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on 23 February 2016
For a non medical reader a useful summary of the enormous challenges facing the NHS together with a description of some of the ways in which the NHS is tackling the problems.Medical professionals are brought up to act decisively, obviously important for a surgeon needing sometimes to make immediate decisions, (but more debateable for GPs ) and so there is unusual fierce resistance to interference whether by managers or patients.Taylor argues that the NHS is the victim of its own success - modern technology is greatly increasing the treatment options (and expenses) and creating ever increasing demands from its patients. Co - underwriting costs with the patients might well moderate the pressure on the system and has I have found out often is that no one thanks you for a completely free service!

I was surprised however that he did not identify obvious ways of cutting costs while preserving the service e.g. bringing all parking services into the hospital, charging all overseas visitors and/or their countries for services rendered (the EU already has the system to do this), and
, using operating theatres 7 days a week rather than 4 days as now (as per Jerry Robinson) axing outrageous salaries and redundancy payments to senior managers, reigning in work to rule practices by porters etc. etc.
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on 5 December 2014
An interesting comment on the state of the NHS and an idea of how an alternative way ahead may be possible.
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on 10 July 2014
will order from this seller again
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on 10 February 2015
Really good book that easily explains the issues facing the NHS and the impact of the demographic timebomb
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on 24 August 2014
A proper insight and real inspiration for aspiring doctors. Should be compulsory for anyone involved in medicine.
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on 3 July 2014
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VINE VOICETOP 1000 REVIEWERon 17 April 2013
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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on 17 April 2013
Roger Taylor has clearly drawn on years of experience of analysing the NHS to produce this book. He cuts through the self-interested posturing, by all sides, left, right, medical professionals, and hospital management. He's written a very comprehensive, hugely informative book (barring the typo's). By utilising data analysis to draw conclusions as to the state of play in the NHS Taylor moves the debate on from soundbites to an examination of facts. The urgent need for more transparency and accountability for outcomes throughout the NHS is a constant thread. The references to comparable services internationally add weight to the narrative. If you have an interest in what the real issues facing the NHS, and therefore us are, I strongly recommend this book.
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on 24 May 2013
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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on 24 May 2013
Very much tallies up with my experience as a doctor in the NHS. It highlighted a few areas and facts that I had previously not been aware of but are extremely important. There are a few stories about miraculous recoveries from LCP decisions which felt a bit tabloidly. However, the author writes with the fluency of an accomplished journalist making it easy to read, and he has remarkable insight into what doctors, nurses, politicians and managers are thinking and doing.

If your involved in health you should read it.
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