To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

Health is approx 1/3 environment 1/3 behaviour 1/3 genetics. People can do little about the genetics (except not reproduce I suppose), not much about the environment (in which I would include the quiet privatisation of a large chunk of the public sector) and I refuse to blame all ill health on behaviour. There's a huge element of luck.

The first of my elderly dad's friends to die (in his 50s) was the teetotal, veggie, cyclist. Most of the smoking drinking fun loving types are in their 80s now.

It's perfectly possible there's a management problem AND all the other stuff you know.

For one thing, in a complex situation, you tend to get stressed managers with no other credible job options (plus a few saints). Who'd want to manage a failing service?

@MidlifeWondering part of the issue with health tourism is the NHS aren’t equipped to assess entitlement at the point of service. If you walk into a private hospital, and no doubt aboard, your ability to pay is established prior to receiving treatment. They also have no teeth in debt recovery.

What is most needed is some people taking responsibility for their own health.

This. If everyone took the NHS’ advise they’d be less demand. People act like a trip to the GP should be some sort of health reset. I think this is true of society generally, everything is a problem for someone else.

@Colango public systems do not work instantly like Amazon or Uber

This is a good point. Public health is a huge problem and many don't help themselves. However, I do think that the NHS could also learn from these companies (and other retailers) in terms of their joined-up systems.

But, for me, the biggest issue is a lack of consistency in staff attitudes - many NHS staff are professional and polite, but some are ignorant, lazy bullies. I've got cancer, lots of appointments, and I experience both far too often.

So, it's a basic, 'shop floor' management problem. Managers who are too afraid to challenge their subordinates for fear of sanction. Managers who can't manage sickness and absence, casual bullying, etc... this is basic leadership.

I'm a patient who does everything to help themselves. I'm fed up of it.

I work in the NHS and it is very top heavy with management.
But I agree that that’s only part of the issue…

1. The European model would work better and make people hopefully less likely to overuse the NHS just because it’s free and they can.
2. Patients need to take more accountability… the number of patients that are obese, smoke, drink, don’t exercise etc and are then surprised they are unwell. If everyone got the basics right, there’d be a lot less ill patients!
3. So many missed appointments! There should be a fee for this
4. Health tourism is frustrating and very common in my department

There are loads of other factors, but those are my main few 😂

Overpromising: the NHS was always only intended to provide "basic" medical care, not the trillion specialisms now on offer.

We need the European funding model. We should have to pay to access some services. Then appointments wouldn’t be wasted.

What is most needed is some people taking responsibility for their own health. I have lots of GP friends who are very frustrated that so many people drink and eat all the wrong things, then expect the NHS to sort out the mess they get themselves into. If you eat lots of junk and are heavily overweight you are going to get type 2 diabetes and all of the grim knock on illnesses that goes with it.

The European model is having the same problems with an ageing population.

I agree about unrealistic expectations: the NHS was set up to serve a much smaller population which died a lot younger and had far less complex needs. It hasn't evolved to keep pace either with what the population demands or what medical science can offer.

I'm not sure I agree on mental health though. If anything I think there is under-diagnosis of medical health conditions: there certainly is under treatment.

I think the NHS needs to be radically reimagined and probably brought into line with what European countries have. But it will have to become even more crisis ridden before any political party will admit that.

The European model for healthcare is what’s needed. The NHS is not fit for purpose

Yes this is how I feel. Management is an issue but this is a big distraction away from the real issue which is expectation vs reality. I am NHS and have witnessed people having an unhinged meltdown that public systems do not work instantly like Amazon or Uber. This is not to say I blame people for having this expectation I think in an on demand society today it’s actually very difficult to process the concept of having to wait