"NHS on its knees"

"The NHS now shares the same traits as many of those relying upon it to keep them alive and well: it is elderly, has multiple comorbidities, and is in dire need of emergency care…

“There are 105,000 vacancies. A&Es are overcrowded. Around one in seven hospital beds are occupied by patients who can’t be discharged. Some patients have had to wait over 40 hours for an ambulance. Care is being put at risk by neglected buildings due to underinvestment. And then there’s the waiting lists, which stretch into the millions across elective care, mental health and community care.”



I finally signed up for a family doctor with the Portuguese SNS (Serviço Nacional de Saúde) and asked for an appointment for a checkup. That was two, three, or four Fridays ago. Haven’t heard from them. I asked a local and he said to get there very early in the morning to try for one of the three non-appointment slots. He also said that if he was in a hurry he would go to a private hospital. Great socialist service so long as you don’t get sick!

There are a huge number of hospitals, clinics, and laboratories in Porto. I don’t know if private or part of the SNS. I believe that work in tandem. When I first arrived I had a broken tooth and the dental clinic around the corner asked for my SNS number. I said I was a new arrival and didn’t have one. They treated me as a private patient, nicely done, and inexpensive compared to Madrid. The two visits cost under 50 € as I remember.

The Captain


A reminder that even those with universal heath care have their limits.

“Send more money” seems to be a constant refrain. The voters always seem to ask for more.


I have a friend in Austin, been in the states for close to two decades (UK citizen) who is currently in so deep in medical bills he will never escape, and he’s still in some serious health issues (he is likely to become permanently disabled because of it) that he just cannot afford to have looked at. Never mind treated. I know too many other people in similar boats.

On the other hand, I have ex co-workers in the UK who used to tell me they can’t get their kids to the pediatrician when they are ill, so they suck it up or wait until its bad enough to hit the hospital instead. I’ve never experienced that myself here. In fact my primary care doctor once told me “if I want you to get an MRI you could get one tomorrow”.

It seems that in America we have lots of health care supply but at high costs, and in the UK they have limited supply but at low cost. (as a whole, we pay 2X roughly what any other first world country does on health care, but we don’t wait to see doctors either). It is odd how that dynamic works out, but it has.


I think that all depends. Medicare doesn’t seem to be all that expensive from the people I have heard from. All my friends that are in the VA benefits really seem to like it, they also think it is cheap.



None of these systems is perfect. Rationing care, treating the urgent cases first, delaying optional care are part of it.

Some national health care services also have insurance for private care if you get tired of waiting for something like a hip replacement.

Canada seems to have one of the best systems. You may have to travel 100 miles for an MRI but its available. But we hear of those who abuse the system by going from doctor to doctor for second opinions running up costs as a way to protest something not provided.


I was quite happy with the Venezuelan private practice. Smaller clinics tend to have better service than bigger hospitals. The doctors are well trained, usually abroad, and they have access to the latest technologies (had before the Chavez dictatorship ruined everything). It was affordable and the insurance was also affordable. One good thing about private practice is that you get to pick your doctor.

Venezuela used to be a medical tourist destination, specially for plastic surgery (how do you think we had so many top misses?).

The Captain


Commentary heard on the BBC during their PM shuffle, the same crowd has been in power since 2010, though the PM has changed. The entire period has seen continuous underinvestment in education, health care, and infrastructure. Now, the foreign nationals that helped staff the NHS are going home, because of BREXIT. The troubles at the NHS have been created over a dozen years of government policy.



Yea Venezuela used to be a bright spot in South America, what caused it to go down the road it is on now? What made the people turn against the country they have and elect an authoritarian?


A continually deteriorating economy after the oil boom of the 1970s. Remember Brady bonds? The country borrowed beyond its means and went bankrupt. Banks were willing to lend because countries don’t go broke and they had to do something with their excess petrodollars. Besides, in America Big Banking is a risk free gig, Uncle Sam will bail them out via the Fed, an organization crafted to steal taxpayer money to bail out big banker folly.

Then there is IMF policy, you have to tighten your belt when you are starving! Imagine the IMF bailing out Europe instead of the Marshall Plan.

Then a president decided to privatize without preparing the people for the painful near term consequences. The increase in the price of gas (from near zero) triggered riots, lots of dead people and the opposition managed to impeach the president on trumped up charges. Chavez staged a coup and was jailed but the opposition lauded Chavez. Then Chavez did what a former dictator did, got himself elected. The first thing he did was “GUN CONTROL.” He made sure only his gangs were armed. Next he sold the country to Cuba, he named his bodyguard vice president who has become the puppet president supported by the military, one of the largest drug cartels in the world.

I lost count but I think they removed 11 zeros from the currency in three stages, 3, 3, & then 5 more.

New Bs. 1 = Bs. 100,000,000,000

For 50 years I labored in Venezuela and then Hugo Chavez said I had fewer rights because my mom gave birth outside the country.

During every election I said “This president can’t be worse than the last one” and I was wrong every time!

Half a century wasted!

The Captain



Experts say Tory leadership rivals appear not to have grasped the scale of the crisis facing the service

Why is it most touted financial experts are not financial experts? Unless they are taking from someone else to make the money?

Bottom line the Tories have decided to rape the UK. It is every last man for himself as the ship sinks. It is still a rape and the public in the UK needs to see it as such.

Well, primary care/GP servuces are stretched to the limit in the UK just as they are here so it’s a serious complaint that’s become worse as manpower shortages hit this sector particularly badly.

One somewhat cynical but accurate statement regarding the NHS is “You can wait to avoid paying … or pay to avoid waiting” This has traditionally meant avoiding waiting lists for non urgent surgery such as tonsils and adenoids, orthopedic surgery such as knee replacements, bunions etc by “going private”, but there’s been something of a growth in the equivalent of concierge primary care also as the private sector capitalizes on this.

It’s been a lot longer than that. Almost since its inception, the “free at time of service” and “treatment based on need rather than ability to pay” tenets were under serious pressure and modest charges for some services…dental, hearing aids, eye glasses etc…were introduced as early as the 1950s. Certainly by the time I was out in the world and paying my way, pharmaceutical charges were introduced with exceptions for the young, elderly, those on income support etc.

The early 1980s saw the beginning of a serious attempt at “privatisation”. After a campaign slogan of “The NHS is safe in our hands”, the incoming Tory government set about making cuts in the NHS. It’s a matter of historical fact (rather than a political statement) that Margaret Thatcher had an almost visceral hatred of public services and what better way to make the private sector look attractive than starve the public sector of necessary funding and that’s what’s happened ever since. Labour govts not doing that much better. Don’t know how much or even if it still happens, but one short term attempt to reduce waiting lists back in the 1990s was to purchase surgical care for NHS patients in EU countries!

For the first time ever, I saw commercials for private medical insurance on TV at our trip back at the start of the summer. A true sign of the times, I guess.


Depends on how you look at it. The mean health care spending as a % of GDP for the EU is 10%. That’s about where the UK is. The UK invests more in health care by this metric than Finland, Australia, Iceland, or Denmark. Relatively speaking that doesn’t seem like a gross underinvestment.

Not coincidentally, the UK has a higher obesity rate than most every EU nation not named Turkey. I’m thinking the most efficient and effective way to deal with the British health care problems is to impose a significant obesity tax to pay for health care expansion. Probably won’t be reelected though.

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Well, how I look at it is that your link is current data, which I infer to mean in the here and now…or, at least, very recent history, right?

Even Steve’s time line for underinvestment is pretty short in comparison to the long term problems the NHS has faced

The UK has been within 0.5 percentage points of the EU mean since about 2008, which is not to say that they shouldn’t be spending more. But the issue seems to be more complex than just money. For example, the UK does have far fewer physicians per capita than most EU countries but no different than that found in the US, Canada, or Japan where the wait times seem much less severe.


Maybe I didn’t mention that even Steve’s time-line for underinvestment is pretty short so I’ll repeat it. I’ll also point out the obvious…that link dumping hard-to-fathom graphs that you think support your point of view isn’t everso helpful really. You should be aware that every medical system in every country on those lists is as different from each other as they are from that in the US and is a bit like comparing apples to vacuum cleaners.

What “NHS spending” actually covers in the UK(or was intended to cover) is certainly far more widereaching than what might be logged under “healthcare spending” here in the US. Can’t speak with any real insight to other countries since I haven’t been educated, received medical care or been a “provider” anywhere but the UK and the US

“Heathcare spending” in the US includes lots of drug advertising on TV. You might suspect that a major fraction of network TV funding is counted as healthcare spending.

That is called “setting it up to fail”. A time honored practice. We have been seeing that with the Post Office, ever since the PO was required to pre-fund retiree obligations far in excess of what is required of the private sector, creating a continuous “financial crisis” at the PO, which was leveraged in 2020 to make postal service even worse.

The other factor to consider is the UK tendency to honk everything up. Remember when UK airframe makers like Vickers, Hawker-Siddeley, AVRO, and de Havilland were major players? All collapsed into making parts for Airbus. Remember Triumph, MG, Austin, Morris, Rover, and more? All collapsed and liquidated. German, French, and Italian companies can compete globally. The UK squanders it’s potential. I remember when oil production started in the North Sea. There was speculation how the UK would use the windfall. The consensus was the UK would “muddle along”, a polite way of saying “squander”.



Seeing as my family comes out of Ireland…bigotry in the UK against everyone else runs very afoul of cheating oneself. Meaning bigotry is an ugly tool to be cheap. Now with Brexit completed the UK can focus on just how cheap the country is.

It really comes down to the leadership. You can see them as stupid. Or you can see them as criminal. You can say they are bright because of their resume. Or you can say they have no job experience in reality and do not belong in public service. The feeding of only the cronies is ugly. Maybe the UK’s citizens can face it is not about the “others”, it has always been about you being suckers.

In western Europe the UK has the lowest cost healthcare system per capita. The results speak for themselves as criminal neglect.

But who are we to talk? Our crimes are worse. What American culture does, when we read 30k people die every year underinsured or uninsured we subtly and automatically very much culturally think, “oh poor women”. The next thought in our patriarchal society is, “oh well. I have something else here I need to read”.