Coffee House

There will soon be a popular revolt over NHS standards

15 February 2013

3:03 PM

15 February 2013

3:03 PM

Can anyone think of a bigger scandal in any British public service than that revealed at Stafford Hospital? It is worse than Aberfan, or Bloody Sunday, or the King’s Cross fire, or Jimmy Savile, or even the abolition of grammar schools. Up to 1,200 people died unnecessarily, not because of one error, or a particular set of errors, but because of the way an entire hospital was run for several years.

There is plenty of evidence now emerging that comparable disasters have taken place at other hospitals, for similar reasons. Yet I searched last Saturday’s Guardian in vain for a single mention. Politicians are desperately closing the subject down. They have persuaded themselves that everyone loves the NHS, especially its nurses. In fact, hardly anyone who knows an old person going through the system is satisfied, and many are utterly disgusted. Soon there will be a popular revolt, and the politicians won’t know what to do.


But although old people are treated appallingly in the NHS, I cannot follow the argument made by the Health Secretary, Jeremy Hunt, when he speaks of ‘the scandal of people having to sell their homes to pay for long-term care’. Why is it a scandal? There is a good chance that one will need long-term care in old age. Buying a house is, among other things, a form of saving, and long-term care is worth saving for. If you need such care, you probably will not need a house any more. If you have a spouse living in that house, the rules excuse you from having to sell it. Selling may be sad, but it is not scandalous.

What is scandalous is that the encouragements for saving are so few, and so more old people are throwing themselves upon the mercy of the state, which will never be able to look after them properly.

This is an extract from Charles Moore’s Notes in this week’s Spectator. Click here to read the full column, and here to subscribe to the Spectator.

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  • EDMH

    Why the health service works for Patients in France

    It is of great sadness to me that political dogma manages to blank out any consideration that methods and experience from elsewhere could ever be applicable in the UK.

    This is particularly so in the NHS, where the dogma that the government has to be directly responsible from taxation for the supply of health care have been inbuilt for so long. This combined with “free at the point of use” is particularly damaging.

    What is even more amazing is the fact that so little in the NHS is actually free at the point of use, prescription charges, dental costs (if available on the NHS at all) and the endemic rationing, which itself translates into huge costs for the individual patient.

    So why are things so different here in France. These are a few simple

    The system is run on an insurance basis based on income supported by the state but with no direct participation by the state: the insurers are even competitive amongst themselves. The system has state protection for the low paid, the chronically ill, pensioners, children, etc. Top up insurance can be purchased out-with the system to cover the balance not paid for within the system.

    The insurance organisation reports on all transactions and produces an annual account for each of its clients showing the premiums paid and the amounts disbursed on behalf of the insured so it is abundantly clear the actual costs of health

    “Free at the point of use” in the UK is a fallacy and only encourages people to use UK medical services unnecessarily and to regard the access to such services as being as of right. The public perception of that “right” may even be one of the causes of violence towards hospital staff in the UK A+E departments.

    Here the modest fee €22 payable to the GP, most of which is normally reimbursed later, is a disincentive to time wasters and malingerers, even in this country of hypochondriacs. It is amazing how effective the cash flow consequences of having to pay the doctor his €22 fee, even though it can be claimed back later, is in making sure that patients really need to be there. Of course anyone with a noted chronic condition or socially disadvantaged will be reimbursed 100% and if he has a Carte Vitale the GP is credited automatically without money changing hands. The GP’s or
    consultants charged fees are his income and he like other health professionals
    are in overt competition with each other.

    Here the €22 / visit is the GP’s income so he will welcome patients and be attentive as he should, (in a competitive manner with his colleagues).

    The Pharmacist will provide over the counter advice and drugs for almost any common aliment. He will also provide prescription drugs (un-reimbursed) if needed at his discretion. Thus the load on the GP is much reduced.

    The local pharmacist also doubles as the hospital pharmacy for any outpatient day patient procedures such as and it is the patient’s responsibility to get the drugs prescribed before and take them to his appointment.

    All the providers in the system, the GPs, consultants, diagnostic labs, district nurses, etc. are independent organizations or self-employed private contractors within the system. They normally work at proscribed fee scales.

    The contractors in the system choose their mode of working from the point of view of their own businesses and lifestyle choices, within those fee scales. This results in the outcomes most of which would be remarkable in the UK except in the costly private sector:

    • The GP (General Practitioner) has no secretary and no appointment system. Turn up when you need and wait perhaps 15 minutes on a busy day.

    • GPs are not paid by a capitation fee based on patient numbers but only on their actual patient appointments, (a piece-work basis just like UK dentists
    remuneration). And only recently a system of affiliating patients to GP’s has been introduced, before that it was totally open to the choice of the patient on any particular occasion

    • The patient also has the choice of which consultant to see but the GP will always recommend the one he considers suitable. It is not necessary to get a referral via a GP to be able to see a consultant, just phone up and make an appointment.

    • The GP will also be happy to make home visits: the reimbursed charge is rather more.

    • The dentist has no dental nurse and runs the practice single-handed. A large proportion of his fees are reimbursed to the patient.

    • The busy cardiology practice with three consultants has just one administrative

    • The district nurse will turn up at on the doorstep to take a blood sample at 7.00 am in the morning for a fee of €6.35 (reimbursed).

    • The consultant dermatologist answers his own phone and makes his own appointmentswithout any need for administrative help.

    • As well as doing major surgery, the consultant orthopaedic surgeon does his own minorsplint work on the spot.

    • Etc. etc.

    Thus the administrative load created by centralised control and
    rationing of consultants and hospital appointments does not exist.

    As separate private contractors, all health professionals work as if “their time was their money”. This difference was emphasized on a Gerry Robertson programme when an NHS consultant clearly stated, that this was the difference was between his work in the NHS and his outside private practice. Most UK hospital consultants are already private contractors as well as being well-paid part-time government employees. The difference in France is that their Health service fees are regulated by the government and controlled by the insurers.

    There is a real emphasis on preventative medicine and prompt treatment is considered to be economically worthwhile. Thus certainly in my experience waiting lists just do not exist.

    There is an abundance of medically qualified people in the system and indeed there is a degree of competition between them. According to OECD figures, there are almost twice as many medically qualified professionals per head of population as in the UK health service

    The medics run the hospitals and other facilities not the government or the administrators. They see the benefit of having an absolute minimum of administrative overheads. Those that exist are mainly involved with the ensuing that the Insurance organisations are charged correctly. This also means that there are no artificial limits placed on maximizing the use of expensive capital equipment and the hospital installations.

    Also, crucially, as the government is not supplying the service, the state does not own the product of the service nor most importantly the patients’ medical records:

    • Patients have bought the service either directly at the proscribed rates or via their
    insurance and they are therefore the owners of the results.

    • Responsibility for the ownership of such records is reasonably unloaded on to the patient.

    • This eliminates another whole swathe of administrative costs. And as there is no
    government duty of care with regard to patient records, there is no need / apparent obligation / or demand to create an expensive nationwide database of everyone’s medical records.

    • I believe that it is only in very few chronic cases that longstanding records are essential for treatment.

    • Any minimal useful information (such as the fact that I am diabetic, allergies, blood type, etc.) is retained on the chip of my Carte Vitale. The Carte Vitale is a type of
    credit card with a chip, that is used to organise the data required for my insurer to pay the sums necessary to the whichever part of the health system I have used. The card can be updated automatically with any changed circumstances at a terminal at any pharmacy. This seems to be a truly efficient use of Information Technology as applied to the health service.

    • Along with a pragmatic hands-on approach to consultant referral and appointment making, the need for a failing £20 billion government organised Health IT project collating everyone’s medical records is eliminated at a stroke.

    And here a much simpler IT system works and it has been working for decades.

    I certainly I believe that health outcomes for a similar percentage expenditure of GDP (Gross Domestic Product) are much better here than in the UK. The NHS is certainly not the only way of organizing a health service and the clear evidence is just across the channel.

    The care about hospital infections is particularly impressive. This is because the staff all know that it would be quite possible for patient to chose to go elsewhere and therefore having an outbreak of MRSA etc. would disastrous for the business of the hospital and thus their livelihoods.

    The additional complexity of GPs (as opposed to care trusts) controlling and being limited by their budgets in what they can provide as drugs, treatments or referrals does not exist. The spending on care seems to be much more laisser faire. So those other tiers of administration are non-existent.

    So in effect everyone in France gets a Private Quality service provided at costs similar to the Nationalised service in the UK.

    The Nation’s Health not the National Health Service should be the priority of government.

    E M HOSKINS MA (Cantab) BDS (Lond) LDS RCS Eng

  • Robert Mason

    The state have robbed us for decades. The firms we work for are taxed first leaving less to pay us, then we pay tax on what we are paid. If we save a bit it is taxed by inflation and any interest is also taxed. From what is left, we pay fines, council tax and to park our cars in front of our house, or to go to the shops. There is precious little left to provide for our old age and then, the government having taken so much off us have so mismanaged public finances that they have amassed debts that will not be paid off for decades and 20% of government tax income goes on interest on those debts s there is noting left to pay for our care when old.

    It is not that I wanted the government to provide for my old age, it is just that they kept taking our money for such things and now we hand them the bill there is nothing left, If they just got out of 90% of what they do now and left it to the market, charities and bit of subsidy it would be done a lot better.

  • CharlietheChump

    Who has died due to the horse problem? Who has been injured? No-one. I am concerned what other little nasties have also been slipped into the food chain but to date public health has not been seriously affected.
    Yet the state “health” system has killed 1200 in just one location and there have been estimates that up to 6000 others may also have lost their lives due to basic lack of care.
    Which is the greater priority? ??

  • Smithersjones2013

    The political cover up that its being perpertrated in Westminster over the Mid Staffs NHS outrage is a disgrace. The whole of Westminster should hang its collective head in complete shame.

    What a disgusting bunch they must be who are vocal and animated over the hacking of their own phones but want to sweep the slaughter of hundreds under the carpet.

    PS As it goes the the horseburger scandal is pretty outrageous and should not be ignored particularly if there is major criminal acvtivity behind it but it should be playing second fiddle to the hunt for those responsible for the Mid Staffs slaughter. The fact that Cameron and Hunt are doing precious little and seem to be sweeping the issue under the carpet makes them as accountable after the fact as those who were responsible in the first place.


  • jose garcia

    you obviously dont have a family……selling the parental home after 40 years of taxes should be the exception, not the rule

  • Hexhamgeezer

    Whenever there is a party line on something it’s a sure sign that something funny is going on. In this case it is so-called ‘reverence’ for the NHS. It might better be called ‘relief’, as in one expects the worse but when you get something approaching OK treatment we feel pathetically grateful – or ‘reverence as the party line has it.

    Two parents-in-law and one of my own were dispatched quite efficiently by the NHS. ‘Reverence doesn’t quite fit the bill.

  • Tom Tom

    I am pleased to hear Nurses love the NHS because from experience I find Doctors do NOT. The gagging orders were introduced in the Thatcher years tro stop Doctors talking to the Media and the Gangsterism now present in NHS Management is worthy of the Abattoir Sector. The Culture of Deceit is endemic in british Public Life as Norman Tebbit alludes to in today’s Telegraph. The NHS is not unique in being yet another giant Corporation demanding Subservience and Obedience. Quite how we are going to dislodge this Apparatchik Class is unclear – Lord Rooker gets in at the FSA as Chairman – retirement home for Left-Wing Firebrand Labour MP and we have Sir David Nicholson “former” CPGB Member married to the Chief Executive of Birmingham Children’s Hospital and with a sidekick from his old stomping ground in Yorkshire who ran Bradford PCT before trashing inquiries into deaths in Lincolnshire probably using Nicholson’s playbook from Mid-Staffordshire.

    Will it take “the armed struggle” to remove these individuals or has the ballot box some residual purpose beyond finding work for Tory and Labour Placemen ?

    • Hepworth

      “the armed struggle” ? And how pray tell is that an option? Are you referring to sling shots or bow and arrows? We all know that real arms are only held by the military, police and our criminal ruling class, (mostly imported by the way).

      • Tom Tom

        You should review the situation at The Curragh and consider that the British Army has no record of blind loyalty to the Regime….John Churchill turned over the Army to William of Orange at Torbay; and you might read up on who wrote a letter to the Daily Telegraph in 1974 looking for “dynamic, invigorating, uplifting leadership … above party politics”to save the country….you are probably too young to remember events in 1968 either with Cecil King et al. There is simply no evidence to suggest that a British Army would sustain the current regime if it came to the test….

  • Haldane1

    Every time I read your columns the same question always comes to mind: Why, Oh why, aren’t you the editor of the Telegraph?

    They should never have let you go.

    • Tom Tom

      After a takeover the former Editor is hired as a “Consultant” or “Guest Contributor” for a while – it was the same at The Murdoch Times, the same at the Telegraph, the same routine to make the transition look smooth

    • 2trueblue

      Because the Telegraph has gone down hill.

  • huktra

    I think the current blog term is weasel.

    Well Weasel Hunt was doing his Head of House end of term speech on the World at One.

    He said that the Chairman of Lincoln had jolly well better tell him what was going on and if he found things to be irregular there would be consequences.

    Just when will he take charge.

    Cameron led on the Stafford Report and what did Hunt say–“Hospitals should face fewer inspections and assessments”
    People are dying for Christ’s sake.

  • In2minds

    The scandal list omitted the windfarm scam

  • Andy

    There ought to be some Police investigations, some arrests and a few trials. These killers in white coats and uniforms should be punished. And unless and until they are you can forget any improvement in care in the NHS.

    • Austin Barry

      In 1946, in ‘How the Poor Die’, George Orwell wrote:

      “During the past fifty years or so there has been a great change in the relationship between doctor and patient. If you look at almost any literature before the later part of the nineteenth century, you find that a hospital is popularly regarded as much the same thing as a prison, and an old-fashioned, dungeon-like prison at that. A hospital is a place of filth, torture and death, a sort of antechamber to the tomb. No one who was not more or less destitute would have thought of going into such a place for treatment. And especially in the early part of the last century, when medical science had grown bolder than before without being any more successful, the whole business of doctoring was looked on with horror and dread by ordinary people.”

      Orwell suggested that things had, by 1946, improved somewhat.

      The NHS is doing its best to prove him wrong.

      • Tom Tom

        It might have helped Orwell to consider that most hospitals in the 19th Century were Workhouse Infirmaries as are many of the major hospitals in the North today to name St James in Leeds as a prime example

  • Jebediah

    1200 dead. It’s the biggest scandal I’ve ever seen. Yet horsemeat, that has killed no one fills the headlines. Is the NHS really such a religion now?

    • David B

      Unfortunately yes it is

  • Archimedes

    Russia Today ran a headline “UK hospital scandal: no action taken”. We must look pretty ridiculous abroad, and not so well governed as we like to pretend.

    • Smithersjones2013

      Since when has anyone been pretending we are well governed? The last four Prime Ministers have all been appalling.

    • Gareth

      RT is hardly balanced in its reporting.

      • Archimedes

        I’m aware, the reason is struck me is because it was actually entirely true.

  • 2trueblue

    In 13yrs of ‘investment’ the infrastructure of the NHS was torn apart. Top heavy management who had no knowledge of caring at any level were pushed through the system at the expense of real care. Nurses were no longer trained in the basic elements of actually dealing physically with patients ,so it is not such a shock to discover that neglect became rampant. They had degrees and that was what mattered. After all going to university was what prepared you for anything in life, under Liebore. Add to that mantra that people are living longer and what a drain the elderly are on our society and now shock horror we have a result that gives you the results hidden by the past government.

    Why when people were being treated so appallingly, patients, friends, relatives, and often visitors, were complaining it still continued? That is the real scandal. Talk of hush money being paid to gag someone retiring blowing the gaff…… All this in our green and pleasant. It is not just enough to want heads to roll in the NHS, ministers who were leading the area at that time should be made responsible.

    Liebore and the BBC are having great fun with the mislabeling of meat at present, shame they were asleep all those years Liebore were in office and still fail to present us with any real journalistic skills in any area where lives were actually being lost through real blatant neglect. Nor have they investigated what Liebore did about labeling in their time.Our media need to get with it. Andrew Neil is the only [erson who seems to be able to ask any intelligent, probing questions.

    • HooksLaw

      I am not sure about ‘Top heavy management who had no knowledge of caring at any level were pushed through the system’. Management costs in the NHS compare favourably with other systems – its as well to criticise the NHS for what it is due. Its a question of people doing their job.

      The point about ‘nursing’ is well made. However even here we need to differentiate between nursing and nursing auxiliaries etc.

      • 2trueblue

        Management costs might well have gone up, that has nothing to do with the quality of caring….as we know. On the issue of nursing. There used to be Sisters, Staff nurses, SRNs, SENs, and nurses in training for their SRN and SEN. A ward of 26 patients might have 2 qualified staff and 2 nurses in training on duty on a good day, and all would be well cared for.
        The wards were well run and it would be unusual to see a bunch of 3 or 4 nurses chatting amongst themselves whilst patients bells rang unanswered.

        Today managers are unable to run wards with more personnel on the floor than it used to require and the actual quality of patient care is far lower.

        • Andy

          It all boils down to the callous indifference of staff, be they doctors or nurses. With the latter there is a huge problem caused by the desire of the RCN to mak ethem into semi-doctors. About 2 years ago a distant relation was in hospital (she was a properly trained nurse) and she was dismayed that a nurse didn’t know how to do an injection properly. Like so much else the NHS badly needs radical reform, but it wont get it.

          • 2trueblue

            Beautifully put.

  • realfish

    Move along Charles, it’s the horse meat scandal this week. Horse meat scandal? Or is it horse meat hysteria? Or is it horse meat hypocrisy?

    Day after day, Mary Creagh has been battering down the doors of the BBC (she probably has a staff pass, actually) or been asking for debates in the House, where she has managed to set new benchmarks for ministerial accountability. The Environment Minister, according to Creagh, is apparently responsible for everything we put in our mouths.

    Using Creagh’s benchmark of what ministers should carry the can for, Andy Burnham and his predecessors have some very serious questions to answer over Stafford. Perhaps that’s the reason Burnham is in hiding…or why Creagh is making such a disproportionate noise over Dobbin burgers.

  • Chris lancashire

    Whilst all you say is true this will NOT provoke a revolt. The NHS is the sacred cow – to be revered, worshipped and held up as an example to foreigners. The fact that it fails in many basic duties,sometimes treats its patients with disdain and is horribly inefficient is never discussed. Those of us who can, go private, those of us who can’t join the hordes who show pathetic gratitude for the awful treatment meted out in too many areas.
    There is no chance of reform other than by stealth – look at the outcry from staff and many patients anytime those terrible words “private sector” and “competition” are mentioned.

  • HooksLaw

    this was the NHS under labour, meeting labours politically motivated targets. The NHS is just a tool for labour. They regularly lie by saying they invented it.

    But ‘encouragements for saving’? What this means is taxpayers subsidising savers. Now this might be good if it saves the taxpayer money later and there is a subsidy already for saving for a pension. But there are limits. And where right now does the money come from?

    But it is us, individuals who need to save rather than spend and if we all saved more and spent less and thus the economy grew less then Mr Moore would be blaming the government for low growth.

    We have had 13 years under labour of mass borrowing of taking money out of house equity to keep spending now not saving later. As a result our economy is hopelessly misbalanced and reliant on spending and is awash in a sea of debt that needs repaying.

    • David B

      The line “you can only trust Labour on the NHS” is shown to be a hollow joke