nursing bursary just before Covid, so that nurses now finish their training in significant debt. What a marvellous bit of joined up thinking given the loss of EU nurses and the demographic timebomb in the current age profile of the nursing workforce.c40-50k nursing gaps in the NHS currently (social care then another c110k causing huge ‘back-wash’ into the NHS). With the increase in leavers too to factor in. As we have no national workforce strategy – Treasury blocked – we don’t actually know when/if the gap will be closed. The additional training declared to date go nowhere near closing the gap and don’t seem to allow for the usual drop out rate. And of course training takes 2-3 years. So suffice to say no time soon and highly likely to worsen over next few years first whatever.

It seems to me the biggest single problem with the NHS is that it is run by non-medical personnel. Did you know that the ratio of managers (not non-medical/nursing staff but just managers) to doctors is 1:4. That is correct. There is 1 manager for every 4 doctors in the NHS.This seems like a colossal waste of money. Not only accounting for the pay of these managers (highest paid roles in the NHS are non-medical), but also because they will have plenty of time to dream up new ‘initiatives’ which invariably take the medical / nursing staff time and effort to do; time and effort which could and should be used for patient care.It is also these self-same managers that attend management seminars and get all hot and bothered over principles like ‘just in time’ and ‘lean’, reducing beds and stock down to ‘minimise’ costs. This inevitably resulted in the issues we see today.

This is absolutely the key issue which has been missed by most of the commentors dazzled by a radically free market anti-state alternative. The author of the article does indeed seem misguided in advising for “more money” and “more people”, what we need is to fire the useless bureaucrats and replace their jobs with competent (former) medical professionals who want a break from practising but whom it would be a waste to drop from the service entirely.

Unfortunately this is quite difficult to do, and the very people who would be auditing reforms like this are the useless busybodys who are the source of the problem to begin with, and will do anything to fight for their budget-draining survival.

You bothered to actually look up the official numbers before making this statement? Clearly not.52.2% of NHS staff are currently professionally qualified clinical staff. So immediately your 4 times nonsense is nonsense. Then of course you’d have all the HCAs, ancilliary staff (catering, cleaning, portering, transport, estates, receptioning, pharmacy, secretarial, IT, Finance and HR functions etc etc). What exactly is deemed ‘management’ is then far from clear-cut? Is a Ward Matron, responsble for their ward of 30 patients and 25 staff a ‘manager’? Is the Medical Director of a Hospital a ‘manager’?There is a strong argument the NHS’s problem is that is it under-managed. There is also a fair debate about how ‘well’ it is managed, albeit given the number of times private sector managers have been parachuted in only to find it ain’t quite as simple as they thought worth pondering.Overall because we avoid the bloating bureuacracy that would go with administering an insurance system the NHS overall admin costs remain amongst the lowest in OECD, despite 30 years of attempting to create an internal market with the contracting and pricing all that added (currently to all intents and purposes suspended).

What’s the ideal age to die? And how do we trade that off against fun-but-risky activities now? It’s not a discussion we ever seem to have.

In fact Logan’s Run was quite unequivocal on this: 21. As much hedonism as you want until then, but then it’s over.

Or once to live and then the judgment.

I think the film adaption had one good change, the ‘death age’ was 30.

What’s your ideal age to die? Please inform us and lead by example…. Let me guess … is it … 40?

The years of your days are three score years and ten.

I reached that day in April. I’d been on chemo since January. My first real encounter with the medical profession since I was born. The biblical estimate was in my case spot on. I don’t know how much additional time the efforts of the NHS have bought me. I’ve no desire to linger on at vast public expense whilst losing my facilities. Life needs quality rather than quantity.

When nu britn enacts laws like further restricting smoking, and we have a parliament and judges benches that look like the RIBs coming over from France… minus, of course, the orange life jackets…

The ideal time to die is when an individual deems fit, provided they are reasonably sound of mind. Assisted death should be elective if we have personal autonomy with the usual caveats about dependents, treatable depression, scurrilous relatives, and the like. I would like to book 26 days hence, please. I’ve done my time and dealt with many decades of chronic health problems.

The younger you are the less you will want to be forty and the more you will think it is a good time to die.

I will live as long as I can but I won’t trade off for unhealthy risky activity.

Time to privatise the NHS. Since it’s clearly not fit for purpose and impossible to reform at least we can save the massive amounts of money off tax and give people a genuine choice as to where to spend it.

Does the NHS need reform? Yes.The reason it has not, is not and may not happen is down to two things:

Too political. Anti tory anti Truss. She has only had five minutes. Give her a chance. She has quite a good record.

The American system, Obamacare is based on the NHS model. A beveridge model and its shite.What we need is a Bismark system like Switzerland or Holland.That’s why the NHS needs to go. It combines regulator, supply and insurance and that’s the disaster. Split those out and there is no conflict of interest that kills patients.Remember, the NHS states it kills 20,000 a year from avoidable errors. Doesn’t include the maimings.

Message here is stay well away from the NHS.

Yet another plea for more of other people’s money which never fixes the problem.

Everyone in the NHS and DHSC hated the Lansley reforms.This introduced a bottom-up patient-centred finance model that effectively made the big service providers (hospitals) financially accountable and competitive. It was resisted by all parties in the system who clearly recognised the threat.In recent conversations with an Australian friend their publicly managed insurance model allows the individual to choose from a selection of GP practices to get the earliest appointment, use a selection of privately run scanning specialists to have scans and select their consultants and hospital services. These services are free at the point of use funded by their monthly insurance payments.If a hypothecated payment to the UK government were introduced rather than funding from general taxation the Australian system could easily be replicated in the UK. It won’t happen because, as we have already seen with the Lansley proposals, the existing establishment will resist change tooth and claw and fully recognise the threat to their cosy status quo of top-down centralised managment control and focus on big hospitals.Let it not be forgotten that most GP providers are already privatised and always have been.

Every problem cited in this article is the direct result of government policy, including the planning, funding, creation of and response to Covid 19. Sir Humphrey was simply stating the obvious: government wants us dead, but only after it’s taken our money.

The funding has increased to record levels, both in real terms and cash terms. The tax payer has provided the fundingTHe NHS demanded autonomy and got it. So the planning and response is down to the NHS.So the NHS has failed.

Quite striking that the good doc finds Ms Coffey’s smoking and eating habits to be despicable, as well as her anti-abortion views.So the doc despairs that those who’v had a full life (possibly full of self-neglect) dying is terrible, whereas killing off those who have yet to start life is absolutely OK.Strange values.

The NHS?You mean the one that k1lls 210 thousand unborn every year?That NHS?All their other failings are of zero interest while this regime continues.There is no moral basis for their existence.

Please get the tobacco numbers right?! Firstly, tobacco industry revenues to HMG come not only in direct taxation, but in tobacco businesses corporation tax, and revenues via those of their suppliers, including packaging, transport, etc., ditto., and retail outlets, again ditto.

The rise in tobacco tax allows HMG to, no surprise here ‘ lie’ that tobacco consumption is dropping, so, therefore, their anti tobacco stance ” works” whereas the factual reality is that the sale of contraband tobacco has exponentially increased, due to cheap pricing, and legal tobacco revenue to HMG is dropping.

Given that life in ” nu britn” is frankly not worth living, and that annoying po faced non- smoker zealots is a pleasure akin to sex, I will carry on being a ” fumigatore”, contributing to the NHS, until it is time to hand over my addled corpse to The University of Cambridge, which I and they have agreed!

The NHS deals with over 1 million patients every 36 hours.My personal experience of surviving death via the NHS was not 5 star luxury stay by any means but it was more than adequate. And for that I am truly thankful. It may not be the shiny example of perfect medical care we want like seen in futuristic movies but it still one of the best in the world.Like all thing good managerial skills make a good place to work any festering of negativity in the larger part the work force comes from the top and rolls down. Poor or inadequate managers do not help the stress and destroy team building. And the routes of communication from the bottom to the top should held on regular basis so the managers are aware of what happening at the bottom first hand and how their decisions are affecting the work force performance and moral.We hear only of the horrific never the 999,990 successful results. As sad as they are and the horrible effect it has on the front line staff of the NHS. Negativity breeds negativity and Although it is struggling. Shine a light on the positives also to bring about a balance of what the NHS truly achieves. Every single day!

The democratically elected free government of the UK allows you your choices.Eat, drink, smoke, play, live as you like & as much as you like, or DON’T . The choice is yours.You have a choice to live your life as you please, to the fullest extent, even to the detriment of your physical and mental self. The choices we make throughout our lives have CONSEQUENCES. Sometimes the choices we don’t make ( accidental or genetic) are dealt to us to as well. But mostly it’s the choices we make that land us in trouble.I don’t understand why the government should also provide a service so precise and perfect such that none of our consequences are ever felt. NHS may be flawed but it’s not non existent.I make a case for personal responsibility. If a person shows disdain in dealing with one’s physical and mental self, then for them to expect NHS to be their salvation at a snap of their fingers is ridiculous.I also make the case for death. It will eventually come to all of us regardless of NHS. People are not suffering because of lack of NHS, they suffer due to their own actions and a misalignment in their expectations.There is a reasonable medical service available at the NHS, if need be we can visit it, or NOT. The choice is with us. Emma , pls stop the complaining, do your job and go home. You need some medication – to up your dose of meditation.

This all stems from too much comfort, excessive hive mentality, intellectual dishonesty and downright mental atrophy as well as laziness and entitlement… What or who is left to fix the problem on this stagnant island? I have no clue

The NHS is getting more money, in real terms, than ever before. Yet still the bloated carcass of a health care system demands more.

It’s time it got some sense, stopped doing tattoo removal for free, stopped killing unborn babies for free, stopped doing sex changes for free, stopped handing out condoms for free, and on, and on, and on.

Then it started looking after the sick, free at the point of NEED, not at the point of “want.”

That which is free is never valued. Fact.

It’s not actually free though is it. We all chip in through taxation. It’s free at the point of use, which may be more what you meant.And as regards ‘valued’ – let’s see what happens at the ballot box if someone tries to remove it.

It’s to be hoped Dr Jones’s bedside manner is somewhat softer than demonstrated here in her angry and patronising (I mean, who knew that ‘yes even doctors get Covid too’?) rant at the world. And, as others have said, if she could offer her thoughts on a few solutions, I might be a tad more willing to sympathise. So much easier to rant.

…the NHS has succeeded to the extent of keeping a lot of very old people in very poor health alive for ten and twenty years longer than they might have been, even back in the sixties. But even if we could spend everything the country had on it…it can’t cure death, or get away from the fact that the longer death is delayed, the more expensive each day of bed-bound misery will get…and the more people will be needed to maintain it. Quite mad, frankly…

But entirely ‘human’. What makes us different to all other mammals.A little disheartening but inevitable that a small number of ‘let em die’ types surface in such a discussion who’d almost certainly never apply that to themselves or close loved ones.

More intelligently there is evidence that in developed countries the vast majority of health care expenditure on the average person is consumed in the last 6mths of life whenever and however that occurs. What is more problematic is social care costs and they have risen much more with an aging population. The failure to institute a better approach to long term social care funding has adversely impacted on the NHS. Were it sorted the NHS would ‘flow’ considerably better.

Well, if you want to critique the NHS let’s make sure the grammar is correct, language before people. Don’t be old, disabled, have mental health issues in England and Wales, the NHS is not here for you, it’s here for the entitled staff.

“Boris Johnson said he would rather see “bodies pile high” than take the UK into a third lockdown”

My memory of that interview, which I trust is the one I saw, is that he said nothing of the kind. He raised the ‘bodies pile high’ quote specifically to reject that approach.And as for Coffey, she strikes me as merely a normal person, with no fashionable axes to grind.

I work in the NHS, and I agree with every word of this. The system is broken, and even if the Govt actually got their arses into gear and tackled some of the root causes (that the Govt themselves have caused), there are no quick fixes. It’s going to be a very dire winter indeed.

at least death means one no longer has to fret and worry about the NHS? Job done?

A lot of negatives in this article but little attempt at solutions.If there was a blockage in a supply chain in a private sector company, they would do something about it. Fit patients with nowhere else to go? Why not build a basic nightingale ward where they can sleep safely and have some basic care? That would free up the main wards and hence A&E and those waiting ambulances.

It’s struck me for a while that the shortage of doctors and nurses could be relieved by having two layers. Does a GP need to be as qualified as a potential surgeon? Why do all nurses need 3 years training? We used to have SENs and SRNs. All doctors have a booklet on their desk with advice, contra indications etc. If in doubt they refer. Ten minutes per patient is hardly the old fashioned bedside manner. As for funding Europe seems to doing a better job. Perhaps a team or two of “immigrants” could be flown in to sort it out. Like some gendarmes brought in to deal with XR and Just Stop Oil.We aren’t the biggest spend per head by far by the way.

Unfortunately you’ve missed the biggest factor, which is that the NHS is also catering for circa 5 million ‘undocumented’ migrant (immigrants here illegally in other words). These people are not recognised by the census, and schools and GPs are assigned money and resources based on these official figures. Not accounting for this extra Scotland number of people means that services like GPs, schools and hospitals will inevitably be a breaking point.Add in systemic resistance, often within the NHS itself, to training enough clinicians and nurses, and then not paying them enough, you have a recipe for failure.

They are paid more than enough. There are far too many of them that could not be employed anywhere else. The NHS employs the people no one else would tolerate and pays them above average. Don’t believe me? Read ONS pay stats for healthcare workers. They do exceptionally well from the national handbag.

The NHS is the worlds 5th largest employer on the planet only surpassed by other outfits from countries with much larger populations and is the largest employer in Europe but we don’t have enough frontline staff so I believe there is something fundamentally rotten about the setup and running of the NHS. Is it there for the treatment of patients with dignity and respect or just a fiefdom to run for multitudes of managers and NHS Trusts ?The NHS has been politically weaponised by all sides of the spectrum to the point of it seems impossible to turn it around. If the only argument is to spend more money then that plan of action will ultimately produce next to nothing results. We need an all party parliamentary group set up to deal with this issue and with real powers to be able to do something positiveWe have to look at healthcare systems around the developed world that actually work by “fixing ” people who haven’t had to wait 1-2 years for an operation so they can have a good quality of life.We need to look at other developed countries and quickly such as France, Germany, Australia and NZ that have healthcare that does what it says on the tin. These countries have a private/public setup paid for by taxes and insurance subscriptions that works. I know people from all the countries I used as an example and they are mainly ex-pats who have said they would never again accept a healthcare system based on how the NHS is ran. They only realised how inefficient it all is when they experienced another healthcare setupNo doubt some people will say just look at the system in the USA. No one in their right mind wants that system in the UK but whilst we dither and just trudge along with what we have had for 75 years people are dying unnecessarily and living in pain, discomfort and worry in the hope of some pretty basic health care.The NHS is not the envy of the developed world so lets stop fooling ourselves about this.We already have Scandinavian levels of taxation but Swaziland levels of service in this country so more taxation is not the answer as it doesn’t work. Also when are we going to stop pinching essential health professionals from poor countries ? We need change and we need it now.I’m not holding my breath as if I collapse any paramedics on shift are probably in a queue waiting to get into A&E with some poor saps running themselves ragged trying to help patients whilst the army of NHS pen pushers, bureaucrats and non jobbers are tucked away safely in bed

All too true – but the NHS was a disaster long before covid. In 2011 my GP (no problem getting an appointment then) misdiagnosed my appendicitis as norovirus. When my appendix burst a few days later, I had no problem being seen at the emergency room- no queue -but was again misdiagnosed, given no tests, just intravenous fluids and narcotic painkillers and sent home. When I returned to the ER a week later, in even greater pain, I was again seen promptly. But no tests were done and I was again given fluids and told to go myself – I could barely walk – to the pharmacy around the corner to renew my prescription for painkillers. I finally took myself to a private hospital where I was correctly diagnosed by ultrasound and MRI in minutes and operated on within the hour. The surgeon told me that I was “hours from multiple organ failure.”

“In fact, she’s advocated working for no money at all, unabashedly calling for a “national endeavour” to support the NHS, which “includes encouraging more volunteering across the health service”.

Obviously no thought to process, motivation, or lessons learned. Am in the States, we do same.

I got to “the state is happy to kill off the weak to balance the books or even make a profit” and I stopped reading. I have no love for thos government nor am I a fan of our NHS but how can I relate to somebody who thinks “the sate is happy”. Whom within the state is happy? Utter bilge

“In other words, the only way we can get new patients into our emergency department — and the only way we can get existing patients into the community — is if people die.”The only solution I can see, are radical changes to Constitutions and electoral systems that result in leadership that’s fair and efficient. The vast majority of politicians and technocrats today, are nothing more than narcist puppets to corporate giants; ‘big pharma’ at the top of that list.Private money, must be completely removed from the leadership selection process, the funding of government agencies and universities; to be replaced with fed funds. And if you weren’t already aware, sovereign nations aren’t solely reliant on income tax to fund anything.

I’d love to read your reasons for the thumbs down.

Emma Jones is 100% correct

What about? More and more money?

The NHS is receiving record levels of funding. Way above inflation increases.

For example, the bus promised 350 million a week. The reality was that the increase from the referendum to the first year we actually left, was 1,400+ a week extra in funding. More in absolute terms. More in inflation adjusted terms

So why is the NHS so crap at turning money into treatment. That’s the real question.Why does the NHS kill 20,000 a year from avoidable errors? Manslaughter. The NHS’s own numbers.If you go into a hospital, you need to be asking, do I feel lucky today.