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Then and now:

April 20, 2007

“For many, the NHS is part of what it means to be British. It expresses values that are ingrained in the British character – fairness and decency, compassion and a belief in the power of community. Social justice as a legitimate objective for the nation. And yet for all its great strengths – its one million staff, its ethos of public service, the great advances it has brought in public health – the NHS Tony Blair’s Government inherited in 1997 had profound weaknesses. In the fifty years since it was formed the health gap between rich and poor had widened. Too often the poorest services were in the poorest communities. Its centralised top down structure had too often stifled local innovation. It was run like an old-style nationalised industry controlled from an office in Whitehall, even when its sheer scale – now 1.4 million employees – made it impossible to do so. Not surprisingly it felt bureaucratic and monolithic. Staff too often felt disempowered. Local communities felt disengaged. Patients had little say and precious little choice. There were neither means nor incentives to improve services”

Alan Milburn, speaking in 2003 about the NHS in 1997-obviously he went on to say how everything has changed and its now the envy of the world

Lets look at that a bit more closely

the health gap between rich and poor had widenedNo change there, as far as I can see

Too often the poorest services were in the poorest communitiesyup, as they still are

Its centralised top down structure had too often stifled local innovation. No, you must be talking about another health service

It was run like an old-style nationalised industry controlled from an office in Whitehall, even when its sheer scale – now 1.4 million employees – made it impossible to do soring any bells, Patsy?

Not surprisingly it felt bureaucratic and monolithic. Well I’m glad we got rid of that

Staff too often felt disempowered. Local communities felt disengaged. Patients had little say and precious little choice See where I’m going with this?

There were neither means nor incentives to improve services: Well maybe we have a bit more means…

I will spare you the bit about the wonderful new contracts which have changed the way everything works for the better.

In short although there has been a much needed programme of capital investment, on the delivery side, with the exception of reducing waiting lists and waiting times, which must be acknowledged, the government has fundamentally failed to improve almost any of the areas it originally identified as key failings of the system

Not really value for money

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5 comments

  1. Not surprisingly it felt bureaucratic and monolithic. Well I’m glad we got rid of that

    It is still the same people (BMA, MRC) in charge
    The government (of the day) simply ‘bankrolls’ them

    Staff too often felt disempowered. Local communities felt disengaged. Patients had little say and precious little choice See where I’m going with this?

    I thought the whole problem with the NHS, was that it guaranteed a job for life – and NHS pensions were eating ever more into NHS budgets.
    So short term contracts, not job security and no pension guarantees supposed to raise staff moral?
    Ability to pay gives patients who can pay – choice.
    The NHS was (IS?) meant to provide health care to All regardless of ability to pay

    There were neither means nor incentives to improve services: Well maybe we have a bit more means…

    The incentive should have been a well paid job for life with a good pension. All the pricing and internal markets have produced is more corruption, and those who can get rich by milking the gravy train.

    It has not improved patient (customer) services for the half of the population who cannot pay or whose job does not offer BUPA or private health insurance.

    Privatising dentistry just left 1/3 (30%) of the population with inadequate dentistry and bad teeth.
    False teeth is the cheap and barbaric solution of a decadent society – where you lose your teeth if you cannot pay. Next you lose your sight because you cannot pay.

    Who wants to live forever with no teeth and no sight.
    Rather keep my teeth & sight – and DIE when it is time to die, rather than be ‘saved’ and live a life dependant on charity or charity fromthe State.
    Thank you!


  2. You seem angry today Q9- can I send Lola over to give you a massage?

    To pick up one of your points about short term contracts v jobs for life. I don’t know the answer to this. I am very happy (obviously) with the concept that I effectively have a job for life as long as I don’t get prosecuted for killing a patient. On the other hand It seems inappropriate that public sector workers are told that they can have job security, early retirement and a final salary pension, whereas none of these things are available to the people who actually work in the private sector to pay the taxes which pay our wages.

    If I ran a company I’d like to think that I would be loyal to my employees and try and offer them a job for life as long as they were able to do it, but sadly this is not easy in today’s world when such loyalty especially added to substantial pension contributions makes employing people extremely expensive


  3. Hi Mens Sana,
    ironically most ‘commercial sector’ companies
    who consider themselves ‘enlightened’
    offer their employeess job security, good pay, contributions to private health insurance and private pensions too – and sometimes company shares.

    Isn’t that what the state offered on the NHS and to teachers in State Education, as well as civil servants ingeneral.

    But the question remains if the mhs pensions bill is crippling the nhs – how do you think private sector health care can do any better – except resorting to what any pyramid scheme does, offer more to those at the top (with real executive powers) and what those at the bottom get is worth increasingly less whether it be in job security, fair pay, and health insurance contributions or private pension contributions.

    There is no REAL logical argument that can provide a better health & pensions system than the State.
    The only thing the US provides which States in the EU cannot is more reliance on share ownership by individuals – on which to speculate or ‘gamble’ health care and pensions stocks. But ironically these in the US are dependant on the knowledge that the US Treasury will always step in and bail them out, except in extremely exposed cases like EXXON.

    Are ‘war bonds’ still a good investment in the US
    I think you yourself have noted that the high cost of pharmaceuticals is mainly determined by R&D and legal or patent costs – as well as high yield dividends to share holders.

    Literally profitting from anothers ‘misery’


  4. PS -yep photons in cancer treatment, you would have to vastly increase the charge to bring down starships


  5. LOL Q9 🙂



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