Blain’s Morning Porridge, September 2nd 2022 – The UK’s NHS is a political nightmare – but could yet be fixed!
“Physician, heal thyself.”
This morning– The last thing new UK premier Liz Truss will try to do is fix the NHS. Too difficult and an electoral minefield. It will get worse. But, tech and medical advances plus a bit of flair could give us a new NHS fit for purpose and ready for the next century. It will take will and imagination – which is unlikely to be found in the Department of Health or No 10.
A few days ago I warned how the UK could squander its global reputation, give up its status as leading G7 nation, and even see our global soft-power evaporate (with all that would consequentially mean for house prices, tourism and the foreign student business). It could happen if faith in the economy, politics, the bond market and currency collapse. I call the relationship between them the “Virtuous Sovereign Trinity”. If one leg breaks, the whole edifice will totter. If the currency collapses because the world thinks the UK is fundamentally broken, they we won’t be able to fund recovery through the Gilt (UK Bond) market.
Ahead of our “eagerly awaited” new government next week (Sarcasm Alert), I’ve upset a number of quite serious (even important!) Porridge readers with my comments. If I’m “so bloody clever, how do we fix it” demanded one, asking me for specific examples of how the UK can turn around the current decline.
Unfortunately, I am not clever. But I know people who are. This morning, let me go into a controlled rant on one aspect of what’s wrong with the UK.
Let’s start with our failing National Health Service.
The NHS is the biggest employer in Europe. It is out best loved, best trusted but possibly least effective institution in the UK. There are some 53,000 bureaucrats in the Department of Health notionally “managing” it, with innumerable layers of local management – many paid excessively well, while nurses live on a pittance. It is a ravenous devourer of resources.
There are calls to change the funding model – some experts have suggested social insurance schemes, but that just misses the point: unchecked the NHS will quite happily consume every penny of taxes or levies it is given, and still bleat about underfunding. NHS spending accounts for 9.6% of UK GDP – but is actually less per head than France, Germany or the USA!
Fixing the NHS is a political impossibility.
To suggest any kind of change would be the death of any government – triggering outcry from unions, staff and the Great British Public about privatisation by the back-door. As we discovered during the pandemic, the NHS has become an obsessive national cult. All governments are willing to do is tinker with it – meaning it becomes progressively less and less efficient.
Don’t expect the new government to act. Fixing the NHS is the last thing the new Liz Truss government will try in the 2 years she has to present herself as a competent replacement to the last 12 years of Tory Chumocratic incompetency before a UK General election is due in 2024.
Disclosure: I am very familiar with the NHS. I love and hate it. It is caring, kind, but bureaucratic and painful to deal with. I had a heart issue addressed through a corrective operation – on a private health package. Unfortunately, private care was not so hot; they missed an infection, the repair didn’t work, and I had a massive heart attack – at which point the NHS put back together again. I could not have asked more of the NHS – they saved me and keep me alive.
We are all aware of the multiple chronic problems faced by the NHS. These include:
- The NHS is fundamentally an organisation designed for the 1950s, trying to function in a 2020s environment.
- Tinkering over the decades has made it less efficient, managerially top heavy and bureaucratically emburdened.
- The NHS is catastrophically short of doctors and nurses, while largely private Welfare care services are short of 150,000 care workers.
- Doctors earn comparatively well, but nursing and welfare jobs pay well below what workers could earn outside – care is considered a “vocation”, meaning employers historically pay less!
- The rebuild of decaying NHS infrastructure – crumbling hospitals, has been delayed.
- Waiting times for patients have ballooned.
- The bulk of resources, costs, beds and staff time are now consumed by the elderly.
- The lack of nursing home care and community care means elderly patients block chronic care beds in hospitals – and UK bed capacity is very low compared to other G7 nations.
- Accident and Emergency rooms – increasingly concentrated in a small number of large regional hospitals – are swamped – one reason being patients going direct to A&E because they can’t get appointments with Local GPs.
- The UK remains at the forefront of medical research, but lags in terms of technology.
NHS England, has a list comprising 41 pages of priorities to address – everything for Autism to Stop-smoking. When everything is a priority – nothing is.
What the NHS needs is a new over-arching plan to address staff shortages (which means paying them properly), an infrastructure plan to rebuild capacity, and a new national health plan to ensure resources are directed more cleverly – more nursing home and welfare care for the increasing elderly patient demographic, smoother access to minor injuries and ailments at local level (to relieve the A&E impasse) and greater emphasis on preventative care. Kind of obvious – but its not happening.
To analyse the entirety of the NHS’s problems in the 2 hours I give myself to write the porridge each morning is not possible – especially when there may be a new crisis approaching.
Earlier this week I read a frightening article in the FT: The growing evidence that Covid-19 is leaving sicker. The data emerging post Covid highlights how Covid may have significant detrimental consequences for survivors on their long-term health – accelerating the diseases of old-age. The numbers show rising respiratory illness, rising cardiovascular disease, rising strokes, rising dementia and increased brain shrinkage among Covid survivors. There is a very good piece on ZeroHedge – The Mysteries of Long-COVID – which illustrates the US experience. It confirms long Covid health problems are hitting not just the vulnerable, but the ultra-fit as well.
Yesterday, I was relieved of a vast quantity of blood to be tested by my chums in the NHS – they confirmed everything in both articles. There is a wave of post-pandemic critical illnesses sweeping the country. There is, however, little evidence to support the growing urban-myth that it’s been Covid vaccines that have triggered a wave of heart-attacks, although I have two good friends who swear Covid jabs trigged their moments of crisis! Its more likely Covid accelerated their existing conditions.
In the face of the extra long-term pressure Long-Covid will place on the NHS, maybe what the UK needs is a more radical solution to health care… like using technology.
A few years ago my Cardiac Consultant outlined a modern healthcare system – all of which was based on then current Genetic, Diagnostic, Data and Artificial Intelligence tech readily available. (Since then the medical tech, data processing, AI and systems have got even better.) Simply put everyone should have responsibility for all their medical data. He suggested:.
- Everyone becomes the owner and retains responsibility for their Personal Health Data (PHD).
- PHD will be encrypted and stored on your smart phone, and backed up on the NHS.
- Real time data from wearable health tech, genetic and medical tests, is added to the PHD, and interrogated by inbuilt AI to highlight changes and suggest causes.
- Your PHD will include all your genetic traits – including propensities to cancer, heart disease and other illnesses.
- Wearables can add exercise, heartbeat, blood-pressure, ECG and other data to the PHD – with the AI can interrogate.
- PHD data is not shared with outside agencies – like insurance companies.
- Individuals can make the decision to share your data – and be paid for it. I.e, Insurance companies would need to reward customers who give them access and record data.
- Every year, everyone gets a full spectrum blood test – to check for markers of change.
- Unexplained changes are followed up with further investigations – such as MRIs.
None of this is rocket science. You can do it privately already. The key to the system is the AI – rather than patients presenting themselves with symptoms and doctors then spending months trying to diagnose whatever ails them – searching for the needle in the haystack – the AI (which will be constantly learning from 62 million UK users) brings the haystack to the needle! It will be able to direct physicians to the most probable cause – dramatically cutting down time delay, and improving the use of resources, freeing them up for preventative medicine.
Unfortunately, the NHS innovating such a modern system is unlikely.
THey may welcome the multiple new bureaucratic jobs the Department of Health will insist are neccessary to examine it, but the Health nomenaklatura is notoriously anti-tech after multiple failures to innovate NHS databases over the years. During COVID, the Test and Trace tracking system devoured £37 bln (20% of the NHS budget!) to deliver absolutely nothing. (Except a damehood for its leader Dido Harding, who farmed the work out to very grateful consultants who were paid rather well at an average of £1100 per day…) The British Medical Journal was scathing: NHS Test and Trace failed despite eye-watering budget.
But….. What Test and Trace did demonstrate was the ability of the UK to build-out very quickly a full laboratory testing infrastructure. The UK’s response to Covid showed what can be achieved – when the will and urgency is present. The AstraZeneca vaccine, the vaccine programme and the (actually never used) Nightingale emergency hospitals all highlight the fact the UK can deliver when pushed and challenged to do so.
If firms like Meta, Netflix, Apple and Amazon can build the tech to amass details allowing them to predict every aspect of our commercial likes and dislikes, its not inconceivable a smart entrepreneur could build out a PHD service for the UK. It would improve treatment and care, and allow the NHS to refocus on the other aspects:
- The right mix of facilities to treat the demographic (the AI would provide the real-time data to do so)
- The right salary structure to attract staff – making care in the community and nursing high quality roles.
There is nothing that can’t be solved – even the NHS.
Six Things to Read This Morning
Spectator – Trussonomics – A beginners guide.
Out of time, back to the day-job, and have a great weekend. I am off to do a charity-walk round Stonehenge this weekend – and really looking forward to it!
Strategist – Shard Capital