Opinion: Public health commissioning in the NHS 2014 to 2015 ex Publications GOV.UK – John Gelmini

Dr Alf talks about spin and weasel words but having read the NHS document I am no clearer as to what has really changed or how the various outcomes are to be achieved.

The money talked about(just under £2 billion gbp) is being supplemented by Lottery money and Petroleum Revenue Tax but we are led to believe that what is stated in the document is the entire story.


The NHS is demand led at the point of need and the public expect more and better delivery as their expectations of the medical profession rise every year.

Even with reform or replacement the UK healthcare system will fail because people expect to be able to down huge quantities of alcohol, smoke cigarettes, eat microwaved food, fish and chips, skip meals, take little or no exercise, take recreational drugs (in many cases), engage in bizarre and unusual sexual practices, go without sleep, live alone, become stressed and remain in good health.

If they become unhealthy through living like this and not heating and lighting their homes properly they expect the NHS to treat them and resolve their problems.


People in the UK do not in the main take any responsibility for their health and the worst offenders and are malingerers cluttering up GP surgeries with non-existent ailments ,depression and problems that they should deal with themselves.

This has to change so that demand can be brought into line with what the NHS can actually deliver under present circumstances which is also unsatisfactory.


After that we need to see:

–Food seen as medicine not as something to be treated as an unaffordable cost

–Hospital Consultants brought under control and made to work solely for the NHS rather than lining their pockets at the expense of paying patients in NHS beds or their private practices who are treated first in order to create long waiting lists

–GP contracts need to be renegotiated and malcontents sacked and replaced

–The BMA needs to be brought to heel or de-recognised as does the Royal College of Surgeons,the Royal College of Midwives and the NHS Trades Unions

–NHS Managers need to be reduced to just 4 layers and NHS Trusts need to be reduced to an optimum number ,say 15 for the whole country or 14 in the unlikely event that Alex Salmond gets an independent Scotland

–Merge the Adult Social Care and NHS budgets and remove duplication

–Create Kaiser Permanente Healthcare Apps

–Remove sugar,salt and harmful chemicals from food, the built environment, farming , power supply, aircraft fuel, plastics and mobile phones

–Variable taxes on foods

–Rife Machines in all cancer wards(as in Germany)

–Vitamin supplementation and other measures to boost immunity and testosterone rather than more drugs

–More Ayuvedic and Chinese medicine to stop minor ailments getting worse and act as a way to cure serious conditions without the need for commissioning expensive clinical procedures

–Use the ESD Toolkit as an aid to early intervention

–Make private medical insurance premiums fully tax deductible

–Greater use of nurse practitioners and Expert systems


After demand and cost reduction, smart procurement, NHS radical reform, the outsourcing of non-core services and the inculcation of more personal responsibility in the minds of the public we will still have the genuinely ill, injured and afflicted who despite smaller numbers will need care and treatment.

For standard or simple treatments this should be done by GPs on-line and by telephone and in consultation with consultants for more expensive and complex ones.


The NHS should be benchmarked against German, French and Italian healthcare with Lean /EFQM as the non negotiable standards.

NHS Mobile MRI Scanner Unit

NHS Mobile MRI Scanner Unit (Photo credit: kenjonbro)

John Gelmini


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3 responses

  1. Pingback: Opinion: Record number of elderly forced to stay in hospital ex Telegraph – John Gelmini « Dr Alf's Blog

  2. Pingback: NHS competition holds up creation of specialist cancer treatment centres | Politics | The Observer « Dr Alf's Blog

  3. There are some follow-up questions which need to be asked here – Who is paying for the Rife Machines in every cancer ward? If we ‘sack malcontent GPs’, where do the replacements come from, given that there is already a shortage both domestically and globally? What is the point of making private healthcare premiums tax deductible when you intend to tie the country’s best consultants inextricably to the NHS? Who in their right mind would buy private healthcare, knowing that this was the case?

    These points aside, I broadly agree with John’s argument that an emphasis on proactive ‘wellbeing’ is sorely needed to reduce the number of people becoming jammed in the health system with largely self-inflicted ailments. The thrust of his argument is certainly very valid.

    One small point on health systems which we should emulate. John is absolutely right to identify the French and Italian systems as examples of excellence. The WHO rankings would suggest that they are the best and second best health services in the world respectively. Germany however ranks 25th in the world – considerably lower than our own NHS which ranks 18th. Germany’s is also the third most expensive system (based on expenditure per capita), whereas the NHS is the 26th most expensive system. This would suggest that not only do Germany spend a great deal more on health than we do, but their system is still worse for it.

    Also worth noting is that the American health system is the most expensive per capita in the world, but manages a lowly 38th in the WHO rankings, just below Costa Rica. It could be a lot worse over here.

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