Why the NHS is crap

Mid Staffs 4 650

It is amazing how so many people treat the NHS as if it is some religion to be worshiped, rather than the 3rd world quality consumer service that it is. They fail to realise that other developed countries also have health services, and nearly all of them do it better. The NHS is not the envy of the world, very far from it.

It is very important to understand that the NHS is composed of two completely different things. Firstly it is a compulsory insurance scheme. Everyone pays in, whether they use the service or not. And the service is available to everyone equally, no matter how much or how little they have contributed. All this is good, but why does the state do it? We could just as easily pass legislation to privatise this so that proper insurance companies do the job, as they do in some other countries.

The second element of the NHS is the provision of medical service. In our system this is free at the point of use, instead of paying then claiming. Both methods have advantages and disadvantages. From a users point of view it doesn’t matter whether the provider is the state or private enterprise. For instance all GPs have always been private, they were never nationalised.

So where does the NHS sit in the international rankings. The most thorough and respected research is the Euro Health Consumer Index (you can see their 2014 report by clicking here) the UK came 14th in Europe in 2015 and has never made the top 10 “mainly due to poor accessibility (together with Poland and Sweden the worst among European healthcare systems) and an autocratic top-down management culture”.

The World Health Organisation produced the World Health Report back in 2000 (click here) which had the UK in 18th in the world. Obviously the developing world countries will have become a lot better since, whereas the NHS was trashed by a Labour government (click for article).

There is a report by the Commonwealth Fund in 2014 which put the NHS first! (Click here to see it). But the Commonwealth Fund is an American left wing lobbying organisation who want to bring the NHS to America, so, for instance, they gave high scores for accessibility and free at the point of use. (Click here to see a total demolition of their methodology). However the Commonwealth Fund couldn’t hide the fact that the NHS kills a lot of its patients, coming 10th out of eleven countries on this score.

Bloomberg produce an annual ranking of health services by efficiency taking the crude measures of cost against life expectancy (click to see). This has the NHS at 17th. Despite the NHS telling us what wonderful value for money they are.

The OECD produce Health care systems: efficiency and policy settings (click here). The UK is Group 6, defined  as: “Mostly public insurance. Health care is mainly provided by a heavily regulated public system, with strict gate-keeping, little decentralisation and a tight spending limit imposed via the budget process.” Within this group the ratings are: High DEA Score: Norway, Italy. Above Average: Poland. Average: New Zealand. Below Average: UK. Low: Hungary, Ireland. So even amongst like systems the NHS performs badly.  The OECD’s analysis of the NHS: “The quantity and quality of health care services (in the UK) remain lower than the OECD average while compensation levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems.” Not good.

There is a website called QualityWatch which has internationally comparative graphs for a whole range of medical metrics (click here). These show up just how badly the NHS performs in many areas.

So it’s not looking good for the NHS. What are its problems?:

  1. Government ownership and control. Everything that the state does it does badly. State organisations do not have to look after their customers, so they don’t. They don’t have to be efficient and make a profit, so they don’t. Compare that with the free market where an organisation has to be efficient and has to look after its customers, otherwise it goes bust. So it is hardly surprising that the world’s best health services are largely privately run. They can still provide universal care free at the point of use. They are just much better at it.
  2. Immense monolithic organisation. The NHS is the world’s 5th biggest organisation with 1.7 million employees, up from 1.5 million in 2010, as the Conservatives have thrown money at it. The US Department of Defence, Chinese Army, Walmart and McDonalds are the only bigger organisations on the planet. This makes it pretty unmanagable. When the NHS was first formed the Conservatives were going to implement a far better structure had they won the 1945 election (learn about it here). But Labour won and imposed a centralised Marxist structure so as to increase their control over people.
  3. Waiting lists. The flow of customers and the availability of service are obviously in balance, otherwise the lists would get longer. So the existence of lists is purely, 100% bad management. Other health services don’t have them, or only have a minimal wait. People’s condition get worse whilst they are waiting, some of them die, many are in severe discomfort. This is Marxism at work, the organisation comes first and dictates to the masses. There is no beginning of a concept of customer service.
  4. Poor diagnostics. If you are pregnant then you are OK, but for many other conditions the NHS just will not find it, or will give up after trying a bit. The cynical might say that they don’t have to pay to treat things that they haven’t found. The result is a culture where instead of treating conditions they treat symptoms. Proof of the poor diagnostics is the immense regional variation, which can be seen in the NHS’s own Atlas of Variation (click here to see it). Why do commissioners in one locality commission over four times the number of audiology assessments per head of population than commissioners in another?
  5. Medical incompetence. The NHS spends nearly a quarter of its budget not on healthcare but on compensation for negligence and on lawyers handling claims against it. £26.1bn out of £113bn. (Click here for article). This is one of the very worst performances of any health service in the world.
  6. Attitude. Because it is a Marxist organisation, because there is no market competition and because it is free at the point of use the NHS behaves as if everything they do for you is a favour, a result of their generosity. But in reality you have paid for the service, you are a customer and you should be treated like one. They work for you, but you would never think so.
  7. Inefficiency. Some people in the NHS work genuinely hard, but spend any time in any NHS institution and you will see a lot of tea and gossip culture and a lot of people doing non jobs with incredibly low levels of productivity. This is because the trade unions rule the roost, because of inept management and because there is no compunction to look after customers.
  8. Excess “management”. Except they aren’t really management, they are administrators, counting the metaphorical paperclips. And a huge amount of the NHS budget is wasted on them. The number of NHS managers in England rose by 37 % between 1997 and 2010, they consume more than 15% of the NHS budget, a high figure by international comparison (click). And remember they don’t have to make a profit or look after customers, they just have to spend money.
  9. Lack of patient choice. You are the customer, you have paid for the service, yet the NHS dictates to you in a way that you would not tolerate from any other provider of services. Eye care and dentistry have been semi privatised, mostly even taken out of the state insurance element. And look how vastly superior the customer care and choice is. When they have to compete for your custom they suddenly become a whole lot better.
  10. Health care rationing. Your GP decides whether you can see a consultant, the consultant decides whether you will be properly investigated and then if you will be treated. The pushy middle class win out by browbeating till they get what they want. The NHS uses the cheapest drugs possible and only upgrade you to something better if that doesn’t work. Without rationing we would not be able to run the NHS as it currently is. So we don’t treat all those who need it or to give everyone the best treatment.
  11. Abuse of the system by patients, partly because it is “free”. When I was young a woman we knew was stuffing her pillows with prescription cotton wool. Two thirds of people attending hospital A&E should not be there (click). More than a million A&E admissions each year (up to 35% of the total) are alcohol related. The NHS does tattoo removal, breast enhancement, fertility treatment and homeopathy. It shouldn’t. People not turning up for appointments costs nearly £1Bn per annum. Most NHS patients are there because of self inflicted conditions; obesity, smoking, bad diet, alcohol and drug abuse. By 2011 25% of our population was obese which causes a wide range of medical conditions, from diabetes (10% of NHS spending), through heart disease to varicose veins and joint failure. Yet the whole monolith does not systematically try to fix this, they are too busy trying to treat symptoms.
  12. Huge numbers of badly trained third world doctors (link). For instance we have about 25,000 Indian doctors. But Indian medical schools are rife with corruption (link). And Indian trained doctors are four time more likely to be struck off in Britain (link).

And so it goes on. The NHS is fundamentally, structurally broken, it looks after its patients badly compared with other, similar, services in other countries. The main problem is its state run, monolithic, Marxist structure. It needs to be broken down into large numbers of independent, competing providers giving true customer care, choice and quality of provision. Until that happens it will always be crap.

Government spending 650


  1. For the NHS to work, we need a responsible nation. The statistics show that this nation has too many irresponsible people for the NHS to work effectively, so there’s 2 options: Privation which won’t happen because that’s political suicide. The other option is possible though and that’s to make people stop being so irresponsible by denying them treatment if they are responsible for their own health problem. Also prosecuting people who maliciously call 999.


  2. There is an area of economics known as “Health care economics”. It is one of the areas where economic theory map most closely to real-world experience. The area originated with Kenneth Arrows “Uncertainty and the welfare economics of medical care”, which was part of the work for which he received the Nobel Price in Economics. It can be read at https://assets.aeaweb.org/assets/production/journals/aer/top20/53.5.941-973.pdf

    I recommend some familiarity with the field.

    Incidentally, the selling point of the NHS is not results, but cost versus results. If the UK were to spend as much on health care as France or Germany, it would need to come up with money equivalent to almost the entire military budget. If Germany were to drop it healthcare costs to the UKs level, it could double its military budget from the savings.



  3. The problem identified here is not that the NHS is state-owned, but that it has too much interference from government; every government over the past few decades has promised “solutions” to the NHS, but each has made it successively worse, usually because those “solutions” involve huge top-down changes that cause massive disruptions and inefficiencies until they are complete, usually just in time for the next one to begin.

    To solve that, the NHS desperately needs to be reorganised as an arms-length body with minimal government oversight; all it should need is a guaranteed budget, and the means to negotiate for increases to it and access to government investment (for stuff like hospitals, rather than having to rely on the insane PFI scams).

    Sort that out and the NHS should do just fine by being given the chance to manage itself and focus on healthcare. This is an important point; you claim that privatisation is more efficient but that just isn’t true, as private companies have over-priced executives and shareholders to pay, and are happy to avoid more expensive medical treatments in order to cut costs. Besides which; no-one *wants* to have to shop around for healthcare, they just want to receive a service that isn’t being stripped and meddled with by the government all the time.


  4. easy, lazy comparisons with Chinese Army and McDo ( every critque has got to have iots Wamart etc comparitor) masks some interesting points that would be far more resonant and would attract some mature debate but you try and sucker punch the folk who could argue and give you(and the readers) a decent debate by the lazy ” the NHS behaves as if everything they do for you is a favour, a result of their generosity” – “they” dont They REALLY REALLY dont. You blow your own argument out the water with that one. you may ( I dont know) have had an experience(S) that leas you to that, but lets not do the lazy generalising, please.


    1. and I apologise in advance for the typos and other grammatical howlers. That is how many of my gears your article ground. In me.


  5. I am an Australian doctor and was unlucky enough to develop a serious infection in your country. My experience of the primary care system was one of neglect, negligence, lack of appreciation of general duty of care and a generally third world standard of primary health care with lengthy access blocks. I heard horror stories from UK relatives of waiting weeks to see a GP.

    Despite a reciprocal agreement with the Aust government for urgent health care I could not find a NHS GP to see me. I eventually paid £50 for the privilege of seeing a nurse practitioner who misdiagnosed me. I knew her treatment was incompetent.

    Eventually I became seriously ill – enough to be admitted urgently to hospital where I was given the cheapest and oldest IV antibiotic when I know there were more effective antibiotics but no doubt budgetary restrictions prevented their use. I have told my husband that I will never go to the UK again due to the high risk of substandard medical care.

    I dont know why the British public puts up with it. No use having free health care if you cannot access good treatment. I used to have a poor opinion of the Aust health care system but now I know how lucky we are in comparison.


  6. hi, you are correct, the nhs is crap, try not to use it, i prefer to use the health service in spain. people are easy to brainwash they have never tried the health service in a different country, maybe it is better than in zaire but not better than north korea. its for the peasants


  7. Let’s add the fact that the NHS has a heavy focus on buying expensive pharmaceutical with public funds from their ilk at the multinational drug corporations. Unfortunately politicians have been paid off to get these rules in place. There is little focus on effective cheap herbal remedies or vitamins (if they do buy vitamins they make sure to get the £2000 packet of vitamin d).

    Mostly just the same old story: more drugs, drugs and more drugs. Just look at the pharmacies struggling to cope with the stockpiles of prescriptions from the sick population. It’s one big joke.

    No medical institution wants to keep people well. They want to keep people sick and keep people buying prescriptions. Wellness does not make money. Sick people make money. Most of these medications don’t cure anything, they just mask symptoms, making you reliant on the medication.

    At the same time Monsanto are gene editing their gmo foods and selectively removing amygdalin from the food supply.

    Yet the mainstream propaganda machine continues telling the trusting public it’s bad for our health and the useful idiots repeat it.

    Our neutrophils are also responsible for neutralizing chemical and mold toxins and common allergens…sabotage them and almost everyone will need epi pens or have mold sickness or chronic lyme, strep, or staph, cancer and other infections – difficult to treat ones since when abx or other interventions cease the pathogens or cancer cells or viruses simply go back to multiplying and the white blood cells simply oxidize painlessly when they try to address the problem. Thiocyanate is the sole antioxidant that prevents the white blood cells self destruction and the body cannot make it without amygdalin which is not in GM food crops, fodder ones, or feed.

    All these sick people. What a wonderful revenue stream for Bayer, Monsanto, Eli Lilly, Merck, Pfizer, and so on…no laws have been broken.

    Now Order 81 and Amber waves later all farmers there are under contract to Monsanto – now BAYER Monsanto. We are watching the very well laid plans of Eichmann and Brunner play out…all the varieties of wheat that can grow after catastrophe in difficult terrains where in that Abu Ghrain bank. There is almost no alfalfa and linseed and other crops in Canada that are not GM – so the amygdalin is gone and the need for abx and other mainstream pharmaceutical treatments is cemented for people, pets, and livestock and will only continue to further skyrocket. A UK food study in 2014 confirmed that there is none in the UK. The USA is not so different. Temperatures above 210 and processing destroy both amygdalin and thiocyanate so it is safe to assume the deficiency in the US as well. White blood cells can be starved while the rest of a body is fed. Host compromise. Amygdalin is a form of cyanide but it is essential to a working immune system despite that. It is the ONLY thiocyanate precursor in microbiology. No other antioxidants fuel our white blood cells to my knowledge and the stores of thiocyanate in our livers are finite…

    The whole medical establishment is full of greedy, money-grabbing scumbags, whether it is privatised or not. No reform will fix it in its current state.

    What we need is a health revolution.


    1. That is a very long way from the truth.
      For a start it now costs well over a billion pounds to bring a new drug from molecule discovery to market.
      These drugs have drastically increased human longevity and quality of life, treating and curing very many diseases that were previously untreatable.
      A drug patent lasts 20 years, but it takes about 10 years to bring a drug to market. So that leaves 10 years to get that huge investment back.
      No wonder than most new drugs make a loss. It is only the occasional blockbuster that pays for everything else, Viagra for instance.
      There is no way the state has the judgement or appetite for risk to make the decisions necessary, which is why drugs come from the free market.
      But you want them developed for free. Which would mean no new drugs. No more diseases treated and cured. More suffering.
      Read and learn: https://www.bruceonpolitics.com/2011/02/03/we-love-big-pharm/


      1. No I don’t want drugs to be developed for free you misunderstand. I want the institututions I fund with my tax money to give me proper information about what is good and bad for my body. Not to fabricate lies so their buddies working in pharma can make us sicker and generate more profits.

        It wasn’t drugs that cured most diseases, it was vitamins that have. Yet the establishment doesn’t want this information public for some reason.

        Dr. Klenner consistently cured chicken pox, measles, mumps, tetanus and polio with huge doses of the vitamin c.

        All these are cured by vitamins: beriberi, pellagra, scurvy, rickets, heart disease (vitamin c), cancer (b17). Why are we not being told?

        Please list some diseases cured completely by drugs?

        Pharma is only interested in drugs they can patent. Not thiocyante, it costs pennies compared to any of their antibiotics and is a lot more effective. There is a huge propaganda machine spreading disinformation about thiocyante telling people it is dangerous, because the top brass in charge of the health system are a bunch of crooks. An institution with so much brainpower behind them doesn’t make foolish mistakes like that. If it does, they are playing dumb to serve an agenda. Sun Tzu: “Hide behind the mask of a fool”.

        The pharmacies are jam packed with prescriptions, and the people are reliant on the drugs. If the people are sick, (in a way the doctors don’t understand), they are fobbed off and sent home with sedatives to shut them up.

        Linus Pauling already found the cure for heart disease but no one in the establishment thought it necessary to inform the people. What they were interested in was making it appear like he was a senile old man while continuing to profit from medications and surgeries.

        This is not how a “just” system is supposed to work.


        1. In your case a little bit of knowledge does a lot of harm.
          The diseases that you say are “cured” by vitamins are mostly just vitamin deficiency diseases caused by a bad diet.
          For instance low levels of vitamin D, common in the North, are responsible for about 20 different diseases.
          So you are very confused.
          There are huge numbers of diseased cured completely by drugs. What do you think that antibiotics do?
          And how about the approximate 50% of cancer patients in the West who now achieve remission and who would, in the past, have died? Mostly now saved due to the use of powerful cancer drugs.
          Also diseases don’t necessarily need to be “cured” for a good outcome. Relief from symptoms transforms the quality of life of millions of people. From a simple aspirin to the latest biologic anti inflammatories the pharmaceutical industry has a massively beneficial effect on humanity.


          1. Name one disease completely cured by drugs, aside from antibiotics?

            Pharmaceutical “health care” is one of the biggest killers of human beings and is based upon and complete misunderstanding of what the body is, and fails because it is based upon profits. More people sick, more profits there are.

            The amount of people killed by conventional cancer “treatment” is much higher than those saved.

            You are deeply, deeply misguided.

          2. Your comment is all easily proven mistruths.
            Many cancers are cured by drugs, so that is quite a few diseases.
            Pharmaceuticals are not the biggest killers. The exact opposite is true, they have massively increased human life expectancy. The statistics are clear to see. You really have no understanding of the immense and strict drug safety regime that applies to pharmaceuticals.
            The number killed by cancer drugs, here again you are easily proved wrong by statistics. Cancer mortality has halved due largely to drugs. You really ought to read more and broaden your education. Maybe try critical thinking instead of confirmation bias because currently you believe the exact opposite to reality.
            You must hate FACTS like this: https://www.telegraph.co.uk/news/health/news/11641771/Cure-for-terminal-cancer-found-in-game-changing-drugs.html

  8. Pharacuiticals are the third leading cause of death after heart disease and cancer.


    Linus Pauling “most cancer research is largely a fraud, and that the major cancer research organisations are derelict in their duties to the people who support them.”

    Thankfully people are refusing chemo and successful treating themselves naturally with few side effects, even after being BULLIED by doctors who try and force them into taking chemo.


    Chemo will eventually be consumer choice-d out of existence.

    It’s a real shame the system doesn’t help us with real research into natural, safe alternatives and most people are left in the dark with no other options.


    1. Your BMJ blog is very confused.
      It says that lots of people have accidents whilst using antidepressants.
      Which may well be true.
      But it doesn’t say how many lives antidepressants save.
      The same with NSAIDs, which create a huge improvement in the life quality of millions of people.
      You realise that Asprin is an NSAID, presumably you want to ban it.


    1. This is a conspiracy theory site for the hard of thinking. It is not peer reviewed science.
      No doubt you think 9/11 was an inside job, that the Americans never reached the moon and that commercial jets lay down chemtrails.


      1. Your sources are not credible. Fake corporate media tells fairy tales.

        Only fools believe fraudulent mainstream sources. Peer review is often manipulated because it depends on who’s doing the peer reviewing.

        The institutions themselves have become medical parasites, metastasized cancers feeding on the heart of the public.


        1. You have no answer to the fact that statistics, for life expectancy and for cancer remission, prove you to be very misguided.
          As I said before you know nothing about medicine, pharmaceutics or human physiology.
          You have just picked up some wild conspiracy and are treating it as fact. When, self evidently, your head is full of lies.


  9. I agree with a lot of what you say about the NHS but a ‘for profit’ model has severe disadvantages – see the system they have in the US. I’ve lived in countries with a privatised ‘not for profit’ model where patients pay some money towards treatment to stop people from taking advantage and the rest is paid through a compulsory health insurance scheme with reasonable fees. I just had a look at some of the costs of their operations and when ‘bought’ privately (for instance in Belgium), they are half price compared to those in the UK and in privatised systems… why? You know why in the uk and no profit is added while staff are still paid a decent wage. I know for a fact that the quality of their treatments is world class and better or of equal quality to those available in the UK. On top of that, single rooms or double at most so you at least have some privacy. Switzerland, which has a privatised system, is really good as well, but expensive. Generally all health services are struggling with increasing costs of increasingly sophisticated and expensive treatments. The NHS, with it being funded and run as it is, is running a losing battle in my opinion, whoever is in power.
    As for the conservatives being best for the NHS… don’t make me laugh. I’ve tried three times now to get a GP appointment for abdominal pain which has been going on for months and I had a third ‘no’. I can’t find any private practices anymore either. They have all disappeared in the past five years.
    As for treatment in the NHS: nurses have always been fantastic but doctors not so much. I’ve been laughed at, almost shouted at by a surgion after a colonoscopy who told me not to come back (I suspect only because the colonoscopy was negative, but I was bleeding quite heavily during the weeks before, possibly stress related because of circumstances in my personal life. My dad nearly died from colonic cancer so I was in panic mode…), made to feel I’m a nuisance and not been listened to by a variety of doctors over the past 10 years, all for real and serious complaints. In most cases, during the few appointments I had, GPs were listening until they seemed to hear a key word and then all listening stopped and they were absorbed by their computer screens. For information, I’m not a labour voter, I eat healthy meals cooked from scratch and eat far more than my five a day etc… I also try and have as much exercise as possible. I’m now faced with a stark number of choices and will probably end up going abroad, which I can barely afford (also thanks to how the conservatives have ruined my profession over the years). People keep saying that they are against ‘Europeans’ coming here purely to use the NHS. In the case of Western Europeans, this notion is laughable as most of those countries have a better health service. So why would they come here? The NHS may have been something to be proud of years ago, but now my experience is that it’s at the standard or lower of some of the developing countries. Shameful.


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