Public blunder - it's Crimea all over again

A tempest is blowing through the complacent hubristic corridors of power in Whitehall. They have been tested and have failed utterly and humiliatingly, and now they must face the gales of change.

NHS central procurement and NHS and PHE central testing, we were told yesterday, wasted £25bn due to incompetence, a confused commitment to central command and control, a concentration on fashionable management nostrums and jargonistic pabulums rather than on efficiency and effectiveness. It was the rule of dire and dismal senior managers with a focus on reducing sugar in breakfast cereal rather than saving lives. It is the grossest and most culpable mismanagement; indeed we have seen nothing like it since the debacle in the Crimea exposed the manifold failings of army management.

You may know how the media and the telegraph shone the disinfectant sunlight into the dark establishment corners of mismanagement, blunder and stupidity in Crimea. Medical and logistic failures. Troops with no tents or winter clothing, no means of preparing food hygienically, inadequate medical care, flogging at the wheel, a system of buying commissions that left the army in the command of idiots and fools. The British public at the time were outraged - but the establishment aristocrats who ran the army closed ranks and blocked all attempts at reform, for a while at least. It took Prussia's thrashing of the Kermits and an establishment panic that eventually allowed Cardwell's reforms of 1870 - 1881. Barely a generation short of powered flight and the cinema we stopped flogging servicemen.

The Whitehall establishment will make the same impassioned defence of their blunder, malfeasance and incompetence as did those cretin generals back in the 1850s. They are as far out of their depth now as they were at the time of Crimea. They have no place in office, no place in power, no place in control of our taxes and no place in a democracy with a government with a mandate to cleanse them.

Pre-Nightingale NHS hospital in Crimea - disease prevention by PHE

GP shortages signal NHS failures

Young people want to live in cities, and young doctors are no different. This is true not only for the UK but for much of Europe - and in Europe the effects of rural depopulation are far more pronounced. It is this metro-centricity that is being blamed for what the Telegraph terms an alarming crisis in rural NHS GP provision. Yet not everywhere that experiences rural depopulation also experiences GP shortages - here in Austria, for example.

A shortage of GPs in rural areas can only be because of two reasons. Either the nation does not have enough GPs, or we have enough overall but imperfections in the GP employment market create surpluses of GPs in the cities and shortages in rural areas. In the UK, both problems can be laid at the feet of NHS mismanagement. It has failed, just like any centrally planned economy. It has failed because the NHS distorts the employment market.

Here in Austria everyone pays into social insurance firms - there are several - that also run hospitals and clinics. GPs are self-employed, and hang their shingle wherever they judge they can earn a living. Some GPs have more than one surgery. Commonly, they work alone - which is not a problem when they're away on holiday (which is frequently) as insured citizens can use any GP; there's no such thing as being registered with just one. Consequently, their skills are offered to the market on very much a commercial basis; If I like Dr Musterman, I can take my business to his ordination, if not I can see young Dr Wächter down the road. An E-card confirms one is insured. For each visit, the GP is paid €18.86 by the social insurance firm and the insured pays a premium of €3.77 on their insurance cost. Of course there are central government subsidies in various forms to the social insurance providers so it is not wholly like the US insured model (for a start, my health insurance is only about €45 a month), but this mix of health by both tax and free market mechanisms works - at least to the extent of ensuring there are plenty of GP surgeries in rural areas.

You see, the reason that UK doctors give to the Telegraph for not wanting to work in rural and coastal practices - the pressure of high numbers of elderly people - is the very reason that Austrian GPs hang their shingle in such places. Old people are good business, if you're paid per consultation.   

Poor women with large tattooed breasts - 11 years on

Back in May 2007 I posted a piece titled "Poor women with large tattooed breasts will have to do the best they can" which has, over the years, attracted over 3,000 hits. I guess some 2,800 googlers or more will have been disappointed. There were no illustrations. It was about non-essential NHS procedures and I wrote

Whilst I also believe that funding decisions should be made at the local level by local bodies of health professionals and citizens, rather than from the State central health bureau, I think the NHS (or rather the NHS at its local level) should be allowed the power generally to ask for top-up fees for a whole range of medical procedures; a charge that is somewhere between free and the cost of a wholly private option.

Fertility treatments, breast enlargement or reduction, tattoo removal, elective caesarians for mums too-posh-to-push, varicose vein removal, cosmetic plastic surgery, piles reduction and many other minor procedures are now seen as a 'right'. This is never what the NHS was founded for. What next? Baldness treatment for men 'psychologically damaged' by being slapheads? Buttock implants for women who see a phat booty as a 'cultural necessity'?

Of course we're all happy to get something for nothing. But I'm sure if given the choice between spending money a year's gym membership or getting our piles sorted next week, we'll go for rectal comfort. 'Unfair to the poor' I hear some say; yes, perhaps. But not life threatening. And poor women with large tattooed breasts will just have to make out the best they can.

Well, NHS England have just caught on. Eleven years late and some £2bn wasted that could have been saved had they formulated policy from our blog posts in a more timely manner.

Of course, back then hardly anyone had gender reassignment treatment on the NHS whilst now there are thousands queueing for gender dysphoria counselling and hundreds waiting to have their tackle lopped at £16k a chop. But I doubt the NHS would dare face up to the Trans lobby - at least not for another eleven years.