June 28, 2023 - 4:00pm
In 1906, a shoemaker and ex-convict called Wilhelm Voigt pulled off an audacious con. Dressing himself as a military officer, he rounded up some soldiers and confiscated over 4,000 marks from a local treasury. Voigt entered legend as the “Captain of Köpenick”, and was eventually pardoned by the German Emperor. The story, meanwhile, illustrated the unhealthy reverence in which Prussian society held the Army.
Which institution would a modern-day Voigt imitate? It probably wouldn’t be the Armed Forces, at least not in Britain. After Newsnight’s bizarre, Pyongyang-style tribute to it on Tuesday night, there is surely little doubt that the feathers to borrow would be those of the NHS.
This country’s attitude towards the Health Service has long been a little weird. After the Second World War saw us eclipsed on the world stage by the United States, we sought solace in a new exceptionalist myth: that the aftermath of the war saw us build the best healthcare system in the world.
It has long been a comforting illusion, and perhaps never more so than today. Our reverence for the NHS is completely out of line with its actual performance, where on many outcome metrics it performs much worse than the systems of peer countries.
Yet as the reality has grown more disappointing, the mawkishness has been dialled up. The opening ceremony at the 2012 Olympics featured a martial parade of nurses in old-fashioned uniforms. Now we have choirs of children on the national broadcaster’s flagship current affairs show.
Isn’t this, as some suggest, a relatively benign phenomenon? If we need to place an institution on a pedestal, surely it is better that the icons are doctors and nurses, rather than soldiers?
No, as it happens. Counterintuitive as it might seem to some progressives, it is far better to venerate the Armed Forces than the Health Service. This is not just because soldiers continue, even in this more peaceful age, to take risks and make sacrifices on our behalf that we ask of nobody else. It’s because the military, at least in a stable and healthy democracy such as ours, doesn’t play an active role in our day-to-day lives.
Barring some unforeseen crisis, it is supremely unlikely that we will ever find our lives in the hands of a British soldier. But unless you and everyone you care about is rich enough to afford private care, it is all but certain that at some point NHS staff will have huge, perhaps even life-or-death power over us.
For that reason alone, it is essential that we can treat the Health Service with appropriate scepticism. Even in the current environment, it receives a negligence claim, on average, every 40 minutes, settling almost 87% of them. In the 2021/22 year, that led to a direct cost to the taxpayer of £13.6 billion, a figure that excludes the so-called “hidden” costs of actually investigating the claims. And if 13,070 settled claims is a statistic, remember that each one is a tragedy. It represents a life worsened, ruined, or even ended through malpractice.
Then there are the big-picture consequences. The NHS consumes a vast amount of Government spending, and that share is only set to rise. Easing strain on the Health Service serves as justification for rafts of authoritarian legislation, from smoking bans to sugar taxes to lockdowns. During the pandemic, we were told to “protect the NHS”. It is impossible to imagine the Army making such a demand: they would recognise that such a sentiment gets the protective relationship backwards.
One can agree or disagree with any of these measures, of course, as well as whether the NHS spends its huge budget wisely. Does it have too many admin staff, as Patricia Hewitt argues? Why has it not yet completely stopped offering homeopathy at public expense? Yet such debates can only be less effective if conducted in an atmosphere of worshipful reverence. For as long as the NHS is a British religion, the national discourse won’t be in good health.
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SubscribeOutside our local hospital, the road markings on either side of the zebra crossing read “Thank you NHS!”. It makes me wonder who ordered this job to be done (it’s proper reflective white paint, so presumably the county council) and what value they thought they were getting for the taxpayers’ money.
I’m wondering what I have to thank them for. After my GP referred me for a scan, I was bombarded with letters telling me how I MUST turn up for my appointment on time, what to wear, what to eat, etc., etc. After the scan, I was told that I might need an operation, and would be informed after the surgical team had discussed my case. There were no further communications with me, and my attempts to contact the hospital were numerous and met with a system which seems to have been designed to send you in endless frustrating loops. My GP has sent letters to them, but to no avail.
And the local Health Centre is little better. Staff there spent two years plastering the walls and desk with amateurish photocopied notices basically telling you to go away. I’ve seen compliant polite middle class elderly people get treated with condescension and outright aggression by the receptionist, who is of course surrounded by the same cheap signs informing the public that abuse and aggression towards staff will not be tolerated, etc., etc. She wouldn’t last five minutes in a private company.
I honestly thought that we had seen the end of the Health Centre; it might as well not exist. But glory be! The government offer surgeries a lump sum for doling out Covid jabs – I read it was £22 for a pair of them – and everything is galvanised. Hundreds of patients are pushed through with teutonic efficiency. Local groups volunteer with the car parking. There are waiting areas, and every available office and broom cupboard is used.
So thank you NHS! Someone arrange a time, and I’ll stand outside my house and clap like a seal!
All the way down Denmark Hill outside King’s College Hospital there are posters of members of hospital staff – medical and administrative – each with some text praising the exceptional qualities of the staff member. Who is paying for this, and is it a good idea to cultivate an internal culture where everybody is a hero or heroine just for turning up to work?
All the way down Denmark Hill outside King’s College Hospital there are posters of members of hospital staff – medical and administrative – each with some text praising the exceptional qualities of the staff member. Who is paying for this, and is it a good idea to cultivate an internal culture where everybody is a hero or heroine just for turning up to work?
Outside our local hospital, the road markings on either side of the zebra crossing read “Thank you NHS!”. It makes me wonder who ordered this job to be done (it’s proper reflective white paint, so presumably the county council) and what value they thought they were getting for the taxpayers’ money.
I’m wondering what I have to thank them for. After my GP referred me for a scan, I was bombarded with letters telling me how I MUST turn up for my appointment on time, what to wear, what to eat, etc., etc. After the scan, I was told that I might need an operation, and would be informed after the surgical team had discussed my case. There were no further communications with me, and my attempts to contact the hospital were numerous and met with a system which seems to have been designed to send you in endless frustrating loops. My GP has sent letters to them, but to no avail.
And the local Health Centre is little better. Staff there spent two years plastering the walls and desk with amateurish photocopied notices basically telling you to go away. I’ve seen compliant polite middle class elderly people get treated with condescension and outright aggression by the receptionist, who is of course surrounded by the same cheap signs informing the public that abuse and aggression towards staff will not be tolerated, etc., etc. She wouldn’t last five minutes in a private company.
I honestly thought that we had seen the end of the Health Centre; it might as well not exist. But glory be! The government offer surgeries a lump sum for doling out Covid jabs – I read it was £22 for a pair of them – and everything is galvanised. Hundreds of patients are pushed through with teutonic efficiency. Local groups volunteer with the car parking. There are waiting areas, and every available office and broom cupboard is used.
So thank you NHS! Someone arrange a time, and I’ll stand outside my house and clap like a seal!
As a great lumbering socialist project inspired by the ideal world of communist fantasy the NHS gives the state a justification for interfering in our private lives. We must mind what we do lest we become burden on the NHS. That includes living too long. Perhaps in the future self-termination (to coin a term) will be encouraged as a socially responsible act helpful to the ever cash-strapped NHS.
I wonder if anybody’s trademarked “Dignitol”…
I wonder if anybody’s trademarked “Dignitol”…
As a great lumbering socialist project inspired by the ideal world of communist fantasy the NHS gives the state a justification for interfering in our private lives. We must mind what we do lest we become burden on the NHS. That includes living too long. Perhaps in the future self-termination (to coin a term) will be encouraged as a socially responsible act helpful to the ever cash-strapped NHS.
Why is anyone still wasting their time watching Newsnight ?
Hard to believe now that I spent so many hours of my life doing so.
Why is anyone still wasting their time watching Newsnight ?
Hard to believe now that I spent so many hours of my life doing so.
As the political elites all have private medicine, it is very useful for them to say how wonderful the NHS is.
.
This has the double benefit of telling the world what great political masters they are – and also reduces the number of people who might opt for private medicine and put their easy access at risk.
As the political elites all have private medicine, it is very useful for them to say how wonderful the NHS is.
.
This has the double benefit of telling the world what great political masters they are – and also reduces the number of people who might opt for private medicine and put their easy access at risk.
Even “The Repair Shop” was inveigled into an episode of cult worship. Pathetic.
Even “The Repair Shop” was inveigled into an episode of cult worship. Pathetic.
At its best, the NHS is wonderful. At its worst, it is truly awful. It can be wonderful and awful in the same hospital, which suggests that management is the issue. But do any of us really know?
At its best, the NHS is wonderful. At its worst, it is truly awful. It can be wonderful and awful in the same hospital, which suggests that management is the issue. But do any of us really know?
Imagine a clinical director being your boss who sits through the staff meeting on his phone has no answers to any problems, communication zero but a great doctor, this is happening at trusts all over Britain yet we still seem to put massive trust in doctors to sort out problems in the NHS
Imagine a clinical director being your boss who sits through the staff meeting on his phone has no answers to any problems, communication zero but a great doctor, this is happening at trusts all over Britain yet we still seem to put massive trust in doctors to sort out problems in the NHS
Still wouldn’t swop our model for any other, albeit I would fund it more in line with other comparable nations and do more on public health (including personal responsibilities).
However strongly agree with the thrust of the over-veneration critique, and there are some reforms needed. For a start the catastrophe on workforce planning whereby the Treasury stops a plan being developed for future needs and thus health and education sectors never line up. Utterly ridiculous. Go to other comparable Nations and they have a national plan.
Tory’s reforms made a bigger hash of things too and actually created additional admin, but whilst admin costs in the NHS remain amongst lowest of all developed health systems it’s not always deployed optimally. Remember Hewitt said NHS ‘under-managed’ too, noting the difference between admin and management.
On the medical negligence – yes perhaps a more ‘no fault’ approach would help. But remember you constantly run short staffed you are going to get a spike in such problems. The claims also take far too long to settle which is dreadful too for those who suffered. But the Author misquotes £13.6b and implies in one year. His own link shows it’s £2.3b. Still way too high but Author was sloppy on this.
Still wouldn’t swop our model for any other, albeit I would fund it more in line with other comparable nations and do more on public health (including personal responsibilities).
However strongly agree with the thrust of the over-veneration critique, and there are some reforms needed. For a start the catastrophe on workforce planning whereby the Treasury stops a plan being developed for future needs and thus health and education sectors never line up. Utterly ridiculous. Go to other comparable Nations and they have a national plan.
Tory’s reforms made a bigger hash of things too and actually created additional admin, but whilst admin costs in the NHS remain amongst lowest of all developed health systems it’s not always deployed optimally. Remember Hewitt said NHS ‘under-managed’ too, noting the difference between admin and management.
On the medical negligence – yes perhaps a more ‘no fault’ approach would help. But remember you constantly run short staffed you are going to get a spike in such problems. The claims also take far too long to settle which is dreadful too for those who suffered. But the Author misquotes £13.6b and implies in one year. His own link shows it’s £2.3b. Still way too high but Author was sloppy on this.
If you put someone on a starvation diet, don’t condemn them for being thin. We get what we pay for, and if things carry on the way they are going, nursing will join fruit and veg picking as a job Brits won’t do, then where will we be?
Except that is nonsense. The figures show very, very clearly the NHS is on the sort of ‘starvation diet’ that killed Elvis.
Look at where we are compared to other European nation’s funding, and where we were under the last Labour government. Then look at what’s happened to waiting times. It’s not hard, Elvis would understand.
Look at where we are compared to other European nation’s funding, and where we were under the last Labour government. Then look at what’s happened to waiting times. It’s not hard, Elvis would understand.
The NHS has had billions after billions thrown at it for decades, yet people seem to think it’s getting ever worse.
The problem clearly isn’t money. It’s management and the nature of the organisation. And the behaviour and expectations of its users. The NHS as currently set up enourages and subsidises personal irresponsibility. That’s got to change if we’re ever going to make any progress.
Putting the NHS on a diet would do a lot of good in my opinion. They’d have to start prioriting things that really matter and stop wasting time and resources or peripheral actvities. And stop trying to run itself for the benefit of its employees instead of its users.
And yes, stop trying to operate as a charity, treating anyone who rocks up. It’s supposed to be a national health service, run for the benefit of its citizens and taxpayers. Not an international do-gooding charitable organisation. It’s perhaps the biggest business in this country. Run it seriously. And stop pretending it isn’t a business with customers. However demeaning that might feel for the staff (which it shouldn’t).
Being free at the point of use doesn’t make the NHS a charity, and the NHS is already on a diet. If you had any experience in working as a clinician in acute medicine you would know that the NHS runs on staff goodwill, putting in hours of unpaid overtime every week because we can’t go home until our patients are safe. That’s hardly running things for the benefit of staff. There are always improvements and hard decisions to be made, but if you want healthcare that people who aren’t rich can access, then it needs to be paid for.
By “charity” I mean the refusal to check whether people are actually eligible for treatment before delivering it. Or the recent point blank refusal of doctors to consider charging patients for not turning up for appointments – something that my NHS dentist seems to have been able to implement without any difficulty.
These are very basic operational requirements in running any business – and any organisation with the size and budget of the NHS is a business, whether they like that word or not. NHS staff are the custodians of vast amounts of public money. And often not very good ones.
I’ve previously recounted the story of my son’s visit to A&E in Poland last summer. 15 minutes from arrival at the hospital to assessment by doctors. Then straight to the childrens’ ward. Of that 15 minutes, 5 was waiting and 10 were checking and translating our papers to make sure we were eligible for treatment.
So the Polish health system has no problem checking whether random people who rock up are eligible for treatment.
This stuff isn’t exactly rocket science.
It’s a serious problem when NHS staff – or civil servants – start believing that their consciences should dictate what their employer can and cannot do. If they want to work for charities or NGOs, then go and do it.
I spent a lot of time weeding out people who were not ill enough to warrant my precious time, not because I felt they weren’t deserving of it, but because I didn’t have the resources to see both them and the really severe cases. The NHS has been rationing its care for years. As for severe checks on eligibility for care, be careful what you wish for. There is treatment resistive TB. on the loose in GB at the moment, if you drive away those suffering from it, poor immigrants, then it becomes endemic. One thing I’ve noticed in this comments thread, no input from the people in the know, who have to make the system work, just from people who think they know.
One thing I will agree on – yes the NHS has been rationing care. The model purports to be free and universal, but is actually based on rationing. It was conceived in the era of rationing, so perhaps that shouldn’t be a surprise. Since there is no price mechanism (or penalties) to limit demand, rationing it must be. That’s the choice we made. We can pretend it ain’t so, but it is.
I’ll also agree – I’m certainly not “in the know”. However, that doesn’t invalidate observations about whether the NHS is a well run organisation.
I will also say this. Experience in industry tells me that if an organisation has problems and fails to solve them, you cannot expect the people who presided over the problems to solve them. If they could do so, they already would have.
TB – perhaps we should have mandatory health checks on immigrants ? That doesn’t seem to be an unreasonable ask – we don’t want to be importing dangerous diseases/leaving them untreated, do we ?
If you’re a doctor (I assume from what you write), then why would you be doing the paperwork to check eligibility for treatment ? That would be an appalling use on NHS resources and a basic management error.
The A&E receptionist at the Polish hospital in Krakow I visited didn’t seem to have any trouble checking.
All you say is perfectly reasonable and we need to have the hard conversation about what the NHS can reasonably provide with the resources it has, and that is an economic decision. I’d want to make the point that the contributors to that conversation need to be honest about any conflicts of interest they might have i.e. being on the boards of private healthcare companies etc. We also need to recognise that healthcare isn’t simply an individual transaction with an organisation, there is a legitimate public health sphere as well. It is partly about money though, the NHS is very poorly funded compared to comparable countries and that needs to be rectified, though I accept there have to be limits on spending and hard choices made.
Agree with the first parts.
We should also note that “conflicts of interest” were built in from day one by allowing consultants to do private work. I’ve never seen that being seriously addressed. Another example of the NHS being run for the benefit of its staff (at least a privileged subset of its staff – whilst junior doctors are exploited).
These are long standing features of a poorly managed and structure organisation which simply has no desire to reform itself.
But the NHS is certainly not “poorly funded”. That may have been true 25 years ago, but it isn’t now. We’re bang average on funding with comparable countries. And worse on outcomes.
And when my sister in law (an NHS nurse) doesn’t tell me about being sent on a horse therapy session (which she didn’t want), I might be tempted to take this claim more seriously. There are some really quite easy choices to be made here.
Depends on how you chop the figures, we spend the second lowest amount of money per person in the G7 countries. Look around the NHS, buildings, kit, staff. It’s awful right now, and getting it up to scratch will cost money, whatever funding model we use.
Depends on how you chop the figures, we spend the second lowest amount of money per person in the G7 countries. Look around the NHS, buildings, kit, staff. It’s awful right now, and getting it up to scratch will cost money, whatever funding model we use.
Agree with the first parts.
We should also note that “conflicts of interest” were built in from day one by allowing consultants to do private work. I’ve never seen that being seriously addressed. Another example of the NHS being run for the benefit of its staff (at least a privileged subset of its staff – whilst junior doctors are exploited).
These are long standing features of a poorly managed and structure organisation which simply has no desire to reform itself.
But the NHS is certainly not “poorly funded”. That may have been true 25 years ago, but it isn’t now. We’re bang average on funding with comparable countries. And worse on outcomes.
And when my sister in law (an NHS nurse) doesn’t tell me about being sent on a horse therapy session (which she didn’t want), I might be tempted to take this claim more seriously. There are some really quite easy choices to be made here.
All you say is perfectly reasonable and we need to have the hard conversation about what the NHS can reasonably provide with the resources it has, and that is an economic decision. I’d want to make the point that the contributors to that conversation need to be honest about any conflicts of interest they might have i.e. being on the boards of private healthcare companies etc. We also need to recognise that healthcare isn’t simply an individual transaction with an organisation, there is a legitimate public health sphere as well. It is partly about money though, the NHS is very poorly funded compared to comparable countries and that needs to be rectified, though I accept there have to be limits on spending and hard choices made.
One thing I will agree on – yes the NHS has been rationing care. The model purports to be free and universal, but is actually based on rationing. It was conceived in the era of rationing, so perhaps that shouldn’t be a surprise. Since there is no price mechanism (or penalties) to limit demand, rationing it must be. That’s the choice we made. We can pretend it ain’t so, but it is.
I’ll also agree – I’m certainly not “in the know”. However, that doesn’t invalidate observations about whether the NHS is a well run organisation.
I will also say this. Experience in industry tells me that if an organisation has problems and fails to solve them, you cannot expect the people who presided over the problems to solve them. If they could do so, they already would have.
TB – perhaps we should have mandatory health checks on immigrants ? That doesn’t seem to be an unreasonable ask – we don’t want to be importing dangerous diseases/leaving them untreated, do we ?
If you’re a doctor (I assume from what you write), then why would you be doing the paperwork to check eligibility for treatment ? That would be an appalling use on NHS resources and a basic management error.
The A&E receptionist at the Polish hospital in Krakow I visited didn’t seem to have any trouble checking.
I spent a lot of time weeding out people who were not ill enough to warrant my precious time, not because I felt they weren’t deserving of it, but because I didn’t have the resources to see both them and the really severe cases. The NHS has been rationing its care for years. As for severe checks on eligibility for care, be careful what you wish for. There is treatment resistive TB. on the loose in GB at the moment, if you drive away those suffering from it, poor immigrants, then it becomes endemic. One thing I’ve noticed in this comments thread, no input from the people in the know, who have to make the system work, just from people who think they know.
Yes, Doug, but it’s not shortage of funds that leads to the NHS relying on staff goodwill, is it?
If there were more staff then we wouldn’t have to work for nothing, so yes it is.
You’re just being silly claiming you’re “working for nothing”. Sue your employer ! That’s not legal.
Don’t be daft, all sorts of people do it
So you work without getting paid ? I’m a big fan of volunteering and do some where I can.
BTW, if there were more staff, you certainly wouldn’t get paid more and might actually get paid less. Not even the NHS is completely immune from the law of supply and demand. But then again, you can’t get paid less than zero !
So you work without getting paid ? I’m a big fan of volunteering and do some where I can.
BTW, if there were more staff, you certainly wouldn’t get paid more and might actually get paid less. Not even the NHS is completely immune from the law of supply and demand. But then again, you can’t get paid less than zero !
Don’t be daft, all sorts of people do it
You’re just being silly claiming you’re “working for nothing”. Sue your employer ! That’s not legal.
If there were more staff then we wouldn’t have to work for nothing, so yes it is.
By “charity” I mean the refusal to check whether people are actually eligible for treatment before delivering it. Or the recent point blank refusal of doctors to consider charging patients for not turning up for appointments – something that my NHS dentist seems to have been able to implement without any difficulty.
These are very basic operational requirements in running any business – and any organisation with the size and budget of the NHS is a business, whether they like that word or not. NHS staff are the custodians of vast amounts of public money. And often not very good ones.
I’ve previously recounted the story of my son’s visit to A&E in Poland last summer. 15 minutes from arrival at the hospital to assessment by doctors. Then straight to the childrens’ ward. Of that 15 minutes, 5 was waiting and 10 were checking and translating our papers to make sure we were eligible for treatment.
So the Polish health system has no problem checking whether random people who rock up are eligible for treatment.
This stuff isn’t exactly rocket science.
It’s a serious problem when NHS staff – or civil servants – start believing that their consciences should dictate what their employer can and cannot do. If they want to work for charities or NGOs, then go and do it.
Yes, Doug, but it’s not shortage of funds that leads to the NHS relying on staff goodwill, is it?
Being free at the point of use doesn’t make the NHS a charity, and the NHS is already on a diet. If you had any experience in working as a clinician in acute medicine you would know that the NHS runs on staff goodwill, putting in hours of unpaid overtime every week because we can’t go home until our patients are safe. That’s hardly running things for the benefit of staff. There are always improvements and hard decisions to be made, but if you want healthcare that people who aren’t rich can access, then it needs to be paid for.
Except that is nonsense. The figures show very, very clearly the NHS is on the sort of ‘starvation diet’ that killed Elvis.
The NHS has had billions after billions thrown at it for decades, yet people seem to think it’s getting ever worse.
The problem clearly isn’t money. It’s management and the nature of the organisation. And the behaviour and expectations of its users. The NHS as currently set up enourages and subsidises personal irresponsibility. That’s got to change if we’re ever going to make any progress.
Putting the NHS on a diet would do a lot of good in my opinion. They’d have to start prioriting things that really matter and stop wasting time and resources or peripheral actvities. And stop trying to run itself for the benefit of its employees instead of its users.
And yes, stop trying to operate as a charity, treating anyone who rocks up. It’s supposed to be a national health service, run for the benefit of its citizens and taxpayers. Not an international do-gooding charitable organisation. It’s perhaps the biggest business in this country. Run it seriously. And stop pretending it isn’t a business with customers. However demeaning that might feel for the staff (which it shouldn’t).
If you put someone on a starvation diet, don’t condemn them for being thin. We get what we pay for, and if things carry on the way they are going, nursing will join fruit and veg picking as a job Brits won’t do, then where will we be?