MEMO TO LANSLEY: WANNABE MANAGEMENT IS THE NHS PROBLEM.

A clear vision, not cross-eyed compromise, is what we need

I have been writing for so long now on the subject of the NHS – and what to do with it – that I often despair of anyone with power ever seeing the various lights that are there to be seen. After years – since 1995 to be precise – of collecting data, and logging the experiences of myself and others I know, reliable stories reported in the media, my experiences with my parents in various hospitals, and other horrors, the conclusions I have reached are as follows:

1. The 1949 version of the NHS should be dumped forthwith: it is based on irrelevant principles and far too big

2. GPs have got far too much of the NHS budget, and they’ve lost the plot about what community doctors are for

3. There is still a ridiculous amount of senior management overstaffing at stupidly high salaries in hospitals

4. Both hospitals and local practices have caught all the adverse effects of managementitis, and inherited none of the advantages

5. Despite this, everyday admin staff and ‘real’ medical staff are unfailingly polite, sympathetic and well-organised, although I have no idea why: I certainly wouldn’t be.

My pocket history would be that the original Bevan concept was gobbled up first by trade unions in the 1960s, bloated by Ted Heath in 1973, flooded with Big Hair and meetings bollocks in the 1980s,  and then systematically shafted by a deadly private business in the Nineties and Noughties. Some say you cannot flog a dead horse, but I say that our National Health Service is a gothic monster with five heads, one leg and no brain. It cannot survive, and it must go.

The way for it to go is more localised, away from government, and socially mutual: but I don’t want to get into another 5,000 word essay… this is the wrong medium for it, and it isn’t the point of this post. My task today is to illustrate by example. This morning, I attended my fifth UK hospital in a year. There’s nothing really wrong with me or my wife, we’re just getting on a bit. Some of this has involved pain management, and thus requires a lot of visits to our local GP joint practice as well. There follow a few bullet points for the embattled Minister to think about. They may sound picky, but I do point out the broader ramifications.

a. Ring the GP up for an appointment at the moment, and you won’t be seen for at least a week. This has nothing to do with cuts, and everything to do with a commercial row going on there about who gets what….in the midst of which the key member of ‘management’ at the Practice has been fired, and has taken all the admin software passwords with him. He is now about to sue the Practice, and vice versa. This is what I would call an idiot’s idea of progress.

b. Turning up at Exeter hospital this morning, the most noticeable thing was a series of queues at the various pay and display machines. These have just been upgraded by senior management, and their main drawback is that one needs an IQ over 130 to use them successfully. It was a senior management decision. I can’t see the benefit in commercial terms of the additional complication. This is what I would call a cockeyed idea of what ‘investment’ means.

c. Management by Notices. “This is a Smoke-Free Zone!” proclaims the banner at the main entrance. Underneath it were various clutches of patients smoking fags. Another notice says this: “Every patient contact needs clean hands!” The hand-cleaning facilities at all entrances were invisible. Nobody took any notice of any of them. I just used the search engine on my site to reveal that I have blogged on this subject 11 times since the start of 2010. This is what I would call the senior management belief that notices solve problems, and it is a very Soviet syndrome: it has nothing to do with real management in the private sector sense of the term.

d. ‘All treatment free at the point of purchase’ was a fine principle in its time, but it was of its time. As I sat in X-Ray’s reception waiting room, I was shocked to read this notice: ‘Number of X-Ray patients who didn’t turn up for their appointments, January 2012: 185′. And that’s just one department. Six no-shows a day in one small area. Nye Bevan was a top bloke, but he didn’t foresee either credit cards….or a culture dominated by dickhead misbehaviour. Simple suggestion: make every no-shower without notice pay the market rate for their next appointment. The no-show rate will be 0% within months. This is what I would call a no-brainer.

e. Myself, my wife, and most of the folks in X-Ray were over 55. OK, a fair proportion were downmarket, but the majority were a long way from the soup-kitchen. My age group takes up an unfair slice of the medication/day-treatment budget in 2012, and as more of us survive thanks to braindead social nannying, that proportion will increase in the future. Simple suggestion: everyone with a private pension plan aged over 60 must now pay for their prescriptions. This is what I would call real fairness in action.

Mr Lansley has – in his disastrous ideas for the NHS – fallen between two stools: he has tried to appease the ‘Hands off our NHS’ Left, while at the same time slavishly trotting out potty Thatcherite drivel about everyone wanting to be the next Alan Sugar. Use The Slog’s search engine, and you will see that the prediction of failure and mayhem was first made here in June 2010…..and regularly threafter. All these expectations have been entirely fulfilled – to everyone’s cost.

Localism, mutualism, more money for hospitals, redirecting GPs to the plot, and banishing senior management’s self-indulgent bollocks: these should’ve been the Health Secretary’s guiding lights. Instead, Andrew Lansley’s narrow dilettante approach has spontaneously immolated to produce an approaching systemic breakdown in the UK’s public health provision. He should be fired, and replaced by somebody with a radical realist vision.

53 thoughts on “MEMO TO LANSLEY: WANNABE MANAGEMENT IS THE NHS PROBLEM.

  1. Spot on John. Three elective surgeries and one EA with Pleurisy in the past three years means I have had a lot of time to talk to nurses. Their one repeated complaint? Management. Too much of it. Ward managers (we used to call them Matrons) who turn up once a month, and spend the rest of the time in meetings. Management indeed, is the bane of public services, too much of it, and almost all shite.

  2. The Swiss method is the best – you must buy insurance, either way:
    1. Buy it with your own money.
    2. Prove to the government that you individually have not got
    the money and it will pay you the health insurance for that year.
    * if you cheat here, proceed to [3] below:
    3. Enjoy the State penitentiary’s Health services.

      • Matt said: “I can confirm that Swiss healthcare is indeed excellent and often available same-day within walking distance.”

        My question to British and Irish sloggers is this: If the Swiss can do it, being the same species with the same faults as us here in Ireland, or yourselves in Blighty, why the hell can’t it be copied successfully in our health services?

        Not sure if this applies to British Pols, but Irish politicians of all levels of power, from Councillor to Minister, have for years been jetting off on expensive junkets to all manner of places around the world to see “best practice” so as to improve delivery of public services. Our public services, especially health, are appalling. Worse I would reckon than Britain’s. How can it be so hard to see what works in another jurisdiction, and copy it? It baffles me.

    • Also in Switzerland the administration, not Management, is small, well computerized and very competant and the universal use of the Medischesausweis and Krankenversicherungsausweis eliminates 99% of delays and mistake.

      The Management is the Chefartz, and his small committee of medical abteilungsleiteren.

      No insurance/means immediate deportation for auslaender(in)

      MFG, omb

  3. Just an aside – what do you mean by “pension plan”?
    I’ve come to believe that the worst way to provide for retirement is by means of a personal pension plan – too many gambles, no guarantees whatever.
    So asking anyone with a pension plan to pay for prescriptions would bypass the more canny savers.
    Incidentally, with prescriptions now over £7 per item, I suspect that they’re a nice little earner for the NHS – not every pack of prescription pills can cost that much!

    • as to £7 (plus) you’ve forgoten the cost of the administration, KPI’s statistics and form printing, filling and filing involved

    • I do not understand why anyone who has paid into a system should unilaterally be deprived of what they were told they were paying for. That to my mind is called theft-whether done by the state or anyone else.
      The state got it wrong-well tough! If it cares to give back what was paid in then it can be absolved of its responsibilities to that person-until then, do what it promised.
      Oh, it can’t? Well it shouldn’t be taking any more tax from those people-at the very least.
      The state isn’t the answer, it’s the problem.

  4. As to point 5
    I’ve had reasonable amount of time in hospital waiting over the recent past and organisation especially in respect of process (an example funnily enough in terms of X rays) is lacking in that often you are not sent to X ray untill it’s time for you to be seen instead of when you join the queue .

    It also seems that a lot of these waiting areas have not really been thought out in respect of such things as “clinics” appointments

    As to point b
    Irrespective of the level of charges for parking at most hospitals just about all of the parking provision is now badly thought ought in terms of where it needs to be. Most especially recently in my case was to get close enough to an A&E building exit to collect somebody who had problems walking. There is a lot of provision for ambulances and excesses of yellow lines but little else

    I would suggest that new hospital buildings ought to have some parking provision integral to the building envelope going down underground so as to leave pedestrian entrance on foot at “ground level” available

    As to point d
    Would this not just add to the administration cost of the whole NHS process with no doubt countless appeals and legal costs

  5. Bureaucracy (managementitis as you put it) always ends up looking after itself, perpetuating the way things are done and increasingly becoming a means to itself rather than to any delivery goals. The same can be seen in many areas, not only in the public sector.

    The only answer is revolution on a regular basis. Looking at the NHS it should perhaps be every 25 years. Tear down the whole management edifice and start again with a minimalist agenda that will grow back into a monster over the years.

    These bureaucracies forget what they are for. The BBC for example is a huge accounts and diversity department that navel gazes its own structure and coincidentally makes and broadcasts some content.

    Trouble is that this same problem is there in the ministries and they should also be torn down every couple of generations.

    In terms of corporatism and monopoly, the same philosophy should apply to overlarge monsters. Compulsory de-mergers on a regular basis to keep them fresh and innovative.

  6. “Simple suggestion: everyone with a private pension plan aged over 60 must now pay for their prescriptions. ” That’s a bit bloody hard if your private pension is £2k pa and your prescriptions cost the NHS £20k pa. Or do you mean something else by “pay for their prescriptions”?

    • Dear Dearieme
      It wouldn’t be that hard to introduce a maximum pp exception. Mine, for example, delivers c. £20K pa. Not a lot considering what I paid in, but more than enough to pay for my own medication.
      We must learn to accept anomolies: if this was easy, there’d be no problem.

      • Ah but we’ve been “brainwashed” by countless Governments into thinking that evryone is equal and that there is nothing akin to “not winning”

        (NOTE can see end of tongue through hole in side of mouth)

  7. ‘All treatment free at the point of purchase’ was a fine principle in its time, but it was of its time. As I sat in X-Ray’s reception waiting room, I was shocked to read this notice: ‘Number of X-Ray patients who didn’t turn up for their appointments, January 2012: 185′

    People simply don’t value things they don’t directly pay for. That’s easy to fix, copy France and charge a variable co-payment and see that nonsense stop.

    Also they can’t say how much things cost. How about the NHS publishing a set of standard costs for each procedure and course of drugs, and relating that to the average person’s tax contribution? I know that would cause a few casualties through heart attacks (and Labour would hate it), but why don’t people know these things? Anyone demanding a procedure or drug costing more than they could ever contribute (assuming they contribute anything, which many don’t) would at least know they have a debt to society. Not for collection, but for information.

    If we had anyone with half a brain working in NHS IT, we could send an annual email to each NI number setting out how much it had paid in and how much paid out for NHS things, with a cumulative balance. What, we can just keep borrowing, and inflate away the problem later? No, that used to work for Brown the Awful but the rating agencies are finally getting wise to that trick. It will be horrendously expensive next time around.

    Something does indeed have to change, and not just your X-rays, JW. Radical thought will upset the Left, but most sensible people in the UK know that we can’t afford to keep throwing cash at the NHS with no discernible improvement because the providers are channelling it to themselves in all sorts of ways.

    A couple more points, though:

    – How can France afford to pay 50% more on health than we do, with a pretty acceptable result? What are we wasting our equivalent cash on?

    – You forgot to mention Pat Hewitt, Labour idiot extraordinary, who was instrumental in stuffing the GP’s with yet another pile of gold. We must claw back those huge increases, and get our GP’s down to the EU average excluding the UK. That will be hard, but not impossible over time.

    • Carys – ‘How can France afford to pay 50% more on health than we do, with a pretty acceptable result?’
      By creating a very large black hole. France has a very fine health service. But it’s a great shame that it can’t afford it.

    • Don’t forget that Government over it’s time hasn’t been able to get an NHS IT system spec let alone a proper working system

    • Carys
      I am generally in sympathy with your original comment.
      As to France and its health expenditiure…if we had a Germany to leech, we’d be OK on the social expenditure thing too.
      As to You can do it of You Hewitt, don’t get me started. A bigger idiot even than Tessa Jowell..and that is speaking volumes.

  8. Until I read that Lansley is planning to sack every person in the NHS with the tag facilitator in the job-title, I’ll believe he is not willing to do a real reform of the NHS. He is just doing some window dressing.

    Can anybody tell us what is the ratio between Administration staff and medical staff in the NHS? Note that I deliberately capitalised Administration staff to reflect their true opinions about the real pecking order as they see it!

    • JGM
      Forget stats in relation to the NHS: I learned the hard way years ago that they are all lies, because definitions are stretched to extremes.
      For example ‘medical patient-facing’ can mean anything from a Big Hair ‘witnessing a procedure’ to a highly-skilled world-famous brain surgeon.
      The NHS has become the realisation of Orwell’s nightmare.

  9. Managementitis – I first became aware of this is the Seventies. I knew a senior nurse who had taken time off to look after her mother but was keeping up with developments in her profession. She was overwhelmed with a huge pack of large, glossy manuals, ring binders etc -all to do with the new management system. It was not the language she would have used but it “did her head in”. “I’ve looked everywhere” she said “but I can’t find a mention of the patients”

    The trouble is that there is a convulsion like this after most changes of government. New Labour undid the “internal market” reforms of the Conservatives and then (more or less) reintroduced them in a different way plus gigantic, unachievable computer projects. Labour were the most enthusiastic users of the bastard Private Finance Initiative which gives the worst aspects of state control, complicated management, expensive finance and corrupt cronyism.
    Now the Conservatives are doing some more of that.

    It would be far more sensible to have an agreed, stable system (almost any system) which did not keep getting pulled up by the roots. The trouble, I think, goes back to the original nationalisation which dispossessed a myriad different institutions – municipal hospitals, charitable foundations etc and threw them all into one giant organisation. I believe that the equivalent continental institutions have a greater degree of self management within the health insurance scheme which is at arm’s length from politics and the contributions kept separate from general taxation.

    This would never suit Labour and their union friends. The NHS is perhaps their most potent “dog whistle” issue. It seems to work nearly every time. They really can persuade people that the wicked Tories will leave the poor sick to die in the streets. Of course, it’s mostly protecting the vested interest of their union comrades (and the contributions they make to party funds)

  10. In the Day Surgery department of Trafford General Hospital – formerly Park Hospital, Urmston, where the NHS was originally launched -is a fine looking clock which occupies pride of place on a wall of the patient reception area. Underneath is a highly polished brass plaque announcing that the clock was presented in recognition for the hospital’s valiant efforts bring waiting times for operations down to …..12 months. The last time I was there, a couple of weeks ago, patients were told to assemble on the floor above and just about as far as it was possible to get from the Day Surgery department – because there were no staff available to actually open it.

  11. When the NHS was created in 1949 the population of UK was a lot smaller than it is now, & they now treat far more types of illness than before. Also, I have read in the DM & the DT that we have what amounts to an ‘International health service’, in that any of the world’s sick can just jump on a plane, get to a hospital & get treatment right away without ever having contributed a penny towards it. Then again, there are the translation services needed for all those who do not speak our lingo.
    Another thing, a friend of mine lives in Waltham Forest & is diabetic. She was told she would have to wait a year for her usual check-up at Whipps Cross hospital. Her husband eventually got an explanation out of the hospital though their MP, & this was that though the ethnic white population of Waltham Forest with diabetes was just 3%, the ethnic asian population of the borough was 23%, & this was why she had to wait a year. So we have unknowingly imported into the country a whole load of people who have a tendency to develop this disease, or else no checks were carried out before they came.

  12. I was going to say before something went wrong, that with all these things, plus all those that have been previously mentioned, how can anybody expect the NHS to work?

  13. At the same hospital – where the NHS was born – when I complained about the thoroughly disgraceful treatment of an elderly relative, I was called before a meeting of so-called care managers armed to the teeth with clip-boards and pens.
    Purely in self-defense I produced an NUJ Press Card from my inside pocket and announced I didn’t wish to listen to any ‘bureaucratic bollocks.”
    I have never seen a gaggle of managers, ward sisters and retinue evacuate a room so quickly. Talk about fleet of foot!
    It left just one mild mannered doctor who said wistfully: “I wish you were managing this hospital.”
    Oh dont get me started on the NHS JW

    • Tip my hat, SITC, I really do :-)

      Many years ago I was hauled before a disciplinary hearing at London HQ where a couple of managers began listing my many faults. I let them stray into the personal, the derogatory and the amusing (to themselves, at least) before I coughed gently and withdrew a small voice recorder from my pocket. I took the microphone from behind my tie and asked if there was anything they would like to add before I disengaged it. All the colours of a starling’s wing were displayed about their gills as they drew the meeting to a sudden close.

      I still use the technique to this day when dealing with officialdom and bureaucracy, and I would recommend it to anyone. Have some fun at their expense.

  14. I agree with your identification of ‘management’ as the problem, but probably not quite in the way you mean it, John. The real killer is government enforcing bureaucracy, of which over-management is a consequence, the need to prove everyone from the head of nursing to the cleaners are doing their job. Although there is often a disconnect between boxes ticked and actual things done as they should be.

    I do not see any way out of this mess except to get government and the NHS establishment out of control, the same goes for education and everything else government tries to impose control over. Personally I would go the privatisation/insurance route, mutuality as the structure for the organisations might well be a good step.

  15. IMV, Lansley should be looking very closely at the NHS considering we throw more than £100bn at it for this financial year .A lot of it is wasted money because of the way the management system works or doesn’t as the case may be .

    I’ve had to use the Hospitals quite a bit in the last 6-7 years and I can say that I don’t feel that safe whilst in hospital, by that I mean if taken in there with a life threatening situation I’m not sure that I’ll come out through the front door or the back door overnight in a body bag .I have have only had the pleasure of using one Centre of Excellence in my many visits, the rest is an ordeal staffed by people who would have problems in getting a job outside in the real world

  16. Well, I don’t want to upset the general flow of comments, but my wife and I have had nothing but excellent service over the last ten years. GPs, minor hospital, general hospital. All good. Of course, we live in Cornwall where we are all very white. Except for some of the medical staff.

  17. John, there won’t be any meaningful improvements to the shambles that is the NHS while the Labour Party remain in existence. It was their baby and they will not allow change. They’ve succeeded in convincing the majority population since the days of Thatcher that it’s the envy of the world and must be preserved. It means that any change the Tories try to make has to be within what Labour will allow to avoid allegations of privatisation.

    • Though it would help if the Tories had some kind of policy to deal with negative comments. Given that Cameron and others were PR people, you would have thought that they would be better at presenting their case. Or, I suppose, not, given who we are dealing with. Am I alone in being as disappointed with DC in power as I was with his pathetic attempts at opposing Labour? Just not up to the job.

      • No you’re not alone. I am also disappointed at DC’s gingerly approach to reforming a lot of things. He’s wasting an opportunity of a generation. I put it down to him simply not being a reformer by nature and has little interest in reform. When he loses the next election (!) it will be Labour that implements yet more expensive, senseless and unworkable changes to the NHS. It doesn’t bear thinking about.

  18. In addition to JW’s offerings may I offer a couple of starters towards improvement of our NHS.
    1. Access to treatments be prioritised as follows:
    1 Avoidance of death,
    2 Life preserving
    3 Pain control
    4 Mobility preservation
    5 Absolute last.. Body image change i.e. breast augmentation, gastric banding etc.
    2. No-one to be given treatment associate with obesity until a BMI of less than 30 be achieved.
    3. Hospital accounts be made public.
    4. NHS contracts be made public.

    • Nobody except those deformed by accident, birth deformity or disease should be getting NHS treatment for appearance. We are far too poor to lavish sums on those who are merely fed up with how they look.

    • The trouble with that list is that things would be run so badly that treatment would only be available at stage 1.1 with a result of 100% death rate in hospital!

      • I haven’t had anything to do with the NHS (apart from the odd G P visit)
        until last month, when I had a heart attack. Now I have nothing but praise
        for the treatment I received.From the fast response of the paramedics
        to the hospital staff, no complaints at all. They do get it wrong sometimes
        and there is too much management .I just hope they reform it for the benefit of patients,not the management.

      • I think there could be a simple list drawn up for those that arrive at A&E – if it’s not an A&E issue, they shouldn’t be there .The A&E staff / Doctors should be able to prioritise cases .If it’s not an A&E issue, they are sent away and told to see their GP .

        The Problem area, what to do with Fri/Sat drunks who often get violent with the staff .Some do need medical treatment, you cannot leave them to bleed to death – maybe a financial charge applies

        Other non urgent cases follow the long established path ie they see their GP and if ncessary, an appointment is made for them to see someone at the Hospital at an agreed time/date .

    • Err, BMI is a load of old bollocks-most of our Olympic athletes would not comply. It is another bureaucratic measure which is useless.

      • and some rugby players are probably well over
        It is however the measure they use and ought to be consistent till various hospitals then put their own increased limits on the figure just to save doing the procedure

        There is a document called “shedding the pounds” that shows that allround benefit of increasing the number of procedures should be several million per year after the first 12 months

      • TJGM…No I don’t hate fatties, I just wonder whether they regret that their size prohibits them from enjoying what they really desire to do. As to your second question; marry a Dinky size woman.
        To those who think that BMI is not the right measure, what about WHR ( waist to hip ratio)? Having a number of friends and a member of the family who are doctors, they all agree that a large number of illnesses are as a result of, or, exacerbated by obesity, especially high blood pressure with its attendant circulatory problems.

  19. I fail to understand why the Coalition felt it necessary to embark on a Bill, with all the political risk that entailed, which has duly come to pass.

    The Secretary of State already had the power to implement the key reforms and should have started that on Day 1, rather than wasting time, effort and political capital working it through the vested interests of both Houses.

    Everyone agrees the NHS urgently needs reform, nothing Lansley could do would make it a worse proposition so, on that basis, he should have just got on with it. By 2015 there would be enough signs of improvement to validate it – but now, after farting about for two years, there will be no evidence until long after the next election. Political naivety.

  20. Despite the great advances in medical science, there is thankfully still no cure for the splenetic outburst..

    My old dad (87) was a GP with special interest (they’ve always existed) in cardiology, amongst other things, and worked in a local hospital one day a week; he started complaining about management interference, as I remember it, in the late 1960’s. Mind you, he complained even more about the unions but let’s not go there.

    It was anathema to him, and many like him, that people with no clinical experience or skills were making clinical decisions, or at least decisions which affected clinical outcomes. Undoubtedly, this is one of the major problems for the NHS and has been for some time. It is, like many other “organisations”, overmanaged and yet underorganised. This comes partly from the foolish notion that if you tell somebody else how to do their job you must automatically know more about it than they do. Unfortunately, the disappearance of many jobs now considered to be unnecessary, if not actually undesirable, coupled with a rising population have caused a disastrous stampede into so called “management” which is behaving, predictably, as others have outlined above.

    Another phenomenon which men and women of his generation who worked in the field of medecine find it difficult to believe is the extent to which basic infection control techniques which, without antibiotics were basic and essential, seem to be sometimes overlooked now.

    Of course, the problems of the NHS are multifactorial just as the suffering which it seeks to alleviate is, but too many chiefs and occasional poor hygiene have got a lot to answer for. Too much handwringing and not enough handwashing perhaps?

    That said, there are many like laurence who have experienced it when it’s got right. It’s going to take a major rethink – a revolution in consciousness – to sort this stuff out; some world changing events might be required.

    GOVERNMENT HEALTH WARNING HOLDING YOUR BREATH MAY CAUSE DROWSINESS AND SUFFOCATION

  21. Hieronimusb…Excellent synopsis. May I add also. Anyone remember the TV program when John Harvey Jones (ex CEO of ICI) or was it Geoffrey Robinson, visited a hospital to review why beds were not available. The extremely competent nursing staff were ‘shouted down’ by one highly paid, arrogant d**k of a consultant saying that they knew nothing. Perhaps these consultants try to stop believing they are managers and keep to their clinical expertise. As my wife and female in-law (50 years in NHS between them) have always said ” The NHS is run for the benefit of consultants!

  22. Ref. no-shows.

    You’re right in principle but a couple of comments:

    1. “They” book everyone in at the same time for the convenience of the producers; this doesn’t encourage people to behave – you just know that (a) you’ll be waiting ages and (b) there are loads of people there anyway so the medical staff won’t be twiddling their thumbs if you don’t appear.

    2. Have you ever tried to get through on the phone (or by any other method) to cancel or change an appointment? I hardly need point out that there are no online systems for anything of this sort.

  23. I Agree with the Saturday night drunks, maybe there should be a financial penalty imposed, plus a look at the video footage of what went on to back it up?
    he other thing that gets my goat, two things actually, one why should the NHS pick up the tab for RTA’s, why should it subsidise the Insurance Industry. and secondly, the number of people who are nod UK/EU citizens who get medical treatment and then do not pay? Emergency treatment yes, any other treatment, either proof of insurance and/or a letter from their Embassy agreeing to compensate the NHS.

  24. “why should the NHS pick up the tab for RTA’s”

    It doesn’t.

    If you receive hospital treatment as a result of an RTA, your insurer gets the bill.

  25. Dear John
    My wife and I were both Consultants in the NHS, we as well as two Consultant surgical colleague friends of ours have now taken up posts in Adelaide and Auckland.
    I could’t agree more with your post. We had good salaries and in my case a good private practise. We were not poor. However we were completely fed up with trying to provide a service that we felt our friends and parents would deserve. This wasn’t perfection but good. It was not possible.
    After years and oddly it did start around 1996 (I did vote for TB, the fool that I am) of working in a system that only cared for quantitive data, system “gamed” it’s data and was run by some of the most unimaginative and self serving careless individuals – we left.
    It is better here if you are middle class, the poor still wait so I can’t say much for the Australian health system.
    For me and my wife well I am sorry but now I work half the week and the rest is my own for the same salary.
    I did not want to leave the UK, my mother and brothers still live there and I hope when retirement dawns to return. Many UK doctors feel exactly the same. There are far too many managers who can apparently talk people out of cardiac, respiratory or renal failure etc -they don’t. They never meet patients you are but numbers, The whole system stinks and rather than continue to battle it we have left.

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