Dr Nigel Kellow

I’m a consultant in private practice in London and I treat patients covered by private medical insurance every day. If you think it’s better in the UK, think again. I’ll share some stories I and my colleagues see every day. After reading these please DM me or share your own 🧵

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@shl That’s a terrible chart. Makes no sense at all

Prediction: healthcare will grow to >50% of consumer spend by 2050

AI and tech will disrupt legacy healthcare from the end user up, and it’s going to happen very soon. Of that, I have no doubt. The days of Big Healthcare are over.

It’s because everyone gets sick and insurance wasn’t designed for something with 100% probability. Bottom line is insurance isn’t right for healthcare. Even the most basic healthcare is unaffordable for most people, so governments and societies have to find equitable ways to get healthy people to pay for the healthcare of sick people.

Short of external factors tearing it down it has to be competition - from an AI native, future-facing system, which is distributed, heavily automated and tech driven. Only by being distributed - open source is the best tech analogy. Only if the NHS faces competition, with the real risk of job losses amongst those who work in it, will it reform. I feel quite strongly about this.

@NigelKellow The private sector isn’t competition because it isn’t accessible to everyone. PMI isn’t the same as “going private” either. What can be done short of tearing the whole thing down and starting again?

The NHS has become fat, complacent, and overtly political. It needs competition. Only competition can save it. Successive governments can keep throwing money into its fiery pit and the best they’ll see is a little flash of flame before it wants more money for less productivity. It is doomed, but until some brave future government (because this one won’t) faces up to that fact, it will suck all it can out of the shrinking corners of UK competitiveness.

No, reforming the NHS (whatever that means) will not make the nation healthier. It’s a top to bottom change in mindset - but it’s a mindset few politicians or health professionals with vested interests have.

I was talking to an upper GI surgeon in his late 50s a couple of nights ago at the opera (as you do in London!), and he told me that he’s doing oesophagectomies for cancer faster now with Da Vinci robots than he could in his early days. He’s sitting down so he doesn’t get so tired, so he can do more. Teaching is easier as his junior colleagues can watch and assist from additional consoles. The surgical access is smaller so the wounds are less painful and recovery to discharge is faster. The complication rate is less. /

telegraph.co.uk/opinion/2025/0… This is a simplistic and incorrect view. Reforming the NHS will not make the nation healthier or reduce already unaffordable healthcare costs. Making the nation healthier requires a wholesale shift from disease treatment to prevention and prediction 🧵

I’ve had Teslas for years and I would never feel safe doing this. There is a ton of evidence their camera-based sensing technology just isn’t safe for use on public roads. You can see the safety driver in the front passenger seat, which is a pointless publicity stunt. Why don’t they just put him behind the wheel so he can do something for his pay ? I bet he has a secret brake pedal. So, a specially adapted ultra expensive Tesla; a local regulatory environment that’s somehow (and I’d like to know how 💰) been incentivised to allow road use, putting other road users - including cyclists and pedestrians - at risk, all for a trick marketing video. You can tell @elonmusk is back at his day job trying to save @Tesla from the Chinese car industry, but that horse bolted while Elon was in DC. We have passed peak Tesla.

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@HarryStebbings The problem with the UK isn’t a lack of talent, because we have broad and deep talent pools from product design, UX/UI through to AI researchers, it’s the combination of stifling regulation and risk averse venture investors

Every evening I go on a walk through London. I walk past Imperial, UCL, Kings, LSE, The Royal Albert Hall, Buckingham Palace and I am reminded of what a fucking awesome city London is with such talent in it. I love that the US has written Europe off. My competitors ignorance is Project Europe’s opportunity. LFG 🚀

The US spends $1 trillion dollars on interest alone servicing the national debt. That’s the same as the entire GDP of Saudi Arabia. Let that sink in. worldometers.info/gdp/gdp-by-cou…