The Lancet reports on the failures of the NHS

No, don\’t get your hopes up:

Britain is failing to keep pace with improvements in public health in other Western countries despite NHS spending tripling over the past 20 years.

The figures are quite stunning:

Figures from the House of Commons library show that NHS spending has risen from £46?billion in 1990 to £122?billion this year, based on 2011 prices.

That\’s adjusted for inflation. But no, this report does not then go on to say that we need to change the method of delivery of health care. No, not more markets, not even less, but something really quite different:

It found that factors such as obesity, alcohol, a lack of exercise and bad diet were still among the leading causes of illness in Britain despite millions being spent on public health campaigns.

They want more power over what we eat, drink and smoke. Quite possibly even with compulsory exercise. They\’re not actually talking about medical treatment in the slightest.

20 thoughts on “The Lancet reports on the failures of the NHS”

  1. The report (which you can read for free if you register with The Lancet) isn’t about the NHS: it compares health statistics between the UK and other European countries, and looks at what the major factors seem to be driving the differences.

    The evidence is overwhelming that if we want to improve our relative ranking, we need to improve prevention and early diagnosis rather than acute care. Compare for example statistics from Glasgow and the Southeast of England – this is not a failing of Glasgow’s hospitals.

    Tim, if you think the Lancet is wrong about this, you should show us your evidence, not moan that reality doesn’t match your prejudices.

    And you make up the paragraph about more powers and compulsory exercise: there’s nothing in the report advocating that.

  2. The doctor on Breakfast this morning had an unchallenged rant in favour of minimum alcohol pricing, though.

    The desire to control people’s lives is totally implicit in the report. I mean, how the hell else do you persuade the fatties and the drunks to make better life choices without forcing them?

    The fact that it doesn’t need to be stated just shows how totally the belief that people making bad life choices is a social problem and that something must be done about it has taken hold of ‘the establishment’. Whether it’s the noblesse oblige of the Tories, or just old fashioned ‘you don’t know what’s good for you’ from the pinkos.

  3. Compulsory exercise. This could be a good use for Sir Gus Donaldson’s good bureaucracy, as he so smugly and slimily outlined it on Radio 4 this morning. What could possibly go wrong.

    This is shaping up to be the cluster fuckers cluster fuck.

  4. PaulB Interesting that you mention Glasgow. See
    http://www.guardian.co.uk/society/2012/nov/06/mystery-glasgow-health-problems

    Extract: “With colleagues at NHS Scotland and the University of Glasgow, Walsh has devoted much of the past five years to uncovering what makes Glasgow so different, compared with other, similarly deprived British cities. If you think deep-fried Mars bars are to blame for Glasgow’s ill health (as many English commentators seem to), then think again: obesity rates in the city are actually lower than in some English cities.

    Nor can Glasgow’s infamous penchant for alcohol and cigarettes explain the puzzle. According to the largest health surveys in England and Scotland, Glaswegians neither binge-drink nor smoke more than their peers in Liverpool or Manchester. Drug abuse (particularly heroin), knife crime, murder and suicide are all significantly more prevalent in Glasgow than in other cities. But that only prompts the question – why is this the case? What is it about life in Glasgow that seems to predispose some of its citizens to such destructive behaviours?”

    Not quite as simple as it seems, is it?

  5. “Quite possibly even with compulsory exercise”

    I seem to remember that George Orwell had quite a good illustration of this in “1984”.

    All for the good of the state, heh? double-plus good.

  6. The desire to control people’s lives is totally implicit in the report. I mean, how the hell else do you persuade the fatties and the drunks to make better life choices without forcing them?

    If lifestyle issues are a factor in differing levels of health between countries then it is relevant to mention it in the context of this report. It doesn’t imply trying to control people’s lives unless one either assumes that this is the answer to all social issues (there may be people who think this) or one sees any attempt by the state to address social issues at all as trying to control our lives (there are certainly peple who think this). There is a big space in between.

    But even if you think that people’s lifestyle choices are no business of the state at all and it should not try to influence them in any way it is surely still legitimate to point it out if they are having a wider impact.

  7. What I genuinely cannot understand is why Dr X in Bristol, or Prof Y in Cambridge, or the govt, think it’s any of their business what I eat or what I drink or how often I go for a run?

    When did I or anyone else vote to give them a say over these things?

    Abolish the NHS, make me at least in some part responsible for the consequences of my actions, vis a vis my ‘healthcare’, and maybe I’ll listen.

    Though I doubt I would.

    Only having the one life, and being forced by biology to live it myself, I prefer X years of reasonable excess and indulgence over 85 years of asceticism, thanks. That’s my choice; Dr X, Prof Y and the govt can live theirs as they choose, too.

  8. Progress of a sort.
    Start by blaming the customer. (As here.)
    Then later you might even consider listening to him.

  9. I’m puzzled by the attitude here that you shouldn`t give someone advice if you see them doing something that strikes you as foolish. They have every right to tell you to fuck off, if that`s their whim, but does that remove your positive duty to try and prevent them doing whatever it is?

    Are you honestly telling me you`d just stand and watch if someone started, say, cutting the branch they were standing on? If you don`t warn them, you don’t get to laugh at them as hard when they fall out of the tree and break an arm.

  10. Re “compulsary exercise”… I’ll start to worry if I hear that Tim Yeo or Lord Deben announce their positions on the Board of any gym companies. 🙂

  11. I’m puzzled by the attitude here that you shouldn`t give someone advice if you see them doing something that strikes you as foolish.

    Advice, fine. Ideally not spending huge amounts of public money in so doing. But what we are seeing here is the Overton Window being ratcheted rapidly towards the dictatorial. For our own good, of course.

    And pretty much what Interested said at #9, as well.

  12. Thre’s no great puzzle here, Dave.

    As SE says, if you’re just advising people, great.

    You should be as free to advise people not to get pissed every night as they are to ignore you.

    Not that anyone seriously suggests we’re just in the realm of advice.

    Bottom line, for me: any adult should be able to do what is legal (and we should proscribe as little as possible) with his own money.

    At the same time, I should not be forced to hand over money that I have earned to Man A to fund him informing Man B that Man B is doing stuff that *strikes Man A as foolish*.

  13. On the infrequent occasions I visit my GP, I am always amazed that she insists on taking my blood pressure, referring me for blood tests, asking me how much alcohol I drink – none of which has any bearing on the point of the consultation. It does, however, generate work for legions of NHS staff and she can then lecture me for my own good….However, I would prefer a system of machine diagnosis rather than all this nannying, which is slowly becoming bullying.

  14. Diogenes, it also generates income for your GP via QOF points, which are an expensive and bureaucratic way of paying GPs to do things they already did where necessary, when they are not necessary.

  15. [email protected],
    You are welcome to spend as much of your own time and money as you like ‘advising’ me.

    As soon as you or your ilk want a minute of my time or a penny of my money in order to dispense such ‘advice’ you can F’ off.

    If that seems unreasonable, I suggest a simply test – please made a cheque payable to Tim W for

  16. Regarding advice.

    I was once at a meeting in which bloke X said to bloke Y, in a caring tone, “Y, do you mind if I give you some advice?”
    To which bloke Y replied, “No X. Providing you don’t mind me telling you to fuck off.”

  17. @Diogenes: Go to a dr in the US. You’ll have your BP taken 3 times before you get there. Every time.

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