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REVISITING IN DECEMBER 2016 – TODAY’S SOCIAL CARE CRISIS (and much else) IS DUE ENTIRELY TO THE COWARDICE OF ALL THREE POLITICAL PARTIES IN NOT FACING UP TO A DESIGN FLAW IN THE NHS

People like me – retired – should contribute directly to the cost and everyone should share responsibility with the State for their own health care right through to their retirement.

THE STATE SHOULD HAND OVER NATIONAL INSURANCE (NI) TO THE INSURANCE COMPANIES FUND THE NHS AND PRIVATE HEALTH CARE  – TOPPED UP BY THE STATE, MAYBE WITH AN INCREASE IN PENSION PAYMENTS, AND CERTAINLY PAYING THE PREMIUMS OF THOSE UNABLE TO PAY

National Insurance is about the same as the cost of the NHS -around £100bn a year!

I have suggested that if you come up with a good idea the first thing you should do is to factor in human fallibility, and certainly you should do this before you start implementing it.

(Visit if you have not already done so http://goo.gl/CoVvY)

Can I test this out with one of the best ideas in the 20th Century, the NHS – healthcare meeting the needs of everyone, free at the point of delivery?

A truly great idea but, when you have read this, you may feel as I do, that this is precisely where they went wrong in the first place and where they have stayed wrong in the umpteen reorganisations ever since. They didn’t factor in human fallibility …. or even the human condition, but I will come to that later.

And they still don’t.

Yes, many doctors, nurses and therapists are highly skilled and dedicated to their profession, but some are not. Many civil servants and administrators are highly competent, but some are not. And, as important as anything else, many people who look to the NHS to address their health needs do as much as they can to keep themselves healthy, but some do not.

You like me will have seen plenty of examples of the good and the bad and the ugly. They are reported in the press, with the bad and the ugly making most of the headlines. Underneath those headlines there is always pain, suffering and COST. You may also have seen it closer at hand with friends, family and neighbours.

The latest headline relates to obesity that costs the NHS a fortune trying to cope. Binge drinking that fills A & E on a weekend is another and doesn’t do kidneys much good either. Smoking among the young leading to cancer another. Drug addiction another. Meanwhile how many get health checks? How many men over 45 get their PSA test to head off prostate cancer?

These are always presented as insoluble problems. The only answer seems to be appealing to people to mend their ways. But they never do.

Before I suggest ways of facing up to human fallibility, I must make it clear that I do so as a beneficiary of the medical profession and the NHS. I would be dead three times over by now without them, without the mass Xray when I went to University that disclosed TB and the treatment afterwards, and a BUPA health screen in 1996 that showed an elevated PSA and prostate cancer and the treatment for that. Between times the NHS saved me from peritonitis and addressed a few orthopaedic ailments and more as well. My writing is a way of saying thank you.

The one great lesson I learned in all this is that it was a mistake to depend entirely on the NHS to know what was best. When I was diagnosed with prostate cancer a good friend of mine urged me to be responsible for my own body and choose the best way to treat it.

That was when I realised that the system should encourage people to do the same, and accept some responsibility for their own bodies, not just expect the State to do so all of the time.

The other lesson I learned is – and I have commended it elsewhere – that promoting excellence is not so much a matter of money as an attitude of mind. I am sorry it will be unequal, and it won’t be everywhere but if you keep chuntering on about equality you end up with mediocrity, as we have now.

So here are three suggestions to address human fallibility. Much better than thinking on the one hand that all you have to do is throw money at the problem. There’ll never be enough. Much better than thinking that all you have to do is eliminate waste. You’ ll end up with enough false economies to fill a bathtub. So here we go!

1. Take National Health Insurance right out of National Insurance and use it specifically it to fund the NHS . Charge it on those who can afford it until they die with employers contributing as now, but don’t stop it when people stop working. Fund it for those who can’t afford it; give a tax credit to pay the premium. For those at work this should be tax neutral. And provide insurance cover in case you need a care home or a nursing home at some time in your life. That may not be tax neutral as much as tax necessary.

When National Insurance was introduced it was assumed that most people would die soon after they stopped working. The NHS has done its job too well – for people like me, as I have said! For my lunchtime companion today who had a heart transplant over twenty years ago! It has helped to raise life expectancy so that those born today, short of some disaster, should expect to live many years after they stop working, maybe until they are centenarians!

Those who dreamt up the NHS never saw the cost of that alone. It wasn’t just that they didn’t factor in human fallibility. They didn’t factor in the human condition either and the exponential growth in the cost of health care to provide for it. Leading edge medicine doesn’t come cheap.

2. Don’t focus on privatising health provision, instead give it to the Insurance companies to collect the premiums and privatise paying for it. They already manage private health care, and manage it very well; and private health care would remain as a top-up for those who could afford it – giving some extra choices that with the best will in the world the State will never be able to offer to everyone, and certainly not on its own. Stop pretending that it ever can. As I have said elsewhere, fairness not equality should be arbiter.

And don’t sneer at Insurance companies here. As long as the State provides the rules, they will play the long game – that is one of their virtues – and they will, in competition with each other, drive up standards and drive down costs. They will want both.

3. Then pay people to keep healthy! This is not such an outrageous suggestion if you think about it. Give people credits if they do the right thing: watching their body weight ratio, having regular health checks, going to health clubs etc. But by the same token load their policies if they don’t: if they over eat, over smoke, take drugs, end up in A & E on a Friday night &c. This works eminently well with car insurance where drivers can have no claim bonuses if they drive carefully, but loaded premiums if they drive carelessly or with alcohol in their blood.

And to those of you are thinking “why does the person on the touchline always seem to think he knows more about football than those on the playing field?”, I have myself a question “Why do those on the playing field never tell you that what I am suggesting is how they do things in Germany? Why, 60 years on, do we still fight the last war on our TV screens while Germany continues to walk off with the prizes? Why do they never tell you about Kaiser Permanente in the States . It is a non-profit making health care organisation and now has 8.9 million health plan members, 167,300 employees, 14,600 physicians, 35 medical centres and 431 medical offices.

There are more ways than one to crack a nut.

I’ll tell you why. It is not because they can’t see the fly in the ointment. They don’t want to see it. It is, as I have said elsewhere, the fly in their ointment. They never like to own up to their mistake. Sorry to harp on it. It is the same as with Inclusion and special education. But if you never admit to a mistake, you will never correct it.

I like metaphors. Death of a Nightingale is a small story but a gigantic metaphor. I’ll give you another one. I have already used it in ispy. There badly needs to be an abattoir for some sacred cows.