To think the time has come to abolish the NHS healthcare model

I’m in France.

Yes, if you have an operation you will generally be given a prescription that you’ll use to collect various medications etc from the pharmacy. Which you will either not pay for or you will be reimbursed for.

DH has a spine operation recently. He went private for this. The total cost to him was around €1000. He had to paya bit more upfront, but a lot was reimbursed. For this price he received:

Choosing the date / time of the operation, at his convenience, with the surgeon of his choice. No waiting at all.
His own en-suite room for the 4 nights he was in hospital, in one of the best private hospitals in our city, literally 5 minutes walk from our home.
Full surgery under general anaesthetic and all follow up nursing care.
Ambulance to bring him home.
All post-operative pain relief and wound care materials - delivered to our home by the pharmacy.
Once home, nurses visiting 3 x per day to give pain relief then change the dressing. This continued for 3 weeks, dropping to 3 then 1 visit per day.

this is stunning value for money. The joy of the French system is that the fully public system is there, free of charge, for those that need / want it. For this who can afford to pay a little, private care is totally affordable. Doh and I are not rich (teacher and admin assistance) but thanks to government reimbursement and our to up insurance (which our employer contributes to) we can access top level medical care at a fraction of the cost in either the UK or the US.

there’s a lot of paperwork but it’s worth it.

Sorry but that's exactly how it works. You make an appointment with any specialist directly, you pay your part of the consultation price, etc.
You only see a GP for general health, or for referral, if you have really no idea what specialist you should see.

In 1948, at the founding of the NHS, Nye Bevan said: ‘We shall never have all we need. Expectations will always exceed capacity. The service must always be changing, growing and improving – it must always be inadequate.’

Historically, healthcare spend in the UK has grown at >3.5% per year, but between 2010 and 2019, it grew at a markedly slower rate of <2%

An interesting academic paper on underfunding in the NHS.
https://journals.sagepub.com/doi/full/10.1177/01410768231214340#:~:text=Imbalances%20between%20supply%20and%20demand,dated%20infrastructure%20and%20low%20investment.&text=Achieving%20the%20'right'%20level%20of,75%20years%20of%20the%20NHS.

And (following your EV model) perhaps we all need to take some individual responsibility for all turning up on Monday morning (or Friday evening at A&E) expecting everything to run smoothly and work perfectly, and then complain that there aren't enough instant chargers.

You might want to check while most of them left. I’ll give you a clue - it begins with B.

@venusandmars and I agree. Same for me, in fact after several years of successful management of my conditions at very little cost my GP has asked to see me in person.

It’s not the model that isnt working. Blaming the model of the NHS is a bit like blaming the model of EV for not working after forgetting to plug it in. It’s the lack of funds and investment into the model that has crippled the NHS. In every study on the causes of the NHS’ problems, it has been highlighted as underfunding and waste on politically driven freebie frauds like £3bn in PPE never delivered on a contract given to an MP’s firm and then written off.

And there are others not available or only available after trying 2 or 3 or 4 other options based on cost.

Not sure what your point is. The ICB and NHS England are open about rationing and it is the responsible thing to do given funding constraints

Happy you got your treatment and many of my patients have too but others would have been treated differently if not for funding constraints. That is life

@OptimismvsRealism
It's not possible to converse with you about a subject and ideas when deflection and avoiding the question(s) are deployed by you. Emotional dysregulation and you posting comments that break guidelines also negatively impact the quality of the conversation and tone of the thread. I do appreciate you are in a sticky situation managing health conditions without the support you wish for, which may be reason for some of your conduct and tone, but not an excuse for it. I'm not able to engage further with you on this subject for these reasons as I have limited energy and resources. I do sympathise with you and your predicament and wish you and your family all the best.

There are many biologics available through the pathway. They've funded all of mine, for a start, along with many tests, scans, multiple physio referrals and podiatry.

@Whyhaveibeencutoutofmamsnot - well thank ye kindly for explaining some of the reasons behind the use of all this 'new fangled' technology n' all. So we swap mercury for lithium instead. Maybe being able to perform simple tasks using both the 'old fangled' ways and the outdated, cumbersome tech saves staff and patients waiting around for a 'unit' to become available.

That is just one of my grassroots suggestions. Next I might suggest that MRI scans are indeed a very costly provision and that patients really need a very good clinical case to have one.

There are small details they could change though. I am on medication for chronic migraine. Only one clinic runs in my hospital. I was prescribed 3 months of treatment. I'm running out. But they can't see me because they have too many patients who need review. When I suggested that 6 months prescriptions may alleviate the pressure, there was silence.

I think some of this has been helpfully 'demedicalised' in recent years.

I'm on a low dose of blood pressure medication, and very stable. I no longer have to book a GP/nurse appointment for a blood pressure review. I can go to a pharmacist, or if I have a home BP monitor, I can take my readings over a few days and email them in.

That is so much better for me, and for them, and for all the other people who actually need to see the GP/nurse.

Care varies. The dailies published the performance of primary care networks across the country last year. It varies, but on average, things are dire. GPs are burning out and stressed hence their current ongoing strike (work to rule)

When we lived in the UK you never waited two hours to see a GP at our surgery, 45 minutes to an hour was more typical.

Can't you comprehend that the progress of today is built upon the past.

Things that were useful in 1940's:

• the use of penicillin
• streptomycin
• invention of the kidney dialysis machine
• malaria treatment
• adding fluoride for dental benefit
• methotrexate - the first anticancer drug used to treat leukemia, breast cancer, lunc cancer
• the first bone marrow transplant
• the early research on the polio vaccine

All those were USEFUL in the 1940's.

And our current NHS is built upon what has happened in the past.

@TheLittleOldWomanWhoShrinks thank you for your reply to my questions
Something I see in the NHS is a person will refuse to pay for much needed social care, even if they have the means to do so. They reach a crisis point and are admitted to hospital, on discharge they get very short term 'free' assistance at home, where it is discovered they need ongoing/longterm social care input, they take the short term 'free' assistance, agree to care input and then cancel it very quickly. They then struggle to the point of crisis and need admitting again and so the cycle continues. Quite often a crisis eventually results in catastrophic injury/illness which then requires long term residential care ( funding for nursing care has a very high bar ) and they end up paying a lot more than if they had accepted a care package in the first place !

And before anyone asks, yes insurance companies can decline treatment, but there is an appeal process and at the end of the day I can choose to pay out of pocket.

Most denials are over drugs and the usual denial is ‘use a generic’ which if medically necessary a doctor can usually give evidence why the name brand is needed.

My example is my bunion. I saw a podiatrist and he said that insurance companies want to less invasive treatment before authorizing surgery. I described the shoes I’d been wearing for years and he said ‘good enough for me’ I’ll work out the details. No issues with the pre authorization.

To be fair - the drug cost was not the key issue. In the grand scheme of things - if you reduce decline by 4-6 months, that is reducing care needs by that long or more - which would be cost effective.

The kicker is the treatment is delivered via fortnightly infusions - which will need to be conducted in hospital (staffing appointments etc) and also access across the country to scans and tests to identify those with early dementia and identify side-effects that may occur. Those costs to fund an expansion in services made the treatment not cost effective. If it was a tablet you took at home for instance with a simple blood test to detect who was suitable - that would have met the NICE cost effective threshold.

The old ways of taking temperature and blood pressure relied on the use of mercury and was very subjective.
Pressure sore prevention was by 2 hourly turning which meant waking a patient during the night and on the whole has been replaced by automatic air mattresses.
Other new fangled things include auto injectors so most patients can self treatment rather than coming into hospital for a four hour infusion

Yes, of course social care is more than dementia.

Most people with dementia will require residential care at some point.

No objection for paying for things I can no longer do which I have a choice about. Do resent paying £50,000 per year or more for something I have no choice over. Dementia, Parkinson etc isn't an inevitable part of ageing, it's an illness. I resent being kept alive when everything I value in life is lost to me. Being asked to pay for it just adds insult to injury.

We never ask "Why should someone with assets not pay for their health care?"

It also shows quite clearly that waiting times were at all time lows on every metric. It was evident in 2010 that the NHS was in its best shape ever.

Aren't we all the post-war generation OP? And what do you mean by "offski" - careful now, you might be accused of being a Russian troll using language like that.

This report highlights succinctly the challenges the NHS still faced in 2010 and the threats to come including increasing obesity, productivity issues within the NHS, longer life span with long-term conditions and financial constraints. It was evident - even in 2010 - that we were on the precipice of decline if significant funding and redesign were not considered

lecanemab is a bad example. It's not used by the NHS because the cost is approx £40k per year per person and, on average, it only delayed cognitive decline by four months. That resulted in the decision that is it not value for money - which does appear to be the case.