I need to tell you where the trap is in relation to the NHS

Both Streeting & Starmer have committed to keeping the NHS “free at the point of use”…

But that can look like many different things
🧵
1/x For example, currently you can see your GP, get referred for a colonoscopy, be seen in a private hospital, and not be charged a penny. Technically, free at the point of care, even though it has cost us all more money to deliver that care.

The Darzi Report (England only)

My thoughts…

🧵 Darzi seems to grasp - to some degree - the depths of the state of the NHS crisis.

Crucially, Darzi gets that primary care is grossly overwhelmed.
His Second paragraph highlights the FACT GPs are seeing more patients with less GPs.

The new commonwealth healthcare survey is out & summarised here by @HealthFdn

Some read!

In short, all the rhetoric about “can’t get a GP appointment” is BS

Our primary care remains one of the best in the world

Hospitals don’t fare so well

🧵1/4

health.org.uk/publications/l… Big news is that access to GPs in the U.K. was one of the best

Yes, you read that right…

“This places the UK among the better-performing nations with respect to same- or next-day appointments, with only the Netherlands (50%) and Germany (49%) significantly higher.”

NEW: SNP manifesto

This is the kind of manifesto many wanted Labour to deliver

The pitch is left of centre - socially progressive…

with a persistent argument about the harms of being tied to a broken Westminster

Protecting the NHS from privatisation is a key theme

🧵 Some highlights:

SNP taking a clear position on integrity in politics and the lack thereof in Westminster. Hard to argue against this

Given some so called patriots want a French healthcare system, let’s take a look at it.

🧵

Summary: social insurance with 95% of people taking private healthcare to cover copays. Costs £40bn per year more. Less equitable than NHS, but can turn a profit
1/10 Akin to some other European countries, France uses a social insurance based model predominantly - where employer and employee pay a means-tested insurance premium

but unlike most EU countries the French people pay a surcharge on pretty much everything they access or use

Labour Manifesto - NHS

Some good policies but overall disappointing and a bit concerning.

A summary thread
1/x 1. There is the title: Build an NHS Fit for the Future

In one way, fair enough. Buildings are outdated and crumbling and IT is hopeless

But, Labour seems oblivious to the fact the NHS leads the world in medical and surgical care. The issue is merely access not tech upgrades.

We are already in a two-tier healthcare system

Nuffield Trust reports this week on a massive increase in private provision

More worrying, a massive surge in people using their savings to access care

From the best health system to one of the worst in 14yrs!

Summary 🧵 The amount the NHS pays (this is our tax money) to the private sector has nearly doubled in five years…

From £1.66b to £3.1b

2/9

I have no inherent obligation to work in the NHS

My obligation is to my patients, whoever they are and wherever they live.

But I want to work in the NHS…

Selfishly speaking, I appreciate not having to say no to treatments because a patient can’t afford it..

But…

🧵 1/6 After 14 yrs of Tory rule and a cowed and complicit NHS Leadership, patients are being denied treatment due to lack of resources. It is hard to witness, day in and day out.

The very principal of the NHS - access for all - no longer exists!

2/6

This is simply unbelievable.

The way the Tories go on about it you’d think we spend all our money on the sick and unemployed

But check out the stats!

We should be paying much more…

Near bottom for incapacity benefit Bottom half for social spending

France spends 50% more

Germany 25% more

The first episode of Breathtaking was so spot on:

The chaos

The fear

The top down diktats ignorant to what’s actually happening on the frontline

And the kick in the teeth: there was no need for such chaos…we had plenty of warning!
1/n You may be asking why only testing if travel history?

There were limited tests available, even though we had months of warning

It should have been a clinical call who gets tested not a management call

It’s been a brutal winter for most of us in the NHS.

Now I’ve a got a few weeks off I’m reflecting on medicine in the NHS in 2024
🧵 To be clear, as a general medicine consultant in the NHS we get an unselected patient group. We see all sorts from sepsis to heart attacks to strokes to cancer to drug overdoses to alcohol withdrawal…I will see most of them from admission in A&E through to discharge or death.

The Covid Inquiry has been asking questions about whether Lockdown could have been avoided. Some (like Sunak/Johnson) have interpreted this as suggesting we shouldn’t have locked down. It’s the entirely wrong interpretation and not the question the Inquiry is asking…

1/14 It is true that some countries didn’t lockdown and did far better than the U.K. But it was not the presence or absence of lockdown that determined the outcome. It was the presence or absence of an effective pandemic response executed early and well that determined outcomes

Johnson’s Testimony - Opinion

After 13 years of seeing this govt attempting to spin even the most damning of self-inflicted catastrophes, Johnson’s attempt to spin the UK’s tragically incompetent pandemic response takes the biscuit. It was as arrogant as it was hopeless.

1/n It should have come as no surprise that Johnson would treat the UK’s Covid Inquiry with the same contempt as he had shown the British people throughout the pandemic.

Johnson’s Testimony: Part 1

Managed to catch up with the first part of Johnson’s testimony.

Broadly, it is clear Johnson has been advised to take a broad view and not to get into the specific evidence. Of course, he can’t. The evidence is damning.

1/n It is better for Johnson to try and reinterpret how to perceive the evidence. For example, there wasn’t a toxic culture in No 10, it was just a heated time and people were speaking freely. A lot of 'don’t remember' and shoulder-shrugging when he can’t spin direct evidence.

Before Johnson gives his evidence we should consider a few things:

1. Just how bad was the UK pandemic response?
2. How much could Johnson have affected this?
3. What was Johnson’s intent?
4. Was there any overt maleficence?

Thread 1/n (buckle-up!) 1. How did the UK perform?
Badly. For many in the wider public, it will be quite obvious that the UK did very badly indeed. But for those who are still able to deny what they see, let's poke this a bit

Johnson will take the view that there was uncertainty and evidence was changing and advice was changing…better to be seen as indecisive than reckless.

But I caution anyone willing to take the dithering PM as a defence to think carefully

He set his stall out very early…
1/11 On 3rd of Feb Johnson gave his infamous speech at Greenwich.

Remember he hadn’t even been briefed by his CMO at this point.

Yet he was very clear that:

a) the pandemic was coming
b) it would necessitate significant restrictions
c) and it would bad enough to affect the economy

I wonder whether Johnson and Hancock have made a pact.

Hancock seemed to go to some length to, as far as possible, insulate Johnson.

The strategy seems to be…

1/6 Hancock was leading the charge Jan to early March - there is good evidence he did make efforts. And they will continue to blame scientists for any delays

Then from 2nd March, Hancock says Johnson was in charge…

2/6

Before Hancock's final evidence (for this Module) I thought I would provide the timeline that is forming from Hancock's evidence.

Bear in mind, this is what has been gleaned by the Inquiry and is of course told by Hancock and from his perspective.

1/n 13th Jan - there is clear evidence that Hancock sought advice about Border Controls. He was concerned we weren’t doing enough to prevent the virus coming to the UK.

21st Jan - Italy locks down Lombardy

Prof Dame Harries testimony was the most illuminating of the week so far

Bear in mind, Johnson only needed a handful of scientists to agree with his callous “take it on the chin” response

The Inquiry seems to ask whether Harries was one of them

1/n Harries is the head of the new UKHSA - the body now in place to lead on the next pandemic.

The Inquiry is right to make this point. This will be the person in charge next time there is a pandemic and their beliefs and approach will affect us all

Matt Hancock in the Covid Inquiry...unlucky for him it's my day off, so here goes the live tweeting

Please mute this thread if you are not interested. Firstly, the state of the Department for Health and Social Care (DHSC).

Hancock gets tetchy 'not clear that Valance's diary entries were written at the time and not with hindsight'

Ministers are clearly annoyed Valance had written it in the first place.

Managed to catch up with Gove's evidence to the Inquiry. It was painful to watch! Politicking at an epic level - trying to obfuscate blame away from him but not overtly dropping others in it...but he did, and like all Ministers he tried to throw scientists under the bus

1/n Gove was effectively head of the Cabinet Office from Feb 2020. As such, he was responsible for the office meant to take a leadership role during the emergency pandemic phase...

Even from Gove's evidence alone, it was clear the Cabinet Office didn't.