Tuesday, August 19, 2008

The NHS …Warts and all .. Is still great

I have been away from the National Health Service (NHS) for almost 4 years after a long career of over 35 years working inside it.

The NHS is the third largest employer in the world after the Chinese Army and the Indian Railways.

The NHS celebrated its 60th birthday in July 2008 having been created as part of the radical, reforming Labour Government of post Second World War Britain in 1948. The NHS was a fundamental part of the new Welfare State.

The founder of the NHS was the eloquent Welsh MP Aneurin Bevan. Among Mr Bevan's many wonderful quotes was this one that I love most;

‘No longer will wealth be an advantage nor poverty a disadvantage. Healthcare will be provided free of charge based on clinical need and not on ability to pay.’

Call me old fashioned if you like but this statement from the great man underpins why our NHS is still the envy of many parts of the world.

What we forget sometimes in Britain is that our health service is a UNIVERSAL service provided to all citizens based on clinical need.

It has been good for me to be away from the NHS for almost 4 years because I have been able to see the service from ‘outside’ and I admit I have sometimes been critical of what I see.

However in recent discussions on Tom Peters Blog I’ve been delighted to see so many people praising the NHS. Dare I suggest there have even been some envious glances from our friends across the pond that we have a well established and (generally) well-loved universal healthcare system?

I will continue to criticise the NHS where it fails patients and their families but let me be clear about something.

Until I see hard evidence that a privately funded healthcare system provides at least as good a service to the WHOLE population of Britain as the NHS currently provides I will continue to promote the NHS as the right way to organise the healthcare for the ENTIRE population.

It is simply not good enough to make shallow unproven throw-away woolly statements like ‘the market must decide.’

One key criterion of how a country should be judged is surely how it treats it most vulnerable and most ill citizens. In Britain I feel we can and should be very proud that successive governments since 1948 have not seen fit to move away from universal healthcare provided through the tax funded NHS and I for one hope we never do.


Peter said...

Trevor, whats the stats for this statement "The NHS is the third largest employer in the world after the Chinese Army and the Indian Railways."

I find it strange, I thought GE was the 3rd largest employee ..

Mark JF said...

I agree with Peter. This, "NHS is the 3rd largest employer" is an example of something that gets printed once, repeated a few times on the internet and before you can say "Check that stat" it's accepted as a fact. What about Wal Mart with 1.8m employees? Don't they count? Or the US government, which employs well over 1m people? In fact, the US army is about 1.4m and the Chinese army is well over 2m. Of course the NHS is a big organisation but this "3rd largest" tag is simply (!) meaningless.

Mark JF said...

I am an unashamed profit-motivated libertarian. I also support the concept of the NHS. BUT... I think the NHS needs to re-focus on what it means by "clinical need" and on to whom the service is provided.

To me, "clinical need" does NOT mean giving people fertility treatment, cosmetic surgery (other than extreme cases, e.g. accident victims) or many forms of elective surgery. Like it or not, there is a limit to how much money can be spent and that money has to be prioritised.

I find it unacceptable to spend money giving someone fertility treatment while a child is dying from a treatable disease because they can't get up the waiting list fast enough. Or that someone gets cosmetic surgery ("to relieve their stress") while older people are denied Alzheimer's treatment.

(I also object to the way we allow foreign nationals to abuse our system, but that's perhaps another debate.)

So, yes, let's praise the NHS and let's develop it. But let's not kid ourselves that it can do everything or that there's no place for private healthcare. The NHS has to treat real clinical needs promptly and effectively and that means having management that is clear and diligent about executing this, right through the organisation.

Trevor Gay said...

Hi Peter and Mark - check out this very respected and credible NHS website


It says;

'The NHS is the third largest employer in the world. In England and Wales over 10,000 employers employ around 1.3 million people. This is around one in every 40 people, or 2.5% of the population, working for the NHS.'

There are other stats which argue the NHS is 4th largest after Wal Mart.

Mark - I don't think the web was actually the basis of the stat being published so often and so widely. I remember it being commonly quoted within the NHS over 20 years ago and certainly well before Google was the source of most of our information ... but I do agree with your sentiment about checking out facts.

Trevor Gay said...

Hi Mark – we agree mostly.

The current Labour government (more than any other since 1948) has made the most serious attempt in the history of the NHS to define clinical need. They introduced the National Institute of Health and Clinical Excellence (known as NICE) to do just that. NICE is largely made up of doctors and other clinicians and makes the difficult rationing decisions. Things are much more stringent now than ever about what can be provided within the NHS than say even 5 years ago. It is now generally rare to get funding for cosmetic surgery and the other issues you raise unless the circumstances are very exceptional.

I am with you totally about treatments for people with diseases such as Alzheimer’s and other chronic illnesses, e.g. long term mental illness, services for older people etc., which attract much less publicity than the more ‘well known’ illnesses. This is the biggest worry I have if we ever had a privately funded health service – where would people who suffer chronic illness end up?

‘Foreign nationals abusing our system’ is definitely a subject for another day and I do have an opinion about that. I don’t believe the situation is anywhere near as bad as often portrayed by extremists. There is a reciprocal healthcare arrangement throughout Europe and we have to balance the equation by looking at how much healthcare we UK citizens get in other European countries.

Like you Mark I believe we should celebrate the NHS – it is one of Britain’s greatest assets in my opinion. I think individuals have the right to choose private medicine if they can afford it – I have no problem with that concept at all. But we must first protect the NHS principles of a free service for all based on clinical need at all costs. You also know I support your view on management in the NHS.

Ken Dainton said...

Nice one on the NHS.

Having spent a fair bit of time living among the folk of Pennsylvania I know which health organisation I prefer and it certainly ain't the US model. Even though their culture is very different to ours, and they are grappling with the universal problems of growing expectancy/new technology etc, this is one thing they haven't got right. Pity more of our public and health service staff do not realise it.

mike said...

I think the most telling statement in your post is the first. The world's third largest employer is in a country of approximately 58 million people. And it is a gov't system, which means taxpayer-funded. I can hear the poor British taxpayers groaning under the strain all the way over here!

Trevor Gay said...

Hi Mike - good to hear from you as always.

Our healthcare system compares favourably when compared with all leading healthcare systems in the world in respect of universal healthcare.

I am not actually as sure as you are that the British tax payer is as angry as you suggest.

No politician since 1p48 of either political party has been prepared to risk losing votes and elections by even remotely hinting we should get rid of our NHS. This implies it would not be a popular option with the British people.

As I repeatedly say, the NHS has many challenges and can always be improved but I await evidence from anyone that a better universal system exists in the world.

If a private system is so good why are British people not bombarding politicians with a plea to scrap the NHS.

You could be right Mike and I could be wrong about a universal tax funded system but we have to start from where we are now. You have a non-universal system and we have a universal system funded through taxation. Difference is good – that way we continue to learn from each other. Thanks my friend!

Trevor Gay said...

Ken - I've neve lived in the US so I'm not able to comment about the US system other than from what I read. I am proud of our system and I agree with you that the British public are generally not aware how good our system actually is relatively speaking when compared with universal healthcare systems elsewhere in the world.

Trevor Gay said...

Ken - I've neve lived in the US so I'm not able to comment about the US system other than from what I read. I am proud of our system and I agree with you that the British public are generally not aware how good our system actually is relatively speaking when compared with universal healthcare systems elsewhere in the world.

Anonymous said...

Phil Shute full time GP current post 23 years working full time in NHS 34 years to date. Comment for Mark really. Health really is no place for unashamed profit making libertarians. Your comments however on what NHS should fund are entirely apt. BUT too much time is spent discussing these peripheral but entirely news-worthy issues about a tiny percentage of total expenditure. Never forget that 99% of expenditure is on the "Basics" and I'm jolly proud to have made an honest contribution to this. Actually immensely proud.

Trevor Gay said...

Thanks Phil - you are absolutely right to be proud of your contribution to the NHS. As one of your former patients I feel I have some personal experience of your skills and dedication – As you always say - party on!

Ken Dainton said...

No doubt Mike is relatively young,fit & healthy & also never lived in UK. Despite its many weaknesses & constant carping about peripheral issues(nice one Phil)the NHS is part of our culture & no politician would risk his reputation on proposing alternatives. Yes it is a drain on resources,but what health care system isn't? As for the taxpayer groaning under the financial burden it isn't nearly as bad as the USA where I met many people who were still working well into their 70s & even 80s in order to pay their health bills.I also met citizens who were growing increasingly,& visibly,anxious about their deteriorating health & financial position-a classic vicious circle.

Peter said...

Trevor , I am not a health care whize.. but this is an interesting infonuggut.

=> "1.3 million people. This is around one in every 40 people, or 2.5% of the population, working for the NHS."

do we know what is gross average ratios of health care workers to every 1000 person ? What is WHO's figures current WOrld Wide Figures ?

mike said...

Whatever, Ken. I live in the US and have not met those people, so I can not speak from your experience. For the sake of argument, let's say it is true. Why is it right for the gov't to forcibly transfer wealth I have earned through my efforts to others in order to pay for their healthcare? Shouldn't the decision to do so be mine, and not that of my elected representatives?

Trevor Gay said...

Hi Peter - the size of the NHS relative to other employers in the UK is amazing. I remember once being told that 4% of those who work in Britain work in the NHS ... so one in 25 people I meet will be part of it.

Peter said...

Trevor, what is WHO ratios' average ? I will do some analysis on this . I got this link on who


Trevor Gay said...

Thanks Peter - I don't know the answer to your question I'm afraid.

Ken Dainton said...

It is called acting for the greater good. What you have highlighted Mike is a fundamental difference between our two societies. Your individuals are very self reliant,generally work harder & the weak fall by the wayside; we have been brought up with the welfare state which supports everyone in the same manner, whether malingerers or 5star generals.

No wonder you can't get on with the Russians!!


Peter said...

Ken, as if the UK get along with Russians !!

Ahemmmm.. actually I think I do get along...remember the Burgess, Philby, McClean et al, and all that nice stuff.. they went to russia eventually :)-

Sorry just could not resist a rebutal to "No wonder you can't get on with the Russians!!" !

Ken Dainton said...



But I wasn't implying that we were any better in that respect-it was merely a comment to emphasize that different countries are organised along different lines. We become conditioned by the society we are brought up in. Which comes first, the organisation or the culture?

To come back to the good old NHS-it clearly wouldn't work if it were imposed on the US.Equally,a privately funded system would not be accepted by the UK.

I'm off now till Tuesday - good day gentlemen and thanks.


John O'Leary said...

Hey Trevor, I'm just catching up on your posts now. The US healthcare system is in such a mess it makes my head hurt just thinking about it. In the state of Massachusetts where I live I am now mandated to buy health insurance for myself at obscenely high premiums. Maybe it will be a catharsis for me to post about it sometime. Cheers...

Trevor Gay said...

Good to hear from you John as always – ho0e you are well.

Bottom line is I’m pleased we have the National Health Service. I know if my Mom needs healthcare at 79 years of age she will get it free without any worryies about how she might have to pay for it.

My country and yours are starting from different places. I look forward to seeing your posting.

J.KANNAN said...

My dear Trevor,

A great and wonderful quote by Mr. Beaven and thanks to you for bringing to the knowledge of many of the simplicity readers.

Working for an organisation, more so health care organisation like NHS for an uninterrupted period of over three and half decade is really a great achievement and calls for great appreciation.

It is amazing to note that NHS provides a spectacular health care service to people and appreciated by so many.

You are a privileged person for NHS and there is absolutely nothing wrong in crtisising the organisation whenever they err or fails in their performance to patients and families who holds absolute faith and trust in their health care needs and depending on NHS. With Regards


Trevor Gay said...

Thanks JK - you are very kind. It was an immense pleasure for me to work in the NHS for so long - although it didn’t always feel that way. I used to get really frustrated when there were complaints about poor standards of care. Having said that most patients’ experiences are good and we tend to forget that sometimes.

I am the first to admit the NHS sometimes gets it wrong for families but overall I am very proud of our National Health Service.

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