In the firing line are some hapless nurses, to name but three: Bonka Kostova; Biju Reni; Ragula Lice Tagiteu (see link below). One wonders where they were trained, and what the culture (norms, values and beliefs) was of their training establishment?  Just an off-the-cuff thought.  (Edit: My ‘thought’ here is not racist-motivated, but is me raising a straightforward, practical question about the NHS’s capability to control the quality of its staff in terms of recruiting and training standards, assuming the NHS has little/no option but to recruit people from the four corners of the earth … to satisfy the infinite demand for its services.  My dentist is Polish, incidentally, and she’s brilliant).

One then – and often – wonders if the NHS is sustainable, as such?

Meantime, the man who presided over the biggest scandal ever to hit the NHS, er, now runs the NHS. He’s Sir David Nicholson of course.  Had to turn off the TV yesterday when he came on to bluff and bluster his way through the interview.  How do these people get away with it?  No different to the bankers I suppose.

For me, just one more leading indicator of impending transformational change to our society.

Incidentally, did I ever tell you about Professor Herbert Stein?  He was erstwhile Professor of Economics at the University of Virginia and Chairman of the Council of Economic Advisers under Presidents Nixon and Ford.  Professor Stein coined a term which has subsequently become known as ‘Stein’s Law’ (funnily enough).  Stein’s Law states that “If something cannot go on forever, it will stop.”  Stein’s Law is more profound than one might think at first glance.

Think, for example, about my wondering above if the NHS is sustainable, as such.  Especially when one learns this week (see my earlier post ‘If Proof Were Ever Needed’) that, come 2015, the UK government’s finances will be some £64 billion short of what’s needed to keep the wheels on: that’s pretty much the total cost of the NHS’s secondary healthcare system … of which Mid-Staffs NHS Foundation Trust is a part.

‘Stafford Scandal: Nurse Told Patient “I Hate You”‘ (DT 7 Feb 13): http://tinyurl.com/b4mxp58


  1. Andy Grafton · ·

    Hi MM,
    Perhaps I have a few insights being an NHS insider for the past 20 years [as a GP] and having worked abroad. You raise some important questions, but ones the politicians duck and dive around.
    1) We have an aging population. A 65 year old uses up 9x NHS resources than a 20 yr old. Pure demographics means the NHS will need to grow to stay still, as it were. It sound a bit like our Fiat monetary system doesn’t it! With our stuffed economy can we afford a first rate NHS?

    2) You raise the issue of culture and health care. The danger is generalising and being racist. There are bad apples in every system, and I’ve seen them in all races and cultures I’ve been in. However, I think it is true to say different cultures have different approaches and habits, some we would approve of, others not. As the saying goes: ‘you can take the person out of Africa,but can’t take Africa out of the person’. I go into many nursing and residential homes, the vast majority led and staffed by overseas nurses and staff. Without them we would have no NHS or care homes. [With their hours and wages few of ‘our children’ want to do the jobs.] Other cultures look at our disrespect and failure of families to care for their elderly and think we are barbarians. And they have a point. [I’m not naive to the pressures on families to care for their elderly, however].

    3) The NHS culture has changed over the years. The foreign born staff aren’t the main issue IMHO. When I started work [early 90’s] I knew consultants who resigned in protest at the new changes coming in at that time – money vs people. It has become more and more a box tick culture where you get no points for being nice or caring. There are many ways hospitals, and GP’s to a lesser extend, can game the system to appear better than they are. Accountants are only concerned with what can be counted, and much in health care is hard to count so it isn’t.

    4) There aren’t enough nurses/carers Full stop! 1 in 4 patients in hospital have some degree of memory loss. Take them out of their home and they become disorientated. The level of care needed is so much higher – they need prompting to eat, drink, even go to the toilet. Managers don’t see or note this. If they do, are juggling to balance a budget on which their job depends. There was a good editorial on the issues at Stafford in the BMJ. The perverse incentives for those running the Hospital’s means pressure from the top down is for a culture where patient care/comfort isn’t a priority. It may be stated in a Mission Statement, but the reality if different.This ultimately stems from Governments priorities: cost control. Sounds bites for Parliament and the media, with facts and figures ruling.

    5) I’m always cautious of news paper reports of individuals with poor experiences [and good] in the NHS. I could prove anything with anecdotes. They polarise and muddy the waters without providing clarity. e.g. If a patient dies from poor care -> and the whole hospital needs to close; all nurses and doctors are crap; the NHS is useless etc. As usual things are more nuanced. A patchy white/grey and black rather than all one shade. The Media are generally useless on informing the public on health care matters.

    6) The NHS per capita does wonders for the health of this country. Free at the point of need. Wow. Is it sustainable? Yes, if our expectations and its remit are well defined. As usual with human nature we want something for nothing. We want a service, but someone else to pay for it. The politicians know they lose votes if they try and tell us the truth, so don’t. How will it end? Well, the politicians will use this report to drive through more reform and changes and see health care fragmented more. That is the real killer. Private companies more and more are cherry-picking the profitable services [health screening/ testing/ routine procedures], and leaving the NHS to care and pick the pieces for those from whom no profit is likely: the sick.

    7) Those staff who are ‘Angels’ and really care, but worked to the bone, are leaving at higher rates. Better pay and conditions in other countries [Canada, Aus, NZ] and without the stress of trying to provide quality care without the support and resources. More sunshine. Moral is low, as low as I’ve ever seen. District Nursing is another service that is being gutted in my locality – there’s another story.

    Hey, I could rattle on for hours about the NHS, its pros and cons. My worry is that the government as moving us to a USA system. Frying pan into fire comes to mind. I think we will keep the ‘NHS’ [its to much part of our identity -see the Olympics opening Ceremony] but like the economy it will be tinkered with to paper over the every increasing cracks.

    Respectfully yours


    1. moraymint · ·


      Thanks for your comment and, as it happens, I also have very close connections to the NHS and so I can empathise with your views. I have edited my original post to avoid any misunderstandings about my mindset and motives. We live in a society now where the politicians have so moulded the national mood that anybody who introduces ethnicity in to a conversation can often (usually?) be assumed to be racist. Of course, the political class engineered unfettered immigration for its own ends (millions of voters for soft socialism – which is the homogenous form of all the 3 main UK political parties today) and, to a greater or lesser extent, for the corporate classes. The strange thing is that these days British politics seems to be a weird mix of Fabianism and Corporatism; odd bedfellows, but when you think about it, perhaps not. The end result is life in clover for the politicos.


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