Is there a doctor on this budget?

The title ‘Is this doctor (and Ukip candidate) right that EU migrants will destroy the NHS?‘ seems inflammatory to say the least, but the reality is actually a lot less appealing. Even when we see today’s article: ‘NHS vows to transform mental health services with extra £1bn a year‘ (at, the quote “People facing mental health crises will be able to get community care 24 hours a day, seven days a week as part of the biggest transformation of NHS mental health services in England for a generation, to be unveiled on Monday“, that quote now reflects back to the initial NHL article. There we see that Professor Angus Dalgleish is giving us another view: “He says the NHS is on its knees and “could collapse completely” because of immigrants from the EU that we are legally obliged to treat“, so even as the Guardian is hiding behind the identity ‘Pass notes‘, there are issues. The first is the unintelligent trivialisation by ‘Pass notes‘. The quote “Eighteen British hospitals made £42m from people coming here for treatment on 2010” is just too ridiculous to be considered valid. I am not stating that it is a lie, but consider that the NHS budget is set to be around £115b for 2015/2016, that £42m amounts to roughly 0.000365%, so how insignificant is that trivialisation? Especially when we consider that many papers (including the Guardian) reported the NHS to be £1.6b in deficit, so there is an issue already.

Now we get the next step.

From several sources we see that refugees are coming. That is not an accusation, or negativism, it is merely factual that over the next 5 years 20.000 refugees will arrive. Now consider that these people come from actual devastated locations, on a horrendous trip that has lasted years (including their stay in refugee centres) to get to the UK, if only 75% needs mental health care, the UK should be thanking their lucky stars. So that £1bn will not last too long, especially considering the current population is in dire need of mental health in one form or another. So as ‘Pass notes‘ complains the quote “But I expect doctors to be liberal! By which I mean intelligent! By which I mean liberal! We expect much. And sometimes we are disappointed“, which is just the Guardian showing that its own values are not set on intelligence. The NHS itself states: “However, if you are now living in an EEA member state and pay into a state healthcare scheme then you are entitled to apply to that member state for an EHIC. Under EC law, this entitles you free of charge to ‘all medically necessary treatment’ here, which provides a greater coverage than that mentioned above since it includes routine treatment for chronic conditions such as diabetes“, which gives way to the claim that Professor Dalgleish is making. In addition the National Health Service Act 2006, section 83 states that “all reasonable requirements to provide or secure necessary primary medical services for all patients, irrespective of their immigration status, within their areas” must be met, this is a legal duty for the primary care trust as reported by the Primary Care Commission (at, which now implies that Professor Dalgleish has indeed reported an issue that the Guardian casually trivialises. Yet, we must also ask, what if the Guardian is correct? Well, section 83 of the National Health Service Act 2006, literally states at s83(1) “Each Primary Care Trust must, to the extent that it considers necessary to meet all reasonable requirements, exercise its powers so as to provide primary medical services within its area, or secure their provision within its area“, which bakes the cake on one side. The issue is however not done, it is about to get a lot ‘worse’, because s83(2)(b) gives us: “A Primary Care Trust may (in addition to any other power conferred on it) make such arrangements for their provision (whether within or outside its area) as it considers appropriate, and may in particular make contractual arrangements with any person“, which now gets us two elements:

  • Make contractual arrangements with any person, which also implies that it could be a contract set at £0.00.
  • Arrangements for their provision (whether within or outside its area), which now implies that the Primary medical services can transfer a refugee or illegal immigrant to psychological care and/or specialised mental health clinics.

So ‘Pass notes‘ is not reflecting on the dangers that Professor Dalgleish was trying to illuminate. More important, these issues have been known for some time. Issues on these elements have been illuminated in plenty of publications going back to 2012. There is even more information at, yet overall they tend to give the same reflection, especially when you look at page 3, where the cubic impression titled ‘Exhibit 1. Three Dimensions of Health Care Coverage Policy for Undocumented Migrants‘, gives rise to the massive growth of costs that could be associated with migrant health care (not to mention due to incoming refugees).

So how much valid weight can be given to the statements of Professor Dalgleish? I personally believe that the weight of his statements should be weight on a debatable high level (evidence to follow at the near end). The issue is not just regarding the costing the immigrants and refugees bring, the fact that the Euro systems is wreaking havoc all over the world is an equal concern. I cannot state for certain what will be the best path, what is a given is that trivialisation was never an option.

When we add ‘Jeremy Hunt on the NHS: ‘I think this decade needs to see the quality revolution’‘ (at to the fold, the plot thickens. You see, quality revolution sounds fair and essential, it is in fact at resent likely the least important part. There is a massive shortage of medical professionals, there is a lack of funds and that lack can be sized into the billions. This implies that quality, though nice is nothing compared towards the lack of resources. Which gets us to the Junior Doctor contracts. You see the quote “none of the 152 foundation trust hospitals in England will be obliged to force their junior doctors to accept the deal and can instead offer them better terms“, which gets us back to that massive deficit and more important, what additional pressures will be added onto it?

That is a part which has been known for a while, I voiced it at least 2 years ago and the current investigation that the BBC gave visibility to in January 2016 (at is still centre in all the issues that will come. You see, without a proper IT system, the NHS will have less and less options to streamline any solution, with that I mean larger operational matters for streamlining. Even as Tavish Scott (Lib Dem Scotland) asked on who got figuratively axed, we got the answer: “The chair of the board is no longer there, the chief executive is no longer there and the chief finance officer“, a very unsatisfactory answer. When we consider “he was not informed of a ‘fundamental flaw’ in the system being delivered for 22 months, adding “other, more junior staff were aware of omissions” in the contract, “but they didn’t tell me”“, we see a systematic shortening of another matter. The fact that junior staff were aware, implies that the documentation was an issue from day 1, in addition, no clear QA protocol was in place. No drilldown teams, from Junior to board member line was in play and overall the system was beyond merely defective. Consider the simple quote: “Mr Turner, who signed the 1,000-page contract for the IT system in March 2012, said he felt “very let down” by a senior colleague, saying they “didn’t advise me at all”“, can anyone explain to me, how such a document does not come with an excerpt chapter by chapter (by members of the NHS) underwriting per chapter how the contract impacts the NHS, the system and their services? A mere SWOT analyses (Strengths, Weaknesses, Opportunities and Threats) would have made all the difference before signing. A waste of £40-£50 million is more than just a few doctors, the lack of such a solution will give additional worry to the claims Professor Dalgleish made. In light of refugees, illegal immigrants and costings, the lack of oversight will soon pressure resources down further.

This all gives a clear view that a doctor is required to take the pulse of the budget. It is billions in deficit and the drain will only increase. The fact that most parties have not given clear light to several sides is only a first reason why Ukip is gaining momentum. That view goes a little further when we consider “Committee convener Paul Martin said there must have been issues with management if staff did not feel able to come forward“, Scottish Labour has more than just a point, the issue becomes why junior members were not asked directly. Someone had to make an inventory, which means that the step was skipped, or intentionally overlooked. That now gives way to the fact that axing three members is not nearly enough. There is, what could be regarded as an institutional failure within the NHS. Considering that the NHS 24 is only one of several systems that are not on par, or even worse, then never got properly managed is proof further still that the NHS cannot handle too many pressure points at present.

What was wrong from Professor Dalgleish is that ‘EU migrants’ are only one of several straws, each currently heavy enough to separately break the camel’s back (read: NHS), which might be a case that the professor was trying to make, but ‘Pass notes‘ was too busy writing lame non-jokes, whilst the editor of the Guardian remained absent in this matter, which is why its readers are left in the dark (and in the near future untreated too). It was interesting to see that Rochdale Online did give more information through the statement by Louise Bours, UKIP health spokesman and North West MEP.

Here you must ask yourself the question: “Is this all just a storm in a teacup?” Especially as the larger papers ignored the ‘Dalgleish matter’. I myself expect that the statement from Dalgleish is out of context and incomplete. This failing as other elements that are driving the NHS over the cliffs were ignored could have been an option to illuminate why Ukip might not be the answer, yet as we see these levels of trivialisation, people are wondering the why; mainly because no clear explanation is coming forward they start to listen to Ukip more and more. Which is EXACTLY why I wrote the initial view with supporting documentation of a more academic level. So it is not a storm in a teacup, as we can clearly see that the NHS could be seen as close to ‘terminal’, but the factors here are a lot more than just the EU-migrants, what is a given is that unless certain things change, the EU-migrants could be breaking the NHS back, but that is equally a given for a few more factors that are currently in play.

Should any of these elements drive you crazy, then you will be equally out of luck as the BBC reported that finding a mental health spot has become pretty impossible, in that element alone, the £1b might be a great help, but there is a decent chance it will not be enough, because it is not just the beds that are unavailable, services are an equal worry, services that require staff and the refugee pressure will only add to that shortage (which is not the fault of these refugees mind you).



Filed under Finance, IT, Law, Media, Politics

2 responses to “Is there a doctor on this budget?

  1. Pingback: Behind the smiling numbers | Lawrence van Rijn - Law Lord to be

  2. Pingback: No Health Statements | Lawrence van Rijn - Law Lord to be

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