At least let's give credit to Mr Streeting for giving this veiled warning: "Streeting also said, "As a proportion of the NHS budget, we want to shift the balance in favour of neighbourhood services."
In real life this means 'increase community support for everything' - the old 'get rid of bed blockers by sending them to local community care homes'. Funny that there doesn't seem to be any mention of re-establishing and funding District nurses. After all, nurse practitioners are already a huge part of GP surgeries. This also means that local council taxes will need to rise, thus scrapping the single-person reduction in council tax will become a necessity: you all want to save the NHS, dontcha, so it's only fair to cough up. Perhaps it'll also get the 'ageing population (widows and widowers)' - ageing ever since baby boomers became the punchball for politicians trying to excuse their failings - out of their houses and into 'homes' where their clogs-popping can be accelerated.
And another thing: why 'digitalisation' is supposed to be the cure-all is beyond me. Do Messrs Streeting and Darzi not know how much installing and maintaining a properly working IT system costs? Or are they planning to let Big Pharma pay for it, in exchange for unlimited access to patient data?
Sorry, I'm just a bit peed off by this Darzi Report ...
Having run a veterinary hospital, I can come up with quite a few pointers:
1. Install good generalists at entrance of hospital, who can triage and refer to the relevant specialists if needed. Prevents people from ending up with the wrong specialist.
2. Work on personalised medicine rather than protocolised medicine.
3. Provide continuity of care, stop people from working in different hospitals.
4. Timely diagnostics, and subsequent reporting followed by prompt treatment.
5. Once diagnosed, treatment back to GP if possible.
6. Put healthcare back in the hands of health professionals.
7. You may want to consider that certain procedures are not essential and therefore not provoded by the NHS.
Just some ideas.
It is a behemoth, turning this ship around will be a Herculean task.
These are the same people who believed a global pandemic of a novel design respiratory tract virus could be stopped in its tracks by hibernating indoors, arrows on floors, covering facial orifices in public, testing, testing, testing, encouraging then coercing then mandating mass population injection with a non-sterilising gene-based novel technology inoculation, stopping routine healthcare provision and throwing a shedload of money on digital technology (test and trace, digital passports, remote consultations etc).
According to the BBC, 'Sir Keir set out three key areas for reform - the transition to a digital NHS, moving more care from hospitals to communities, and focusing efforts on prevention over sickness.... This would mean "more tests, scans and healthcare offered on high streets and towns centres" alongside bringing back the family doctor and offering digital consultations to those who want them'.'
Seems as though they are approaching the health and social care crisis with the same simplistic mindset as they did the pandemic (test, test, test, technology). It wouldn't surprise me if their plan is to deploy an army of neighbourhood metabolic health marshals into the high streets and town centres to provide life-saving NHS health checks. Perhaps those with a BMI over 30 will be encouraged then coerced then mandated to take Ozempic. Joe Wicks will be made Exercise Tsar. There will be incentives for weight loss and punishments for those who don't comply.
Thank you for this wonderful article. I wonder how France offers such high quality healthcare. France is not a wealthy country, but they do seem to be a bit more organised. Wondering why the nhs doesn’t study and implement best practice. Perhaps they do.
Did like TTE’s conclusion about simple solutions for complex problems. And anywhere Hancock has his sticky fingers is where I want to stay the hell away from. One more incidental, just think how many fewer patients, now requiring expensive treatments for both cardiac and oncology disease, would there be, if the covid vaxxes had been adequately studied in the first place. I am only a family nurse practitioner, retired. I admire most of the healthcare providers we come into contact with. But I have advised my 81 y.o. husband, our job is to maintain our health with exercise, wt control, healthy eating and a good night’s sleep. Nearly all people have these preventive tools at their disposal, all accept buying food are free. I do believe people have a responsibility to maintain their health, but seek medical care when needed. Seeking medical care is becoming more difficult. Everyone has their own version/examples of difficulty with access.
thanks for your ever thorough and direct analysis; your clarity is always marvellous to read; so refreshing and so needed against the obfuscation of all else;
this video https://www.youtube.com/watch?v=Zt__JOalJEY provided good discussion recently; more and more eat UPF (ultraprocessed food); made by food companies; that some now insist were bought by tobacco companies in the 1990s; so folks get sick on the UPF: but have no fear; BPf (Big Pfarma) ride to the rescue with an endless avalanche of "blockbusters", "gamechangers" and whatever else to restore the population to perfect health; one just fears down, and down and down
in this interview with Rory Stewart https://www.youtube.com/watch?v=DGhiTZMCc2g he mentioned the unmentionable; that the NHS will have to look at some degree of insurance underpinning; ever year; folks pay more for less and less; some of those working in the system saw that coming years and years and years ago; eat real food; keep away from doctors
We already are a nation with an NHS attached (amen, peace be upon her 🙏).....our biggest problems are obesity and old people having the brass neck to continue living (I know, how very dare they!). I used to be a fitness instructor and I can tell you an uncomfortable truth right now - people are generally lazy. If there was a pill to make you slim AND fit, boy, would it sell. Regardless of the side effects. No amount of "but exercise is so good for you" "step away from the Deliveroo app!" will change folk. So. Cut the endless layers of useless management for a start Wes, then come back to us....
I must remind you all that the disastrous NHS dental contract introduced in 2006,by Blair's Labour government,which has turned out to be the beginning of the end,was supposed to be based upon prevention.
We see no signs yet of Streetings plans for recovery of dentistry - indeed politicians forget that the oral cavity let alone head and neck,are part of the body,treated by dentists - apart from vague talk of mobile dental units being sent to dental deserts.
My dear old father who qualified in 1939 operated out of a mobile dental unit lorry in Normandy in the DDay landings!
Would be very useful to expand NICE's remit to consider NPIs and the extent to which they represent value for money. Otherwise the enthusiasm for prevention risks a different set of wasted investments in screening and dietary epidemiology - the Muz Muz fantasy perhaps?
The vast socialist bureaucracies never deliver value for money. They get set up to buy votes and end up impoverishing the country. Here in Australia we have Medicare, which is a publicly funded, government run, universal health insurance scheme. In recent times Medicare was supplemented with the National Disability Insurance Scheme. The cost of the NDIS - which only covers disabilities - now exceeds the entire cost of Medicare.
I would like a definition of preventative medicine .I say this slightly tongue in cheek, I trained as a health visitor in 82, practice and principles included helping people to reach their best health outcomes. Health visiting is a service that has suffered at the hands of beurocrats ,managers who don't understand the long game and not least becoming slaves to the computer as a task manager. I think anyone who has worked on the patient facing end of NHS knows they see less patients and have more managers than 40 years ago.
I was "entertained" by your assertion that ‘waiting lists couldn’t get any worse’. If you want compelling evidence that they can, and are, have a look across the Irish Sea at the part of the UK NHS no one wants to talk about – Northern Ireland. Neither the Tories nor the incumbent Party can be blamed for that chaos. It is all of our own making. We currently spend 52% of our budget on health and have the worst lists, outcomes etc in the entire Kingdom and some of the worst in Europe. The Health Ministry has been run by a variety of political parties so incompetence is not confined to one particular side of our divide. The Health Minister Robyn Swann – of the UUP and now an MP, famously told a BBC journalist in November 2020 that he would have to turn away cancer patients from hospital in order to have space for Covid patients and that the cancer patients may well die as a result of this. This outlook has not helped our situation but to be fair it was diabolical before ‘Covid’.
We are a population of just under 1.9 million. In September 2023, there were about 429,000 patients waiting for a first consultant led outpatient appointment at hospital!
Thankfully our local prostate cancer referrals are dealt with in a timely and efficient manner but for all other plumbing problems waiting time for a urology clinic appointment is 2.5y for non urgent, 8m for urgent. There is no doubt at all that the pandemic response has been a significant factor in this delay though oddly that fact is often skirted around, as if we would have been in this position anyway had we not halted all routine investigations/clinics/operations for a considerable period of time (summer 2020 stands out as a period of wasted opportunity to catch up in the NHS, in great part to the Zero Covid organisational mindshift).
Well possibly the pandemic response brought forward the inevitable demise of the NHS but it also did so in a very abrupt way, unlike the slow tightening of the screws of the austerity years.
I may be missing something obvious but the NHS model does rather rely on people presenting when they feel less well, rather than us hunting for disease and ‘pre- disease’ and creating a whole new work stream of testing, monitoring, treating, dealing with iatrogenesis etc. to further clog up an already broken system. I’m mystified as to how Starmer’s new three pronged approach of digital technology/AI, testing, testing, testing and pushing more secondary care work into primary care will help reduce our 2.5y urology waiting list.
And surely we ‘neighbourhood’ clinicians will be busier than ever dealing with all the abnormal metabolic parameters revealed by the life saving health checks, and running our Ozempic clinics.
It just doesn’t add up at all. The only thing I can conclude is there must be a plan to introduce some form of privatisation/ hybrid model of funding.
As you so rightly say Old Geezers, ‘The answer to the NHS seems to roll out the cronies that have failed in the past.’ Where would we be without them indeed. The first old crony, I mean ‘Darzi’ centre opened in 2008. ‘Lord Darzi’s Next Stage Review of the National Health Service, and popularly referred to as “Darzi centres,” the Labour government ordered 150—one for every primary care trust (PCT). They would be open 12 hours a day, every day of the year, offering walk-in services and having their own lists of registered patients. London was to take them a step further with polyclinics offering diagnostic and other services traditionally provided in hospitals. The Department of Health invested the lion’s share of its £250m (€285m; $403m) “equitable access” fund in GP led health centres, and the first opened in November 2008. All but about a dozen PCTs had commissioned one by the time of the general election,1 and seven polyclinics had opened in London.’
But then….. ‘Now, however, Darzi centres find themselves stranded in a very different political and economic climate. Incoming health secretary Andrew Lansley was quick to axe London’s polyclinic programme, declaring that “a top-down, one-size-fits-all approach will be replaced with the devolution of responsibility to clinicians and the public.”2Then NHS Stockport announced the first closure of a GP led health centre. It will not be the last.’
I posted some time ago about the waste of resources intended for UK healthcare. I agree that interventions should be restricted to those which are evidence-based and politicians, management consultants and civil servants would be best to "bow out".
I believe we should focus on innovation in the community and strive to prevent emergency admission of vulnerable people using community based 24hr multidisciplinary teams. They are expensive, but not as expensive as repeated hospital admission. We need clinical trials of such innovation (not of the latest "me too" drug.)
Change is unlikely to happen, though, because powerful companies will fight hard to keep the contracts they now enjoy. Sorry to be a bit negative.
I think Lord Darzi did a similar report for New Labour. Community care seems like a return to a previous world because the last years have all been about centralization. Like that social care it needs investment to make it work, and there's the problem for to make savings you first have to spend. Since doing a three day course in FORTRAN 4 in 1964 for scientific research I have had a love affair with digital – however, it is a tool for the health service and really what we need most is human contact and human expertise without which ‘digital’ will be worse than useless. Milton is clearly another Pharma funnel, the name is odd because we used to use it for baby’s drinking vessels. If by prevention we mean injections of stuff like Ozempic or mRNA ‘vaccines’ I fear for the future of our species. I doubt powerful businesses will want the real solution to health, proper food like I used to eat in my childhood (though not optimal even then – WW2 and all that).
At least let's give credit to Mr Streeting for giving this veiled warning: "Streeting also said, "As a proportion of the NHS budget, we want to shift the balance in favour of neighbourhood services."
In real life this means 'increase community support for everything' - the old 'get rid of bed blockers by sending them to local community care homes'. Funny that there doesn't seem to be any mention of re-establishing and funding District nurses. After all, nurse practitioners are already a huge part of GP surgeries. This also means that local council taxes will need to rise, thus scrapping the single-person reduction in council tax will become a necessity: you all want to save the NHS, dontcha, so it's only fair to cough up. Perhaps it'll also get the 'ageing population (widows and widowers)' - ageing ever since baby boomers became the punchball for politicians trying to excuse their failings - out of their houses and into 'homes' where their clogs-popping can be accelerated.
And another thing: why 'digitalisation' is supposed to be the cure-all is beyond me. Do Messrs Streeting and Darzi not know how much installing and maintaining a properly working IT system costs? Or are they planning to let Big Pharma pay for it, in exchange for unlimited access to patient data?
Sorry, I'm just a bit peed off by this Darzi Report ...
Having run a veterinary hospital, I can come up with quite a few pointers:
1. Install good generalists at entrance of hospital, who can triage and refer to the relevant specialists if needed. Prevents people from ending up with the wrong specialist.
2. Work on personalised medicine rather than protocolised medicine.
3. Provide continuity of care, stop people from working in different hospitals.
4. Timely diagnostics, and subsequent reporting followed by prompt treatment.
5. Once diagnosed, treatment back to GP if possible.
6. Put healthcare back in the hands of health professionals.
7. You may want to consider that certain procedures are not essential and therefore not provoded by the NHS.
Just some ideas.
It is a behemoth, turning this ship around will be a Herculean task.
Well said.
These are the same people who believed a global pandemic of a novel design respiratory tract virus could be stopped in its tracks by hibernating indoors, arrows on floors, covering facial orifices in public, testing, testing, testing, encouraging then coercing then mandating mass population injection with a non-sterilising gene-based novel technology inoculation, stopping routine healthcare provision and throwing a shedload of money on digital technology (test and trace, digital passports, remote consultations etc).
According to the BBC, 'Sir Keir set out three key areas for reform - the transition to a digital NHS, moving more care from hospitals to communities, and focusing efforts on prevention over sickness.... This would mean "more tests, scans and healthcare offered on high streets and towns centres" alongside bringing back the family doctor and offering digital consultations to those who want them'.'
By preventing sickness it looks like they might be putting a lot of faith in Ozempic: https://inews.co.uk/news/politics/ozempic-style-weightloss-drugs-labours-sights-nhs-shake-up-3272450.
Seems as though they are approaching the health and social care crisis with the same simplistic mindset as they did the pandemic (test, test, test, technology). It wouldn't surprise me if their plan is to deploy an army of neighbourhood metabolic health marshals into the high streets and town centres to provide life-saving NHS health checks. Perhaps those with a BMI over 30 will be encouraged then coerced then mandated to take Ozempic. Joe Wicks will be made Exercise Tsar. There will be incentives for weight loss and punishments for those who don't comply.
Thank you for this wonderful article. I wonder how France offers such high quality healthcare. France is not a wealthy country, but they do seem to be a bit more organised. Wondering why the nhs doesn’t study and implement best practice. Perhaps they do.
Did like TTE’s conclusion about simple solutions for complex problems. And anywhere Hancock has his sticky fingers is where I want to stay the hell away from. One more incidental, just think how many fewer patients, now requiring expensive treatments for both cardiac and oncology disease, would there be, if the covid vaxxes had been adequately studied in the first place. I am only a family nurse practitioner, retired. I admire most of the healthcare providers we come into contact with. But I have advised my 81 y.o. husband, our job is to maintain our health with exercise, wt control, healthy eating and a good night’s sleep. Nearly all people have these preventive tools at their disposal, all accept buying food are free. I do believe people have a responsibility to maintain their health, but seek medical care when needed. Seeking medical care is becoming more difficult. Everyone has their own version/examples of difficulty with access.
AZ develops a new AI tool - and calls it, MILTON.
Maybe because our NHS is - Paradise Lost.
thanks for your ever thorough and direct analysis; your clarity is always marvellous to read; so refreshing and so needed against the obfuscation of all else;
this video https://www.youtube.com/watch?v=Zt__JOalJEY provided good discussion recently; more and more eat UPF (ultraprocessed food); made by food companies; that some now insist were bought by tobacco companies in the 1990s; so folks get sick on the UPF: but have no fear; BPf (Big Pfarma) ride to the rescue with an endless avalanche of "blockbusters", "gamechangers" and whatever else to restore the population to perfect health; one just fears down, and down and down
in this interview with Rory Stewart https://www.youtube.com/watch?v=DGhiTZMCc2g he mentioned the unmentionable; that the NHS will have to look at some degree of insurance underpinning; ever year; folks pay more for less and less; some of those working in the system saw that coming years and years and years ago; eat real food; keep away from doctors
We already are a nation with an NHS attached (amen, peace be upon her 🙏).....our biggest problems are obesity and old people having the brass neck to continue living (I know, how very dare they!). I used to be a fitness instructor and I can tell you an uncomfortable truth right now - people are generally lazy. If there was a pill to make you slim AND fit, boy, would it sell. Regardless of the side effects. No amount of "but exercise is so good for you" "step away from the Deliveroo app!" will change folk. So. Cut the endless layers of useless management for a start Wes, then come back to us....
I must remind you all that the disastrous NHS dental contract introduced in 2006,by Blair's Labour government,which has turned out to be the beginning of the end,was supposed to be based upon prevention.
We see no signs yet of Streetings plans for recovery of dentistry - indeed politicians forget that the oral cavity let alone head and neck,are part of the body,treated by dentists - apart from vague talk of mobile dental units being sent to dental deserts.
My dear old father who qualified in 1939 operated out of a mobile dental unit lorry in Normandy in the DDay landings!
Would be very useful to expand NICE's remit to consider NPIs and the extent to which they represent value for money. Otherwise the enthusiasm for prevention risks a different set of wasted investments in screening and dietary epidemiology - the Muz Muz fantasy perhaps?
The vast socialist bureaucracies never deliver value for money. They get set up to buy votes and end up impoverishing the country. Here in Australia we have Medicare, which is a publicly funded, government run, universal health insurance scheme. In recent times Medicare was supplemented with the National Disability Insurance Scheme. The cost of the NDIS - which only covers disabilities - now exceeds the entire cost of Medicare.
I would like a definition of preventative medicine .I say this slightly tongue in cheek, I trained as a health visitor in 82, practice and principles included helping people to reach their best health outcomes. Health visiting is a service that has suffered at the hands of beurocrats ,managers who don't understand the long game and not least becoming slaves to the computer as a task manager. I think anyone who has worked on the patient facing end of NHS knows they see less patients and have more managers than 40 years ago.
I was "entertained" by your assertion that ‘waiting lists couldn’t get any worse’. If you want compelling evidence that they can, and are, have a look across the Irish Sea at the part of the UK NHS no one wants to talk about – Northern Ireland. Neither the Tories nor the incumbent Party can be blamed for that chaos. It is all of our own making. We currently spend 52% of our budget on health and have the worst lists, outcomes etc in the entire Kingdom and some of the worst in Europe. The Health Ministry has been run by a variety of political parties so incompetence is not confined to one particular side of our divide. The Health Minister Robyn Swann – of the UUP and now an MP, famously told a BBC journalist in November 2020 that he would have to turn away cancer patients from hospital in order to have space for Covid patients and that the cancer patients may well die as a result of this. This outlook has not helped our situation but to be fair it was diabolical before ‘Covid’.
We are a population of just under 1.9 million. In September 2023, there were about 429,000 patients waiting for a first consultant led outpatient appointment at hospital!
Thankfully our local prostate cancer referrals are dealt with in a timely and efficient manner but for all other plumbing problems waiting time for a urology clinic appointment is 2.5y for non urgent, 8m for urgent. There is no doubt at all that the pandemic response has been a significant factor in this delay though oddly that fact is often skirted around, as if we would have been in this position anyway had we not halted all routine investigations/clinics/operations for a considerable period of time (summer 2020 stands out as a period of wasted opportunity to catch up in the NHS, in great part to the Zero Covid organisational mindshift).
Well possibly the pandemic response brought forward the inevitable demise of the NHS but it also did so in a very abrupt way, unlike the slow tightening of the screws of the austerity years.
I may be missing something obvious but the NHS model does rather rely on people presenting when they feel less well, rather than us hunting for disease and ‘pre- disease’ and creating a whole new work stream of testing, monitoring, treating, dealing with iatrogenesis etc. to further clog up an already broken system. I’m mystified as to how Starmer’s new three pronged approach of digital technology/AI, testing, testing, testing and pushing more secondary care work into primary care will help reduce our 2.5y urology waiting list.
And surely we ‘neighbourhood’ clinicians will be busier than ever dealing with all the abnormal metabolic parameters revealed by the life saving health checks, and running our Ozempic clinics.
It just doesn’t add up at all. The only thing I can conclude is there must be a plan to introduce some form of privatisation/ hybrid model of funding.
As you so rightly say Old Geezers, ‘The answer to the NHS seems to roll out the cronies that have failed in the past.’ Where would we be without them indeed. The first old crony, I mean ‘Darzi’ centre opened in 2008. ‘Lord Darzi’s Next Stage Review of the National Health Service, and popularly referred to as “Darzi centres,” the Labour government ordered 150—one for every primary care trust (PCT). They would be open 12 hours a day, every day of the year, offering walk-in services and having their own lists of registered patients. London was to take them a step further with polyclinics offering diagnostic and other services traditionally provided in hospitals. The Department of Health invested the lion’s share of its £250m (€285m; $403m) “equitable access” fund in GP led health centres, and the first opened in November 2008. All but about a dozen PCTs had commissioned one by the time of the general election,1 and seven polyclinics had opened in London.’
MJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6287 (Published 08 November 2010)
Cite this as: BMJ 2010;341:c6287
HURRAH!
But then….. ‘Now, however, Darzi centres find themselves stranded in a very different political and economic climate. Incoming health secretary Andrew Lansley was quick to axe London’s polyclinic programme, declaring that “a top-down, one-size-fits-all approach will be replaced with the devolution of responsibility to clinicians and the public.”2Then NHS Stockport announced the first closure of a GP led health centre. It will not be the last.’
https://www.bmj.com/content/341/bmj.c6287.full
BOO!
Money for old rope anyone…..well not any old crony….not you two I fear…
I posted some time ago about the waste of resources intended for UK healthcare. I agree that interventions should be restricted to those which are evidence-based and politicians, management consultants and civil servants would be best to "bow out".
I believe we should focus on innovation in the community and strive to prevent emergency admission of vulnerable people using community based 24hr multidisciplinary teams. They are expensive, but not as expensive as repeated hospital admission. We need clinical trials of such innovation (not of the latest "me too" drug.)
Change is unlikely to happen, though, because powerful companies will fight hard to keep the contracts they now enjoy. Sorry to be a bit negative.
I think Lord Darzi did a similar report for New Labour. Community care seems like a return to a previous world because the last years have all been about centralization. Like that social care it needs investment to make it work, and there's the problem for to make savings you first have to spend. Since doing a three day course in FORTRAN 4 in 1964 for scientific research I have had a love affair with digital – however, it is a tool for the health service and really what we need most is human contact and human expertise without which ‘digital’ will be worse than useless. Milton is clearly another Pharma funnel, the name is odd because we used to use it for baby’s drinking vessels. If by prevention we mean injections of stuff like Ozempic or mRNA ‘vaccines’ I fear for the future of our species. I doubt powerful businesses will want the real solution to health, proper food like I used to eat in my childhood (though not optimal even then – WW2 and all that).