[Misc] How can the NHS survive in its current form ?

[Uncle Buck]

I think the UK could be convinced about the advantages of paying a much higher ring-fenced tax two ways
1) You do not have to sell the family jewels/house to fund care homes
2) Dentistry. Walk around Berlin and you will see a dentist every couple of blocks or so.

There are obviously many other advantages but I feel these two will resonate most.

The dentist point was a real surprise in Berlin. Pretty much all included in the public insurance. For instance SBK covered the removal of 4 wisdom teeth, slight worry was the dentist in a former DDR building at Alexandraplatz seemed to enjoy her work a bit too much.

If I had to have these removed in the UK, on the basis that NHS dentists are hard to get this I suspect would have been a 4 figure charge with a private dentist.

One annoyance I have with the German insurance based system is if you go for something basic like ears cleared that doctor will try and find other things that need doing and potentially refer you up the chain, so other people can bill the insurer, when these things often do not really need doing, more a nice to have.

 

[dsr-burnley]

No uproar from me. I may be a Labour party member but the only "-ist" I can rightly affiliate with is scientist. Whatever works, short of flogging off the NHS and creating an American style corrupt insurance model, or creating another rubric that is designed to destroy the NHS (which may be what we have now, as I will explain) is game.

The question is how to make the system work. What you have outlined is a charging model. I don't have any problem with that.

However, the elephant in the room is the infrastructure. I would argue that the NHS is now in the worst of all possible worlds. It is ostensibly state owned, and yet swathes of it have been privatized. The franchising of large elements, from cleaning to catering to temping....is all done on a 'for profit' basis. Its a bit like the Albion selling off the centre half position to Crystal Palace to manage.

So a new financial model is all very well, but we need to get all the NHS under one roof in my view. Here is why:

Where I work (a research floor in one of London's major hospitals) I have seen what bringing the market into the rubric has done to the place. A simple thing. We used to have our labs and offices cleaned once a week by an in-house person who did a brilliant job. Twenty years ago cleaning was 'sold' to a cleaning company. Not only are they contracted to clean only half the stuff the old set up cleaned (they won't go near equipment or places where biological waste may accrue, or agree to be trained how to clean this stuff), they routinely neglect the simplest things like emptying bins, sweeping under the chairs etc. And here is the rub. To complain I have to complain to my floor manager, who then leaves a message on the answerphone of the cleaner manager, not the owner of the cleaning company who probably lives in Barbados) who promptly does little or nothing, rinse and repeat.

And even within circles managed by the hospital, there are increasing layers of management that slows change, slows the fixing of errors, delays implementation of fixes and makes crazy decisions. Once you separate the workers from the decision makers you are f***ed. An example. We have three lifts to my floor. On other floors there are patient services. So two or three times a day there may be a patient in a bed in a lift, with other patients, visitors and people coming for hospital appointments, and the researchers on my floor. Apparently on one occasion a patient said something to upset another patient who was being transported in a bed on wheels. Management panicked and with zero consultation made one of the three lifts available for patients in beds only. So this lift stood unused and locked (bed movers had a secret code) for 7 hours and 50 minutes out of every 8 hours of a regular day. Meanwhile the other two lifts were perpetually clogged. I had to tell students to arrive ten minutes before a tutorial in order to ensure they can get to my floor on time. A first world problem? Maybe. But here is the main point. It took 18 months of lobbying and going through various levels of management to get this small but absurd cock up reversed. Imagine what goes one with respect to other aspects of the running of the show, and there you have it.

To fix this we need a streamline accountable coherent system, with all elements under one roof, clear and clean lines of management, and less separation of roles. Only then will new ways of funding have effect.

I agree. You can run the show for me - consider yourself head of "NHS England".

I certainly agree that we don't want the US system, but one thing that I saw in a letter to the Telegraph rang very true. It was from a surgeon who has worked in a surgical hospital in America, and said that there, the surgeons are in the operating theatre for three or four days every week. The reason being that surgery is where the hospital made money, so everything was geared to getting him to earn money. An unworthy ambition maybe - but the same result would be achieved if the ambition was purely to cure as many people as possible. The NHS systems should be entirely geared to the medical work, and management should be merely a way of how to get the medical work done.

 

[Kinky Gerbil]

Tony Blair urges expanded role for private sector as NHS turns 75 | NHS at 75 | The Guardian

Former PM says service needs radical reform, including pointing patients to private healthcare offers

amp.theguardian.com

 

[Harry Wilson's tackle]

I agree. You can run the show for me - consider yourself head of "NHS England".

I certainly agree that we don't want the US system, but one thing that I saw in a letter to the Telegraph rang very true. It was from a surgeon who has worked in a surgical hospital in America, and said that there, the surgeons are in the operating theatre for three or four days every week. The reason being that surgery is where the hospital made money, so everything was geared to getting him to earn money. An unworthy ambition maybe - but the same result would be achieved if the ambition was purely to cure as many people as possible. The NHS systems should be entirely geared to the medical work, and management should be merely a way of how to get the medical work done.

Lol! Cheers. I'm not sure I'm the best person to run anything. Sadly my autism lends me to suffer fools and foolishness poorly, and leadership seems better suited to those who can smile at liars and cheats and manipulate them as best they can without calling them out. That is not part of my skill set. I say that despite realizing, of course, that you are being kind rather than actually serious

Your example is good. Here is another. Imagine having a fantastic striker who is scoring record breaking numbers of goals. It would make sense to feed him and set the side up to do so. It makes no sense to start moaning that it isn't fair that other players don't weigh in with many goals, and that the overall style of the team is less pleasing as a consequence. This is not just my whimsical analogy since, even when the treble seemed inevitable, there were still plenty of talking heads claiming that Haaland was detrimental to Citeh's ambitions

In the NHS, just one more example, as you well know, patient contact time has been reduced because GPs have to spend more time doing paperwork. When I see the GP they spend half their time scribbling notes, and carry on doing so between patients. The most stressed I have ever seen a GP is when I rocked up with two issues, having mentioned only one on the phone when I made the appointment. Her whole time management was threatened by this and she had a right old go at me. I tried to 'beg your tiny pardon' at her, but I think that if she thought she could get away with slapping me she would have slapped me. When GPs forget what they are here for owing to the inflexible and (doubtless) ludicrous working rubric, you just knw there are serious problems.

 

[Harry Wilson's tackle]

Tony Blair urges expanded role for private sector as NHS turns 75 | NHS at 75 | The Guardian

Former PM says service needs radical reform, including pointing patients to private healthcare offers

amp.theguardian.com

Yes. Blair was wrong wrong wrong with this. The state funding of religions was why I resigned from the party (not to rejoin till Steer Calmer took over). In hindsight I should have resigned over PPF. But at the time, it was easy to fall into line.

At the time, of course, Blair was applauded for boldly modernizing Labour and embracing the market economy. Perhaps he believed this. The idea of using market knowhow to modernize the NHS and make it better is a seductive concept. There were few dissenting voices. Corbyn was probably one of them (someone else can check). Good old clever Jeremy with his finger on the pulse of truth. Or simply knee jerkly opposing anything not red in tooth and claw.

What was not obvious was that this was not the problem or the solution. What was overlooked was that as soon as you introduce partners you need to employ new management, new people to measure targets to check if the new partners are bringing to the table what was offered. And you need new people to work out how to set the targets to be be met. You then need to employ more people to oversee whether targets are appropriate. You need to employ more senior people to anticipate issues and create plans for the future. And you need to employ expensive managers to create a long term vision for the project. And as we have seen recently, we need to elect a government that can set up a review and create a long term strategy to deliver the healthcare that we all want.

Do we f***. Do we bollocks.

We need what I said earlier.

 

[Kinky Gerbil]

Yes. Blair was wrong wrong wrong with this. The state funding of religions was why I resigned from the party (not to rejoin till Steer Calmer took over). In hindsight I should have resigned over PPF. But at the time, it was easy to fall into line.

At the time, of course, Blair was applauded for boldly modernizing Labour and embracing the market economy. Perhaps he believed this. The idea of using market knowhow to modernize the NHS and make it better is a seductive concept. There were few dissenting voices. Corbyn was probably one of them (someone else can check). Good old clever Jeremy with his finger on the pulse of truth. Or simply knee jerkly opposing anything not red in tooth and claw.

What was not obvious was that this was not the problem or the solution. What was overlooked was that as soon as you introduce partners you need to employ new management, new people to measure targets to check if the new partners are bringing to the table what was offered. And you need new people to work out how to set the targets to be be met. You then need to employ more people to oversee whether targets are appropriate. You need to employ more senior people to anticipate issues and create plans for the future. And you need to employ expensive managers to create a long term vision for the project. And as we have seen recently, we need to elect a government that can set up a review and create a long term strategy to deliver the healthcare that we all want.

Do we f***. Do we bollocks.

We need what I said earlier.

SKS and Wes Streeting are suggesting a less extreme version of the Blair plan, using the private sector more with reform alongside and instead of more funding in some cases.

Streeting is an excellent choice for the role ,given his experience with his cancer battle, he knows the journey faced by patients.

Both major parties are leaning towards reform, comes down to who you trust with it more, which has an obvious answer.

Still think it should be run completely independently from politicians, everything seems to be short term planning based on election cycles

 

[beorhthelm]

I agree. You can run the show for me - consider yourself head of "NHS England".

I certainly agree that we don't want the US system, but one thing that I saw in a letter to the Telegraph rang very true. It was from a surgeon who has worked in a surgical hospital in America, and said that there, the surgeons are in the operating theatre for three or four days every week. The reason being that surgery is where the hospital made money, so everything was geared to getting him to earn money. An unworthy ambition maybe - but the same result would be achieved if the ambition was purely to cure as many people as possible. The NHS systems should be entirely geared to the medical work, and management should be merely a way of how to get the medical work done.

the most important thing we do is stop comparisons to US system. no one including the Americans want that, its not by design but a series of mis-adventures and failed fixes over time. its not even as bad as we picture, with some state and city level provisions similar to europe. the problem is they lack anything near universal healthcare system, its disjointed with seperate providers, payers, healthcare insurers, doctors, liability insurers, all with various conflicts and overlaps.

 

[beorhthelm]

Yes. Blair was wrong wrong wrong with this. The state funding of religions was why I resigned from the party (not to rejoin till Steer Calmer took over). In hindsight I should have resigned over PPF. But at the time, it was easy to fall into line.

At the time, of course, Blair was applauded for boldly modernizing Labour and embracing the market economy. Perhaps he believed this. The idea of using market knowhow to modernize the NHS and make it better is a seductive concept. There were few dissenting voices. Corbyn was probably one of them (someone else can check). Good old clever Jeremy with his finger on the pulse of truth. Or simply knee jerkly opposing anything not red in tooth and claw.

What was not obvious was that this was not the problem or the solution. What was overlooked was that as soon as you introduce partners you need to employ new management, new people to measure targets to check if the new partners are bringing to the table what was offered. And you need new people to work out how to set the targets to be be met. You then need to employ more people to oversee whether targets are appropriate. You need to employ more senior people to anticipate issues and create plans for the future. And you need to employ expensive managers to create a long term vision for the project. And as we have seen recently, we need to elect a government that can set up a review and create a long term strategy to deliver the healthcare that we all want.

Do we f***. Do we bollocks.

We need what I said earlier.

that is both problem and solution in private sector. having worked in large and small organisations, observed that most the claimed benefits of private enterprise are with the smaller business. as they get large, they lose efficency, which might work for some business (dispersal of costs, purchasing power). i can completely understand the intent to outsource cleaners and building maintenance, its the specialisation thing. and also why the f do you want health care managment dealing with cleaners? its cheaper (get them off the pension scheme for one, provide sick/holiday cover) but of course you still have to do the actual managment of that. without supervision quality goes down the toilet.

i reckon source of most problems with NHS is due to size, and institutionalism, i'm not sure can be fixed without breaking it up. which is heresy, even when every other healthcare is broken up, and NHS itself is not as singluar as people think (GPs have always been private contractors). what we need, that doesnt need privatisation but some market thinking, what services do we need and where do we need them? rather than someone deciding in 1960's we should do something a certain way and stick with it. getting rid of the GP gateway for a start.

 

[One Teddy Maybank]

The question is how to make the system work. What you have outlined is a charging model. I don't have any problem with that.

However, the elephant in the room is the infrastructure. I would argue that the NHS is now in the worst of all possible worlds. It is ostensibly state owned, and yet swathes of it have been privatized. The franchising of large elements, from cleaning to catering to temping....is all done on a 'for profit' basis. Its a bit like the Albion selling off the centre half position to Crystal Palace to manage.

So a new financial model is all very well, but we need to get all the NHS under one roof in my view. Here is why:

Where I work (a research floor in one of London's major hospitals) I have seen what bringing the market into the rubric has done to the place. A simple thing. We used to have our labs and offices cleaned once a week by an in-house person who did a brilliant job. Twenty years ago cleaning was 'sold' to a cleaning company. Not only are they contracted to clean only half the stuff the old set up cleaned (they won't go near equipment or places where biological waste may accrue, or agree to be trained how to clean this stuff), they routinely neglect the simplest things like emptying bins, sweeping under the chairs etc. And here is the rub. To complain I have to complain to my floor manager, who then leaves a message on the answerphone of the cleaner manager, not the owner of the cleaning company who probably lives in Barbados) who promptly does little or nothing, rinse and repeat.

And even within circles managed by the hospital, there are increasing layers of management that slows change, slows the fixing of errors, delays implementation of fixes and makes crazy decisions. Once you separate the workers from the decision makers you are f***ed. An example. We have three lifts to my floor. On other floors there are patient services. So two or three times a day there may be a patient in a bed in a lift, with other patients, visitors and people coming for hospital appointments, and the researchers on my floor. Apparently on one occasion a patient said something to upset another patient who was being transported in a bed on wheels. Management panicked and with zero consultation made one of the three lifts available for patients in beds only. So this lift stood unused and locked (bed movers had a secret code) for 7 hours and 50 minutes out of every 8 hours of a regular day. Meanwhile the other two lifts were perpetually clogged. I had to tell students to arrive ten minutes before a tutorial in order to ensure they can get to my floor on time. A first world problem? Maybe. But here is the main point. It took 18 months of lobbying and going through various levels of management to get this small but absurd cock up reversed. Imagine what goes one with respect to other aspects of the running of the show, and there you have it.

To fix this we need a streamline accountable coherent system, with all elements under one roof, clear and clean lines of management, and less separation of roles. Only then will new ways of funding have effect.

This example feels more like an example of not knowing who to go to initially to me…. (I know it’s not that simple).

I would argue it is incumbent on the decision makers to have an understanding of what the workers actually do, so any issues can be discussed and resolved at a local level prior to escalation.

Sadly, I have a strong control gene, so I like to think I know practically everything that is taking place within the area I work in, some things of course I have more knowledge in than others.

Re some of the posts on here, everything is always easier looking in, and everyone has great ideas, until they end up working in a particular industry, and then realise there are a number of co-dependencies impacted by a decision.

More money for cancer, but does cardiology go without? No beds for the patients, that’s because they can’t find a bed in social care for those who need to be discharged. No staff, well pay them then. There is no incentive to stay for nurses, who can earn more elsewhere.

Medics are more accountable than ever before, the public have a litigation mentality for practically everything. So it’s no wonder that before a clinical treatment decision is made, often multiple people are involved. It slows things down.

 

[Harry Wilson's tackle]

This example feels more like an example of not knowing who to go to initially to me…. (I know it’s not that simple).

I would argue it is incumbent on the decision makers to have an understanding of what the workers actually do, so any issues can be discussed and resolved at a local level prior to escalation.

Sadly, I have a strong control gene, so I like to think I know practically everything that is taking place within the area I work in, some things of course I have more knowledge in than others.

Re some of the posts on here, everything is always easier looking in, and everyone has great ideas, until they end up working in a particular industry, and then realise there are a number of co-dependencies impacted by a decision.

More money for cancer, but does cardiology go without? No beds for the patients, that’s because they can’t find a bed in social care for those who need to be discharged. No staff, well pay them then. There is no incentive to stay for nurses, who can earn more elsewhere.

Medics are more accountable than ever before, the public have a litigation mentality for practically everything. So it’s no wonder that before a clinical treatment decision is made, often multiple people are involved. It slows things down.

Taking just one issue, having all my details taken down three times by different people, yet not seeing a medic for hours, when hospitalized with chest pains, is symptomatic of a shit show, not understandable attention to detail. When I was finally seen by a medic, he hadn't read any of the notes - and not one of the three versions of my details.

The root cause is the solution for everything is create new management posts and more process.

In the uni where I work we had a perfectly decent staff student liaison committee and managed the recruitment of class reps ourselves. Then the college introduced a department of and head of 'student experience'. She took over the process of rep recruitment, and even the writing of our agendas. The upshot is that whereas 10 years ago we would get 15 class reps at the meetings, we were not quorate the last 3 meetings, and at the last meeting no student reps turned up. None. And yet a lowly administrator still had to write minutes, get me to check them and file them. As long as the paperwork is done the box is ticked and we have all done our jobs and can give ourselves a pat on the back. I have complained to heads of teaching and they just shrug their shoulders.

 

[Harry Wilson's tackle]

I don’t see prevention services prioritised that keep the nation healthier. It’s all reactive. The latter is just not sustainable.

Here is another take. If we have better preventive services we will make things even less sustainable. Why? because people will live longer and the elderly are statistically sicker more often and with multiple complex medical conditions.

To me we either flog it all off and make people insure themselves (the true conservative view - it would be mine were I conservative) or you have fully nationalized integrated socialist health provision.

A poster above explained why the idea of in house cleaners is mad, then explained why contract cleaning doesn't work! FFS! It would work if the NHS paid loads more money for contract cleaning. But that would cost loads more money. FFS!

 

[One Teddy Maybank]

Taking just one issue, having all my details taken down three times by different people, yet not seeing a medic for hours, when hospitalized with chest pains, is symptomatic of a shit show, not understandable attention to detail. When I was finally seen by a medic, he hadn't read any of the notes - and not one of the three versions of my details.

The root cause is the solution for everything is create new management posts and more process.

In the uni where I work we had a perfectly decent staff student liaison committee and managed the recruitment of class reps ourselves. Then the college introduced a department of and head of 'student experience'. She took over the process of rep recruitment, and even the writing of our agendas. The upshot is that whereas 10 years ago we would get 15 class reps at the meetings, we were not quorate the last 3 meetings, and at the last meeting no student reps turned up. None. And yet a lowly administrator still had to write minutes, get me to check them and file them. As long as the paperwork is done the box is ticked and we have all done our jobs and can give ourselves a pat on the back. I have complained to heads of teaching and they just shrug their shoulders.

I know these are examples, but….. (and I’m sure you know this).

Point 1 - so frustrating, the number of times I actually say “read the notes”…. For me and slightly off subject, consultants do not carry the gravitas they once did, and there is little fear factor amongst juniors, so they don’t care if they take details more than once. It probably seems easier than reading notes or going on PAS. As for the medic, it is just rank bad practice, I don’t care how busy they think they are.

Point 2 - difficult to comment without knowing which box is ticked, but if it is the difference to being a teaching centre or otherwise, or alternatively until there is an incident from a treatment/trial, the notes will be mundane, but ultimately may be useful…. (Sorry I know very little about Uni’s)…..

In terms of management, if you have fewer, you lose control and have little or no governance. You’d get clinicians buying robots, that would stay in boxes, practising rarely used techniques rather than refer to a specialist centre, no audit, less research, no accountability, more pressure on clinical staff etc…

 

[tigertim68]

The NHS would be funded properly if there was not 10 million adults not contributing to tax or national insurance at all ,
time to get people working and not claiming long term sick pay

 

[Commander]

presumably you’ve complained about this?

I would suggest you raise it with the Patient Advice and Liaison Service.

I really don't have the time or energy for it at the moment. I've worked out the system- cause a massive nuisance of yourself and things get done. Otherwise they don't. The sad thing is that plenty of patients don't have friends or family to do this for them.

 

[HalfaSeatOn]

Here is another take. If we have better preventive services we will make things even less sustainable. Why? because people will live longer and the elderly are statistically sicker more often and with multiple complex medical conditions.

To me we either flog it all off and make people insure themselves (the true conservative view - it would be mine were I conservative) or you have fully nationalized integrated socialist health provision.

A poster above explained why the idea of in house cleaners is mad, then explained why contract cleaning doesn't work! FFS! It would work if the NHS paid loads more money for contract cleaning. But that would cost loads more money. FFS!

My take would be that atleast preventative and healthier living measures delay the inevitable scenario until to ‘as late as possible’. I’d also have a whole systems perspective to support ‘as late as possible’. The Food industry, for example, doesn’t help this with people demanding health services ’too early’ through their food diet ‘choices’. It’s only with a package of whole system measures that the NHS has any chance to succeed. Demand is accelerating and it’s going to cost loads more money however it’s sourced! I for one want the NHS to succeed on its founding principles but it’s not going to be easy.

 

[Harry Wilson's tackle]

I know these are examples, but….. (and I’m sure you know this).

Point 1 - so frustrating, the number of times I actually say “read the notes”…. For me and slightly off subject, consultants do not carry the gravitas they once did, and there is little fear factor amongst juniors, so they don’t care if they take details more than once. It probably seems easier than reading notes or going on PAS. As for the medic, it is just rank bad practice, I don’t care how busy they think they are.

Point 2 - difficult to comment without knowing which box is ticked, but if it is the difference to being a teaching centre or otherwise, or alternatively until there is an incident from a treatment/trial, the notes will be mundane, but ultimately may be useful…. (Sorry I know very little about Uni’s)…..

In terms of management, if you have fewer, you lose control and have little or no governance. You’d get clinicians buying robots, that would stay in boxes, practising rarely used techniques rather than refer to a specialist centre, no audit, less research, no accountability, more pressure on clinical staff etc…

Actually....yes. Albeit enforceable rules and process with streamlined management by trained managers is what's needed, not more and more managers who spend most of their time managing other managers, and answering to their own managers.

Otherwise I agree. Indeed, nobody should leave physicians to their own devices (pun intended). I have often said that where I work the physicians are great physicians, but they are piss poor at everything else, whether it be teaching, marking, purchasing and even replying to emails. Some of my best pals (etc.) but they are still not to be trusted with changing a lightbulb. And there is a reason why they all wear *slip on shoes?

(*I made that bit up - most of them can tie their own shoe laces. The bit about the lightbulb however is fact. Fact.)

 

[Gazwag]

Absolute nonsense.

Another report published by Institute of Public Policy Research, highlights a significant shortage.

Well it's the case in my neck of the woods

 

[Harry Wilson's tackle]

My take would be that atleast preventative and healthier living measures delay the inevitable scenario until to ‘as late as possible’. I’d also have a whole systems perspective to support ‘as late as possible’. The Food industry, for example, doesn’t help this with people demanding health services ’too early’ through their food diet ‘choices’. It’s only with a package of whole system measures that the NHS has any chance to succeed. Demand is accelerating and it’s going to cost loads more money however it’s sourced! I for one want the NHS to succeed on its founding principles but it’s not going to be easy.

Yes but delaying morbidity is simply kicking the can down the road and shifting the age of the patient when they become a healtcare burden from their 50s to their 80s. Great for the individual as they live longer, but no cost saving to the NHS. Removing type 2 diabetics (for example) from the health service may largely keep more people alive longer but they will pop up later in the health system with prostate cancer, arthritis, COPD, heart failure and cancer. The problem is that in the long run we are all dead, and unless it is by a sudden and swift stroke or MI, there will be a costly interlude between the end of good health and the appearance of death. I may be exaggerating this but I have seen an increase in 'diseases of age' over the last 40 years as general health (and wealth) has increased, so it has become an issue when it wasn't an issue 50 years ago. My uni created a center for age related diseases 20 years ago. So the removal of type 2 diabetes (etc.) may give an illusion of less strain on the NHS, but if the result is an increase in other types of diseases 20 years later then the financial and logistic burden will be unchanged. Swings and roundabouts. Ironically the health care costs would fall greatly if we went back to the 1890s where it was common for mother and child to not make it through childbirth. Neither would go on to develop chronic illnesses later in life presenting a cost burden to the health system, whatever it may be.

 

[St Leonards Seagull]

Still think it should be run completely independently from politicians, everything seems to be short term planning based on election cycles

This, this, this.
So much short term planning. Governments don’t care what happens beyond their term. A bit of grandstanding for politicians in the short term, screw the long term.

 

[dsr-burnley]

Yes but delaying morbidity is simply kicking the can down the road and shifting the age of the patient when they become a healtcare burden from their 50s to their 80s. Great for the individual as they live longer, but no cost saving to the NHS. Removing type 2 diabetics (for example) from the health service may largely keep more people alive longer but they will pop up later in the health system with prostate cancer, arthritis, COPD, heart failure and cancer. The problem is that in the long run we are all dead, and unless it is by a sudden and swift stroke or MI, there will be a costly interlude between the end of good health and the appearance of death. I may be exaggerating this but I have seen an increase in 'diseases of age' over the last 40 years as general health (and wealth) has increased, so it has become an issue when it wasn't an issue 50 years ago. My uni created a center for age related diseases 20 years ago. So the removal of type 2 diabetes (etc.) may give an illusion of less strain on the NHS, but if the result is an increase in other types of diseases 20 years later then the financial and logistic burden will be unchanged. Swings and roundabouts. Ironically the health care costs would fall greatly if we went back to the 1890s where it was common for mother and child to not make it through childbirth. Neither would go on to develop chronic illnesses later in life presenting a cost burden to the health system, whatever it may be.

Exactly. If we divide causes of death into four groups, 1 - illnesses caused by overweight, 2 - cancer, 3 - old age and dementia, 4 - everything else including heart disease not caused by overweight;

then, by definition, thin and healthy people must suffer more from causes 2, 3 and 4 than fat people, because they don't suffer from 1 and yet they still die.

Add to that, one of the problems of persuading people that they ought to try and live more healthily is that they have seen what happened to their parents and other relatives, and they don't think those last few years are an ambition worth chasing. They prefer to eat, drink and be merry, and take their chance.