Breaking down monopolies in the medical profession





Waiting times














Medical emigration



State planning in general practice







The monopoly of state finance



David Joselin is the author of The Crisis in British Medicine.

Very interesting from David Joselin. These things come as little surprise, but it is informative to see the detail. One thing that is not mentioned, however, is the restriction on the supply of medics in the first place. We have fewer per head of population than most similar countries and this is because of licensure and the fact that the number of places on medical training courses required to become licensed is artificially restricted in the UK. Thousands of well-qualified applicants are turned away every year - something we simply don't do for other university courses.
The feminisation of the NHS over the past 30+ years deserves far more coverage in an article of this length. It costs some £250,000 - £500,000 to train a doctor, and 70% of medical students in the UK today are women. Compared with male doctors, female doctors are: - more likely to quit the profession altogether - more likely work part-time, whether or not they have children - less likely to work in the most stressful disciplines e.g. A&E - more likely to work in the least stressful disciplines e.g. general practise - more likely to retire earlier It's been estimated that the NHS gets around half the number of working hours from the average female doctor over a working life, compared with the average male doctor. The inevitable collapse in the staffing capacity of the NHS has been 'solved through recruiting a huge number of foreign doctors, many from poor countries which have paid for their training, and can ill afford their working abroad. The bottom line? An ever more mediocre NHS run to suit women choosing work/life balance over work, and costing ever more for taxpayers to fund. The beneficiaries? A small number of women, many of whom wouldn't have made it into medical schools on the grounds of merit. The losers? Patients (e.g. those unable to see a GP at the weekend) and taxpayers. By taxpayers we mean, of course, men mostly. Men pay 72% of the income tax collected in the UK, and women only 28%. As usual, men are funding both their own disadvantaging and the mediocrity of the public sector. My political party may include in its 2015 general election manifesto a proposal that medical students be required to pay back the cost of their training once in work. With the average GP today earning £104,000 p.a. - outrageous remuneration given the hours GPs work, their job security, the absence of consequences for poor performance - paying back the cost of their training within a decade should be perfectly feasible. Mike Buchanan JUSTICE FOR MEN & BOYS (and the women who love them)
Dear Policymakers Let's look at making Doctors' and their surgeries independent companies/ That is to make them compete with each other in a free market.
There is a state monopoly in healthcare and this does stifle innovation and investment. He is right to say that doctors do not have an incentive to be more productive and this is very much to the detriment of patients. The answer is deregulation of the state monopoly and more private enterprise. Until that happens the quality of care for every person when they reach old age will remain highly variable (even if you have private medical insurance).
The NHS is a monopoly. The UK tax payer funds an archaic and cost ineffective business without having any choice or opt outs. In all likelihood, faced with competition options, 90% of the uk would opt out and pay for private health cover instead (assuming they got the tax rebate from opting out) When you look at the laughable state of the NHS, it's already widely acknowledged we are slipping behind the rest of the developed world, yet the NHS still have the balls to throw money around after paying their massive management team over inflated sums. Recent articles highlight the amazing degree to which funds are frittered away on some patients while for others the whole system creaks and strains at risk of collapse.
The reality of working in the NHS will never be truely understood. Most free market thinkers suspect there must be something sub-optimal but they can't quite explain it. The truth is that the second and third order services are of poor quality. It is not just "seeing" a specialist that counts, but seeing one quickly, who has good communication and clinical skills, who can order tests quickly performed by machines that are up to date, with good IT connectivity and excellent technical support and finally cancer networks which are efficient in working together to diagnose and treat the patient successfully even for less common conditions. This does not happen in the state system and many patients suffer in unseen and unmeasurable ways which are impossible to quantify and therefore will never be brought to light.

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