The FT has an editorial today in which it discusses the NHS, saying:
The government cannot avoid responsibility for the present mess. The Treasury's imposition of deep cuts in the provision for social care has had predictable consequences.
These, it says are:
The net effect of Whitehall myopia has been to save pennies while wasting pounds.
Wasn't it ever thus with supposed frugality imposed for dogmatic reasons?
Even more damning though is this:
The NHS has also had to manage the costly bureaucratic upheaval introduced after 2010 by David Cameron's government. The changes fragmented provision at a cost of billions of pounds. They will have to be reversed if the NHS is to capture the productivity gains and savings available in an integrated system.
In 2010 David Cameron promised no top-down reorganisation of the NHS in one of the biggest lies ever told to an electorate until the Leave campaign came along. It has been a disaster. Premised on the idea of competition, and clearly intended to deliver privatisation, it has created enormous and costly waste that has simply served in increase NHS admin but not help the delivery of services.
The FT is right to say that the Cameron and Lansley reforms have to be reversed. Many of us said they would be a disaster at the time. We were right.
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Just a coincidence, Lansley, author of many of these ills, having bowel cancer. As ye sow, so shall ye reap, perhaps.
He has my sympathy on that, however much I may have disagreed with him
But it is interesting that he blames the Treasury for his late diagnosis
[…] have already referred to an FT editorial published this morning that made welcome comment on the need for NHS reform. […]
The NHS does not track or evaluate the outcomes of its policies. The easiest one to see is that its dietary guidelines are causing an massive wave of disease in many fields(e.g. diabetes, CVD, obesity, mental health). The fundamental management reform would be to manage the health of the population as implied by having a universal service.
When there are calls for greater funding I am completely split, because no funding will solve the management problem while it is not reflexive.
You think the NHS causes our diet problems?
“You think the NHS causes our diet problems?”
I have to agree that sounds a fanciful proposition.
I think there has been a degree of complicity in accepting dubious recommendations from food (and drug) industry lobbying interests, but that’s a far cry from attributing cause to the NHS.
I have never seen the NHS recommend Cream Eggs
But even I admit I had one over the weekend
It was not a good choice
But I cannot claim the NHS
I blame Cadbury’s advertising budget
“I blame Cadbury’s advertising budget”
They’ll need to spend a great deal more on very carefully targetted advertising to get past my now hard-wired association with Kraft margarine.
Bleuk !
Good to see mainsream media catching up with reality & common sense.
Cameron’s NHS is a bereaucratic labyrinth and it is designed to deliver privatisation, as you point out, but also to make reversing the ‘reforms’ increasingly impossible. It is privatisation hidden in plain sight, so when a new ‘initiative’ like ACOs comes along, most people just glaze over. Rabbits in headlights.
Any new Labour manifesto (other parties are available) will have to contain an NHS reinstatement bill. I recommend watching this short talk from Professor Pollock to understand why.
https://www.youtube.com/watch?v=Cz5dl9fhj7o
Thanks
Mike W says:
“Good to see mainstream media catching up with reality & common sense.” Quick on the uptake aren’t they 🙂
Excellent link. Well worth watching and worth disseminating far and wide.
https://www.youtube.com/watch?v=Cz5dl9fhj7o
Thanks for that one, Mike.
Allyson is brilliant
I say that without any bias
She is what academics should be
And many aren’t
(That will make me popular)
Agreed. That’s an excellent presentation by Allyson Pollock. Factually argued, concise and comprehensible to a lay audience. While the main critique still applies, maybe she could update it to cover recent detailed developments. I hope it is widely disseminated. I note thus far it has had 131,053 views.
We need something similar for MMT. How about a TEDx Talk, Richard?
Maybe…if the right one comes along
The coalition government removed the middle or regional layer of management in many functions: regional trusts in health care introducing GP-managed services, local education authorities introducing academies, regional development agencies introducing local enterprise partnerships, regional planning introducing borough-led planning. The GP-managed services and academies are open to privatisation & corruption through consultancies owned by GPs & headteachers. The local enterprise partnerships are run by large construction firms.
Regional management allowed efficient use of resources and gave the frontline lowest tier a voice against central highest tier management. Removing the regional layer is a power grab by central management leaving neighbouring districts fighting each other with no collective voice. Localism means no democracy since the local chiefs win over the silent majority – the new feudalism. And no doubt these changes were intended as irreversible, burnt earth.
Meanwhile, surgeries suffer from insufficient GPs & poor management, academy chains go bust, the construction companies get massive unwanted infrastructure projects (HS2), and community planning is run by the biggest bully.
Jeremy Hunt has completely eclipsed my memory of Lansley.
I’m sorry for his pain, but I won’t be sending flowers.
Is the NHS responsible for our diet problems? Yes and no of course. There is propaganda at our GP surgery every time I go insisting that I eat carbohydrates for the bulk of my diet. As a diabetic I am told to eat carbohydrates which is medical lunacy. The NHS is busy testing everyone for cholesterol and prescribing statins, when the cause of CVD is high glucose and high insulin together. Lowering cholesterol in older people helps bring on dementia. And and and.
The lack of proper dietary advice to deal with all our lifestyle long term conditions is I think literally criminal. I personally have had advice that is diametrically wrong and would bring about my early demise. I applaud anyone trying to clip the wings of the industry funding of misleading research (quite as bad as tobacco and oil). But the NHS has a prime authority and it is on the wrong side of the argument. This is what I mean by actually managing the cost of universal care.
Let me say again that there are many parallel stories about failure to deal with long term conditions and the cost of long term conditions. Diet is just an easy and huge one.
I have to say I think this a tiny part of the NHS agenda
Are you sure you have things in perspective?
I think Aidan does have it right.
If I recall correctly diabetes is the NHS’s biggest cost and increasing all the time.
We’ve reduced consumption of saturated fat as instructed but we are still more obese and diabetes is on a continual rise. There are instances of people curing their diabetes by eating more fat but very much less sugar or carbohydrate. Yet Public Health England (admittedly not actually the NHS) continues to focus on fat when it should, in fact, be focussing on sugar.
Lots of links below (sorry) but Public Health England are just wrong. If PHE get it wrong it only increases the problems for the NHS.
Don’t forget 5 a day was a marketing campaign and not anything to do with scientific evidence! Though subsequent research has suggested that at least 5 veg a day (if not fruit) is certainly a good idea.
The Pioppi Diet book is particularly informative.
http://www.zoeharcombe.com/2012/03/five-a-day-the-truth/
http://www.zoeharcombe.com/2018/04/carbohydrates-cardiovascular-disease/
https://www.penguin.co.uk/books/305991/the-pioppi-diet/
http://www.progressivepulse.org/health/do-you-take-sugar-no-thanks
https://www.theguardian.com/commentisfree/2013/oct/23/butter-bad-saturated-fat-healthy-eating-industry
I stand corrected on this one
Peter May says:
“I think Aidan does have it right…….”
Public health authorities are gull-able and corrupt-able. Probably got the wrong sort of old-fart place-men (and women) on them as rewards for services rendered. The welfare benefit system at the top of our society is well supplied with sinecure positions in QUANGO-type organisations. Nice little earners masquerading as ‘giving something back’
But the alternative of opening up health and social care to the private sector is terrifying. And the public at large don’t believe it can happen.
Thing is……. it’s already well in train.
https://www.nhs.uk/Livewell/Goodfood/Pages/Goodfoodhome.aspx
Richard, Aidan is indeed correct. GPs are under pressure to follow the advice of bodies like NICE and the British Heart Foundation. If you read the publications and blogs by Dr Malcolm Kendrick or Dr John Briffa you will come to understand just how hopelessly tied-up with Big Pharma or Big Finance that these bodies are.
The BHF advocate not eating saturated fats and guess what? They are sponsored by Flora. NICE recommend statins for just about everybody and guess what? The main protagonist is Professor Sir Rory Collins, who with his Cholesterol Treatment Trialists collaboration has trousered over £260 million from Big Pharma.
There is much about modern health-care that we have cause to be thankful for but we must be on our guard against some of the more dubious practices. I suppose a good maxim may be “follow the money”, something which you are very well qualified to do.
May I add, Richard, how much I enjoy your blog and I log in almost every day.
OK
I will take another look
Richard, you will have gathered that I’m in sympathy with this opinion that NHS practice is affected by commercial interests.
That doesn’t one iota diminish my support for the principle of the NHS and support for the level of care I’ve personally received in my lifetime.
And privatisation would inevitably increase, rather than reduce, the influence of vested interests in the health ‘market place’.
That of course is why ‘they’ want it exposed to exploitation. it won’t cost the vested interests nearly as much in devious corporate lobbying and dubious ‘scientific’ studies.
I would totally endorse the comments from Aidan Ward & Peter May. Generally speaking the UK’s institutionalised medical profession has a lot of catching up to do when it comes to the effect of diet on human health. For a century Big Pharma and the major food corporations have routinely suppressed and distorted traditional evidence for healthy living in order to maximise profit from their patented, processed and over-marketed poisonous junk food. This is no exaggeration. For them profit has always come before people. The major supermarket chains are complicit.
The Internet is a jungle of dietary advice which can be very confusing and misleading for laypeople.
You can literally chose your own witch doctor! Always best to double check everything before reaching a decision. However, one of the most relaiable evidence-based authorities on food & diet is probably Dr Michael Greger – https://nutritionfacts.org. For those interested, his newsletter is worth signing up for. He posts regular YouTube videos (https://www.youtube.com/user/NutritionFactsOrg), and his recent TEDx presentation is well worth 18 minutes of anyone’s time – https://www.youtube.com/watch?v=xnKaOL2IBPY. Strongly recommended.
Be well!
Thanks everyone for opening this question up, and for your openness, Richard.
The figures for the amount of future “demand” being generated are real and terrifying, completely unfundable. That is why this is a central and strategic management question: one that is not being addressed except by “blame the patient”. Look at all those stupid people not doing what we tell them and getting obese and ill.
You can see the misinformation campaigns very easily: for instance more exercise for school kids is fully aligned with Coke advertising featuring sports. The evidence is that you cannot compensate for a bad diet with exercise but the public think you can.
But let me say again, this is not just the diet question. There are several areas of medical practice that are creating many more health problems than the solve. My colleague Nora Bateson and the International Bateson Institute did a fantastic study of addiction in the US school and college system, for instance. What do you think the forward cost is of someone who has side effects from coming of anti-depressants?