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Dear Mr. Snowdon – Tsk!

The NHS lies to us and we lie to ourselves about the NHS. That’s the deal. On Sunday – the NHS’s 72nd ‘birthday’ – Matt Hancock asserted that the NHS is ‘the best healthcare system in the world.’ Can he really believe this? Does anyone? It is debatable whether the NHS is the best healthcare system in Britain. Believing it to be the best in the world requires a uniquely insular form of blind patriotism.

It is a claim that can be tested with empirical evidence and there are plenty of health statistics to consult. The UK has 2.5 hospital beds for every thousand people. The OECD average is 4.7. We have 2.8 practising doctors for every thousand people, less than the OECD average of 3.5, and we have 7.8 nurses for every thousand people whereas the OCED average is 8.8.

It is outputs that matter, not inputs. Or even, the relationship between them. But it’s still not true that the size of the inputs is the defining measure of whether something is good or not.

I don;t believe the NHS is better either but the number of doctors, beds, nurses, isn’t the way to show this. It’s the outcomes of however many we do have.

16 thoughts on “Dear Mr. Snowdon – Tsk!”

  1. So Much For Subtlety

    I don’t know. There are grounds for thinking that the medical profession has little to do with our health. That is down to good civil engineering and the pharmaceutical revolution in the 40s and 50s.

    So what they do is provide comfort and reassurance. Getting to see your doctor is a positive good. Waiting is not.

  2. GP’s seem to be intent on demonstrating their lack of value. My practice sent me this message

    In our effort to keep the surgery COVID secure and patients safe, from Wednesday 19th August 2020, patients requesting a GP appointment for a first / new episode of a common condition will be asked to complete an online consultation form. This will apply to patients aged 16 to 64.

    If I need to see a doctor I don’t want to tell them the reason on a fu**ing form. What do we pay them for? Let’s just make the bastards redundant

  3. About a month ago I managed to injure my foot on the farm through my own stupidity, got it crushed quite badly. Luckily no bones seemed broken so was sent home from A&E with a boot to keep it rigid, and bugger all other instructions as to its care. Having struggled on with work for a couple of weeks it was both improving in some ways and not in others, so thought it might be wise to get it checked out to make sure there wasn’t anything obvious that I might be exacerbating by continuing to work. I rang the local private hospital on a Monday, I was given an appointment to see a specialist on the Thursday. Saw him, he wanted some more X-rays so sent me down the corridor to the X-ray dept who took 3 inside 10 minutes, back to the specialist who checked them over, was satisfied all bones were intact and in the correct alignment, so suggested more time to let the soft tissue damage heal. All done inside an hour. Now I’ve no idea what this will set me back, I’ve not had the bills yet. But whatever it is I’ll guarantee it won’t be as much as it will have cost the NHS to do the same, given it will have taken them about 3 months and a cast of dozens to organise the exact same service, if they could be bothered to provide it at all.

  4. Bloke in North Dorset

    Our GPs are doing initial telephone consultations which I think is great, COVID or no COVID. GP surgeries and hospitals are full of sick people and the less contact I have with them the better.

    One of Mrs BiND’s friends had a minor stroke and picked up Covid in hospital and there’s no end of stories of people going in to hospital for minor ailments and picking up MRSA.

  5. The weekly round of applause for carers has morphed into an annual clapathon for the NHS as an institution. It has become a full-blown cult.

    True, but…

    The public will brook no criticism.

    Shades of Charles Mackay here. Except it’s not really the Great Unwashed pushing the NHS as the reification of compassion. Most proles, while genuinely pleased not to worry about bills when they visit a hospital, are well aware of the health service’s shortcomings.

    It’s Metropolitan elite opinionbaters like Danny Boyle, the BBC and the Guardian who treat it as a latter-day Ark of the Covenant.

    Yunno, the same people who probably also use Bupa.

  6. @Diogenes: my practice has switched to phone calls and improved their service. Last time I wanted an appointment before lockdown it was three weeks in the future and a paper prescription at the end of it. Phoned up on Friday asking for an appointment, got a phone call today and the prescription sent via EPS to the pharmacy 300 yards down the road. Finally they’ve caught up with the 21st century.

  7. Jim. You’re experience is the same as I’ve had in forrin’. Except they’re more same day immediate. The NHS is one reason you aren’t going to see me in the UK. I’d think twice about even a visit.

  8. I don’t visit GPs as I regard them as – with notable exceptions – fvcking useless at best, if not actively harmful. The second last GP I saw in the UK was smoking a pipe during the consultation, so that gives an idea how things have changed. A Budapest GP equivalent I took a work colleague to visit in the 90s was – literally – staggeringly pissed, bouncing off the furniture.

  9. Worstall is right. Measuring the quality of anything by inputs is stupid or dishonest.

    Mind you some claimed output measures are daft too. The classic is cancer survival from first diagnosis. Another would be what % of the population you’ve got taking statins.

  10. It is outputs that matter, not inputs. Or even, the relationship between them. But it’s still not true that the size of the inputs is the defining measure of whether something is good or not.

    Surely the defining measure of whether something is good is the efficiency of the system ie. Output per input.
    (Assuming output quality and quantity to be a set value across different techniques)

  11. Don’t believe all you currently hear about phone consultations, they have a place but as they now constitute 80% of my surgeries ‘appointments’ they also now have a waiting list especially if you need to speak to your own designated! doctor on a relevant condition, as they are as I discovered doing one day week.
    i had doubts about this originally but have two doctors who live over the road, since the lock down they rarely leave the house and one is a surgeon, still on the same money though, be careful what you wish for.
    Go private, no chance all private facilities are currently in the hands of the NHS, an article in the Times business section a couple of weeks back said people were cancelling their private health insurance as they could not use the service.

  12. Bloke in North Dorset

    Perhaps in pure economic terms looking at inputs isn’t a measure of efficiency, but if two countries spend x on health care and one gets X doctors and the other 2X doctors, all else being equal, you’re going to have to do a lot of work that to convince me that one set of doctors can be twice as productive as the other set.

  13. Bloke in North Dorset


    Someone was recently asking about Raedwald. Dick Puddlecote has just reported on Twitter :

    “ Hearing the sad news that long-time blogger @Raedwald has passed away. His writing was always sound, measured, thoughtful and erudite, he’ll be missed. RIP.”

    Sad news indeed.


  14. one is a surgeon
    Maybe he’s fixed up a spare bedroom as an operating theatre and is working from home.

  15. @wiggiatlarge

    +1 My mother’s GP practice is effictively closed. Phone practice and deluge of warnings then “u r in a q”. Then GP via phone is 4 week wait, blood samples: 3 nurses each doing 1 per hour in car park.

    Must see GP? Eight GPs, only one patient per hour allowed in.

    @BiND’s C21 modern GP? More like dark ages

    All this idiocy when C-19 virtually gone, herd immunity achieved weeks/months ago and five times more dying from Flu than C-19 since mid June

    Very good : )

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