Soles of your feet

We’re not far off an anniversary.

About a month from now…

… on 9 January,

in 1868 the convict ship Hougoumont arrived at the port of Fremantle in Western Australia.

On board were 269 convicts.

They were the last convicts to be sent to Australia… and the end of 80 years of penal transportation from the UK.

We don’t do that anymore… quite right, too.

However, the Australians might be forgiven for thinking we’ve started exporting our silly people.

Silly-Boy Streeting has been in Australia, looking for new wheezes for the NHS.

Every time I’ve been to Oz I found them very sensible practical people. Goodness knows what they made of Silly-Boy.

With respect to Oz and pretty well every other country in the world, the one thing they all admire about the NHS is equity of access and primary care as the gate-keeper of care.

The Oz system is a hybrid system, funded by state and federal taxes and insurance premiums. Like everywhere else… the pressure’s on.

States can either find additional money elsewhere to meet rising demand for health care (for example, by increasing state taxes such as payroll-tax, or making cuts elsewhere)….

… or it can ration services, such as not providing enough operating theatre time…

… which results in longer waiting times for elective procedures…

… sounds familiar…

… or it can improve efficiency or productivity. They’ve been trying since 2015…

… sounds familiar.

An easier option for states is to apply political pressure to get the federal government to lift the cap on funding and give the states more money…

… yes, it sounds familiar.

The upshot… 45% of Australians choose private health insurance, despite the universal availability of government-run coverage.

Looking at the bigger picture, the Commonwealth Fund (a US think-tank), who once rated the UK as the top performer, now rates the UK 4th, behind Norway, Netherlands and…

… Australia.

Access to Oz-care was rated poorly and there are an increasing number of stories about… guess what… ambulance waiting times…

… the Australians even have a word for it… it’s called ‘ramping’.

Oz primary care? Research this year identified complex and multilayered barriers including;

geographic and socio-economic barriers and inequality, staff dissatisfaction, turn-over, low adoption of person-centred care, inadequate sectoral collaboration, inadequate infrastructure in rural areas

… sounds familiar?

Whilst Silly-Boy was there, did he have the chance to talk to the thousands of former UK doctors who have followed the sun?

No, because there aren’t…

The facts are; each year there are 5-6k applications to the GMC, for a ‘certificate in good standing’, a piece of paper that UK Drs need to move abroad and practice and the most accurate way of calculating the numbers…

In 2022, 630 Drs went to Australia… not the movement en-mass, it’s often portrayed as.

What am I saying?

Definitely, I’m not trying to diss the OZ healthcare system where outcomes are generally very good.

My points…

Australia, us and pretty well everywhere there is a developed healthcare system, demand is outstripping supply and the pressure is on finance and shortage of healthcare workforce.

The perfect health system doesn’t exists, each of them has something to learn from and try.

Young professionals will always be mobile and want to travel… nearly half of recruits to the NHS come from overseas.

Our primary care, is unbelievably resilient. Thirty four million appointments last month. A soft target for politicians like SB. It’s been reformed, messed about, pushed and shoved more times than I can remember and it’s still here.

Silly-Boy went half way round the world to look at community-hubs, where services congregate in one-stop facillities.


We pioneered them here, called them Darzi Centres, from his Framework Review.

They are in use in Australia, yup but nearer home in France, Germany, or just across in Northern Ireland. Even in Russia, where they are called ‘Semashko’ multi-specialty polyclinics.

A review of Darzi clinics by management consultants McKinsey revealed;

“NHS managers had vastly overestimated the ability of polysystems to handle the shift in care from hospitals and revolutionise GP care”.

Oh dear, sounds familiar.

What do we not need to sit hours on an airplane to know;

Pretty well every healthcare system struggles with productivity, workforce, demand and funding.

Fund the NHS properly and look after the people at the sharp-end… and it will do a great job.

Insurance or taxes? Take your taxes from your left-pocket and insurance premiums for the right… it’s still your trousers… you still have to pay.

Competition? Tony Blair and Alan Milburn tried that… it didn’t improve quality and it didn’t control costs… as they are finding in Australia.


… you can walk a thousand miles in search of something different but you’ll waste your time if, before you set off, you don’t look for the diamonds under the soles of your feet.

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