The NHS

[A slight divergence of theme]

As an election looms in the United Kingdom of Great Britain, the National Health Service has become the usual political football. All political parties now claim to love it and want to hug it, and squeeze it, and spend eye watering sum of money on it. Because, for the next three weeks or so, they truly ‘care’. Sincerity, once you can fake that, you’ve got it made.

A UK politician, Nigel Lawson, once called the NHS “the nearest thing the English have to a religion”. This, of course, rather pissed off the Scots, Welsh and Northern Irish. Forgetting that England is not the only country in the United Kingdom is something English politicians just, unconsciously, do. They now wonder wonder why the Scots are all going to vote for the Scottish National Party in a few weeks time. ‘But how could anyone possibly dislike us?’ Oh well.

But what is the NHS? It is, to state the bleeding obvious, a National Health Service. It is paid for out of taxes which are gathered with the usual threats of punishment and fines. The Government then hands it out, well over a hundred billion pounds (~$150Bn), through a mind-bogglingly complicated bureaucratic system, losing vast chunks as it goes.

What pitiful sum finally remains is spent on the healthcare of the people of the United Kingdom (including Scotland, Northern Ireland and Wales). Although Scotland would claim it now has its own NHS, sort of. As would Wales, and Northern Ireland, sort of.

Whatever country you are in, the key underlying principle of the NHS is that it is free at the point of use. If you turn up at a GP, or accident and emergency, or hospital, whatever is wrong with you, you are charged, not a penny. Yes, it is free.

Actually this is not quite true. Dentistry used to be part of the NHS, but most people now pay for dentistry. Many people also pay for prescriptions, and it is eye-watering expensive to get a decent hearing aid. Also you cannot get medical equipment for free, e.g. a nebuliser. So the NHS is mainly free, but this concept is being sneakily eroded.

I know that many Americans believe the NHS to be some terrible ‘communist’ system where you queue forever, cannot get expensive treatments, and people wither and death in dimly lit hospital corridors whilst uncaring staff blow their noses on your sheets and cackle as they stride past in their jackboots. The NHS, at least as reported over here, seems to be held up as the poster child of an ‘evil’ system by those on the right wing of American politics.

I would just like to point out that it costs less than a half (as a percentage of GDP) of American healthcare. Yet, almost all measurable outcomes for health in the UK are better than in the US. Looking at the single most important outcome, which is overall life expectancy; people in the UK live longer than in the US. As do, it should be added, the French, Germans, Italians, Danish, Swedish, Spanish… Indeed, in virtually every way you choose to measure it, US healthcare comes last of all developed countries in the Western World. Just saying. So, the NHS may not be perfect, but please, please, let us not drift into US style healthcare provision.

However, having said all this, I still have a huge problem with the NHS. In that, it is no longer a ‘free at the point of access healthcare delivery system paid for out of taxes’. It has become ‘The NHS.’ Sounds of trumpets and a celestial choir. A kindly bearded figure sits on a throne in the clouds, beaming, surrounded by angels. Hallelujah, hallelujah.

Many years ago, the one thing that Margaret Thatcher said which, more than anything else, marked her out as an evil witch (in the eyes of many) was when she said that ‘there is no such thing as society.’ This is all that most people remember her saying, and they still hate her for it.

It marked her out as an uncaring monster, which is why they song ‘The witch is dead’, from the Wizard of Oz, got to number on in the UK charts shortly after she died. Not, perhaps, the UK’s finest hour.

In fact, the full quote was as follows:

“I think we’ve been through a period where too many people have been given to understand that if they have a problem, it’s the government’s job to cope with it. ‘I have a problem, I’ll get a grant.’ ‘I’m homeless, the government must house me.’ They’re casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There’s no such thing as entitlement, unless someone has first met an obligation.” http://briandeer.com/social/thatcher-society.htm

As for me, I don’t really believe that there is such a thing as ‘society’ either. But not, perhaps for exactly the same reason as Margaret Thatcher. My problem is when an abstract concept becomes a real thing which is a form of ‘magical thinking.’

For example, on the left we have those who believe in ‘society’ and ‘the NHS’. On the right we have those who believe in ‘the Market.’ As in, the market won’t like this, or the market won’t like that. When the EU tries to bail out Greece, we are told that the Markets will stop this from happening. This idea, I believe, derives mainly from Adam Smith’s ‘The invisible hand of the market.’

I say. ‘Can you please introduce me to the ‘the Market’. Could I have a word with the market to understand what it thinks?’ Oops, silly me. There is no ‘market’. There are just individual bankers and financial workers and economists. These, in turn, are just individual men and women, with a high percentage of psychopaths sprinkled in.

You see, Market does not exist, it purely an abstract concept. Yet we talk about it as if it were almost a person, an entity with powers beyond mere mortal man. God like, in fact. The ‘invisible and all-powerful hand.’ Kind of like the vision of Emmet in the Lego Movie when he saw ‘The hand’.

When Nigel Lawson called the NHS the nearest thing the English have to a religion, he was right. In that many people have also raised ‘the NHS’ to a status of an entity. A super-corporeal being, infused with special powers and goodness beyond our understanding. An ‘invisible’ hand that works in mysterious ways to improve the health of the nation.

However, until we can stop thinking of the NHS as some sort of deity, and start thinking about the most equitable way to fund and provide healthcare in a rational way, all discussions about healthcare will become bogged down in cant and emotion. People will continue to wave banners about emblazoned with ‘Save the NHS.’ Politicians will gaze at television cameras with that special, coached, excruciating limpid expression on their face talking about how much they care about ‘the NHS.’ Bleurrgghh!

Guys, there is no such thing as ‘the NHS.’ There are paramedics and porters and lab technicians and nurses and managers and doctors and some buildings and equipment. What is the best way to use these resources to provide the biggest bang for your bucks? End of.

Sorry, I shall start slagging off statins again next week.

103 thoughts on “The NHS

  1. Tom Welsh

    Very good post, Dr Kendrick. Although I think Mrs Thatcher meant exactly what you explained! Of course, there is such an idea as “society” – it just isn’t real in the sense that it can’t do anything the way we people can. (Technically, treating abstractions as if they were real things is called “reification” which translates to “thingification” – a word that should be used a lot, just because it’s so fine). I’m thinking of writing a book about exactly the problem you described – the habit of treating abstractions as if they were real, solid things; it causes untold trouble in all sorts of ways. May I quote what you wrote here (with the usual acknowledgement, of course)?
    Incidentally, I have come across the interesting statement (from a professional psychologist) that it’s less intelligent and educated people who tend to over-rely on abstractions. Whereas it takes someone more intelligent and better educated (like you and me) to say, “Wait a minute, that doesn’t actually make sense. What do we really mean here?”

    Reply
  2. Helen

    Oh dear, I nearly PML’ed myself over your paragraph about the typical US view of the NHS. That is how I often see it reported in American media. Thanks for the laugh.

    Now, you’ve sometimes pointed out, on your blog or in your books, that your political sympathies lie to the right of centre. Well, mine are on the left. I think it is not a contradiction to have strong belief in an individual’s right to self-determination in matters medical, while still cleaving to the ideal of a public service that is paid for from general taxation. It is sometimes said (can’t remember who was first) that taxation is one’s subscription to a civilised society. As I think you are saying here, some kind of public health system that is affordable and accessible to all members of a society, means that society benefits from a longer-living and, hopefully, happier and more productive population. I’m using the word ‘society’ here in a collective, plural, non-Communist, non-abstract way to refer to all of us individuals living in the UK.

    If you can’t stomach ‘society’ in the abstract sense (and I couldn’t stomach Thatcher in any sense at all), how about the phrase ‘public service’? The term, and the people who work in public services, are nowadays derided by those on the right. I am a member of a public service, though non-NHS, household. I can no longer work because for the public at large because of chronic ill-health, but my husband still works within a publicly-funded system, doing a job he believes is worthwhile. He hopes, still, to make the world a better place by doing so. It is the similar emotional attachment to such services that politicians exploit in the run-up to a General Election, as you point out. But do you have an objection to public systems per se, whether well-organised or not?

    Reply
    1. Dr. Malcolm Kendrick Post author

      Not at all. I think medicine should be a public system, and those that work in it should feel a sense that they are doing a good thing and are energized by that to enjoy what they do, and do a better job.

      Reply
    2. Flyinthesky

      It would be interesting to know in which areas you and your husband bring your expertise into play. And, how much we, the public who are being “served” agree with you.
      As a personal observation the farther you move to the left the more dictatorial the edicts become.
      My interactions with public services seem to be based on authority rather than service and their remit expands daily, “we know best” but do you?

      Reply
      1. eddie watts

        i used to work for the Inland Revenue, 2000-2006, my wife works for DWP, 2002 (maybe)to present.
        mine was a mostly back of office data entry but with specific industry knowledge meaning someone would not be able to walk in and do the job.
        I did some face to face work too, which I always enjoyed.

        my wife worked in claims work: signing people on, providing advice on how to find new work, help with CV’s etc.
        she enjoyed that role as she was helping people get back into work, mostly worked with longer term unemployed so over 6 months with no job.
        she now works in benefit fraud, which she enjoys for similar reasons. important to note that benefit fraud is actually very rare and a lot of these are genuine cases but when things improve people don’t report it and then get caught later on.

        I have worked in tax accountancy and now debt recovery for nigh on 6 years.

        from these experiences I can say there are those that you allude to who “know best” but in fact actually providing help to people is hard work and you will quickly get a feel for those who are genuine when compared to those who are not.
        sometimes these feelings can be wrong: when someone is out of work for a very long time they lose confidence and feel useless, it is hard to know whether they are trying to avoid work or are just so crushed by their situation and length of that situation that they come across as someone seeking to avoid work.

        as an aside I exercise and study nutrition as a hobby, hence being here after reading M Kendrick’s excellent book, and I find the same thing there too.
        people with terrible health who ask for help, which I provide, then ignore it and ask again 6/12 months later for the next 5 years.
        all while ignoring the advice given.

        any further queries?

  3. Helen

    I can’t believe I typed the words ‘pubic service’ in my comment above… of course, I meant public service!

    Reply
    1. Richard Gibbs

      Helen, I remember Bernard Cribbins doing that in a movie more than 50 years ago when his character was a stone mason carving a monument.

      Reply
  4. Jean Humphreys

    Until the Whitehall and Westminster contingent are able to make a diagnosis and administer a treatment, they should accept that Government’s role is to write the cheques. They have not been trained in the business of waving magic wands, and are so prone to doing the lovely gesture that brings unintended consequences – TB’s “you must all have same-day appointments” comes to mind. Overnight, my neighbour, who had several problems, became unable to see the doctor at all, since she had to put arrangements to get there in place well before the day.
    Now the politicians are all wanting our love, these same all earnest good wishes are coming out again – same day appts for over 75’s: a designated midwife for every mother – I’m sure I heard that one years ago – why can they not acept that the NHS workers are nearly all dedicated, and doing their best. They too would love to be able to provide all these good things, so the power seekers would be better employed enquiring as to what is needed to make the system work better – and the answer is very unlikely to be money.

    Reply
      1. eddie watts

        I share your stuff on FB so no fear there.
        sadly a lot of people who could benefit from some articles would not read something hosted on a different website, whereas if the exact same thing was copied and pasted into a FB status they would read it.

        people are weird!

      2. maryl@2015

        Your most recent interview about your new book, is, in fact, on Facebook. I hope they can learn from it all those who don’t realize what is happening to Western Medicine in general.

    1. David Bailey

      Paula,

      Why not copy the address (URL) of this site and paste it into some text in Facebook? Like Malcolm, I have never really seen the point in Facebook!

      Reply
  5. Professor Göran Sjöberg

    Thank you for the food for my thoughts!

    As in UK I agree that the NHS also in Sweden is of a religious character. You are as a well behaving citizen supposed to ‘believe’ in this NHS-religion. Myself, though, I have lost my earlier belief that these systems are set up for the care of us but rather and foremost for the care of of a huge industry. “…while uncaring staff…” is just a part of an ‘uncaring system’.

    But the most frightening thing for me is what I have now arrived at after having ‘scrutinised’ different medical disciplines; heart disease, diabetes, mental illness and just when I am trying to understand what relates to cancer; I just find religion not only in the general attitudes (basically with no interest in the causes – an interest which is synonymous with science to me) but also in the actual and specific medical treatments applied. By-pass operations for the ‘clogged’, sugar and insulin for the diabetics, pharmacy for the mentally ill and chemotherapy plus radiation for the cancer patients are ‘golden standards’ which I no longer ‘believe’ in although I am supposed to believe in these treatments as the good citizen.

    As an example having now read Professor Seyfrieds great book “Cancer as a Metabolic Disease’ I am pretty convinced that cancer cells ‘love sugar’. From a scientific point of view (if I should believe in what Seyfried tells me) it does not seem to be a very smart idea to treat cancer patient with sugar. With that in mind it was a quite depressing experience to visit a close friend, a couple of days ago, at the hospital after a very comprehensive cancer surgery operation and to find only sweet drinks at his bed table and as a part of the present ‘golden standard’ in the care of seriously ill cancer patients.

    Reply
    1. David Bailey

      I am glad you have managed to return to the subject of the matabolic theory of cancer, because I would like to recommend Travis Christofferson’s book on this subject.

      When I started it, it seemed to be too soft and people-oriented for my taste, but a little further in, it tells the story in plenty of detail.

      One thing about this story really puzzles me. I always understood that, regardless of its ultimate cause, researchers were constantly on the lookout for features that distinguish cancer cells from normal ones. How did they miss the fact that these cells metabolise glucose to lactic acid, even when there is plenty of oxygen about!

      Reply
      1. Helen

        Peter Attia has written on his blog about the possible metabolic advantage of a ketogenic diet in cancer treatment – very interesting.

      2. Professor Göran Sjöberg

        David,

        As you I tend to get more interested in ‘serious’ ‘thick treaties’ and the more referenced the book the better. Seyfrieds book is of this kind. Christofferson’s book sounds interesting not least as it is opposing Seyfried’s hypothesis if I don’t misremember and as such calms down on overoptimistic attitudes on carb-restriction as a cure for cancer but suggest high carb alternative diets. Was it not a vegan type of diet – and why not – it might work?

        Today I am almost allergic to any categoric claim concerning medicine. Be open-minded, listen to the arguments from all sides, go deep, judge for yourself and then keep clear of any dogmatism!

        (Just now I am deep with my nose in a brand new book on GMO food in the ‘science’ of which I was as strong a believer a few years ago as I was in medicine twenty years ago. “Altered Genes, Twisted Truth” by Steven M. Druker. My lesson learned so far is here as with medicine a cautious one and as such to keep away as far as possible from this kind of GMO-foods – there seems to be a WHO-confirmed cancer connection here through the pesticides involved – as of course to keep away from BigPharma ‘bestsellers’.)

    2. rockingbass

      Have you read My Life Without Bread -Dr Lutz at 90 by Valerie Bracken where he looks back at 45 years working as a clinician with patients?. fascinating
      Mark

      Reply
      1. Professor Göran Sjöberg

        rockingbass,

        No – I have to look that up. The name Dr Lutz ‘rings’ to me but I could not on top of my head place it. There is another one on the same theme “Grain Brain” by David Perlmutter which you might be aware of.

        As a strikt adherent to LCHF bread is a ‘no-no!’ in my family. It is here not just the carbs but the problematic gluten issue as well.

        I am just sick of the religious abuse of science in the hands of BigPharma and all the frowning on the clinical practice from the same entity as well as on the ridiculing of all us anecdotes.

        If one person with established diabetes (as my wife) quits all carbs and get rid of a host of serious health problems carried for many years, and now without any medication, that person is for sure an ‘anecdote’ in the religious medicine perspective but definitely, at the same time, what that person has experienced constitutes a scientific fact as far as I have been able to understand the word science in the terms of cause and effect. If there is a number of similar cases in the clinical experience the science involved tend to grow stronger. And there is a grim logic in avoiding things that make you sick as sugar for a diabetic.

  6. Flyinthesky

    The whole aim of practical politics is to keep the populace alarmed
    (and hence clamorous to be led to safety)
    by menacing it with an endless series of hobgoblins, all of them imaginary.
    H. L. Mencken.

    The hobgoblins have to be imaginary so that
    “they” can offer their solutions, not THE solutions.
    And we fall for it every time! don’t we!

    Now if we substitute the word politics for the acronym NHS we can see the similarity.
    It isn’t a perfect analogy by any means as some of the hobgoblins are real, though not as many as people are coerced into accepting.
    The NHS is in the fortunate position, as the clergy hundreds of years ago, of being able to cite the prime emotive: believe in us, with your wallets and deference to our perspectives or die.

    Consider the statement “And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves ” Where does that lead governments? you are not looking after yourself as we deem you should do so we’re going to make looking after yourself compulsory, why would they do that, principally because they can and we let them. They are coerced by financial interests that it is in their economic interest to treat the populace as a herd and the accrued benefit will exceed the cost.

    I near spit blood and feathers every time I see the emotive on any social media: Save our NHS, most of the front lines of any demonstration are made up of it’s staff.

    The reality that no one dare to address is the NHS has created a fear inspired need, expanding, that it will never be able to service. How long is it going to be before you “have” to attend the GP surgery or health clinic for your annual screening and proscribed vaccinations, it will come.

    Reply
      1. Pat

        I would be very grateful if you will elaborate on when we are all likely to be forced to attend GP surgeries for annual screening and to receive a list of drugs which the system decides we must take.

    1. Flyinthesky

      Pat, I don’t think the government could get away with it in the foreseeable future on a direct legislation basis but they have options, for example, retaining your driving licence, access to certain benefits and ably assisted by insurance companies making annual screening for life policies compulsory.
      Governments would love to have us all data logged and categorised. Covertly they do a good job as it is.

      Reply
  7. Christopher Lansdown

    Dr. Kendrick,

    Your main point is of course quite correct, but there’s one point I would like to address when you talk about comparing the American and European medical systems. I would like to see how well European systems would do if they treated exclusively Americans.

    I have very little experience of the world, but what experience I do have has convinced me that American virtues and especially American vices are not well understood outside of America. They’re not well understood inside of America either, but we at least have something of an intuitive grasp of them, since we live with them. Relevant here, we combine a tremendous amount of energy with very little trust of anyone but our friends. Constantly on the move, we are a nation of strangers. When no one has a past, there is nothing to base trust on, and so we don’t tend to do it. We trust in a casual sense, of course. When you hand over the money to buy something, you don’t film it in case the cashier will then lie about it and demand more money, because people don’t do those things. But when a dispute arises, no one is trusted by anyone, which is why we sue each other so often. Our litigious habits are not an anomaly, but come straight out of the nature of our society, and anything in America, if it is to work at all, must take this into account. That and the tremendous energy we will put into whatever it is we’re doing. It should always be born in mind that it is not easy to sue somebody, which makes how often Americans do it all the more remarkable. All of which is why I say that I would like to see European medical systems function with all Americans in it. Our system is quite broken, but I suspect that Americans would break a European medical system far more than we’re able to break our own make-shift system which evolved to be resistant to the vices we practice so regularly.

    And if you think that the European model might survive American patients, imagine it staffed with Americans too, especially the sort of Americans who will seek out the jobs from which it is difficult to be fired (that is, about 99% of government jobs).

    Reply
      1. Gary

        Thanks! You’re right, the health of folks on this side of the pond is growing more atrocious by the day, and because of a few dozen measles cases (which everybody in my day got), here in California, and many other states, the politicians on the left are trying to forcibly vaccinate everyone from cradle to grave, which will certainly make things worse. The drug lords are pleased. Along with the nutrient-free, starvation diet promoted by Washington and fed to school children, were going to hell fast. We need the people of 1885 Leicester to come to our rescue. Alas, they’re all six feet under. Keep it up; always a pleasure to read your cogent offerings.

    1. somercet

      Lest we forget: in almost all of America, you can sue and sue until you bankrupt your defendent, whether plaintiff or hospital. Britain has “losers pay” as a tort policy, which prevents this, but most of America does not. And the trial lawyers associations, which contribute almost exclusively to Democrats, do not want to see that change.

      Texas, the fastest growing state in the Union for over a decade now, changed their tort rules and they are routinely vilifiedfor that action.

      Again, these are the people (Democrats) you want to implement your brave new world.

      Reply
  8. Hans

    As someone with ancestry from and through the “Brit”-ish Isles of only English blood (despite my best genealogical searching so far…) I am often amazed (as an outside observer) that by now the Scots haven’t hacked off their part of the landmass severing it somewhere down by the ancient Wall and set sail for something better – to do so at least if only to have full *control* of the navigating toward that something better.

    Of course that’s impossible ….and I realize it’s not all that simple and that many considerations weigh upon the individual Scottish voter when the question of “to be or not” their own nation comes up here and again.

    It’s just… oh well. I was looking forward to a blue/white X flag to be added to the field of independent nations. Might inspire the English then to take a hard look inside and spur themselves toward something better, more efficient, more vital, a living reason for being. Not just to “remain”.

    “to fund and provide healthcare in a rational way”. Sooner shall I expect to see the Scottish landmass -itself- at full sail over the bounding main than to see a working sustainable system inaugurated anywhere in the world by humans. Other than just the being here, and fighting wars and reproducing to make more little replacement workers, warriors, consumers. Here’s to proving me wrong!

    Now for something I can truly do something about:

    Where should one go in Scotland to get the best Haggis (or another less well-known but equally Scottish delicacy)? Not limited to “in Edinburgh”, but anywhere across the country… ? I must emphasize I have no fear of saturated fat or cholesterol gain. I am free at least in that respect

    Reply
    1. Neal Matheson

      My heart says yes to independence, The SNP are a superbly professional party who do amazingly well in the political pantomime presented in the media. However the recent (pre North Sea oil) history of Scotland should give the country pause for thought as indeed should the popular yet flawed policies of the SNP. There are many many reasons why Scotland’s biggest export was people!

      Reply
      1. Hans

        You’re fully right about the emigration “solution” that’s been underway for centuries as opposed to the cartoon thought of geographically severing ties with England in a full-on Monty Python sail-off-into-the-sunset sort of way. That’s true about every European or “Old World” country – emigration- it’s the pressure relief valve of nations.

        There’s alleged to be an observation by Schopenhauer that truth passes through stages where, first it’s ridiculed then it’s simply taken for granted, as if it always was so. We must still be in the stage or phase where those like Dr Kendrick who publicly oppose the cholesterol scam (or honest “mistake”) are to be ridiculed. And I’m ready to move on… so

        Now, where ta get the best haggis in Schottland…

    2. Dr Liz Stansbridge

      Haggis cannot be degraded any further than it already is. It is made with offal and oats. You cannot get any cheaper ingredients than that. So take your pick anywhere in Scotland, Haggis is Haggis.
      There are no Scottish delicacies that don’t involve huge amounts of carbohydrate (except Salmon), the fat ain’t the problem. The health of the Scots is atrocious in general. I look at people’s baskets in the supermarket in amazement.
      I am English retired to Scotland these 7 years. My Scottish friends don’t want independence. We expressed our views a few months ago, as you know. And as my son says, what would England do without all those Labour voters? The Tories would take over the rest of the UK.
      Scottish government is as unimpressive as Whitehall. Here in Dumfries and Galloway, they have just brought in recycling, about 15 years after the rest of the UK.
      Lovely, lovely Scotland wouldn’t be better on it’s own. The crash in fuel prices recently showed that.
      Trying to take a balanced view. What would we do without ‘Society’. We may rail against it’s inadequacies, but in Britain we live in a safer, healthier more ethical world than it has ever been in history.

      Reply
      1. Hans

        Scotland just can’t “make its’ way” on its’ own? How so? They once did, didn’t they? We all did. It’s interesting to think of the notion that globalism is a necessity. Ever bigger unions are “necessary”. But the planet *is* finite. At some point in the near or distant future even the entire planet after it’s “unified” globally – economically and politically with everyone getting everyone else’s taxes (???) – will have to live within its’ own means – the limits that Nature dictates. But living within one’s natural means is “not do-able” some would have us believe. In very recent news is the “Mediterranean refugee crisis”. Why is there a “crisis” in the first place? “War”, they say. (people understandably fleeing that). And “economic hardship” (as a result of war). Where does all that come from? To “fix” it will you yourself go and be a “peacekeeper” soldier there? Or vote to send someone else’s son? (Ex-military myself) And if the European machinery breaks down from an overload of (externally focused) altruism and neglect of its’ native sons and daughters where will Africans – or anyone else- flee to then for “refuge”? How did Africa ever survive without help from Europe – or the “EU”, or the rest of the world ? Did not Africa exist for quite some time without external aid or interference of any kind? But Scotland can’t? Norway can’t? Why a mere EU then? By the reasoning that “bigger is not only better, but necessity” you really MUST join with Russia. And China and India. A mega-sized union like that would need a new name, maybe something like “Eurasia” or “Oceania”. To decline that offer would really make you appear to be anti-“social”.

        Haggis. I’m anti-grain but I’ll allow some oats in there. You only live once.

  9. somercetsomercet

    “A little knowledge…”

    Aside from that, the only thing more dangerous is a damned Euro-snot trying to shove Socialism down America’s throat. So, what would it take to cram “The Public Option” down American’s throats? First, you must be willing to pay all those public pensions. This is not simple media panic. Orrin Hatch (R-UT), no Tea Partier, points out those pensionsbankrupted Detroit. Obama’s home state of Illinois may be next.

    Any nationalized American NHS would need to match the generous pensions expected by members of the American Federation of State, County and Municipal Employees (1.4m), the Civil Service Employees Association (300K) and National Federation of Federal Employees (100K). (I’m not even mentioning the National Education Association’s 3.2m workers; I know the Michigan branch refused to tell the State of Michigan how much the state was paying for teacher healthcare.)

    And don’t even think about reducing those pensions, you know a certain party is quite set against it. This is the same part that wants your NHS-er, “Public Option.”

    Of course, it’s funny, but aside from Canada, no one else has an NHS-like system. Is there a reason for that?

    Reply
    1. Tom Welsh

      A nation that spends over $1 trillion every year killing people (and preparing to kill more people) shouldn’t complain about a lack of money. If the USA cut back its “defence” and “security” spending to a reasonable level (say, on a par with Russia or China) it would have more than enough money to solve all its domestic problems.

      Reply
      1. mikecawdery

        Is US Health Really the Best in the World?
        Barbara Starfield, MD, MPH
        JAMA. 2000;284(4):483-485. doi:10.1001/jama.284.4.483.
        Every year, in the US, the medical system kills 225,000 people. 106,000 die as a direct result of ingesting medical drugs. 119,000 die as a result of mistreatment and medical errors in hospitals.

      2. Leaf Eating Carnivore

        You are right, but we can’t – we (the U.S.) – are caught in the monoculture trap. We seem to have little resiliency here right now, fiscally, socially, or, most importantly, cognitively.

        Realize that the American “Defense Department” (formerly – and more honestly – known as the War Department) is little justified by the reasons we traditionally associate with with armed conflict (witness the shallow and opportunistic circus that passes for U.S. foreign policy), and is mostly an economic enterprise that keeps Boeing and Lockheed Martin and their ilk and suppliers engaged. Job creators, you know – the darlings of the right wing establishment, who trickle their golden showers down on all our heads, and call it largesse. (!!!?!)

        It’s not just about oil (or water, or face), it’s about keeping the existing system, and those who run it, in place. They (who do not care a whit about me and thee) have to find/start wars to keep the edifice from collapsing, having little appetite for imagining and implementing alternative economic engines…

        Sometimes, at least for now, you do have to fight, if only for defense: remember that all of life’s dynamics are Darwinian. It would, however, be nice if we could do less of it, and that more intelligently, rather than expensively.

        I’m not holding my breath.

  10. Spokes

    Have you read ‘The establishment and how they get away with it’? It’s pretty illuminating when it comes to thinking about this sort of thing.

    Reply
  11. gina wrelton

    Hello Dr Kendrick, I have enjoyed your thought provoking articles for a short while and I wonder if I can ask your opinion on the following; my husband who is a fairly healthy 71 year old was diagnosed with a stenosis in the proximal to mid left anterior descending artery of the artery. He had three stents put in to the offending artery, in January of this year. He was prescribed Clopidogrel 75mg one per day and an aspirin 75mg. and Atorvastatin 40mg. Three weeks ago the statin caused pains in his limbs and his GP suggested changing the Statin to Pravastatin 40mg. The reason given for the statin prescription is that it may stop further blockages forming as well as lowering cholesterol levels. My husbands cholesterol levels were LDL 0.8 and altogether it was 2.5. checked on the 9th of March. He has not taken the statin for three weeks now and the concern is, could he be risking further clotting of the arteries by not taking the statin. Your comments would be very welcome as there is so much confusing advice.

    Thank you
    Georgina Wrelton
    Sent from my iPad

    >

    Reply
    1. David Bailey

      Gina,

      From Dr Kendrick’s responses to previous requests such as yours,I gather there are rules forbidding a doctor from offering specific medical advice over the internet.

      I really sympathise with you because once you lose your trust in the medical system it can be very worrying.

      I gave up statins because of the intense cramps that they caused me, but I would suggest that you and your husband read “The Great Cholesterol Con” and decide for yourselves.

      Reply
  12. Jeff Cable

    Nicely topical post, Malcolm. I have good reason to think the NHS is an important institution. As a baby, I was hospitalised for 8 years with TB spine. I learned to walk when I was 8 and spent 3 more years convalescing. I had no formal (or any) schooling until I was 12. I was given daily streptomycin injections during the final stages of my hospitalisation. Otherwise the treatment was bed rest on a plaster bed and being wheeled out onto a freezing veranda for hours at a time every day; to ensure that I had plenty of fresh air. Apart from auditory nerve damage and restricted growth in height, I am alive and well because of the NHS.

    Political colour and party politics is clearly inimical to sensible government. Where are the statesmen of these islands? The fantastic encompassing vision of Bevan is seemingly missing from all political thought and relevant commentary these days. The convenient political football of the NHS (every government now reorganises the NHS when it gains power) belies every single reorganisation which I have witnessed and worked through.

    Salmon was the very first one I endured and these days it is far easier to find an assortment of managerial staff; the ones who have bedecked themselves with gold badges proclaiming their self important roles. Clinical staff don’t count for much any more. My training hospital had 1000 beds and one person administering medical records, without the benefit of a computer. That hospital now has 350 beds and 70 medical records staff who each have a computer! When I trained, the record keeping side of medical records was impeccable. Now, you are lucky if the 70 staff can even find the patient records.

    I recently worked in a hospital where the written record was being left behind in favour of the computer record. The unitary system (no other trust has it or uses it) was purchased at a cost of £30 million and it is American made and American in concept… A giant billing system. It was singularly unsuited to the work of the NHS. A GP has absolutely no access to the patient record of clinical care episodes. ???

    While working in America, I was both saddened and astonished to learn that around 60% of the populace have no access to healthcare. Of course they are the poor and the needy. The NHS is a great institution that would be well served by removing 6-8 layers of managers and spending that money on staff training and patient care. I am not against paid services. In the Netherlands, I only saw hospitals that were well equipped and well staffed. This is because they are not all fighting for a tiny slice of the same cake.

    Free at point of service is what saved my life. Other models exist but the American model is to be avoided at all costs. Perhaps looking at the Cuban health system would also be instructive. I recently worked in Kenya and I was struck by how good it was to work in a system where everyone had the best interests of the patient at heart. They were severely resource limited in Kenya but the patient was always top of the list when it came to importance… the raison d’être why staff worked.

    I don’t care for politicians or administrators and I still work for the NHS on a freelance ad-hoc basis. I will never follow the wishes of a non-clinician and as for the retail managers who appear to have the NHS in their thrall, words fail me. I enjoyed your take on it too.

    Reply
    1. Lori Miller

      “While working in America, I was both saddened and astonished to learn that around 60% of the populace have no access to healthcare.”

      Say what? Even when I didn’t have health insurance, I went to doctors and hospitals and paid cash. Nobody ever turned me away, even when I had to pay them in installments. Where I live, health insurance was inexpensive before the state of Colorado made it cover pretty much everything whether you, the patient, wanted so much coverage or not–it didn’t do anyone any favors to make some of us choose between having health insurance or keeping the utilities on. But I digress. By law, pretty much any hospital in the US has to provide care in an emergency regardless of a patient’s ability to pay. And the elderly and poor are typically eligible for Medicare and Medicaid.

      Reply
    2. maryl@2015

      Jeff, where in the world did you get that information that 60% of the populace have NO ACCESS TO HEALTHCARE? There has always been adequate healthcare available to those without medical insurance. There are and were free clinics and hospitals everywhere in the U.S. It is this kind of inaccurate information that got us into this healthcare crisis called Obamacare. I have worked primarily with the very poor indeed. In some respects their healthcare needs were superior to those who could afford and had access to insurance. Even people who were receiving government subsidized healthcare are not getting near the services they had before Obamacare was pushed through our Congress so swiftly and so incredibly dishonestly that no one had an opportunity to review it or to understand it without an Ivy League attorney close by. You really are clueless as to what goes on in the American Healthcare system. My father spent a small fortune in taxes to a system that was supposed to care for my mother adequately in her old age. But, I insisted that she buy supplemental coverage. It does not make a damn bit of difference unless you happen to know your doctor and can get things done. But to say that our 60% of Americans did not have access to healthcare is a bold unadulterated lie. The poor among us have access to cell phones (government provided), free dental care for their children and healthcare for expectant mothers who had no fathers around to help take care of the children that would soon show up. They can get more services than millionaires if they know how and they do. Get your facts straight and stop lying. What a cruel and bloody foolish thing to say about Americans!!!

      Reply
      1. BobM

        Ok, let’s not go crazy here. Could you explain how poor people can get more health services than millionaires? That doesn’t seem possible to me. And could you explain these government-provided cell phones? Free dental care for children? I’ve never heard of those.

        Sincerely,

        Born in the USofA Bob

    3. maryl@2015

      Jeff Cable your statement that 60% of Americans had NO ACCESS TO HEALTHCARE is a bold, unadulterated lie. I have worked with many people in both the private and public sectors. We have ALWAYS had free clinics, hospitals, dental care, cell phone access, food stamps, re-imbursements for travel to and from doctors, just for starters. We have section 8 housing where people can live in very nice homes funded by the US. Their portion is minimal. The poor in America don’t even like Obamacare. In many respects the healthcare available to those who did not have access to or could not afford private pay “healthcare” had services far superior to middle America. We Americans pay our taxes for those services and paid into a system we hoped would take care of our elderly. I insisted my mother buy supplemental healthcare for her old age. It does not make much difference. So to say that over half of Americans don’t have access to healthcare is a lie. Either you never worked here or you are simply grand standing. That is how this Healthcare Reform Act was pushed through our Congress. It was done in a cloak and dagger fashion with wording of over 1,000 pages that no one could understand, lest you had an Ivy League attorney close by who had a year long opportunity to review it. How dare you insult my country in this way!!! Your sir, are no gentleman!!

      Reply
  13. Leigh Gold

    I was feeling great since I stopped the statins…….. Then you had to spoil it all, and bring Maggie Thatcher into the blog, didn’t you? Didn’t you? Have you got no heart? No consideration for those of long memories and long-suffering? What about your Hippocratic oath?
    I’ve had a relapse. Help!………..

    Reply
  14. Richard Gibbs

    It’s not Americans that would break a medical system, it’s the laws. They sue in the US because they can. Despite the insane rantings of Republican politicians here, Obamacare is an improvement. Many people hope it will pave the way to a single payer system. Given all the different insurance companies involved, the amount of paperwork surely must exceed that generated in the NHS.

    Reply
  15. Michael W. Perry

    I suspect that, in addition to being a substitute for religion, in the eyes of many Brits, the NHS has become a substitute for the once great British Empire that was dying as it was born. Instead of ruling over lands on which the sun never sets, they find their national pride in a health care system in which (almost) no one ever pays. Unfortunately, no human institution can bear that sort of burden. That unhealthy worship created many of the current ills. A huge influx of money won’t fix them.

    I see the answers to healthcare ills elsewhere than in better-funded bureaucracies. Many years ago, by an odd series of events, EMT training landed me a night position as a nursing assistant caring for children with leukemia at one of the top ten children’s hospitals in the country. Over the next sixteen months I saw nursing morale descend to the point where nurses were making mistakes that made no sense, including one nurse, blindly following a resident’s order, who gave a small boy a ten-fold overdose of morphine.

    The clash between nurses and the hospital administration grew so bad, that just weeks after I left, some 20% of the nurses resigned in a matter of weeks and the hospital’s reputation was such that replacements became almost impossible to find.

    I’m now wrapping up my third book on those experiences, which were filtered through graduate work I did in medical ethics at the University of Washington’s medical school. One of those books, My Nights with Leukemia, describes my experience, including that collapsing morale.

    In it I attempt to make sense of why the hospital administration, relatively benign when I started, embarked on what seemed to be a deliberate campaign of criticism that created in those nurses the confusion and fear that led to so many mistakes.

    Keep in mind the context. This wasn’t some public hospital in an inner city staffed by nurses so unmotivated they couldn’t get any other jobs. This was the top children’s hospital for almost 25% of the land mass of the U.S. It was generously funded by its community and attracted highly motivated nurses eager to care for children. I have never had a job where those I worked with were more highly motivated. And that’s where the problem lay. Subject talented and highly motivated nurses to unfair criticism and they become unhinged.

    I describe what went wrong from several different angles. For the failures at the top, I ended up ascribing them to the fears that those in upper administration would feel particularly strongly in the the early 1980s, fears that created in them a feeling of powerlessness. One was Diagnostic Related Groups, a Carter-administration idea that hadn’t yet been applied to children. The other was the huge explosion in medical malpractice settlements taking place in the early 1980s. DRGs pressured hospitals to take more chances, running fewer tests and discharging patients earlier. Malpractice did the opposite, pressuring them to practice expensive defensive medicine. Crushed between a rock and a hard place, they turned on the most readily available target, nurses.

    I can’t say more here, but intrinsic to top down, bureaucratic medicine is that it crushes people beneath a burden that leaves them feeling powerless to do what they feel is right. As their morale collapses, they quit trying or, in the case of those nurses, they quit altogether. I suspect that lies at the root of many of the ills of the NHS.

    Even working underneath the nurses, I felt those pressures, including demands that I do busy work that generated the proper numbers at the expense of my patients. However, I was fortunate. Unlike the nurses I worked with, I had no career to protect. I didn’t have to please a system that was growing increasingly dysfunctional. I could tell myself “to hell with you” and do the right thing for those little children or later for teens. I made a point of enjoying my rebellion.

    Most of the time, I wasn’t caught being kind rather than efficient. If I was, I simply played stupid. Since the hospital regarded its nurses as incompetent, that worked quite well. And the treatment-related criticisms I received were so outlandish, they only left me shaking my head and thinking, “If this is the only charge they can make against me, I must be doing quite good work.”

    For instance, I managed the aftercare for an 18-year-old boy who’d gotten cisplatin, one of the wickedest chemotherapy drugs in existence. I hated that drug and never stinted on giving proper care. I did his treatment to perfection, and yet the head nurse pounced on my for not specifically noting that his urine volume (a key part of that care) was fine. “Nonsense,” I thought to myself. “Nursing notes are terse. We only make a note of problems. If a patient has a normal temperature. We just record that temperature. We don’t write, ‘This patient doesn’t have a fever.'” Rest assured, if something had gone wrong, I would not have written little notes. I would have been yelling bloody murder. Like I said, I hated that drug.

    That’s the sort of mistreatment, multiplied many times over, that nurses were getting. No matter how hard they tried and how successful they were, they were still criticized. And that was causing them to fall apart.

    In my almost done book, I offer what I hope is at least a partial solution, one similar to reforms the U.S. military adopted in the mid-1990s to ensure good morale in an all-volunteer army. It’s a new position called a senior nurse mentor whose very reason for existing is to watch over nursing morale and speak up when nurses are unfairly treated. To ensure her independence, she’s not a part of the nursing administration. She is able to act on her on initiative, to maintain the secrecy of those she talks with, and is responsible only to the hospital’s CEO. Only he can fire her.

    I posted a draft of the book describing what she does on Wattpad about a month ago.

    http://www.wattpad.com/story/34716705-senior-nurse-mentor/parts

    The book’s within a few days of being complete. When it’s out, the digital versions for all platforms will be free to ensure the widest possible readership. The full title will be Senior Nurse Mentor: A Cure for What Ails Hospital Nursing.

    My basic argument is simple. If you want to prevent a problem, make someone talented responsible for it and give them all the necessary authority.

    –Michael W. Perry

    Reply
  16. David Bailey

    Unfortunately we have a way of importing our habits from the US with a few years of time delay. Some years ago, I was sitting in an NHS hospital waiting room, and there was a prominent advertisement from a firm of solicitors inviting patients to contact them if they felt they had problems with the service. I really pity the doctors and nurses that have to work under such conditions.

    The number one change I would make (in the unlikely event of becoming Prime Minister) would be to make it impossible to sue the NHS, replacing this with ex-gratia payments where something really did go wrong.

    My second change would be to open an urgent inquiry into the safety and efficacy of statins chaired by Dr Kendrick!

    I would then give Dr Kendrick the power to investigate any other aspects of the system that he felt necessary. This might also entail giving him an armed guard!

    In addition, I would put a stop to further politician-led reorganisations of the NHS!

    Reply
    1. mikecawdery

      The Us Govt. made it illegal to sue Big Pharma for vaccine damage to patients. Result – some very poor quality vaccines are produced, But a “vaccine court” pays from tax payer funds.

      The UK Govt. cut legal aid to sue Big Pharma. Result – Big Pharma uses a trick to stop legal suit by demanding a £1 million deposit in case the plaintiff loses to cover company costs in defending the case.

      Difficult. It was better decades ago when research was funded largely by Govts.

      Reply
      1. maryl@2015

        If your guidelines suggest that statins should be used for primary and secondary prevention and they cause harm, it makes no sense that there is no way to hold pharmaceutical companies responsible. If important facts about the statin trials are withheld and there are, indeed, financial conflicts of interest, what is a person to do? That I do not understand. At the very least, there should be some services available to those who MAY have been damaged by statins. How that should come about is a very complicated issue as I am not familiar with the UK laws regarding torte. At this time, I think the issue of whether statins actually do a great deal of harm is still under heated debate. This may be an issue that only resolves or is answered with more time and effort. We all have to learn to be patient but still make sure the issue is front and center with regard to the statin debate.

  17. Obhi

    On Friday evening, I’ll be attending the ‘Bring Back the NHS’ event in London hosted by Sir Ian McKellen: http://youtu.be/pAf-lfVav5Y . I admit I’m not entirely sure what to expect. However, I hope the audience will hear from doctors, nurses and others what makes them passionate about the NHS.

    Back in 1990, I was an audit senior in Price Waterhouse’s healthcare specialism. It gave me an opportunity to see at first hand the mess being created by the Thatcher’s NHS reforms. Entire ‘sales’ departments had been recruited to generate invoices for patient care based on a complex reporting mechanisms.

    Since the vast majority of patients were being treated for free, these invoices were almost all passed to an enlarged ‘purchasing’ department. A massive bureaucracy had appeared almost overnight just to be able to bill the handful of private patients.

    Patient care stopped being patient-centred. Instead, it became a process. Managed by managers with no experience of treating patients. After successive reforms under Labour and Conservative Government’s, the result is a very complex organisation with patient care distributed between many layers.

    Adding to this mix, the national dietary advice demonising saturated fat and cholesterol came since 1977 and 1983 – based on practically no detailed scientific evidence. And then statins since 1987. All guaranteed to make more people more ill as they got older. But looking after older people became the responsibility of local authorities, just in case anyone would put two and two together and notice that older people were somehow becoming more demented than before and listen to their story.

    9 years ago, a community nurse in the Netherlands called Jos de Blok founded a community nursing organisation called Buurtzorg. Having started with 4 nurses, they began by talking to the patients to establish what they needed. Now they are 8,000 nurses looking after 60,000 patients – around 80% of community nursing in the Netherlands.

    Their administration? 45 staff, of whom 15 are the finance department. The nurses work in teams of 12 and have to manage themselves.

    The patients live more independent lives than when they were treated as products of a care process. The nurses are happier too, which is why they have flocked to work for Buurtzorg. Jos de Blok gave a fascinating talk about Buurtzorg at the RSA last year.

    Various groups like the King’s Fund and the Royal College of Nursing have studied applying the Buurtzorg approach to the NHS. Probably the only real obstacle is the layer which would become extinct: the NHS managers who would need to decide to apply it! Will any politician dare to take them on, rather than simply feeding more money to ‘the NHS’?

    Reply
  18. offshoretinker

    Here’s a novelty.
    What about taking one’s health in one’s hand and avoiding the NHS and it’s magic bullets?
    That way we might see less thin, dementia ridden old ladies in care homes swallowing statins.

    Reply
    1. Anne

      Avoid the NHS’s ‘magic bullets’ yes. But not everyone can avoid the NHS completely. If you are born with a disability or ‘defect’ (I was born with a heart defect) or develop a serious infection or have a serious accident, you will sometimes need to see a doctor and you may not be able to afford private care !

      Reply
  19. Anne

    Your post on the NHS has raised my hackles, not at you, because what you say makes perfect sense, but at the NHS. I’m on the Patient Participation Group at my GP practice. If ever there was a box ticking exercise to earn the practice partners more money the PPG is just one of them. A few years ago all the older partners retired. That left two younger partners. They have not taken on new partners but employ salaried GPs. The salaried GPs stay for a few months, 18 months at most and then move on. The best ones move to practices where they can be partners because they want to have a say in how the practice is run. The worst ones are not committed to their job. This is not good for patients and erodes continuity of care, something vital with an ageing population who often have several long term conditions. It now takes around three weeks to get a routine appointment and is very difficult to get an emergency appointment. This means patients have to go to walk in centres or A&E – not ideal at all the not the purpose of primary care. The practice has an enormous number of patients, over 15,000 and the partners keep the books open for more patients. The partners have also bought two other practices in the area.

    The trouble is that the partners get paid for the number of patients on the books – they don’t get paid for the number of patients seen or treated. This seems to me a large part of the problem.

    Last summer patients who wanted to could sign up to have access to their medical records online, including notes from consultations and test results etc. This meant patients could be more of a ‘partner’ in their care. Could take more respnsibility for their care. Only a few patients signed up for this, including me. I found several mistakes in my notes and was able to begin to rectify them. Important errors which could have a negative impact on my care. I was also able to view test results and research them, and make sure letters from consultants were at the GP. Two weeks ago this facility was withdrawn and they now only allow patients to see their medications, their allergies and their immunisations. At a time when it’s very, very difficult to see a GP, and near on impossible to see one who ‘knows’ you for continuity of care, the ability for patients to be able to take a more active role in their care is taken away. I have written to NHS England, to the Patient’s Association, to our area CCG, about this.

    If patients could vote with their feet and move practice they would, but they can’t as the other local practices are full. The local NHS, ie our GP primary care service, aka the two partners owning the practice, are just businessmen, they don’t even see patients themselves anymore, too busy running a business which is not at all patient centred and about which patients can do nothing. The complaints about the surgery on NHS Choices are extremely worrying.

    Anne

    Reply
    1. Flyinthesky

      I seem to recall, though not in detail, that the conservatives were going to introduce a policy whereby you could register with any GP, ie: if it was more convenient to register near work than home it would become possible.

      Reply
      1. Anne

        PS Flyinthesky – If a GP practice has too many patients for the number of doctors then they can close their list to new patients. So the other practice near us has closed its list to new patients and there’s nothing anyone can do.

    2. James Alexander

      Very interesting post indeed. While I’m too old ever to claim to be certain sure of anything any more, I’m pretty damn sure you have an absolute right in law (Data Protection Act) to inspect all your records at your leisure. Just ask, formally. They can make a nominal or token charge. Mine didn’t, sounds like yours will, if they know. They may have withdraw internet availability, but they cannot “only allow patients to see their medications, their allergies and their immunisations”.

      Reply
    3. James

      Anne,
      Thanks for a most interesting and disturbing post.
      You (we) have a legal right to see all of your records, by virtue of the Data Protection Act (a modest service fee may be charged). Just tell them you want to. If your practice has (as appears from your account) first enabled online access by patients to their own records, then altered the facility to offer only limited access, when full access is a legal right, then that seems peculiar, not to say suspicious. Implications seem to be a) the practice is ignorant of the law, b) it has decided in its ignorance that it wants some things kept hidden! Certainly worthy of formal complaint?
      (Sorry if something to this same from me effect appears here twice. I made a similar observation earlier, saw it apparently posted, then it disappeared. Probably my fault.)
      James

      Reply
      1. Anne

        Hi James – when I phoned and complained, the practice manager told me that the patient records belong to the practice and that it would cost me £50 to look at mine ! She was so patronising.

        NHS England have told me that wiithin five years all GP practices will have to enable online medical records for patients…so I will have to wait up to five years to get back what we had before. It really helped to make patients responsible to see and read their medical records.

        We can’t correct all errors on our medical records. I found a major error going back 40 years. To correct that apparently the secretary of state for health would have to be involved as they would need to investigate something a doctor had written all that time ago. But when an error has been made just a few weeks ago it’s easily put right…and a patient is more likely to know than the doctor, especially when there is no continuity of care and pateints see different GPs each time they go to the surgery.

        Hi Flyinthesky – yes a person can register with any practice…but that’s no good when you need to see doctors fairly regularly, you don’t want to have to travel miles to get to another surgery. And elderly people or disabled people or young children need a surgery close to home. The issue is to get NHS GP surgeries back to working for patients.

    4. James

      Anne – shop them to the Information Commissioner via https://ico.org.uk/ . The whole rotten story, up to and including the unreasonable charge and the line that the records ‘belong to the practice’. The practice is seriously ignorant, probably the wrong side of the law, and bluffing and blustering. As you’re probably already in the practice’s bad books, it would probably sober them up immediately if you both complain to the ICO and then tell the practice that you’ve so reported them. They don’t like it up ’em. James

      Reply
      1. Dr. Malcolm Kendrick Post author

        Medical records belong to the Secretary of State for health. All patients have an absolute right to see everything in their records. If you want them printed off the practice is allowed to charge for this.

      2. Helen

        I’m afraid I can’t find the correct link at the moment, but if you go to the BMA’s website, there is some very interesting guidance published by the Ethics Committee about patients’ access to their records. It warns GP practices that they cannot treat this as a revenue stream and that charges must be proportionate. I am about to quote parts of this guidance to my own practice, which shares many of the same problems you describe, and which has instituted a minimum charge of £10, even for a single sheet of test results. It’s designed to put people off, of course.

    5. Anne

      Interesting that a patient’s medical records belong to the Secretary of State for Health – at the next Patient Participation meeting I will challenge the practice manager who told me they belong to the practice. I wonder if there is a link to this fact which I can print off ?

      I don’t actually ever need a print out of my medical records, I just need to check them from time to time to make sure they are correct…and then get them corrected as far as I’m able.

      Reply
  20. Maureen Berry

    Dr Kendrick, I also realise that you cannot give specific advice to Gina Wrelton – but can you answer a general query? Is a history of blood clotting an indicator for ‘statination’? Are they of special benefit for people who have previously had a clot (and coincidentally have high total cholesterol) or are they irrelevant? Even guidance as to where to look, research wise, would be good, if you feel you can’t express an opinion. I would like to be a bit more ‘clued up’ before I have my next review.

    Reply
    1. Dr. Malcolm Kendrick Post author

      My view of coronary artery disease CAD/CHD/IHD/CVD… whatever is the best term, is that blood clots/clotting is the central underlying processes. The most powerful anticoagulant in the body in Nitric Oxide (NO), synthesized in endothelial cells. Statins increase the production of NO.

      Reply
      1. Anne

        “Sunbathe, exercise and eat foods high in l-arginine”
        Vitamin D, exercise and meat and fish 🙂

      2. Stephen Rhodes

        So do celery, cress, chervil, lettuce, red beetroot, spinach and arugula, celeriac, Chinese cabbage, endive, fennel, kohlrabi, leek, parsley, but probably without the side effects?

      3. David Bailey

        Paradoxically, Nitric oxide (NO) is a noxious gas that combines easily with oxygen and moisture to create nitric acid – so don’t just buy a cylinder of it to sniff! I think the discovery that NO plays a role in body chemistry is utterly amazing!

      4. mikecawdery

        Dr Kendrick

        Statins are anti-inflammatory by disrupting production of NF-kappaB (mevalonate pathway) but “make” NO which activates NF-kappaB which in turn activates cytokines that cause inflammation. NO is a well known vasodilator..

        What is going on?

        In your book Doctoring Data you raise the issue of QoF (Quality and Outcomes Framework). Surely this disaster is another product of the NHS and the medical establishment?

  21. Nigella Pressland

    Dr Kendrick, I enjoy your blog immensely. I am not usually able to comment on your more medical posts, as I simply don’t have the knowledge – but rest assured, I will never be taking statins!
    With regard to the NHS and the medical system in the UK, I feel I can comment, as along with pretty much everyone else, I have experience of it. Personally, I think that like a lot of the great systems we have here in the UK, we take what is given to us for free (at the point of delivery) for granted – in a bad way. It is the same with education, social security & even having the right to vote. People abuse these fabulous systems, because they can & they somehow feel they have the right to. You only have to be unfortunate enough to be in A&E on a Friday or Saturday night to know this is true.
    I think the change of nursing from a largely experience based occupation where it was a privilege to care for the sick, to a degree based profession has not been a success. My poor father had several long stints in hospital prior to his death & I can honestly say that the care on the general geriatric medical wards was so dreadful as to be borderline abusive. We were a pain in the backside & stayed with Dad pretty much all the waking hours we could, so that we could feed him (no one else did & he wasn’t capable of doing it himself) & ensure his bedding was changed as he was doubly incontinent. My 81 year old mother even slept on the floor (yes you read that right – the floor) one night when he was very distressed. We did this, because the care was so lacking. He was in & out for weeks on end over a year long period & during that time I did not see the nursing staff rushed off their feet, looking exhausted & harried, like they simply couldn’t fit enough caring into their working day. I saw exceedingly slow moving people who seemed to prefer to stand around the admin desk chatting rather than attending to all those patients desperately in need of their care.
    I also worry very much about the impartiality of organisations, such as NICE, who issue the treatment guidelines. I can’t help feeling that big pharmaceuticals hold more sway with them than they should & that treatment advice is overly influenced by those who stand to make profit from the treatments given.
    I believe nothing that the politicians say about the NHS because they don’t have the interests of individuals’ health as a priority. Their motivation with regard to anything they say is to win votes! And I’ve yet to understand whether or not the NHS continuing as a free at the point of delivery service is sustainable with an ageing population. Does anyone have any thoughts on that?

    Reply
  22. Ali

    Have to laugh. Horrified they are at the thought of the SNP getting a majority vote meaning that only one part of the UK would be ruling the rest. Ummm. Isn’t that already the case?

    I don’t vote. My loyalties lie in a far better prospect. Worldly governments are all the same. They just juggle the numbers differently. If they could heal the sick and resurrect the dead, now that would be something worth voting for…..

    Reply
  23. tranwell2015

    From James Le Fanu article in todays Telegraph. “The crucial issue here is falling productivity, less output for greater inputs. This is admittedly not readily measurable in health but is dramatically illustrated by the experience of consultant anaesthetist Paul Shannon from Doncaster. Twenty five years ago his department, staffed by six consultants and four registrars, performed 21000 anaesthetic procedures a year. “Now it is 25000 with more than thirty consultants and eight registrars,” he writes in the British Medical Journal. “Do the maths”.

    Dr A.E. Hanwell 84 Holgate Road York YO24 4AB Tel 01904 624760 Mob 07973176707

    Reply
    1. mikecawdery

      Rather than do the maths, how many extra forms do they have to fill in to meet “administrative” requirements? About 10 consultants worth taking into account longer and more detailed operations?

      Dr LeFanu’s book “The Rise and Fall of Modern Medicine is a gem of common sense; should be compulsory reading for health care workers

      Reply
  24. Jonathan O Keeffe

    The market exists as does society. Just because they are not easily defined in terms of embodiment, or Newtonian physics and simple rational equations, it does not mean they are not real economic players influencing the lives of the individuals you mention. Darwinian natural selection tells us you don’t need a visible helping hand to see environmental ‘guidance’ of change at a macro level. Again – the NHS does exist, although difficult to capture in any discreet form and it is subject to macro level forces. It is a fantastic institution but one who’s ability to evolve is daily being outstripped by the demands of both the market and society. It risks an extinction event unless we accelerate its ability to reinvent itself (by prioritising further resources and innovation) or severely curtail the market and societal pressures it faces. We need to stop pretending the NHS can be all things to all people from cradle to grave. It clearly can’t.

    Reply
  25. Maureen Berry

    It amazes me how, in this age of modern communication, true good practice and best practice from across the world is not understood and applied across the world. We spend our winters in Spain and on many occasions in recent years have observed, then been treated by the Spanish Health Care System. It differs from our NHS in many ways. First, the nurses don’t nurse in any traditional sense that we are familiar with. They dispense drugs, dress wounds, undertake basically the skilled, professional tasks. All the personal care is performed by the family / friend / carer. If that care is likely to be required through the night, then that family member is expected to stay in a reclining chair and perform it. Result? Wards are calm and peaceful places where a patient can expect a good nights sleep. Patients are clean and cared for. The meals are freshly cooked from real food. Hospital stays are short and people get better. There is no such thing as ‘bed blocking’. Nobody gets cross infections. What will happen in the next few decades, as the extended family becomes more rare is anybody’s guess, but I feel that, even in our NHS there is a bigger place for family / friends helping with patient care, rather than being perceived as a ‘problem’ or a ‘pain in the backside’.
    Mind you, it’s not all good news. A neighbour went to A&E yesterday morning, fearing he was having a stroke. He had a battery of tests, including a CT with contrast, and was home by early afternoon with the diagnosis of a trapped nerve in his neck. Apparently his bloods had been normal and LDL was low. His prescription was for painkillers and a statin, ‘just as a precaution’. I told him about you, Dr Kendrick, I don’t have ‘The Cholesterol Con’ with me (I feel confident to travel without it these days) but I’ll lend him ‘Doctoring Data’.

    Reply
  26. Stephen Town

    Dr Kendrick, at some point will you be able to reproduce your article in ‘The Times’ on obesity and dementia? I get the Times but missed the article and it’s now behind the paywall. It would make a good subject for the blog.

    Reply
  27. dearieme

    “the NHS is mainly free, but this concept is being sneakily eroded”: oh come now. It was sneakily eroded by the government that founded it, which in short order introduced fees for three things – prescriptions, dentistry, and … I can’t remember the third – spectacles perhaps. It led to a flounce-out from the Labour government in ’51 by that Mighty Man of Principle, Harold Wilson.

    Reply
  28. dearieme

    “let us not drift into US style healthcare provision”: that’s just a bogey-man argument. Nobody I’ve ever met wants that grim outcome. But I’ve met plenty who’d like us to adopt a superior system – French, Swiss, Icelandic, Singaporean, or whatever. I’m now old enough to know plenty of people who simply hate the NHS because of how common it is for (some of) its employees’ attitudes to blight the patients’ lives – uncaring, unintelligent, and sometimes plain cruel. And they feel they must bite their lips or they’ll be picked on. Monopolies are ever bad things.

    Reply
  29. maryl@2015

    Bob from the USA
    http://portal.hud.gov/hudportal/HUD?src=/topics/housing_choice_voucher_program_section_8
    http://www.freegovernmentcellphones.net/
    http://www.benefits.gov/benefits/browse-by-category/category/MED

    Now I don’t know how you don’t know these things, but Bob, they exist!!! And when I say they can get more free services than many millionaires…I mean it. I mean it because someone with private pay insurance has to pay for it. Some of them happen to be millionaires, but their services are not free. It is not some big surprise or secret. There are so many government and non profit programs to help the needy in this country and abroad, it sounds like it is made up, I know. 100% of Americans can access some form of healthcare including dentistry. All you need do is go to any Federal Website and find a program you need. This why I feel Americans don’t appreciate how very fortunate they are. That is why I cannot tolerate people who take advantage of any programs by lying or doing nothing to help themselves. I don’t like it in the pharmaceutical industry or in government sponsored programs that go too far with entitlements. Dishonesty is dishonesty no matter who does it.

    I don’t care to argue this point or be rude, but the truth is that dishonesty goes on with many different kinds of people be they rich, poor, or somewhere in between.

    Reply
  30. Maureen Berry

    The Queen, the royalty and the rich don’t understand queues, sharing, taking turns. They can afford to ‘push their way to the front’. The rest of us want, and should be able to expect, a fair Health Service, where everybody is prioritised according to medical need, everybody gets good treatment in a timely manner and treatment is effective and proven, delivered by individuals who are motivated by altruism rather than personal gain. Not too much to ask, is it?

    Reply
    1. Dr. Malcolm Kendrick Post author

      I think it rather supposes that people will act purely out of altruism to provide a ‘perfect’ service for others, without gaining anything from it other than a sense of duty performed. A nice dream, until real human beings get involved. At which point, history would inform us the likelihood of such a Utopian system working, to the required specification, will approximate to zero. I find that people get in the way of all the best ideas.

      Reply
      1. obhichatterjee

        All this may seem Utopian but it does actually seem to happen in Buurtzorg, the non-profit Dutch community nursing organisation. By making teams of at most 12 nurses responsible for all aspects of the care of their clients, they apply a very similar community approach to Grameen banks. The back office administration is very light compared to the NHS, where a layer of non-medical staff has been implanted since the early 1990s to generate invoices, most of which are sent to other colleagues. The only reason that is needed is to be able to bill private patients.

        See the RSA talk Humanity above bureaucracy by Buurtzorg founder Jos de Blok.

  31. Sarah C

    If there’s a 16 week wait for physiotherapy, and I opt to go privately, and am seen at a non-NHS facility, am I pushing to the front (like royalty), or rather relieving the pressure on a clearly overstretched NHS practice?

    I think the NHS should be a no-go area for politicians, and should probably be run by a mixture of clinicians and business managers (someone has to buy the paperclips) with the emphasis on delivering efficient patient care, at reasonable cost. Those running it should be free of conflicts of interest of any sort.

    Reply
  32. Maureen Berry

    This was the question “If the NHS is so wonderful why does the queen, the royalty and the rich opt for their own private health system?”

    I have no problem with anyone opting for private care, in fact I remain in hope that Dr Kendrick obtains suitable premises for ‘Clinical Edge Health Care’ because I eagerly await the opportunity to consult him. And yours is one of the examples when anybody who can afford to should sensibly opt for the private system. Physiotherapy is so much more effective sooner rather than later.
    And maybe my choice of words was unwise, maybe I meant that people should not be motivated by greed. Of course, health professionals deserve a remuneration commensurate with their skills, education and commitment. I spent about 10 years in the health service, leaving after I had my children as Education was a preferable profession to attain a work – life balance. In my day (and I left in the 80s, hopefully things have improved,) virtually all Consultants in a field where they had the opportunity to earn substantial sums in private practice were part time, many only one session down on full time, but they had no motivation whatsoever to keep their waiting lists under control, see people quickly and effectively. They were simply creating the market for their private practices.
    I was working in a major teaching hospital, and I was also similarly shocked and appalled by the lack of ‘interpersonal skills’, empathy and concern demonstrated by some of the junior doctors. I felt very strongly that far more emphasis should be placed on personal qualities, commitment and concern. All student doctors will be straight “A” students these days, I do hope that more emphasis is placed on personality (and of course common sense and a questioning mind).
    I have read about the Buurtzorg system and it sounds absolutely superb, but no doubt the top-heavy, beaurocratic, control obsessed Health Service will never look at / introduce such a scheme (why would turkeys vote for Christmas – no managers!) – but the patients and the staff would love it.

    Reply
  33. Tommylee

    As a conservative American economist, I have three observations. First, government is almost always the problem, not the solution. A market always exists when there is an alternative to providing the good or service. Thus, there is a market in health care when there exist alternative providers of those services/goods. Third, free choice is about freedom. There is a great video series, initially on PBS, by Nobel economics winner Milton Friedman called Free to Choose. I conclude NHS would be a lot more responsive and cheaper to operate if it had some competition. Great bog.

    Reply
    1. Stephen Rhodes

      Your first ‘observation’ is an assertion not an observation. And it certainly places you firmly on one extreme of the Health Provision argument. As does your claim to be ‘a conservative American economist’ and, probably, also your appeal to authority by ‘praying in aid’ Milton Friedman.

      Your second ‘observation’ only applies if the medical ‘goods or services’ are of similar benefit to the patient in the market place.

      And your third ‘observation’ is only true if ‘choice’ is informed. Which begs the question ‘how does a patient, who is not a medical specialist in his/her suite of illness/es, know how to make the best choice for him/her?’

      It appears that the perennial problem of ‘conservative American economists’ that they are aware of the price of everything and the value of nothing, still rings true.

      What you are suggesting is that the market is capable of placing a value on the provision of health services so that patients only have to check the price before making their choice.

      Einstein made a better observation than your three, to the effect that ‘not everything that can be measured is important and, not everything that is important can be measured’.

      As I see it, not being an economist, for the market to have a place in healthcare will require that there is an inversion of marketplace behaviour, since what the patient desires is good health not good healthcare and that if that is the objective of the NHS – which it should be – then the achievement of that objective will result in low levels of economic activity in the provision of healthcare, and conversely the failure to achieve that objective will result in high levels of economic activity in the provision of healthcare. The latter being exactly the opposite of what patients require, but exactly what the providers of healthcare – and their shareholders – require, demand, and, if you read Dr Kendrick’s blog top to toe you will see they are achieving.

      Reply

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