Once more its election time and the warring factions of the LibLabConScotsNazi Party are all trying to claim NHS success in the hope that the voters will not see real NHS. The fundamental question is: Is the NHS Myth, Monster, Football?
Sadly, the answer is yes – to all three.
It is not a mystery why the NHS is in perpetual crisis, but how it manages to function at all and how the staff manage to work under the conditions that face them daily.
1. The Myth
The NHS is presented as a ‘world-class’ service and an internationally heralded triumph, far superior to any other system. It is also claimed to offer health care, free at the point of need. The reality is very different.
A very large part of the UK Government tax revenues goes to the NHS so tax payers are footing a large part of the bill. Dishonest politicians claim that this doesn’t count because the money is taken up front from every taxpayer. The perpetual lack of facilities results in very long waiting lists and this means that a great many patients are forced to pay for private treatment. The politicians claim that these people are rich gits who should be taxed more harshly. The reality is that many private patients can ill-afford to rely on the NHS. The choice is find the money or go blind, or die, or end up with no teeth.
The charge for prescriptions also affects many who can ill-afford to pay for essential prescribed medication and, in many cases, could obtain a private prescription for the same medication at a lower price. That is just a few of the basic extra charges for what is supposed to be a free at the point of use service.
Then there are a range of extortionate charges for parking, the use of phones inside the hospital and the cost of refreshments. That does not just affect people who are forced to travel long distances to find a hospital, but it affects friends and family who have to deliver and collect patients and/or to visit patients detained in hospital. It often means that patients do not receive visitors, adding to their distress and sense of isolation. As the number of hospitals continues to be reduced, it means more and more patients have to travel long distances which is a further extra cost to receiving treatment.
It is not all one sided. NHS incompetence and bureaucracy introduces delays and high NHS costs. For example, the NHS provides retina scans for at risk patients and estimates the per patient cost at £180 per patient per scan. Patients have to wait for a scan date and in rural areas that can mean that they have to make a round trip of up to 40 miles. As the NHS routinely uses eye drops, that means the patient is not fit to drive for at least 2 hours after the scan, requiring either a taxi, or delivery and collection by a friend or relative, or a two hour wait in the car park. The same scan can be performed, usually without eye drops, by suitably qualified opticians using similar, and usually more modern, equipment for £12.50 per scan per patient. The patient is again having to pay for a service theoretically available for free from the NHS and, presumably, the optician is recovering all costs and making a modest profit. That example applies to a very wide range of relatively simple and commonly required health care. A similar example is cataract operations which are now routine and offered in Africa very promptly on special trains, in some cases assisted financially by British taxpayers through the foreign aid budget – one of the few really worthwhile uses of the bloated aid budget. The majority of NHS Trusts currently are very reluctant to treat both eyes and usually wait for the patient to go blind before trying to operate on one eye at a remote facility that the patient has to travel to, at the patients cost.
There are also many other Myths about the NHS that are promoted by politicians and fake news channels like the BBC.
2. The Monster
The NHS is certainly a monster in numerical terms.
Only the Indian Railways and the Chinese Army employ more people. The NHS is a huge nationalised industry and lumbers along like any other out-sized giant. However it is also a monster in other darker ways.
The NHS is allowed and encouraged by politicians to get away with murder. The discredited ‘Liverpool Pathway’ was supposed to have been stopped after public outcry. Disgracefully it is allowed to continue and kills more people each year than any serial killer. Sentencing any individual to death by denial of food and water is an outrage but, in a number of cases, the usual excuse that the patient is dying does not apply because the medical staff have misdiagnosed patients who are perfectly capable of making a recovery, providing that food and water are not denied.
The NHS now routinely ‘buys off’ patients and bereaved by agreeing huge out of court settlements for negligent treatment and the consequences of that treatment. This now accounts for a very large part of the funding the NHS receives.
3. The Football
The NHS is a football for politicians. This is most obvious at election time as each faction of the Establishment tries to con voters into believing that it and it alone is the guardian of a magnificent NHS that would be destroyed instantly by the competing factions.
That is just the highlight, but the process is continuous. Each faction of the Establishment has, when in power, forced re-organization after re-organization on the NHS. Each time it consumes more of the funding and frequently results in a reduced service. In opposition, the factions scream about the claimed defects in the ruling faction’s policy and this can lead to the abandonment of a part-completed re-organization, usually resulting in all of the cost for negative benefit.
Where do we go from here?
That is a very interesting question. There is the story of the flash young toff in a sports car who asks directions from a yokel. After long deliberation, the yokel answers that he would not have started from here. Sadly, politicians usually give this answer when asked what they would do in power.
A positive answer is more difficult because some fire brigade actions have to be taken just to avoid the NHS falling apart quickly and completely. It is only a case of putting a sticking plaster on a limb that should amputated, but there may not be any credible alternatives in the very short term.
Certainly, the situation could be immediately improved by requiring anyone, who has not paid in to the NHS in taxation, coming from outside the country, to hold medical insurance. It is after all a National Health Service and not an International Health Service. There will always be a few cases where exceptions have to be made, but they will be a tiny percentage of the cost currently expended on foreign patients, some of whom come from countries that accept they will pay from their own health funds for their citizens abroad.
There are a great many savings that could be made by reducing the number of over-paid bureaucrats in joke jobs in the NHS and a complete overhaul of how funds are expended, particularly in procurements where billions of pounds are cheerfully wasted.
Then there are the long term solutions which will take time, need to be implemented carefully and require some honest debate.
We need to decide what the NHS has to provide and the real answer may be to de-nationalise the NHS, set up an ombudsman with power to investigate costs and services provided by the independent services and make sure that the taxpayer gets real value for money. Payment by patients is then a completely separate issue which is relatively easy to address. The Government may have to set up a real national insurance scheme that is revised regularly to ensure it works, and where everyone has to contribute during their working lives, with the Government using general taxation to plug any short term gaps. It really is not rocket science and it should provide a better service at a lower proportional cost.