Like many Europeans living in the UK, we have criticised the NHS many times. It is simply not as great as British people tend to think. Why is that? Why is it so bad? And why do British people think it is not?
It was time to bring an expert to give us some professional view. Our guest today is dr Richard Fitzgerald, a retired radiologist, a former RCR Vice President and an online activist, campaigning against harmful changes to the NHS.
You can find him on Twitter HERE
For people with hearing difficulties, below is an automatized transcript of the podcast. It was briefly proofread, but it’s still pretty raw.
Tomasz Oryński (host)
Hello everyone. My name is Tomasz Oryński and you are listening to another podcast from the series of Mądrze Gada or as we call it in English, Talking Sense. And our guest today is Doctor Richard Fitzgerald. Hello.
Dr Richard Fitzgerald
Hello.
Tomasz Oryński (host)
Doctor Fitzgerald is a radiologist who worked in NHS for many, many years. But there’s much more to the things you are doing. So if you can like briefly introduce us to what you have been doing during your career.
Dr Richard Fitzgerald
Thank you, Tomasz, for inviting me. So essentially, I’m a retired radiologist. So I grew up in Ireland, qualified as a doctor in Ireland and came to Britain in 1981. To train to be a radiologist and then after five years of training, to be a radiologist in Birmingham and the West Midlands, I became a consultant in Wolverhampton and I was consultant radiologist there until 2017. And for the final 20 years of my professional life, I was also involved in national medical politics in the British Medical Association, which is the trade union for doctors. And in the Royal College of Radiologists, which is the professional body for radiologists. Not only have I worked in the NHS for many years for over over 30 years, but I also, you know, I’m an NHS patient myself, albeit minor things not, not serious things and my late partner died last year from cancer. And of course he was in NHS.
Tomasz Oryński (host)
I’m sorry.
Dr Richard Fitzgerald
Thank you, Tomasz. For 18 months. So I saw it at first hand plus of course the older you get, I’m now 69. The older you get, the more friends you have who have illnesses and you hear what’s going on in, in their difficulties in trying to access. To get NHS care. And the good and the bad. And so that’s my background.
Tomasz Oryński (host)
OK, so let me put you to a small test because you said you were born in Ireland but then moved to Britain. So let’s see how British you are and let’s answer that question.
Dr Richard Fitzgerald
Oh.
Tomasz Oryński (host)
Is the NHS the best thing ever?
Dr Richard Fitzgerald
It’s even more ambivalent than that, Tomasz, because I’m a dual citizen now, an Irish and a British citizen simultaneously, which is a concept that the Irish find extremely easy to accept. But not every nationality. Is so easy, are so promiscuous with our. ability to be two-national. And so the question was, is the NHS perfect or not? And the answer is no, sadly no. And I think there are two major reasons, in my opinion, why the NHS is is in deep trouble at the moment.
Tomasz Oryński (host)
I actually wanted her to ask you that because I hear mostly from British people. I mean, at least those who don’t claim that NHS is the best thing ever and you don’t, they’ll criticise it, that NHS have been broken by the Tories. But my own experience, as someone who moved to Scotland in 2005 is that it wasn’t really great even before Torres. So I just wonder, let’s be honest, it is a great idea and I’m sure it was very great at one point. What went wrong?
Dr Richard Fitzgerald
What went wrong? You’re right. Although the Tories have done immense damage over the past 14 years, it wasn’t perfect beforehand. I think there are various issues if you consider World War 2, which of course is was a defining event for all European countries after World War 2 that you know there was an acceptance in society that a better world must be created not just in mainland Europe but in Britain. And part of that dividend, as it were, peace dividend after World War 2.
In Britain was the establishment of what they call the welfare stage and part of the welfare state was improved social. But the major part of it was the National Health Service, and the principle was that, to quote the founder of the NHS Bevan, who was a Labour health minister, “in place of fear so that if one was sick, instead of being afraid of not having enough money to see a doctor and get treated, but in place of fear, there will be a National Health Service that would be free at the point of delivery”.
So the access to healthcare, be it with AGP or in an A&E or in whatever context that it would be free at the point of delivery. Now, of course, the treatments that were available in 1948 were limited and, you know, bare absolutely. You know, little resemblance to the treatments that are potentially available now. Moreover, people at that time lived much shorter lives and patient expectations, of course, nowadays are much greater than they would have been in 1948. I think one of the problems is that politicians, politicians of all parties, like the public being justifiably proud of the. Health service. Have never wished to be in any way frank about any of its shortcomings.
And so over the past, the the NHS now is, I think, 75 years old. It’s it’s 76 years old this year. Over that time, the gap between the funding provided through taxation. And what patients could reasonably expect has widened and I think it’s useful to compare and I’m not saying that the German system is perfect or the French system is perfect or the Swiss system is perfect. But when you take in Britain, the average person, the average citizen and living in the average person living in Britain, whether they’re a patient or not, the stage through taxation spends £3500 per person per year. In France, that’s about 4000 pounds. In Germany about 4500 and in Switzerland it’s about 5500, and in America it’s about 9000. So the point is nobody will tell me that the French or Germans or Swiss are lazy or wasteful. Know there are problems in their systems as well, but the bottom line is you can’t get for £3500, but the Germans are spending £4500 on and you just look at the statistics as to the numbers of doctors. Per 100,000 population, or the number of nurses, or the number of hospital beds, or the number of ICU beds. And so, you know, you can’t do miracles. You can be efficient and so on. But this is sustained. So this is sustained under funding.
Tomasz Oryński (host)
OK, so so if I can step in so we can like establish one point here, that money is indeed a problem. NHS is underfunded, yes.
Dr Richard Fitzgerald
The other thing that I would say then is that over the past few years, you know the Tories saying they have prompted money. And never has more money been given to the NHS, but the bottom line is that during the COVID epidemic, a pandemic. Written. Wasted. At least £60 billion, you know, that’s about 70 or 80 billion on COVID contracts that were corrupt. And the reason I can say this so confidently is there have been not just one but four different inquiries into how test and trace, you know the COVID testing and tracing contracts, were given out. Two by the House of Commons Public Accounts Committee and two by the government’s national coffers and all four reports found no evidence of benefit. In other words, vast amounts of money were given to companies to do stuff that was not effective.
I’ll give you an example. The little town where I live. About 10,000 people. For weeks, if not months on end there would be a tent in the car park there to do COVID testing and there will be 5 or 6 people in the tent and you can go and have a test. Basically, most of the time there was nobody there. Were doing nothing. I give that as an example, but that’s how a vast amount of money was wasted. And the other thing that I would also say is that over the past 20 years, more and more money has been given to private contractors, so whether that is Tele-radiology companies are sending patients to private hospitals to have operations done or allowing big companies, often with subsidiaries of American companies, take over general practises, but the nature of these contracts is that typically 30% of the money goes in profit to the company. And not to invest in the NHS.
Tomasz Oryński (host)
Yes, we had one of those early chapters of our podcasts when we were discussing privatisation of the British Railway and how it was.
Dr Richard Fitzgerald
After you know and you have, it’s the same principle and you have, you know you have a British Railways and various British utilities, be it.
Tomasz Oryński (host)
So I guess it’s the same mechanism.
Dr Richard Fitzgerald
Or the National Grid or whatever. Owned by hedge fund companies or in some cases. German, Swedish, Spanish governments or pension funds making profits quite legitimately, but basically so, and this brings me before I go on to it, really is the other. So one aspect is about the NHS is it was set up as a matter of pride. But it has been increasingly underfunded. Better to what people could and should expect.
Tomasz Oryński (host)
If I may like step in here with something because you’ve said how much money was wasted on on COVID and on on this, like subcontracting to private companies, this is basically just people trying to make money on out of it, which is. To be expected in this like wild capitalism. But there are also accusations of that the money in NHS they are not spent wisely, and I’m not going into that right-wing crap about equality and officers and everything. But even from my own experience, I’ve been sent on NHS. I’ve been offered mindfulness, which, as my my psychologist friend, say it’s not really confirmed medical technology to of of giving people mental health.
Dr Richard Fitzgerald
Correct.
Tomasz Oryński (host)
I was offered acupuncture, which I can know that it’s completely complete quackery and it has no medical value from all the research I’ve seen and also famously in Glasgow, there was a thing called Homoeopathic Hospital. Which is again pseudoscience, so I don’t think such things should be funded by the NHS.
Dr Richard Fitzgerald
But I what I would say about that, Tomas, is that. Being a radiologist, interpreting X-rays and scans, you’ll gather I’m not well equipped to comment on the value or not of mindfulness or acupuncture. I certainly wouldn’t be in favour of homoeopathy. But the other thing I would also say on the issue of the capitalist. I’ll come back to waste in a moment, but on the issue of capitalism and the NHS. The other thing is when you look at British society over the past thousand years. Essentially, in the United Kingdom, where you have England and Wales and Scotland and Northern Ireland, and in the past all of Ireland, but fundamentally you have two different tribes, so you have the Celtic nations, namely Scotland, Wales and Ireland and that is as different an ethnic group. As you know the French from the Germans, quite frankly. OK, we speak the same language. But or shall say you know it’s a fundamentally different racial group, which really added the basis, is very much a kind of social demographic and a model, whereas the Anglo Saxon race, which is England, is fundamentally a capitalist and hierarchical society. And you look at, you know, how the society been structured in England and then ultimately in Wales and Ireland and Scotland, where you have a monarch, a king or a queen, and they gain their power not through election but through grabbing. What they can and having enough supporters to hold on to it, and so within various families, you’ve been various feuds and people various monarchs being killed or exiled, and all the rest of it and these, to maintain their grip on things, had, you know, set up a thing called the establishment where you would have various people who would be made and Lord or made a Sir, or made a Dame or whatever, and these would be enforcers. And this is like a giant mafia set up.
Tomasz Oryński (host)
And it’s it’s, it’s also part of this classist system in Britain that’s that’s really.
Dr Richard Fitzgerald
All very much so, very much so and so having that kind of concept that actually society is not, it shouldn’t be run on Social Democratic values, but should be well known whoever can grab what they can and can hold on to it. Good for them. The same applied obviously in the colonies. Britons who went abroad and, you know, raided pirate ship ships and brought back money to the king or queen who gave them some money in return and so on. And to the colonisation of countries. But the problem about this colonisation culture and grabbing and very greedy capitalism is it is also applied to people living in Britain. You get my vibe, so however badly people in India or in Ireland or in Scotland felt they were treated well, people abroad in the colonies were often treated much worse or similarly or similar tactics. And so similarly, even with an institution as sacred as the NHS, the same principles, full aggressive capitalism is applied to the contracting, so like in any institution that is so vast as the NHS, there will be waste. The bigger problem by far is this capitalist model of privatisation and also of a willingness to. To accept a concept that some people should have to make do yhe lesser quality of care than others. And than if you could have paid, it you can get a better quality of care.
Tomasz Oryński (host)
Yes, but as you mentioned, Indians and people from abroad, let’s, let’s use it to segue into this other.
Dr Richard Fitzgerald
Come on
Tomasz Oryński (host)
I believe it’s misconception, but maybe you you put me right at that, it’s this migration that’s such a great burden to the NHS and that’s why it’s collapsing. But there are few. Just if you just think about with a common sense, like look at the Polish community in the UK, not only plenty of doctors.
Dr Richard Fitzgerald
No, no, no, no.
Tomasz Oryński (host)
Who are educated in Poland and, I dare to say, some of them to higher standard in the British counterparts on some occasions and they work in the NHS, so you’ll get actually free, free qualified staff that you haven’t had to spend a penny on their education. But also when you look at the general general Polish population, most of us who came to Britain, We were in our like prime age or very young could have ready to work and everything. They weren’t like disabled or retired.
Dr Richard Fitzgerald
Alright, you’re absolutely right. The thing about about migration is first of all, you know, when you look at migration figures for Britain. Although there’s all this howling about small boats and asylum seekers and so on, relatively speaking, you know, there are maybe 30,000 last year out of 900,000 net who came in. And when you look at the other groups who come in, the biggest groups are either students or studying in universities and basically propping up the universities with their fees, which are more expensive than for the local students. And people working in the NHS and social care. And under the other, your point is also well made, Thomas, about the fact that immigrants, very often, are young and which is a very important point because it basically in terms of those who are the most expensive users of healthcare, it’s people who are age 60 and above. You know, so the, the, the various people who have come from Poland or other EU countries or other parts of the world, you know, in the past 20 years, most of these are are young people, young people. And they actually are net contributors to the government in terms of the taxes that they pay and are actually very light users of the NHS in comparison to somebody, say somebody who has a hip replacement or cancer treatment or ongoing treatment for diabetes or heart disease or whatever. And so the case for it has never been made.
And the other concept is that in terms of multiculturalism and racial integration, and so on. You know, ultimately it takes 2 to tango, it takes 2 to to form a relationship. And so in terms of people integrating in society, they must be made feel welcome. See what I mean? And so when funding is cut from English language classes, this is just madness because it means the person who’s come in is less productive, and it also means they’re less able to integrate. So, you know, I think that partly stems from the island nature of Britain. Now, you may say Ireland has a different attitude. Well, of course, Ireland has a different attitude. Because we’ve been a donor nation of people we have emigrated in vast numbers and millions over the past 200 years.
Tomasz Oryński (host)
Exactly what you mentioned before.
Dr Richard Fitzgerald
Yeah. And so every Irish family will have at least if not immediate family member, certainly a very close relative who lives abroad and so the relationship in that respect is very different. But the the other thing I would also say about public discourse about the NHS is the bottom line is under the age of 16, most people rarely use the NHS. I have a younger brother who lives in London and yes, he’s registered with an NHS GP. He has never seen his GP. And they, you know, 30 years, he has been living here.
And so you have a lot of what I might call, uninformed talk about the NHS from people who actually don’t use it, and the other thing that I would say is that those people who do use it by the time people get cancer. Serious heart disease or involved in an accident or whatever, by and large, people are so weary and so weak and they’re not able to speak up for what they need are about the good points that they see in the NHS. And so we don’t get a patient’s perspective we get, what I call, a commentary at perspective and when you look at the media, first of all, most of the mainstream media, be it in, in you know, the big newspapers. They’re owned by oligarchs, many of whom are resident for tax purposes abroad. And when you look at the TV channels, the BBC is reliant on taxation for its funding. And they’re always, you know, very anxious to please whatever government is in power. And then you can look at a channel like GB News and I’m not sure exactly what its funding is like, which can be generally sure it’s right wing funders. So the the public get a diet of either the NHS is great and look at this most wonderful treatment that is now available or they get, you know, they they don’t tell the truth about all the problems. I’ll give you, I’ll give. An example, say general practice. General practice is a major positive aspect of them healthcare in Britain in terms of sorting out problems locally and conveniently for patients and risk managing things. So you know you you won’t believe how little. The NHS pays a GP to see a patient.
Tomasz Oryński (host)
Actually I wanted to go back to that later. So maybe we put it aside for now because I I I still wanted to to expand on this perception you said because you rightly said that some people like believe in NHS and some people criticise the NHS, but I find it amusing that both sides are using the same arguments to support their points and they are both wrong. And I give you the example of that. I hear that NHS is so great that people from all over Europe are flocking to benefit from it and those who believe that it’s great, they think it’s a proof how great it is. And those who think it’s crap, they say it’s crap because of them. But the fact is actually opposite.
Dr Richard Fitzgerald
Oh, no, they’re not. Oh, no, they’re not.
Tomasz Oryński (host)
All my friends, not only from Eastern Europe but Italian or Croatians living in Britain, they also fly to their own countries to get medical help after they are unable to get one on NHS. I myself was told by my own GP after I’ve been assaulted and I had some head injury and he was trying to get me to neurologist. He was really trying to like making phone calls, trying to move me up because it was urgent in his view and he finally said “I think you’re safe to fly: Just go to Poland. There’s no chance you will get a proper help here anytime soon”. So it is actually the opposite to this myth about people flocking to Britain to use NHS that is used by both sides.
Dr Richard Fitzgerald
I agree with you, Thomas. I can’t imagine they would come to Britain, unless they were going for extraordinarily expensive private treatment in London. Those are the only people who come to Britain for care and you’re you’re absolutely right. There’s a journal that comes out every month called European Radiology. And you look at the articles in that journal every month and you look. Where the high quality research is being done and it’s not being done in Britain. And it’s been done in Germany or Belgium or Finland or France or Italy or whatever. And what are the reasons for that? That because the NHS is so understaffed, there isn’t time or energy to do research. And because the funding, when you look at funding for research in general in Britain. Decades. If if Britain has one particular talent, it is actually it is. They are very inventive. It’s a very inventive nation. And so in my own branch of medicine and so on, you know: Penicillin was discovered by somebody in Britain. Similarly anaesthesia. Similarly, X-rays were discovered in Germany, but ultrasound, CT and MRI were all discovered in here. In a branch of radiology, you know, the bottom line is it’s fundamentally a British invention, with the exception of the X-ray, but it’s this marketing, but essentially in Britain. What Britain fails to do is to invest money in research and so therefore to sustain long term development and marketing. So if you contrast, Britain spends 1.8% of GDP on research. Across the board, not just in health but across across everything. You look at a country like Germany, they spend 3.3%. So, you know, coming on to twice as much. As a percentage of their gross gross domestic product on research. So you know, there are lots of myths.
And you know, before we came on air we were saying about how my view is that Britain doesn’t doesn’t play to its full potential because of various handicaps. I think a fundamental handicap is this kind of hierarchical system whereby, you know, the top. can have vast amounts of money and you kind of block the huge numbers of people underneath you to have that amount of money. And you know that that is not good as a basis for funding for research and development and therefore for innovation and technology and so on. But it’s also not good for funding public services. And the second one is this supremacist view of colonial attitude. But just because in the past one had an empire that covered, you know, I forget how much of the globe and that the sun never set sat… You know there was sun always shining at any point in the day. In some place within the Empire. That’s not a good historical basis for competing and playing properly in a modern world, or at any time, so it’s like a player in a football team who is a wonderful player, who is profoundly inventive and so on, but who, by virtue of thinking that they are always the best and that they are always leading and that they play great games in the past and feel that they should be given preferential treatment and that’s that’s unrealistic.
Tomasz Oryński (host)
But that’s that’s actually very British. I’m just observing some discussion about the Brexit where where those British activists demand access to the freedom of movement, and they are arguing exactly along the same lines. You read them and you think that they think that because they are British, they should get better treatment than any other non-EU country.
Dr Richard Fitzgerald
I have a question. It’s not and it’s totally unreasonable and the thing is that, you know, if you are in a club or a group or a consortium or whatever is is the the EU of 27 nations, there has to be give and take. And yes, and and whether you’re a big country or a small country. You know, there has to be give and take, but I think it I one of the another handicap that Britain has had in the past 50 or 70 years is that because of its false relationship with the United States during World War 2 and after World War 2? And because it spent so much of its gross national product on defence. It was kind of cushioned into thinking, well, actually, we did work well in World War 2. We won World War 2, and now we’re with the most powerful nation in the World, America. And so therefore, we don’t really have to be wholehearted players and members of the European Union. And so I think that special relationship with the United States, which has gradually withered since the end of the Cold War, and with the rise of China and America’s focus on China has been damaging to a realistic assessment of Britain’s place in the world. In this century.
Tomasz Oryński (host)
Yes. And there’s another aspect of that special relationship with the US, which is related to the NHS as as as we are talking here that I think that because of that many British people have more interest in in how the things are working in the US than how the things are working in the EU? So they often often compare the NHS to America and say we are doing great compared to what’s health service in America looks like. But let’s be honest, that’s hardly an achievement to be better than a than the US, isn’t it?
Dr Richard Fitzgerald
Correct. And I’ll tell you the other thing is to be fair. When Tony Blair was Prime Minister and Gordon Brown was Prime Minister, now they made terrible mistakes in respect of Iraq. But they did put in a lot of money into the NHS. So any modern healthcare system in the developed world? Bees to increase its health spending by 4% per year. That is because people live longer. New treatments become available and expectations rise. In the case of Tony Blair and Gordon Brown, they increased the NHS budget not by 4% a year. But by 7% in. Yeah, by contrast, since 2010 under the Conservatives, healthcare spending has increased not by 4%, but by 1 to 2%. And hence we’re in the huge mess that we’re in. So. So if you look at the, you know, the French, the Germans, the Swiss and so on, they would all but increase their health care spending 4% year on year. Obviously, there’ll be some years, might be more or less or whatever, but there hasn’t been this kind of. Increase of only one to 2% for 15 years, as occurred under the to.
Tomasz Oryński (host): Hmm. So we we we spoke about the money, we spoke about the the immigration and with the bank that idea, we think that’s the immigration is actually great for the NHS because you get, to put it as simple as possible, thanks to immigration you get much more doctors and nurses then you get sick people. Just a net profit for for the NHS.
Dr Richard Fitzgerald
Other thing. I would say on the question of the of, say, doctors and nurses. And I say this as an Irish doctor who, you know, who came to train to be a radiologist here and who worked at the radiologist. In a perfect world every country would produce its own doctors and nurses. And these doctors and nurses would have a a particularly, it would have an advantage in understanding the circumstances of their patient. The language, the values, the expectations, the kind of the, the things like the Society or Beliefs and so on. That matters so much to some people rather than to others. And undoubtedly, if you want the NHS or anybody here hires a doctor or nurse from abroad, you’re buying off the shelf. They’re ready made. You don’t have to wait for them. You don’t have to wait, you know, to train to be a radiologist between university and medical school and doing your basic medical training and radiology, it’s 12 years. That’s a long time to wait for a radiologist to wait. Or for a surgeon or an oncologist you’re waiting 15 years. So you can see the attraction for the state in Britain of employing people from abroad. Odd, but you can see that that that that’s not, you know, the other problem is in terms of fairness. You have huge numbers of British doctors who want to be, a young British people who want to be doctors or nurses, but and in particular to be doctors. But when they qualify as doctors, they cannot get a peer post in the NHS to advance to train to be a radiologist. So when I came to Britain and I applied for radiologist’s post and I remember being interviewed and there were 8 posts. And there were only five of us who had applied, so I wasn’t taking a post from any young British doctor. Nowadays, if you look at a training post, so these will be for young doctors, they’re qualified young doctors. They’ve spent five years in medical school. They’ve spent their first two years in what we call foundation here. And they’re looking to be a radiologist or AGP or physician or whatever. There are 10 doctors, British doctors looking for one job and this is because the underfunding of the NHS over the past number of years has cut the number of funding jobs.
Tomasz Oryński (host)
To correct me if I’m wrong, but I also assume that there’s less positions because you don’t need to pay for training of your own if you can just pick one from other countries. But then on this side we also have to remember that you are picking someone from the other country, the other country paid to train them. And then they are gone. So it’s also a brain drain on.
Dr Richard Fitzgerald
And the other thing that I would say, unfortunately, the latest capitalist trick in Britain is instead of hiring a doctor, hiring what they call a physician assistant.
Tomasz Oryński (host)
Oh yes, I wanted to ask about that. So let’s go straight away into that.
Dr Richard Fitzgerald
Because it’s an important point. So a physician associate has only two years training, not the 10 years to become a that takes it takes to become AGP are the 12 years to be a radiologist or the 15 years to be a surgeon. They train for two years. And the title they have – physician associate – is deliberately vague so that the average patient thinks they hear the word physician. They think this is something really good. And these people? But I won’t go into all the politics and all the rest of it. But as things stand, as things stand there is no limitations on what on what any employer be at a hospital or general practise can ask one of these two year trained people to do and they Say oh, we have done a degree beforehand.
The degree may be in something like nursing or it may be in Podiatry or physiotherapy, but it may be in zoology, it may be in some other science subject or a technology subject and fundamentally. If you do three years, for example, training to be a nurse. And our training to be a, if you’re training to be a doctor, quite frankly, there are many things that a nurse or a physiotherapist does that a doctor is not trained for. So, for example, I’m a radiologist. I’m a doctor. Supposing I wanted to be to practise as a physiotherapist. The idea that I would be able to do that in two years would be ludicrous. Yes, there will be certain things that you would know kind of already, but there are many things that one wouldn’t and say in my own branch in radiography, the professionals who perform the CT scans or the MRI scans, the technical aspects of that I really I know the broad principles of, but I would need the two to three years that a radio that an ordinary radio requires to do it. But this is, again, the kind of capitalist, the ultra capitalist model of the establishment, but wants to basically have an NHS on the cheap whereby ultimately the quality of care is so poor that people have to go privately. And when you look at West region with the health secretary, there’s a thing in the House of Commons called the Register of interests. And so anytime you’re given a donation, you’re supposed to put it in the register. Interest now the fact that the donation is a is inappropriate or wrong or is corrupt is neither here nor there. If you get money and if you accept it, you’re supposed to put it in the thing. So you look at the donations that we know of. That we’re seeing, the health secretary has had in the past two or three years he has had 200,000 pounds we know of from donors with huge private healthcare investments serving their hedge funds and managers of private healthcare companies. And so what that gives him these people, it certainly gives them easy meetings with the health secretary and it certainly gives them his e-mail address and his mobile number. And if they’re interested in making submitting to get a contract for this, that or the other, he can, they will say to him always, who should we contact to find out about what they NHS is really looking for in this contract. And you know, it’s only natural they’re they’re on the inside track.
Tomasz Oryński (host)
OK. But coming back to this PA’s, because there’s something I don’t get and maybe you can help me out. So I’ve read some articles on that and you mentioned that this is like money saving or probably rather money making exercise to make more money on the NHS, but I’ve seen something that shows that these PA’s after just two years of training, they often paid more than the actual doctors. So what is the saving of the money if you employ, what can be considered under qualified guys and the doctors cannot get a job.
Dr Richard Fitzgerald
You’re absolutely right. And you’re you’re well read, Thomas. So the the young doctors in their first few years are paid less than the PA and this is basically, you know, it should go back well before you were born. But think about Mao Tse Tung and the cultural revolution in China in the in the 40s and 50s and 60s. And the intelligentsia was sent out to the rice fields to work, sowing rice and picking rice. Because it was a, it was, you know, a part of the dogma of the regime. And so here the dogma is get rid of the doctors out of the NHS as much as you can, as fast as you can, demoralise the doctors who are there so that they emigrate or so that they go and are hired by private companies. And that’s why these people are being paid more. And the other thing that I would say is that I go back to what I said about a GP. If you see a GP in the NHS, the NHS only pays the GP 25 pounds. 25 pounds to take history examine if you’re physically present or due a telecom consultation, make out what’s wrong, write the prescription, explain that to the patient, and then do notes for the computer immediately after the consultation, all within 10 to 15 minutes.
Tomasz Oryński (host)
And if I understand correctly, it’s not the money that goes to their pockets. It’s also he needs to run the surgery on it or everything. So he needs to pay reception is he needs to hire a building, pay maintenance or electricity bills, everything of them.
Dr Richard Fitzgerald
And the other thing is, by contrast, the NHS will pay a pharmacist, you know, in the chemist shop 40 pounds for a consultation on just 7 limited conditions, so the GP is expected to see anything from a mother who is pregnant and with baby in the womb right through to a person on their last death day on life. All diseases, everything. But for seven simple illnesses, earache, sore throat, urinary tract infection, shingles, whatever. Just 7. So yeah, they will be paid 40 pounds and you can see that the policy of the NHS is at every opportunity demoralised doctors are being disposed probably to drive them out of the NHS, get the public used to the idea that you don’t need to see a doctor, you can see somebody else.
Tomasz Oryński (host)
But there is also other insight to this coin, and I remember how I realised that the Polish Community in Glasgow and Czech community in Glasgow and Balkan community in Glasgow, they all have the same or like equivalent nicknames. So if you go to a British doctor, you say I’m going to “doctor paracetamol”. And if you’re going to some doctor that was educated elsewhere, you say I’m going to a “real doctor”. Why? Because there is this notion that whatever you you suffer from, you go to see a British GP and we tell you to get paracetamol and rest. And sometimes it’s an upsetting thing. I give you some funny story. I used to work as an interpreter for mostly for the police. But sometimes when there was no other interpreters available, I also helped with the medical kind of of of jobs and I had a client who was a Polish lorry driver in his 60s with a long history of cardiac problems. And he was feeling some pain in his chest. So being responsible man and driver as he was, he wanted to see a GP for the GP to tell him if it would be safe for him to continue driving this 32 tonne eight Wheeler Tipper he was driving.
So he then went to this GP and he like, dumped this pile of documentations which was like in Polish, but then Polish doctors still use latin a lot, and then there was in English and he got like files and files on that. And he started to explaining. I was struggling because it was well beyond my vocabulary. But he explained his medical history and told that to this doctor. And then Dr looked into this paper, started browsing that said “hmmm” and then said, you know what, let’s do that: I give you a paracetamol and you stay up and you will just keep this paracetamol and and stay where you are and we’ll see in three weeks if you are better or not. And this guy like went balistic, he said “I cannot take paracetamol because I take this medicines and I’m not allowed to take paracetamol when I take these pills”. And the doctor said “Hmmm”. Then browsed some of more of his paperwork and said, you know what we’ll do? You don’t take paracetamol. Stay where you are. Just observe. And you come back to me in three weeks and we’ll see how you’re going. And before we left the surgery, this guy asked me, can you help me book a ticket? I need to fly to Poland to see a real doctor.
Dr Richard Fitzgerald
I don’t, I know. I’m very sorry to I’m very sorry to hear. This is a terrible experience I and I think that illustrates two things, Thomas. Firstly, it illustrates if the GP is expected to see a patient every 10 minutes and is paid 25 to cover his cost in the practise cost. Unfortunately they can’t give enough time to complex patients.
Tomasz Oryński (host)
Yes, but we actually I use this example because we spent a lot of time at this GP much longer than ten minutes, half an hour, something he was really carefully browsing this documentation, reading, asking additional questions. So he really spent some time on it and then came up with paracetamol. Or not.
Dr Richard Fitzgerald
The other thing that I say is and you know this. This may seem a very sensitive point that I’m about to make, but accent matters. And so somebody who is and obviously people who are coloured experience more, but somebody who has a particular accent that can make that can adversely affect the quality of the of a consultation and of the reception. So for example. It should be blunt. If that doctor was talking to somebody who came from the same part of Britain as himself or herself, I suspect the outcome would have been different.
Tomasz Oryński (host)
Hmm. So you think that experience is typical to migrants, not because they know better, but because they got worse treatment.
Dr Richard Fitzgerald
I have. You know, there’s well documented evidence that people who are. You know, the other thing I would also say is in Britain, in the NHS, there are probably about 200,000 doctors working in the NHS, a huge number now, just like 200 policemen or 200,000 teachers, or 200,000 anybody’s. They’re not all going to be going to be caring. They’re not all going to display the common sense. And good decision, good decisions. You know what I mean? There’s tremendous variability and again, you know, within general practise, they’re expected to do everything from the care of the unborn baby to the care of the patient in distress shortly before they die. And you cannot know individual will be experts in all of those things. And it. Well, be that this particular doctor should have said: look, cardiology is not my strongest point, but my colleague Dr. X knows more, let’s make an appointment for you to see him because this is a very big decision to make as to whether a lorry driver with significant heart disease is fit to work and I think it would be wiser both for you and for society that you see one of my colleagues. And that and that by contrast my particular strengths are looking after children and women’s problems and problems of women when they’re expecting babies, and my other colleague, his expertise is in psychiatric problems and stress, and I have another colleague and their particular expertise in musculoskeletal backache and joint pain and so on. And we also specialise and that’s what happens in a general practise is that there are, even though they’re general, but the bottom line is and they will, so they’ll be able to cover. So if you take 100 patients turning up to a GP general practise, most of the conditions will be fairly routine and straightforward. There might be blood pressure, there might be asthma, there might be a urinary tract infection. There might be pneumonia or something like that. All of those would be fairly straightforward, but cardiology fit to be a lorry driver. That’s a very serious decision.
Tomasz Oryński (host)
Well said. I just see that, but if if my because the first thing is, it’s not like unique experience, I I just use this example because it’s very like, I would even say quite amusing. But in the sad way, I guess. But if you go to any Polish forum for like Polish Community in Britain, you will have those examples piling up in one another and so on. And let’s remember that the GP is not a unique British concept. We have the same in Poland, it’s called lekarz rodzinny, a family doctor. But his role in the system is basically the same and whenever I speak with my friends who live in Poland, even foreign friends who live in Poland, their experience is vastly different. And also this is also not only limited to the GPS. I had a car accident, for example, still in the 90s, so I went to the hospital and I remember it looked so bad, you know, it was well before we were in the European Union. So you could shoot the Chernobyl series in there. This is how hospital looked like. And I remember the nurse rolling me on the wheelchair with the punctured wheel, because they had no others, and yet: I was kept overnight, I was seen by the two specialists, I had an X-ray of my head and everything. And when I was assaulted in Britain I went to the hospital to A&E after blacking out while driving. So I would say that was quite serious.
Dr Richard Fitzgerald
Very serious.
Tomasz Oryński (host)
Yeah. And they just, like, snapped fingers left and right, asked me to stand on one leg and they said, oh, you’ll be OK in two weeks. Three weeks later, I was dying of the of pain and my GP, who was brilliant, couldn’t do anything about that. He told me, just go to an emergency again as probably you are in an emergency. You have to see them and they’ve seen me again. Fingers again on my head and they said no, no, you’ll be fine. And that was the moment when he told me you need to fly to Poland. You won’t get any service here, he said. I flew to Poland and the doctors in Poland were outraged that I haven’t even get a X-ray done or MRI or anything. And by the way, I’ve been off work for almost 12 months, and when I finally got my neurology appointment with the NHS doctor after 54, I think, weeks from my accident, she was like: “you’re looking great, and you say you’re feeling alright, why you’re bothering me?” So that was the system of NHS.
Dr Richard Fitzgerald
I do feel, Thomas, that within the NHS, you know and and I I stress, 200,000 doctors are no case you’ll be able to say what I know of. And through my friends, I know of 50 doctors and they’re they’re, you know, the standard of care has been poor, I think within a kind of a structure that is so state-run that is so vast that has been a religion of society for 75 years. Thereby, if you are, you know, unless you are over 75, unless you’re over 80, you will never recall a system other than the NHS. So very few people know of any other form of healthcare. So they don’t know what it should be like as in Poland or elsewhere, you understand. And there is a complacency that this is the only thing they have experienced.
Tomasz Oryński (host)
It must be the best because it’s British.
Dr Richard Fitzgerald
Both this must be. This must be. You know what you expect and I also would say and you know if you take say somebody, I said earlier and an ideal world in any country around the world all the doctors and nurses ideally should be from that country because they will be familiar with the accent, they will be comfortable with the tone and intonation and so on, and they will pick up on things that are sad or anxious or angry or whatever. And if you take, for example, in Scotland, how somebody in Scotland will relate to somebody with an accent from the South of England or conversely, how somebody in the South of England will react to a doctor with a Scottish accent. It may be. It may not.
Tomasz Oryński (host)
But maybe there is something to this culture. I recall briefly reading some article years ago about how, like the British NHS is great. It’s really great when things go bad, but it’s not so great on prevention.
Dr Richard Fitzgerald
Oh yeah, I think the prevention thing, obviously that’s a huge one. I won’t go into that now, Tomas as my area of expertise. But you know the bottom line is that. You know, I spoke about healthcare spending should be 4% and under the Tories it was 1 to 2%. In the case of public health, it was even less than that. Yeah, it was frozen.
Tomasz Oryński (host)
But, but let let me tell you how I recalled this article because I had some experience here recently in Finland when I had the problem, a minor problem in my health that I’ve been trying to address in Britain. And after I’ve been like, nagging my doctor for some time he sent me to some basic test, which came inconclusive and said well, I cannot say anything of this, but don’t worry when it gets bad, we will like address this. And then this problem came out on my like regular workers check. Because like you you got this employment medicine I’m sure how it’s called in English that where you go under througful check and I was never examined like that in my life. So it’s it’s a really high level and they started to look into this problem and because it was out of the scope of my work medicine, I was referred back to the mainstream medicine because in Finland’s the the health services to tier, but let’s let’s not go to it. The the bottom line is that after being proded and tested and MRI’d and USG’d and like I had every possible test done, the doctor, the specialist I was referred to, told me that so we know this is not this, not this, not this, not this. This is this. It won’t get any better but it won’t get any worse. This is just how your body works but it’s nothing to be worried about. Now I’m like, peaceful and calm. That I wasn’t when I heard from my British doctor “we will deal with it when it
gets worse”.
Dr Richard Fitzgerald
I think right again, I’ll give you an example because you mentioned there about having tests and so on. So you know the waiting times to get the results of a scan. You know, I know ofof two cancer patients having treatment now and each of them have on occasions waited six weeks for the result of a scan as to determine whether that treatment was working, whether that treatment should continue or whether they should go in a different time. And the bottom line is in the college where I was on committee we told the government every year, we provided data from every hospital, 100% of hospitals across Britain. How many radiologists there were, how many were coming up to retirement, how many were needed and how many they should find. They were told this every year in a report since 2007. And they continue to underfund posts to train doctors to be radiologists and hence there’s this kind of weight of six weeks or even longer for a report of an MRI scan or ACT scan. So you can see why in the NHS they wouldn’t have done many tests because they are taking forever for the bloody report. And again the same kind of concept in neurology like, you know, you you’d look at you. Look, I mentioned about how there are fewer doctors and fewer nurses and all the rest. And you, you drill down and this really has an impact on the care of any patient, because if if you know if the you know I’ve, I forget the relative figures of how many radiologists per head of population that were compared to France or Germany or Italy or Finland or whatever, but there was way, way less way, way less.
Tomasz Oryński (host)
Yeah, yes, that’s true. But. Still, in Finland’s the waiting times aren’t great, but they’re they’re much better than in Britain. That’s not an achievement, but it took me a year to have this problem sorted because I’ve been referred to different examinations and and specialist and it was always months of waiting between them. But still they were like willing to do that. So that’s that’s I think this this cultural difference.
Dr Richard Fitzgerald
I. I think I also think. You know, because of I I think there is a variety of things, but I do go back to, you know, the Soviet era and and if you think of the way healthcare deteriorated in the Soviet era. And you know, it was partly obviously funding and so on, but it really was rundown. And you know the healthcare outcomes and so on. We’re dreadful and so on. And in the case of the NHS, so bear in mind. So the collapse of Communism, 1989 and 1990 or whatever, and that was about 70 years after the communism started. It’s now 75 years since the NHS started. A state-run near Monopoly system. And I don’t know of any near monopoly that really does well.
Tomasz Oryński (host)
Here I have to defend it slightly because the Polish health service under the Communism… I was still a kid, but I remember that and it wasn’t really that bad. Some people say it went once much, much worse after communist collapsed and we went into this free market economy and funding was cut and everything so. The the results of this opinion that for example in Cuba they are like way, way underfunded. But the attitudes of the doctors and how well educated they are it’s it’s it’s one of the best in the world. I don’t know how.
Dr Richard Fitzgerald
Oh yeah, True is that.
I think I think it is predominantly good. I also think these things depend also on how well staff are treated, how much valued they feel. So I’ll give you little to two or three different companies and I’ll give you a Kwik Fit, you know that put on tyres in Britain and I put you on Halfords. But in particular Kwik Fit so I have used Kwik Fit. And I have used several different branches over the years. And I suspect the mechanics are not hugely paid. I don’t know how much they’re paid, but without exception I have always found them to be positive about their work, positive about their dealings with customers. And so it’s not about pay, but it’s about the atmosphere in the company and..
Tomasz Oryński (host)
Or in the actual branches, because I had quite opposite experience with Kwik Fit here, but I get the point you’re making here, yes.
Dr Richard Fitzgerald
You know what I mean? And again, I’ve had less experience, but also very positive experiences from Halfords. It is kind of a more the shop rather than the servicing but they also do kind of things. And So what I’m getting at is I think in the NHS people are not, you know again you can, I can give you statistics, but the bottom line is that for people working in the NHS, be they doctors or nurses, their pay relative to other groups in society relative it to the private sector, their pay has dropped far more than other groups of society. And so that’s one aspect pay I also think there is one hell of a lot of propaganda and managerial, pardon my language, bullshit in the NHS that really demoralises and is hypocritical. And is hated by staff. So I just…
Tomasz Oryński (host)
I also heard that there is like way too many managers compared to the actual staff who do the actual jobs that NHS is supposed to do and not only they are not needed but they are also are interrupting the flow of work of of of those people who do the real work, it’s something out of the David Graeber’s book, “The Rise of Bullshit Jobs” that they have these jobs that they are not really needed, and then they make up things to fill that they are doing important jobs.
Dr Richard Fitzgerald
You know, I wouldn’t say, you know, many NHS managers are actually doctors or nurses who go into management because, in particular with nurses or radiographers or physiotherapists or whatever, to really get the best pay. One has to stop being a nurse or a radiographer, or a physiotherapist or a paramedic, and going to management and ask everybody else around. And so that’s a very bad system. By the people who are the most talented, who are the best people managers, are paid less than if they went into this kind of bullshit. Trying to make the NHS to the staff and to slate. Do you understand?
Tomasz Oryński (host)
Yeah, I think I know what you mean. Although on the on the right side, it’s maybe better for the NHS if the actual doctors became the managers rather than someone with just like economic school or whatever, because they will really understand the needs of the staff and of the system, unlike the the guys who are trained in making money.
Dr Richard Fitzgerald
The other thing is I also feel that patience and society in Britain have no idea of the costs of healthcare. And it’s it’s a lot, you know, my view would be that anytime an NHS patient would go to a healthcare setting, there should be notices on the wall as to how much certain things cost in that area of activity. So if you go to a clinic there would be the cost of having an X-ray is this, the cost of having a plaster is that, the cost of an operation for a broken hip – such and such. To give people an idea as to the cost of things, because a lot of people are in Britain don’t value the NHS appropriately because they have no idea of how much it costs, and similarly, when people get their service either free or at very low cost, they should get a kind of a print out of these year’s drugs. This is what it costs the NHS and this is what you’re paying. And some people will be nothing, and for some people will be a fraction of the real costs. And you know, there’s there’s been lack of public education of the cost of health care and I’m a huge fan of the principle of the NHS, but I’m afraid the system is being deliberately run down both by labour and the Conservatives to benefit the donors of their parties.
Tomasz Oryński (host)
Mm hmm, so I wanted to like slowly starting wrapping. So I wanted to ask you what we can do to fix the NHS and I think the first thing ever is even such an ignorant person as me can see is to admit you have a problem because until you admit you have a problem, you won’t be working towards solving it. So that will be the first problem. Now that you you mentioned several times about underfunding and I wanted to as as we already mentioned about the costs and and and people patients lack knowledge on how the things really cost. What do you think about partial payment? I met this first time in here in Finland and you pay for your medical service, although I bet you don’t pay full costs because my recent consultation, which included MRI, USG, some other examination and consultation with the specialist I got an invoice for that for 48 euros.
Dr Richard Fitzgerald
Oh well, I can tell you the MRI, the MRI. The real cost of an MRI would have been up to €200. So just the MRI alone would be 150 to €200.
Tomasz Oryński (host)
Yeah, that’s what you would pay when you went private in Poland, but that’s that’s that’s is something that’s that makes people worry how much their care will cost. But it won’t. You want to drive you bankrupt because there’s a cap, a few hundreds EUR per year. I’m not really fully familiar, but if you are unfortunate to be in some very terrible accident, a cancer or something, you pay only up to certain level and then it’s a cut off. The government takes every bill after that on themselves.
Dr Richard Fitzgerald
I would be I would be all in favour of it. But of course that would break the the golden dogma that underpins the NHS of free at the point of delivery. And so to go back to the first point, you have to admit the NHS is seriously in big trouble, and the second point then you have to go back to that the principle that was affordable and reasonable in 1948, when there were few, very few very, very few… and I was a medical student in Cork in the 1970’s, the chapter on cancer was about 3 or 4 pages. The medical student in Cork now studying cancer, a similar book, will probably have a chapter that’s 30 or 40 pages. So you know the the the funding system, whereby the NHS could say, you know, you come along and we’ll sort it and it’s free at the point of delivery, that concept is just not affordable or reasonable nowadays and, you know, you can have all kinds of things about a cap on on what percentage and you can have some people – If you’re on a very low income – that they might have what we had in Ireland when I was a young doctor, a medical card, so there were certain groups of patients who just automatically had free healthcare. And they were children, they were women who were pregnant and there were people who were on benefits, you know. Unemployment benefits, or it might be the at a certain level of income, but the point is to implement that in Britain, the dogma of the NHS, founded in 1948, is free at the point of delivery, It meets that kind of brick wall.
Tomasz Oryński (host)
Yes, but I think there’s also this like ethical issue because our money is limited, while the science and technology is making enormous progress, and we could cure many people we wouldn’t be able even 20 years ago, but now if you are running an organisation like NHS, you basically face the trolley problem. Should I spend 2,000,000 to cure that one person or should I spend the same money to cure 100 people from something easier to cure and and…
Dr Richard Fitzgerald
But in fairness, the at the NHS, that is one thing that they have that is good, they have a thing called the National Institute for Clinical Excellence – NICE. It’s is the acronym and they do very detailed evaluations of all new treatments before they become funded by the NHS. They go through very, very rigorous cost benefit analysis and usually there is, I forget the details of it, but there will be a limit and it’ll be something like it might be say 30,000 per quality adjusted life year, so they actually work out the health economics of how much, which takes into account the cost of the treatment, how long it will go on for and what benefits will be to that person, not just in terms of how long they live, but also the quality of life and their productivity for society. So that system is actually well run by by the NHS in terms of healthcare evaluation.
Tomasz Oryński (host)
Yeah, I have to say, like, let me make a slight diversion here because I probably come out as like NHS basher and and it’s it’s not I see many great things with NHS. I heard plenty of stories about people getting wonderful treatments. Which may be two exceptions, like every single employee of the NHS I ever met was like lovely and professional and helpful and everything.
Dr Richard Fitzgerald
But it doesn’t mean that it’s it cannot be fixed and that’s why I am so like self in this because my point really is this is a sad point. But because the Labour Party as well as the Conservatives are so fixated on this replacement of doctors by physician associates, it shows that the political class in Britain are determined to create a 2 tier healthcare service whereby if you want to be sure that you’ll see a doctor, you’ll have to go privately and they are determined to do this. Because they’re corrupt. And. And it’s very sad. And because they won’t be frank and honest with the public about the costs of healthcare and also, you know, the needs to tackle corruption. And so the corruption in Westminster in in, you know, in in the British state has just rocketed. Past eight years, so Brexit had many adverse consequences, but one of them was that lying doesn’t matter. Because Brexit was one online and so Brexit won. So lying doesn’t matter. Ultimately Boris Johnson became Prime Minister the greatest liar of all times. And then we had all these COVID contracts.
Tomasz Oryński (host)
Yeah.
Dr Richard Fitzgerald
Get my drift? And so the scale of corruption which exists in every country at every age just rocketed in the past eight years. And sadly, Labour does not show any signs of changing that direction.
Tomasz Oryński (host)
Yes, but what you said about the two tier health system, this is not even the worst because in Finland there is like generally speaking the two-tier medical system. There’s this state-run medical system which is still much better than NHS from my little experience. But they’re like long waiting times and everything, and then you can go private or if you have a good job, your company will pay you for access to the private, which is really brilliant. Brilliant. But I’m afraid that this, like physician associates and everything, will completely destroy the NHS as an experience for the patient because here I will wait till longer. But I go to my local surgery sooner or later and I will meet a great Doctor Who will do a great job, and when I’m thinking about what is happening tonight just in Britain, I’m afraid it would end up with this benefit system. I think I mentioned that to you before we started recording I used to be interpreter, I had briefly very briefly this job when I was accompanying people who were going to some kind of benefit office to have established if they deserve to get this uncapacity benefits for disabled persons or not, and it was straight out of like “I Daniel Blake” movie. It was so sad, I couldn’t bear it. I went there like 3 or four times and then and I just just let you know how it looked. It was some rented office in the building in the centre of the city. And in this office there was just a conference table and also a with the laptop. The girl was maybe like 22 years and what she was doing, she had this like Google Questionnaire and she was ticking boxes. She was asking questions and she was ticking boxes. She had no medical experience at at all. She was just there to tick boxes.
Dr Richard Fitzgerald
Oh, I think there’s no doubt this is going to cause immense misery in Britain. And I, as you know from following my tweets, I tweet every day about it. But unfortunately, the public are complacent because most of them under the age of 60 have never had to rely on the NHS and they assume the NHS is OK to most of the public are silent for that reason and those who have used the NHS. The others are often too weak and too tired and too elderly to make a noise. And the other point is I get again the British system of the hierarchy that you don’t speak out against the authorities. And then you have the media that don’t report the stuff because ultimately they’re dependent on the state and politicians for their next news story. And if they were to be reporting about physician associates, they wouldn’t get access to good, you know, to to, to new stories. And many of these papers anyway, are owned by oligarchs and similarly with the media and so on. And as I say, unfortunately, both Labour and the Conservatives, and hence when you look at the opinion polls, Labour, which won a huge majority on the basis of first past the post, which is a political system which is only the only other country that use that in Europe? Is Belarus, isn’t it?
Tomasz Oryński (host)
But they don’t have free election, so…
Dr Richard Fitzgerald
Right, they don’t have real elections. And fundamentally in Britain the system is designed to deliver one party government, but it’s not a democratic system. And so the point about making is you look at the opinion polls, you look at the local elections. I see there’s an opinion poll in Scotland this weekend and at the next elections in the Scottish Parliament, the SNP are going to have going to have a majority government. They will have 60 seats on current polls compared to Labour 20. And in Wales and Wales, where the Labour Party has been the most popular party for over 100 years, every election, Labour has been way in away at the top. Labour now is at the same level as Reform, which is Nigel Farage’s party and Plaid Cymru, which is the Welsh Nationalist Party. So the public are rumbling that labour under Starmer is not into social justice. It is not taxing the ultra rich. It is not taxing the IT companies, the oil companies, the banks, the big corporates, the Amazons and all the rest of it. Instead, it’s taxing the ordinary people on low incomes. It is not into fairness.
Tomasz Oryński (host)
You know one of my podcast co-hosts described this in very picturesque way, so- pardon my language, but he said that Labour andTories are two cheeks of the same arsehole.
Dr Richard Fitzgerald
Correct.
Tomasz Oryński (host)
Yeah, I think this is. This describes the problem with the British politics very well.
Dr Richard Fitzgerald
Because the other point is sadly, Britain is heading towards a system like America where the Democrats and the Republicans… Now, you may say there’s huge difference. And yes, there is a big difference. But fundamentally both the Republicans and the Democrats have vast funding. I mean vast funding, which inevitably corrupts them..
Tomasz Oryński (host)
Yes, but because I think we, we we are about to finish. So let me try to sum up what we came up with this conversation and then you correct me if I’m wrong on something. So I believe that if we want to have if we want to fix the the problems the NHS has. First of all, we have to admit it’s not perfect and there are some elements of it that can be improved, we have to start spending money wiser by, like getting rid of those private subcontractors and like PA’s and instead start paying doctors more. At least as much as the PAS earn, because on the side note, I used to drive vans and I’ve been making better money than a young doctor I knew at this time and to drive a van, you need a Category B driving licence and you don’t need to train for several years. So. So, so that’s there’s something wrong with that. We need to train more doctors locally in Britain, not that the migrant doctors are wrong, they are great, of course, and they are welcome. But Britain needs to to train more doctors locally. What else?
Dr Richard Fitzgerald
And I think fundamentally. I know this is a rather pessimistic note. Starmer needs to be replaced and I suspect will be replaced by somebody else in this party within two years, and it can’t come soon enough.
Tomasz Oryński (host)
So generally everything ends up in the politics. There’s no other way to do it.
Dr Richard Fitzgerald
When they’re they fundamentally they decide how much money and they not just decide about how much money, but they also decide how the system will be run. You know physician associates rather than doctors. You know various things, but you know, leadership in society matters. Leaders in the society and the other thing is the values of a society matter. And you know, you look at different you European countries.
And you mentioned about the Poles and I I met many Poles in Ireland as well as in Britain and so on. But the Poles, you know, fundamentally Poland it is a Catholic nation? I know much less church going than previously, but those values, even for people who’ve never who never goes to church, those values endure. You know what I mean? And also Poland as a country never invaded any other country. It has been invaded on all sides, but it has not been an invader so different.
Tomasz Oryński (host)
Well, we can discuss that, but it’s not so black and white, but yes, we are not an imperial nation, so to speak, like the English.
Dr Richard Fitzgerald
Countries have this. Alright, alright, alright. So I think I think the values of society and the values, not just of society, but what they demand and what they accept, also have an impact on outcomes.
Tomasz Oryński (host)
Yeah, but. As we mentioned about this like co-paying system in Finland, that’s brings me one other idea. Do you think Britain needs a fundamental discussion about the NHS, like people and politicians have to sit down like, I’m not saying literally, but as a way of speaking and say: “listen guys, we cannot afford to have the NHS that is free to everyone and offers everything to everyone. We need to make it working because people live longer. We have much more, much more expensive treatment. We need to do some reshuffling for for it to work better for everyone”.
Dr Richard Fitzgerald
But there is I think then does need to be a national consultation and there is a national consultation that was launched about a month ago and will run for six months, but we shall see what they do with the consultation. So it’s one thing to have a consultation, there has to be an open discussion. The other thing is that these discussions are quite painful, so if you look at countries where you have these kind of discussions in Ireland, for example, they were held in the past 10 years over the matters of abortion. The matters of marriage equality. And gay rights and so on. And there were public meetings all around the country or organised by the government and currently the same process is starting with a view to the reunification of Ireland in two years. So these public discussions on major topics are possible. But they are quite painful. And it requires serious societal buy in. But I’m, I’m afraid the level of corruption in Britain and the political parties and in the media is such that I’m not sure that that that model is possible. And you know, you look there are things called there’s an organisation, I forget what it’s called, but it’s what they do. They publish things called the Transparency Index. And you look at a country like Finland. I did scores extremely highly and you look at a country like Britain and its transparency or its honesty has fallen dramatically in the past 10 to 20 years. And so there’s objective data about what I’m saying about the the corruption and the impact on public discussions on things. I’m sorry to sound rather gloomy about it, but I’m afraid. In my opinion from having treated one of a lot every day for 18 months on the bodies position, associates and the lack of political change and the lack of public outrage. I’m not optimistic.
Tomasz Oryński (host)
And that was about to be my last question. If there’s any reason to be optimistic. So if you just answered that that, yes.
Dr Richard Fitzgerald
Unfortunately, unless I’m right, when I say I think Starmer will be replaced within two years. The reason that I say that is that every may there are elections across Britain. And that most of these are held at local level, County Council level or City Council. And I think on the way things are going every week, in fact in Britain there will be half a dozen local council elections around Britain. And you can see these results on a Friday morning and they tell who has the one is it on, and what we find is Labour for losing lots of seats. So there might be a local election in Birmingham, there might be one in Glasgow, there might be one in Oxford or whatever. So across the board, different parties and so on. So obviously, most of these things, the, the what’s that, so of 50 of these local elections since the summer Labour, this party with a majority in government has lost 25. The Conservatives have gained 23, reform has gained 5, Lib Dems have lost a few. And this year?
Tomasz Oryński (host)
But then it’s it’s it’s what you mentioned before that without the proportional representation you’re destined to be bounced from one to another and back.
Dr Richard Fitzgerald
Alright. What will happen the next May is this will be on a grand scale. And if there is no change of leader, it makes may the following May there will be the Scottish parliamentary elections and the Welsh parliamentary elections and all these elections, and what will happen then is, that you will, for the first time in over 100 years, labour not in power in in Wales. And the SNP, back in the majority in Scotland and in England, a whole pile of labour councils flipping to be green or Reform or whatever. And the MPs, the Labour MPs will be afraid that they won’t be re elected in five years time and they will among themselves say enough is enough of Starmer. He is a loser. I will be in three years time, if we don’t get rid of him and get a new leader. So that remind you of about where the hope is the realistic? Opportunity for hope, but time is, you know, we live in a very fast changing world of climate emergency and of great global uncertainties in security and of the economy and so on. And so this is, you know, for Britain to be marking time waiting for a good Labour leader is a very dangerous and a very bad state of affairs to be in, but I actually I actually regarded as the best sign of hope that I can see.
Tomasz Oryński (host)
OK, at least we have some hope. So let’s keep our fingers crossed for that.
Dr Richard Fitzgerald
We have some hope here. We will, we will.
Tomasz Oryński (host)
And remember that maybe we are annoyed at our local “doctor paracetamol”, but we have to remember those people are working really hard in the terrible system and they deserve all our respects for that.
Dr Richard Fitzgerald
All right, all right.
Tomasz Oryński (host)
So thank you again, Richard for joining us
Dr Richard Fitzgerald
And you are very welcome, Thomas. Thank you for inviting me. And I thank the listeners for listening and you know, if you have any feedback, I’d be very interested in what people thought. What I said.
Tomasz Oryński (host)
Yes, we will definitely get back to you if we got any messages and you can also follow Richard on Twitter.
Dr Richard Fitzgerald
Thank you.
Tomasz Oryński (host)
We just put it in the notes to this podcast so we can just go there and find him on Twitter that way. And meanwhile, thank you very much again. Our guest today was Doctor Richard Fitzgerald.
Dr Richard Fitzgerald
Thank you very much Thomas. Thank you.
