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5 of 6 people found the following review helpful
4.0 out of 5 stars The NHS crisis
In this book, Roger Taylor, one of the team that produces the widely respected Dr Foster guide to hospitals, examines the current crisis in the NHS. He starts by examining attitudes to the organisation. It is de rigueur for politicians to pay lip service to its founding principles, universal access, free at the point of use etc., and by and large most members of the...
Published on 17 April 2013 by Brian R. Martin

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1 of 1 people found the following review helpful
3.0 out of 5 stars Decent overview of current state of NHS
It is a very brief introduction to the current problems in the NHS and so it does the job. Very large font so not a huge amount of substance for how thick the book is. As an NHS staff member I'd have liked more detail but it is probably the right level for people not involved in the NHS, and this is a good thing as more people should be aware of what is being done to our...
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1 of 1 people found the following review helpful
3.0 out of 5 stars Decent overview of current state of NHS, 27 Oct. 2013
This review is from: God Bless the NHS (Paperback)
It is a very brief introduction to the current problems in the NHS and so it does the job. Very large font so not a huge amount of substance for how thick the book is. As an NHS staff member I'd have liked more detail but it is probably the right level for people not involved in the NHS, and this is a good thing as more people should be aware of what is being done to our health service.

One issue I have, he talks about the case of footballer Fabrice Muamba and erroneously refers to him as 'Patrice' Muamba throughout the chapter! Did nobody read through the book for errors before going to print?! A bit disrespectful to the player in my opinion, if you're going to use his personal medical condition as an example in your book at least get his name right!!
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5 of 6 people found the following review helpful
2.0 out of 5 stars If this is ‘The Truth’, then truly only God can help the NHS, 14 Feb. 2014
By 
David Levy (London, UK) - See all my reviews
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This review is from: God Bless the NHS (Paperback)
A while ago, I formulated the empirical Levy rule for determining the mendacity quotient of a book by briefly examining its cover (splashy with title at an angle, preferably in typeface that subliminally recalls Daily Mail and Express headlines), together with the page format (larger than standard paperback), line spacing and margins (very generous) and paragraph size (Daily Mail length). Here Roger Taylor refines my model by introducing three other criteria of wholesale nonsense: the hubristic 'the truth’ in the sub-title (actually, of course, 'The Truth'); even more dreadful, a title that hilariously suggests that the author has a grip on irony, and finally the almost complete absence of systematic references, which allows his prejudices to wander unchallenged in his magisterial 100 word paragraphs. The result is total mendacity: a self-declared journalist (actually a bureaucratic quant) purporting to celebrate the NHS as a national treasure while everywhere undermining its principles and components. In other words, no different from any senior person in the current NHS. The joint publication of the book between the Guardian and Faber completes the shame. How The Guardian can believe that publishing this ill-disguised right-wing diatribe will help its irretrievable bottom line is incomprehensible; Faber used to be a respected imprint.

Taylor allows no ‘on the one hand this, on the other hand that’ tag-team opportunity to slip through his fingers in his boiler-plated assemblage of platitudes-for-all-seasons. Take, for example, his tiresomely ironically-titled Chapter 4: Too Noble to be Measured in Money Values, which starts with a description of a fictional parody of Edwardian medicine in Shaw’s The Doctor’s Dilemma (presumably to confirm how little the medical profession has changed in the past 100 years), cuts to a two-paragraph excursion into medical ethics (which Taylor seems to think covers only pecuniary conflicts of interest), then segues through some impressionistic murk into a full frontal assault on ‘clinical freedom’ – the view held by Polly Toynbee and The Mail alike (right and left equally have it in for doctors) that pin-striped professionals going puce over the hospital board room table while demanding -- and succeeding in that demand, of course – that they have the right to do anything they damn well please at any cost to any patients, something that I perhaps saw once or twice in the early 1980s when I was a junior doctor. Even teaching hospital professors have largely stopped this ridiculous and embarrassing behaviour.

His attention span covers no more than 40 pages: for example he eagerly supports a neurosurgeon’s pleas to allow a patient to undergo a special technique for removal of certain brain tumours, against the pen-pushers, ignoring any subtlety. This is the so-called ‘gamma knife’ treatment that is an almost perfect tabloid technology – ultra-targeted radiotherapy that behaves like, but avoids the need for, a ‘knife’, but unfortunately whose clinical outcome value and cost-effectiveness is unknown – Davies et al, Neurosurg Focus, 2012: 33(1):E11. ‘The argument [of ‘clinical freedom’] has won for doctors a degree of autonomy almost unheard of in other fields’ is simply a fiction beloved of everyone who hates doctors. Well ... perhaps it isn’t clinical freedom that he means: it’s ‘clinical variation’, which on balance means that doctors have some wriggle room outside of guidelines – which he clearly doesn’t believe they deserve (in addition, he tells us a couple of very brief paragraphs later that ‘clinical variation’ is the biggest cause of waste in the health service – where is the reference and evidence for that?) On the other hand, perhaps doctors should have some room for clinical variation, because they’re dealing with some complicated cases, and all eventualities can’t really be covered even by an infinity of guidelines. But – no – we caused massive harm to patients by not prescribing 'evidence-based' beta blockers after heart attacks. Actually, there has been little evidence on the value of beta blockers since the 1980s, when we were just beginning to use aspirin, and statins, probably the most important drug in current use to reduce the risks of further heart attacks, had barely been thought of. Now that we are targeted and have to prescribe them, we do, and that eradication of clinical variation (apart, apparently from Ipswich) possibly helps patients, but there’s no evidence for it, unless they have some degree of heart failure after their heart attack. But that's awfully clinical, so don't bring that in. In a final wobble – on balance doctors have wisely decided that rules and guidelines ARE needed. Oops, sorry, on page 118 we have: ‘such guidelines are welcome, but they cannot completely substitute for the judgement of the clinician in the consulting room’.

God preserve us. What does this man really think? He is of course doing what every politically and financially astute fence-sitting management person does when dealing with doctors, but who are really aiming for the stratospheric mega-quangocracy: he dissimulates and vacillates, in the hope that his loathing might be interpreted otherwise by some readers who truly believe that he thinks doctors are miracle workers. But he doesn’t believe any such thing.

He’s honest about his provenance, though not in the cover blurb. He paired up with Sir Brian Jarman, originally a clinician, to form the part-private company Dr Foster, which does its best to use sophisticated statistical models to alert hospitals to higher than expected mortality rates; this is one of the means by which the Mid Staffs shambles came to light (though the Health Care Commission, now the Care Quality Commission, can very likely take most of the credit for uncovering Mid Staffs). In a sense, then, as a previous reviewer has noted, he is a fully paid-up member of the ‘if you can’t measure it, it doesn’t exist’ Neoliberal persuasion. He has recently been appointed a part-time National Professional Advisor at the CQC, and Dr Foster’s website blurbs about his ‘outstanding knowledge and experience in healthcare data and quality improvement’ (with the now commonplace elision between data collection and ‘quality’).

He is, on the evidence of the case histories he quotes at painful length and tabloid monochrome, also a strong supporter of the technomiraculous approach to medicine (‘Modern medicine deserves hyperbolic descriptions. Highly skilled people working in high-pressure environments using some of the most remarkable technology ever developed to overcome … insurmountable odds’… blah, yeah). In fact, of course, this is a neat Knight’s move dissimulation in itself: he really believes that it is the technology that cures, and probably holds the view that a well-trained non-medical operative, given sufficient training by the doctors, could do it as well, more efficiently, and of course, at a quarter of the cost.

In short, he shares the view of countless Daily Mail readers who genuinely adore the cranky and uneven NHS while relentlessly plotting to dismember it and replace it with the more efficient and stylish private sector. His tawdry recitation is long on the rhetoric, detailed on the miracles and very very short on anything that might discomfit his impeccable Neoliberal views, including the truly bizarre recitation that it’s the ‘economics, not the politics, that will shape the future of the NHS’. So it’s the economics that tell us all that healthcare demands are infinite (demonstrably and arithmetically untrue), and that fully funded and sophisticated healthcare is unachievable (don’t compare us with the USA, because that’s a turkey shoot; try nearly all of continental Europe, especially Germany, which as John Lister reveals in his magisterial and fully-reasoned recent book, not very long ago had surplus capacity in their system, while spending only a fraction more of the GDP on health than the UK)? What about the rapidly aging population (untrue: it's been slowly and predictably ageing for about 80 years) that’s apparently going to mean that we spend the last 50 years of our lives in full dependence on the social and health services? All these canards are exposed full frontal in this miserable account, culminating in the vacuous statement on page 78 – ‘if we want to continue to have healthcare of the highest standard for the next generation and the generation after that [tabloidy alert; surprised he didn’t say for our children, grandchildren and all future generations, world without end] we are going to have to come up with a different way of doing things’.

And what might that be? Well, it’s certainly not taxes, according to this angel of hope. That wish went out of the window with the financial crisis in 2008, which we are told we are now nicely emerging from. As befits a quant, he accepts at face value the government edict that sets a target of 20% cut in the NHS budget – actually by next year, 2015. Presumably so there’s bags of cash available the next time the banks take a wander round the outer reaches of the universe of probability theory. Actually, on page 84, Richard the smarty-pants laid-back sage tells us that Dilbert has the answer. Where he can elicit sympathy from everyone, and it doesn’t take his book to reveal it, is the view that the latest round of mendacious NHS reorganisation (more opaque and more devious than any of the other 4 in the past 15 years or so) is likely to be a disaster. But, as a fully paid-up neoliberal, he must hold the view that disasters for patients are simply money-making opportunities for others. He never quite tells us openly what he thinks the opportunity is. Actually, of course, we do know, and the answer is a hundred or so pages back – eradicate ‘clinical variation’ ie eradicate senior doctors, and the job’s done. Phew, got there in the end.
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5 of 6 people found the following review helpful
4.0 out of 5 stars The NHS crisis, 17 April 2013
By 
Brian R. Martin (London, UK) - See all my reviews
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This review is from: God Bless the NHS (Paperback)
In this book, Roger Taylor, one of the team that produces the widely respected Dr Foster guide to hospitals, examines the current crisis in the NHS. He starts by examining attitudes to the organisation. It is de rigueur for politicians to pay lip service to its founding principles, universal access, free at the point of use etc., and by and large most members of the public go along with that. It's when one gets down to the details of how such lofty ideals are to be implemented that views start to differ, often very sharply. At one extreme there are those who believe that the NHS should remain a purely public service, and receive all the funds required to continue this mode of operation. Others point out that the success of doctors and medical scientist has meant that more and more conditions previously untreatable are now treatable, but often only by expensive hi-tech techniques and costly new drugs, leading to ever rising medical costs, a fact exacerbated by increased longevity. But the nation cannot indefinitely continue to increase the percentage of tax revenue devoted to health care.

All political parties now seem to agree that the first position is untenable and private money will have to play an increasing role if the standard of health care is to be maintained. The NHS already uses private organisations to provide some services and it remains to be seen how this develops. Incidentally, Taylor points out that many private providers are actually non-profit making charities. He also debunks some of the myths surrounding private providers, such as the belief that the scheme when teams of surgeons were drafted in to do multiple operations of one type, such as hip replacements, the complication rates were much higher that normal. Taylor points out that the evidence does not support this, and in many cases the outcomes were better.

There is no doubt that aside from the costs, there is a crisis in the NHS, and this has been brought into sharp relief by a number of very public scandals in hospitals, particularly recent events in the West Midlands. The public all too often feels that it is a `them and us' situation, where they are not kept informed about important matter, whether it is their own personal care, or the nature of official `reforms'. Successive governments have introduced many such reforms, none more extensive than the massive restructuring current being pushed through by the Coalition. But, like so many initiatives (and not only in healthcare), there are rarely any follow-up studies to examine what the changes actually achieved. One fears that this will also be the case this time.

Taylor believes that in the future people need to be persuaded to take more control of their own health and that would mean full access to all their medical records, and being treated by medical staff as equal partners, each contributing from their own experience and expertise. The former would require a major improvement in computerisation, which unfortunately has a terrible track record in the NHS, as well as a massive shift in the culture of the NHS, as will the present government reforms. Personally, I am pessimistic of it being achieved, but I hope I am wrong.

The topic of health should be of interest to everyone and for that reason this book should be read by everyone, but the writing does not help. It is repetitious in places and there are typos that an editor should have spotted (the word `data' is plural, for example). Nevertheless, it is well worth reading.
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1 of 1 people found the following review helpful
4.0 out of 5 stars God bless the NHS - brief review, 2 July 2013
This review is from: God Bless the NHS (Kindle Edition)
Roger Taylor casts into relief some of tensions that beset the NHS: public vs private ownership and delivery; a growing caseload of more elderly patients suffering from chronic diseases; and the unaffordability of healthcare provided as it is now.

Roger's solution is to make patients more accountable for their own health, thereby reducing demand, and part of that lies in providing patients with control of their own medical records, he says. His ideas tie in well with those in 'Stop Saving the NHS and Start Reinventing It' by Colin Jervis.

Jervis takes the need for greater use of technology further and links IT to new models of care delivery and outlines the potential shape of health services in the future. His examples include the need for units that focus on the delivery of 'commodity' care, such as knee and hip replacements, which Taylor shows deliver outcomes far better than their reputation.

James Aker
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3 of 4 people found the following review helpful
4.0 out of 5 stars A balanced and well-informed view, 29 April 2013
This review is from: God Bless the NHS (Paperback)
I greatly enjoyed reading this, whereas often I read books about the NHS in modern times while grinding my teeth.

Roger Taylor brings balance, intelligence and a very well-informed perspective to the never-ending debate about NHS. Blending elements of policy discussion, personal experience and research, Roger has brought a little light to topics which usually generate nothing but heat. This is not one of those great works that will catalyse a whole change in approach or make you radically re-think your own position (in fact, it is arguably so balanced as to allow the possibility that anybody approaching this with entrenched views will find little but support for their personal convictions), but that is perhaps the point: the NHS is not in quite as much of a crisis as many would have us believe, and the best answers for the future are subtle and unlikely to be found through highly polarised or political argument.

If you want to read a really good professional review of this book, I recommend finding that by legendary healthcare journalist Nick Timmins in the New Statesman.
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1.0 out of 5 stars In defence of the Lansley reforms ..., 4 April 2014
By 
Mr. M. L. Stone "mathewleestone" (Manchester, UK) - See all my reviews
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This review is from: God Bless the NHS (Paperback)
This author does a better job of defending Lansley's NHS reforms better than the man himself, but that's not much a reason to like this book.
p.s. The authors uses the goings on at "Bradford General Hospital" to illustrate a few points which surprised me as I've worked for the NHS in Bradford and no such hospital exists! He probably means Bradford Royal Infirmary.
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2 of 3 people found the following review helpful
5.0 out of 5 stars God (or somebody in real authority) Bless the NHS, 24 May 2013
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This review is from: God Bless the NHS (Paperback)
Very readable and a change from the usual blame game. Short on answers perhaps, but that was agreed at the outset. Who does have all the answers? As a visitor from Australia and having just received a prompt visit at home from an NHS doctor, I know there is a lot of good work being done. We must encourage the best.
I have worked in the NHS and in Australian health care and I believe we have a better system at home in Australia, but the people are often the same so why is it so? I received the best of emergency care in State and private hospitals in Australia, and am happy to have contributed all my life to private insurance over and above the State provision everyone makes. I think perhaps the 'everything free for all' culture, needs to be adjusted to a model where very minor costs are carried by the majority of people, and the occasional massive expenses are covered regardless of income and based on clinical need only. If you look at the history of 'insurance', it was meant to cover catastrophic events such as the loss of an entire ship and cargo, not minor losses.
I liked the section which illustrated the case for fewer highly specialised services that were first class. I agree as long as the secondary hospitals and community services which are then needed even more, are not downgraded and 'raided' to support them. The answer to the ED problems must be to keep people out where possible, but provide efficient and fast services once there.

Finally I agree with the need to stop endlessly re-organizing services - I detest the term 'reform' which the politicians trot out so readily every couple of years' as it implies wrong-headedness on the part of workers up to then, who have often been simply trying to recover from the last 'reform'. Health workers want to do their best and they need to be encouraged not disparaged. The politicians should try to build onto progressive services, rather than tear down and restart endlessly. This disease in politicians happens in OZ too!
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8 of 11 people found the following review helpful
1.0 out of 5 stars very poor and misleading - read 'NHS SOS' instead, 3 July 2013
By 
Mr. A. Peters - See all my reviews
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This review is from: God Bless the NHS (Paperback)
'...In order to know where we are going, we need to know where we are.
And order to know where we are, we need to know where we come from...'
Julian Tudor Hart (2008) Lecture

(available on You Tube)

I am not sure what is more dismaying; Roger Taylor's work, or the high ratings given by so many of the reviewers on this page. I do wonder what exactly Taylor is trying to achieve here.
The NHS is the means by which the English people look after each others health. This is not an 'emotional attachment', it is a rather obvious practical necessity - or at least it should be obvious.
Another obvious fact is that we all, at some point in our lives will become ill, and require medical attention.

*I would not want to be denied healthcare. I know that my life has no more value than another persons, so I would not want anyone to be denied healthcare either.

The NHS is based on Dorling and Shaws 'Positive Care Law' (Google Scholar). The Positive Care Law demonstrates the essential decency of human nature. It needs to be said that this is not romanticizing people. People look after each other because they know this is the only way that they can ensure that they will be looked after. It is a pragmatic response. In 1948 the NHS represented this response to health needs in a higher form by radically bringing a patchwork of private provision and charity into a unified system of planned healthcare delivery.

The result, despite right wing propaganda to the contrary, was an exceptionally efficient healthcare system (see Guillbaud report 1956 - [...]), as compared to other systems.
One gauge of a a health systems efficiency is the level of internal transaction costs (admin costs). In 1990 the UK NHS system had admin costs of 6%, which equates to £6billion from a £100 billion budget, and had the lowest running overall costs of any western system. This was due to the NHS operating as a 'Gift Economy' where market forces were pushed to the periphery, and where no one knew the price of anything.

Post 1990 saw the Internal Market (Via Thatcher) which turned hospitals into independent businesses, in which clinical staff were increasingly forced to prioritize commercial considerations before clinical ones. Pre 1990, thatcher had bought in a supermarket man to bring his wisdom acquired through running supermarkets...to running the NHS. If you cannot see what is wrong with this then you may as well put your head in an oven. Sorry.
Cleaning was outsourced to contract firmed which removed the control over hygiene from nurses. A huge rise in infections then resulted.
The internal market saw a rise in transaction costs (lawyer's bills, accountancy bills, invoicing etc.. ) moving the Admin costs from 6% to 10-12% by 1997. This move to an US healthcare system (officially planned in 1987 see - Julian Tudor Harts 1994 article 'A Plot Exists' [...])which ultimately will lead over time to similar administration costs of the US system (20-30% representing £20-30 billion from a £100 billion budget.
This is the economic argument. The clinical argument against privatization is that commercial considerations distort clinical decisions. Evidence for this abounds in the US. Doctors there are forced to serve the hospitals need to generate income. The result is that people receive treatments, (operations, investigations etc..) that they do not need.
Also the lack of comprehensive coverage has lead to huge rates of bankruptcies in the US (see Michael Moore's film 'Sicko'- [...])- This is all in a system that costs twice as much to run per capital as the UK system.

I could go on - but I don't want to write a book!

Taylor is not an expert in his field. Will have learned more in my review than will through reading Taylor's book. He fails totally to provide the reading public with the information/concepts they need to understand the situation.
Also it seems to be lost on Taylor the fact that people are going to die as a result of the NHS's destruction. This is real and a lot of suffering will result. We need writing that demystifies and informs. The best current book out there is 'NHS SOS' by Jackie Davis et al. (2013).

All I can do is to ask you to please read the following authors -

'NHS SOS' Dr Jackie Davis (2013)A current work designed to inform the public of the 'reforms' history, mobilize the public behind the NHS Reinstatement Act drafted by Prof Allyson Pollock and David Price, and taken to the House of Commons by Lord Owen this Spring. The Act supported by Owen is designed to reinstate the legal duty upon the Secretary of State to provide universal equitable health care for the population.

Allyson Pollocks seminal 'NHS Plc' (2006)
Plot Against NHS Stewart Player

'The Plot Against the NHS' by Colin Leys and Stuart Player (2011)
Plot Against NHS Stewart Player

Julian Tudor Harts work -
Political Economy Health Care Society

John Lister's Work
Health Policy Reform Management Educatio

The first two are aimed at the Public - the last two are more challenging but are worth working at
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4.0 out of 5 stars Four Stars, 10 July 2014
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This review is from: God Bless the NHS (Kindle Edition)
will order from this seller again
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5.0 out of 5 stars A really honest book about our health system, at last., 24 Aug. 2014
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This review is from: God Bless the NHS (Paperback)
A proper insight and real inspiration for aspiring doctors. Should be compulsory for anyone involved in medicine.
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