The NHS crisis- a fundamental issue

James Bond
4 min readFeb 8, 2023

The crisis in the NHS has now reached new heights.

In case you don’t know in the UK healthcare for citizens is free at the point of need. It’s paid for out of taxes.

However, there is a fundamental issue that nobody has addressed. It’s common among the public to believe that there is a conflict between politicians, NHS management and clinical staff. The general public appears to believe that politicians and NHS management both want to cut costs whereas clinical staff want more money for treatment.

When I was a 3rd year medical student, I attended a lecture and one of the speakers was the clinical director of Rotherham District General Hospital. He said that when he was a final year medical student he couldn’t understand why there was a conflict between management and clinical staff. Some 30 years later he still couldn’t understand why.

There is one simple reason.

In every single case, without exception, well organised good quality clinical medicine is ALWAYS value for money medicine. The better the quality of medical treatment, the cheaper it is.

Let’s me give you a few examples.

Ear wax

Anyone who has children will know that a build up of ear wax among children is a common condition. The mainstay of treatment is to ask the parents to put some warm olive oil down one ear and leave it for 10 minutes, then ask the child to turn over and do the same on the other ear. This softens the ear wax and in most cases the ear wax will fall out by itself.

Commonly the family doctor (GP in the UK) will refer the patient to the ear, nose and throat (ENT) surgeon who will remove it under the microscope.

This is what we did in my Dad’s GP practice. We’d get the parents to put olive oil down the ears. The patient would be referred to the ENT surgeon. However the referral letter would ask that the appointment be no less than 3 months after the date of the letter. That would give the olive oil time to work. In near enough every case the ear wax would fall out and the patient would cancel the appointment.

Combining of operations

Although NHS treatment is free, paid for out of taxes, we paid privately for my grandmother to have surgery. Now she needed a manipulation under anaesthetic for her frozen shoulder. She also needed her gall bladder taken out. My Dad being super organised decided to liaise with the orthopaedic surgeon, the gut surgeon and the anaesthetist. Whilst she was having her gall bladder taken out, whilst she was under anaesthetic, the orthopaedic surgeon did the shoulder manipulation.

Now, this was done at a private hospital. It saved everyone time, and resources and most of all it was better for the patient.

Had it been on the NHS then all three of those doctors would have been suspended and put through the disciplinary action process. On the NHS she would have had two separate operations wasting money for the taxpayer.

See what I mean?

My asthma and family history of diabetes

Technically speaking I have asthma. I was diagnosed when I was 12. However, my Dad got me swimming competitively for a local swimming club and I ended up becoming a very fit indeed. As a teenager I never used my inhaler. In 2017 my family doctor gave me a repeat prescription for an inhaler. It’s been at the bottom of my sports bag since. Unknown to me, it expired in 2020. In August 2022 my mother noticed this and made me get a repeat prescription from my GP.

The last time I went to see my GP for my annual check up we discussed my asthma. He asked if I had kept a peak flow diary to monitor it. I said I hadn’t because I’ve had no problems with it. He asked how often I had used my inhaler. I showed him the box, the seal hadn’t been broken and said “not once and I told him I work out 5 days a week.”

I asked him what my blood tests showed for my blood sugars given my family history of diabetes. He told me that everything was in the lower range of normal.

He examined me and all was normal. Being a former doctor, I asked him if he was going to send me to the hospital for a chest X-ray and spirometry (where they assess lung function.) I also asked him if he was going to refer me to the hospital for a glucose tolerance test. He said he could not justify the £300 or so that would cost given I was in such good health.

I have never had an asthma attack. In the worst case scenario, someone who ends up with a medical condition called status asthmaticus when the asthma is life-threateningly urgent is transferred to an intensive care unit. However, that can cost upwards of £1000 per day.

I have never had an episode of diabetic ketoacidosis. All patients who have a DKH should be looked after in an intensive care unit. Again costing at least £1000 per day.

The cost of my supposed asthma and diabetes is an annual check-up, one blood test a year and an inhaler which never gets used to be prescribed once every 3 years.

See what I mean? By contrast look at this example.

A relative of mine is booked in to have a diabetic eye screen at the local hospital in a few weeks.

One week later the same relative is seeing the same specialist for cataract check. Would it not make sense to do both at the same time?

Now I am sure you understand what I mean.

If they want to cut NHS costs then there is no conflict. Clinical care needs to be better organised and be of tip-top quality.

Bibliography

Image from https://www.bbc.co.uk/news/health-64190440

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