The perennial political football - Credit, public domain

A useful little example of what is wrong with the National Health Service – it’s run by government and politics. The biggest problem with government and politics being to stop it doing something. No, not to stop it doing the stupidities which any system is prone to. Rather, to get it to stop doing something which is out of date, or proven ineffective, or even just not necessary any more. The problem being that government and politics doesn’t have that radical pruning method of markets and competition – those doing something useless go bust. If no one wants it – a useful definition of not needed any more – then there’re no customers, no revenues, thus no production. Remove an activity from that feedback loop and we get this:

Hundreds of thousands of NHS patients will be refused operations judged futile as part of cost-cutting measures in the health service.

Procedures including injections for back pain, surgery to help snorers and knee arthroscopies for arthritis form part of an initial list of 17 operations that will be discontinued completely or highly restricted by NHS England as many of these problems get better without treatment.

The health service hopes the measures will save £200m a year by reducing risky or unnecessary procedures. It will tell patients they have a responsibility to the NHS not to request useless treatment.

Varicose vein surgery and tonsil removal also feature on the list of routine operations to be axed as part of NHS England’s drive to cease outdated and ineffective treatments.

The routine procedures are performed about 350,00 times a year and cost more than £400m. NHS bosses hope to stop at least 100,000 operations, saving £200m.

Obviously, this is actually happening so there is a system of sorts. But it’s only significant budget pressure – that starving of the national religion – that is causing it. As opposed to a market based system, where the simple absence of custom would have closed it all down already.

NHS England said an estimated £200 million could be saved every year by tightening criteria for treatments where “the risks… outweigh the benefits”.

While there will be some circumstances where these procedures go ahead, NHS chiefs said they will only take place when there is good reason to do so.

Why were they being done i there wasn’t good reason anyway?

All of which is a useful little lesson for these people:

Tens of thousands of people will demand an end to cuts to public services and a halt to “ruinous” privatisations at a protest on Saturday to mark the 70th anniversary of the NHS.

Politicians, actors, musicians and union leaders will address a rally in central London calling on the government to give the health service more money amid claims it is being “deliberately underfunded”.

Well, privatisation is the cure for the problem we’ve just identified, isn’t it? That difficulty we’ve all got in stopping government and politics from doing things which don’t need doing any more. No, not because private suppliers make a profit, but because they make a loss from those things not desired and so stop.

But over and above that why not listen to what the people in the NHS itself are actually saying? That we can and should be saving money within this service. Which does rather mean that ladling yet more cash into it isn’t the only viable solution, doesn’t it?

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Chester Draws
Chester Draws

America is hope of both privatised medicine and useless procedures. I’m afraid privatisation isn’t necessarily the solution.

Free enterprise provides what people want. And they often want harmful medical practices — antibiotics for viruses, surgery for knees that just need time, full scans for every niggle.

The NHS needs competition with incentives for winning and punishments for losing. Which might be private alternatives, or comparisons between regions.

Chester Draws
Chester Draws

Home of, not hope of.


“patients will be refused operations judged futile as part of cost-cutting measures” — Here, “cost-cutting” is the goal of the bureaucratic effort, and “judged futile” is the rhetorical justification. That one’s snoring might go away with the passage of time (certain, in 50 years!) means that denial of care is even more explicitly the business of the NHS. “Health care is a human right!” being redefined here as bureaucrats telling you why you don’t need health care. But at least it’s free.

Let the paying customer decide what is futile and what isn’t.

Quentin Vole
Quentin Vole

It’s quite likely that many surgical procedures are useless or, at least, no better than placebo. Double-blind trials are almost impossible for surgery and even single-blind (fake procedures) tend to be unethical. We can look at similar cases that have been treated surgically and non-surgically, but (obviously) both the patient and medic will know which treatment they had.


I thought if someone is paying for something it is up to that buyer to decide what they get in exchange not the seller, or of course not pay. Am I being old-fashioned?

The NHS modus operandi has always been, ‘You’ll get what you’re given, shut up and get on with it. It’s free!’

So the NHS is not to be a general healthcare provider, just an acute service… one big A&E.


‘… as many of these problems get better without treatment.’


‘… treatments where “the risks… outweigh the benefits”.


‘… will only take place when there is good reason to do so.’

ATTENTION ALL MALPRACTICE LAWYERS. Knowingly carrying out unnecessary procedures and procedures where the risk outweighs the benefit, not only breaches professional codes of practice, but is common assault and medical malpractice. The NHS has just confirmed it has been assaulting patients and committing malpractice as a matter of routine.

If this were the USA…

Nigel Sedgwick

The UK government (2017 figures, £144.34billion, pop. 65.0million) spends £2,220 per capita on health care. If NHS England (agreed not the whole of the UK) saves £200 million, that is £3.60 per capita for the 55.6million just in England. Thus a saving (per capita) of 0.16%, Is that the sort of figure to impress? Or is it the sort of figure that should be accepted as lost in the noise? While avoiding unnecessary or ineffective health procedures is a good thing, surely the vastly more pressing problem for the NHS is its massive bureaucracy and the associated massive inefficiency that… Read more »