Tag Archives: National Health Service

Lets Re-Rethink HealthCare: let’s revisit what we proposed — and see if housing might have the cure.
When we finished Let’s Rethink Health, we didn’t pretend the NHS was broken because people didn’t care.

We were clear that:

staff care

patients care

and most policy intent is, broadly, well-meaning

The problem wasn’t values.

It was how the system is asked to function.

Lets Rethink HealthCare: Doctors, Demand, and the Cost of Not Planning.
We’re often told the NHS struggles because demand is unpredictable, people don’t want to be doctors anymore, or because training more staff is simply too expensive.

None of that is really true.

Demand has been rising for decades, driven by an ageing population and more complex care. Medicine remains hugely oversubscribed. And the cost of training enough doctors turns out to be similar to the economic value we currently lose by relying on a highly mobile workforce.

This post walks through how we got here, why the system quietly locked itself into dependence on overseas recruitment, what it would actually cost to fix both the future demand and the inherited deficit — and whether a redesigned model could still be working 50 years from now.

It turns out the NHS doesn’t have a money problem.

It has a planning problem.

Ok so I ended the last post saying I wasn’t going to do this –

But I then got interested in investigating a few possibilities – so here we are.

WHAT A STABLE, MODERN, NON-FRAGMENTED NHS SHOULD LOOK LIKE FOR THE NEXT 30 YEARS
Other countries rearrange their health systems about as often as they repaint post boxes.
We rebuild ours like a kitchen remodel every election cycle.

So let’s explore systems that actually work — and what they teach us.

AND WHAT THE UK COULD LEARN

The UK is not alone in running a universal health system.
But it is almost unique in constantly rebuilding its health architecture.

Other countries rearrange their health systems about as often as they repaint post boxes.
We rebuild ours like a kitchen remodel every election cycle.

So let’s explore systems that actually work — and what they teach us.

STRUCTURE, ECONOMICS AND INCENTIVES

In Part I we saw how the internal market emerged.

Part II explains why it never achieved what its architects intended.

The answer lies not in ideology, but in economics and structure.

There’s a line often attributed to the Roman army:
“The only constant is change.”

If that doesn’t describe the NHS, nothing does.

And during the 1990s, when yet another restructure rolled in, someone in a Birmingham hospital taped a follow-up note to the management accounts department wall: (this was in a time before email – yes ask your historians there was such a time)

“Due to further cuts, the light at the end of the tunnel has been switched off.”

Dark humour, yes — but also a quiet acknowledgement that the NHS experiences more structural churn than almost any other health system on earth.

To understand why the NHS looks the way it does today, and why Birmingham is a perfect case study, we have to go back to the beginning of the internal market era.