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

I'm still upset that someone I know who used to live here then retired abroad used to fly back for check ups and medicine for cancer after finding out medicine alone would cost £150k+ per annum privately, where he lived. The problem is that the NHS isn't set up to deal with any level of health tourism, much less this where the person already has an NHS number.

I think the question of the 'worthy' and 'unworthy' ill is a perennial one. I wonder how many tax payers in reality want money diverted into such areas such as breast cancer which has a high genetic component rather than lung and head and neck cancers which have more of a environment component (e.g. smoking)?

I do think for a lot of the middle classes they do see the NHS as a branch of state that supports low income families and they do not see the quid pro quo of people choosing healthier lifestyles so they do take it badly when they are on a long waiting list and therefore would support an insurance based syatem.

Look how seriously the government is aiming at PIP in the commons and we can see it would be easy for government at some .point to review the whole syatem.

treating people who have preventable illnesses (Type 2 diabetes, heart disease, lung disease etc etc) is an odd stance to take.

How does one prevent all lung or heart disease?

Saying "no" to the other post is incorrect. Objectively there are big time societal issues that are as, if not more, crushing to the NHS than inefficiency/management issues. More than a quarter of the population being obese (a massive change in a relatively short period of time) being a good example. Look at the vast increases in costs the NHS has had to spend on providing type 2 diabetes care. Nine out of ten people with diabetes in the UK have Type 2, not Type 1 (Type 1 is the one that cannot be prevented). The dialysis costs are crippling and have nothing to do with NHS inefficiency or mismanagement: The NHS could be a bastion of efficiency and great management and it would still be having to fork out millions upon millions of pounds every month just for dialysis costs for a preventable illness. It's one of the reasons that the NHS is actually spending money on ozempic/mounjaro: to reduce dialysis and insulin spending - it's not so people feel more attractive!!!

Ruling out causes isn't helpful - that's a "head in the sand" approach. You may be very upset about mismanagement and inefficiency, but saying there are NO issues with the NHS having to support a population that not only has a significant population who are elderly and have untreatable illness that requires long term management (dementia for example), and NO issues relating to the NHS having to expend vast amounts of money treating people who have preventable illnesses (Type 2 diabetes, heart disease, lung disease etc etc) is an odd stance to take.

Here are some figures for you to consider: The NHS spends some £10 billion every year on Type 2 diabetes-related treatments alone! That's 10% of the entire NHS budget being spent on PREVENTABLE illness treatment! For you to ignore that and say it's not an issue that is contributing to the NHS being under pressure is extraordinary. In 2024 Labour claimed that the NHS was wasting some £10 billion per year on inefficiency/waste (disputed figures). So: according to you the NHS is being crippled by waste, but isn't being crippled by the exact same amount being spent to treat a preventable illness - and those are proven figures.

In addition, more than 2 million people in the UK have pre-diabetes - which itself causes a raft of health care problems and predisposes people to a range of costly care. In 2023 alone the NHS had to spend around £1 billion on dialysis treatment for type 2 diabetes. Dialysis requires people to go to and be in hospital - which takes up space, care, staff, equipment etc etc etc. Type 2 diabetes is as, if not more, crippling to the NHS as any claimed inefficiency/waste.

[Figures quoted are taken from the NHS's Diabetes Prevention Website.]

Exactly right. And people who have low incomes such that they are truly very poor usually qualify for free prescriptions anyway - meaning that they can get the prescription strength vitamins/iron tablets etc etc etc free.

For those who don't know about this already I would suggest that if you have more than one prescription a month and pay the prescription charges you look into signing up for the monthly prescription pre-payment certificate. It can save you an absolute fortune if you pay for your prescriptions and have more than one a month. I had no idea about it until the lovely pharmacy techs told me about it a number of years ago. It's since saved me a fortune. It's the certificate that allows you to tick the "F" box on the back of a prescription form.

This is one of those "how long is a piece of string" posts. There's no one "correct" answer - it's going to be a mixture of many things, and a good number of them are subjective because they depend on how people view and interact with the NHS, and the opinions that guide those interactions.

I do think it would be helpful if people were given information on the actual costs of their treatment every time they are given treatment. Even if it's just comparison figures. Some of this stuff is easy: Pharmacies could easily print the ACTUAL cost of the drugs that are prescribed on the carton of meds (this happens regularly in places like, for example, the USA, where the prescription co-pay is listed, along with the actual cost of the drugs that was billed to the insurance company etc etc. Some of those are incredibly eye opening: for example when I had spine surgery in the US the cost of the numbing/soothing patches for the skin next to my surgery site was over $1,000 for a pack of 10 patches. The pain meds I received were relatively expensive EXCEPT for an IV administered (i.e. injected - not tablets) version of paracetamol which cost a fortune compared to, for example, IV morphine (which is cheap these days given the age of the drug).

This would be easy enough for the NHS to do - the drugs costings are all in the med books that each GP has in their office (you can ask yourself next time you see them how much the drugs actually cost - they can tell you direct from the book).

Other costings - like how much it costs to see a GP, or a consultant, or basic procedures etc are more subjective/difficult - but they could put basic comparison costings next to them. For example, an out of pocket GP appointment in the US would cost somewhere in excess of $600. Or, if you use the "private medicine" comparison in the UK: a private consultation with a spine specialist in the UK at a private hospital would set you back somewhere around £250 (.increasing to over £450 for some of them at my local private hospital).

Here's a stark example for you: I had a microdiscectomy surgery done in the USA. The cost, before insurance, was over $130,000 - for the surgery and two nights in hospital. The NHS wouldn't have charged a penny out of pocket. You can get a private microdiscectomy surgery un the UK starting at around £20,000 (depending on days spent in hospital, scans required, meds required etc etc - note that no private hospitals can do emergency discectomy surgery).

The UK Is also dealing, as are many other countries, with the perils of a population that is increasingly obese and diabetic. Over a quarter of the population is obese. Two thirds of the population are overweight generally (that figure includes people who are overweight, obese, morbidly obese). That is a staggeringly awful figure in terms of national health.

Diabetes Type 2 (the diabetes variant that is typically caused by an unhealthy lifestyle) treatment alone (dialysis and insulin together with the various equipment and tests required) costs the NHS an absolute fortune every year. meaning that the British population's increasing desire to eat and drink junk is costing all of us a fortune and causing horrific pressures on the NHS. Our local village hospital, where people use to go to recuperate after an operation (i.e. elderly having a hip operation who needed a bit of building up between hospital and going home) has now been taken over by a giant dialysis unit! Meaning that people are no longer able to recuperate in their own village, close to home and their support systems. The concept of local village hospitals has been utterly devastated, which again has cost all of us a fortune and impacted community healthcare in more ways than just £££.

Add smoking, booze, alcohol, and a lack of exercise to the problems and you've got a recipe for future disaster unless something is done to drastically change the way people eat/drink and the fact that so many have a sedentary lifestyle. It's not just an age issue, it's a population lifestyle issue. Indeed, many elderly people have a far better diet than young people these days. Spend a few days at a school or college and you'll get an idea of the problem: the kids eat junk and drink monster/redbull and a variety of other horrific synthetic/artificial/overcaffeinated crap. The NHS is dealing with the impact of that already, but the future costs are going to be astronomical.

Well said

Well said.

I think that ageing population is one aspect of the NHS issues but the main issue is overpopulation.
The NHS cannot possibly keep up with the demands on it with the population growth we've had in the last 25 years.

Other PP have said that we have become a more demanding society but I believe that's because we are waiting much longer for appointments and treatment when compared to a few years ago. When you're in pain that feels like an even longer wait. 😒
Also the wait for GP appointments has become ridiculous. Where I live it's not unusual to have to wait 3 to 4 weeks for an appointment which isn't acceptable but no one in power seems to have a solution for this 🤔.
I realise that this government has a mountain to climb with the NHS but I worry about much worse things are going to get before they begin to get better.

In my experience, NHS care is fantastic once you get through all the red tape and failed management. Administration is shocking. I don't understand why people such as Type 2 diabetics get medication for free when they should be paying towards it themselves. It is a lifestyle choice at the end of the day.

GP services are seeing more patients than ever with less funding (due to inflation). How’s that failing? Did you mean, underfunded?

YES! I hear you I live in a sweatbox one bedroom flat and food goes off so quickly. You cant store everything in the fridge. Which brings me to my next point Flat gets so hot in summer that my fridge freezer stops working. And before anyone says anything its FINE in the WINTER. Very small kitchen with small workspace. Even having the hob on is unbearable at the moment. The UKs shit housing has a lot to answer for. 31 years ive been in this flat

It would help if their appointments weren't so scattergun. I'm undergoing a load of pre op stuff in a hospital 50 miles from me. The first one got cancelled at last minute (I was about to get on the train!) because of staff illness. Ok, can't be helped but I lost £25. Next day, consultant phones with, as it turns out, a very abbreviated version of what my op involved & gives me date for the op which involved me cancelling my holiday. On Monday, the physio rings me with a prewritten script about being as fit as poss for surgery - I am not the fat, kebab munching alcoholic she imagined me to be but my views were of no interest to her. She also said my op wouldn't be on the site where I might be expecting it to be.
Yesterday, I attended the rearranged pre op appointment & got told a whole load of slightly different things including the fact that the date I was given isn't likely to stick as it's only 'pencilled in'. Great.
Today, I get another pre op appointment for two weeks after the date I was given so now I don't know when I''m having the op. This is a cancer situation; what's the point of patting me on the head & telling me 'not to worry' & 'keep healthy, don't think of yourself as ill' while they appear to be going out of their way to make me feel as anxious as possible?
I had all this last year as well. I really don't think I'm being entitled or too demanding. I just want clarity.
Rant over.

People expect to much of the NHS and don't do enough for themselves.

@hellhavenofury35 I see this a lot with people who either don't wash and apply cream to their own legs or if they are unable to, won't pay for carers to do it.
So they develop new ulcers because of course they also won't elevate their legs or wear the hosiery provided by the NHS.
Each time they inevitably develop a new leg ulcer we have to go through the whole rigmarole of treating it for months on end, finally healing it and discharging them, only to know they will be back on the books in weeks because they refuse to follow the simple preventative advice.

It costs the NHS £3.1billion each year, just to treat leg ulcers.

i see this a lot. And in theory you’re right, it should be achievable to eat healthily on a budget.

however. What a lot of people forget, and I didn’t realise until I was in that situation, is it’s not just about the food budget.

i had to move into a small apartment with my kids temporarily. Storage and cooking facilities have a massive impact.

no freezer, only an icebox in the fridge. Nowhere to store the affordable frozen veggies. Limited fridge and cupboard space, no where to store the big cheap bags of lentils and rice. Small preparation surface, no dishwasher. Cooker had one shelf. No ability to batch cook in large amounts, even if I had a freezer. If I got the slow cooker out there was no where to prepare the food. I had to do one thing, clean and wash up, rinse and repeat which meant I could never time dishes to be ready.

no transport to the supermarket. Which was useless anyway as nowhere to store a “big shop”. So it was pretty much daily trips to the Tesco extra. That’s not cheap. Add in the fact I worked full time meant we ate more takeaway than I’d have liked, but I could pick something up on the way home, no washing up and no trying to cook.

Apples do cost the same as a chocolate bar. But they go off relatively quickly. You can’t have a choice of fruit and veg lying around because there’s no fridge or counter space and it goes off. So again, it’s off to Tesco everyday for a couple of apples after a day at work. Chocolate is smaller and keeps for ages.

so yes, lentils and frozen veggies are cheap and nutritious. But if your budget is that low it’s likely you don’t have a big spacious kitchen and a chest freezer in your non existent garage.

That's not correct. The ones from supermarkets / health food shops are very low strength but you can buy prescription strength iron tablets from a pharmacy, either in store or online.

I do pay for my own weight loss meds and I am fine either way that. However, for someone who is developing health conditions because of their weight, weight loss meds may be the most cost effective option. If the weight loss meds lead to sufficient weight loss that diabetes and cardiovascular problems are substantially reduced that may save money. That’s the conclusion the NHS / NICE has come to.
Someone who is morbidly or severely obese maybe on diabetes medication, be vulnerable to sores and poor wound healing, have high blood pressure, sleep apnea, joint issues, circulation issues, fatty liver etc. The cost of having to treat that may be a lot more than weight loss meds especially over a few years.

It’s really is a complex picture.

Well it kinda does mean it isn't true. There are factually families up and down the country feeding their children healthy diets and spending nowhere near the amount that the Broken Plate report claims is required. Apparently their estimate is based on the government's Eat well Guide but this guide isn't prescriptive and doesn't state that fruits need to be expensive berries or that protein has to come from meat. The Broken Plate report has averaged food costs by category and then compared healthy and unhealthy food but it's obvious how this approach could skew the data. Lean mince costs more than full fat mince but if you have lentils or eggs instead of mince then that will be cheaper and fulfil the protein quota. A punnet of blueberries will be more expensive than a kitkat but a banana or apple will be cheaper. You certainly get less choice if you have less money but it absolutely doesn't have to cost 50% of your household income to eat healthily.

UPFs are generally cheaper, I never denied this but some non processed foods are super affordable. What is true though is that it often takes more effort to cook a healthy meal and this will be a massive factor for hospitals. They also have to cater for the masses and sadly most people eat processed diets whereas people will complain if you start giving them a quinoa salad even if it is cheaper to make than chicken nuggets at home, the cost of labour and people simply not liking the food needs to be factored in.

Just because you dont want to believe the Broken Plate survey doesnt mean it isnt true.

if healthier food is cheaper why are hospitals and care homes serving UPF

Why shouldnt they pay for an appointment cock up caused by them They are getting too much like the housing associations. No accountability.

If IVF is your own problem, does that mean any challenges or problems that arise from having children are also your own problem, along the same line of thinking?

My problem wasn't weightloss or IVF or cosmetic. Nor was it chronic. Mine was a problem that occurs naturally in both men and women, but in my case it was triggered by having a baby.

So we're back to that question - is it my responsibility because I chose to have children, even if it could have occured naturally as it does in so many others?

I think there is a very grey area here.

As medical advances at both beginning and end of life, now play a big part in NHS costs, I think financial contributions should be sought from Big Pharma and Big Medicaltech to help pay for them. Fat chance, I suppose.

People expect to much of the NHS and don't do enough for themselves. It shouldn't be providing weight loss meds/surgery or IVF. Those are your own problems. If it only treated chronic conditions and made people pay a few pounds to see a GP or clinician I think a lot of people will have far fewer health problems.
Mental health is also not under diagnosed....every adult that struggles with life suddenly has ADHD and wants to get onto a waiting list!

I would argue it’s the minority of workers having their parking fees deducted from their already uncompetitive salaries.

People expect high levels of professionalism and efficiency from staff but when it comes down to paying fairly for it attitudes like yours are common.

Well I'm currently lounging in a private hospital, recovering from surgery by a high ranking private consultant, enjoying the privileges of a private room within said private hospital.

The NHS outsourced me to ease the waiting list, and they are footing the bill. I was waiting for 4.5yrs.

For me, I had to advocate strongly for myself against male GPs who noted that I'd had a child and so instantly wrote me off as just being postnatal. Which then meant I had to make more appointments for myself, taking up more time at my GP surgery, knowing that I had a problem, even though it wasn't being recognised, wasting their time and resources that could have been directed elsewhere and to other patients if I'd only just been respected enough to be listened to in the first place. The problem with the NHS isn't just at the very top, at management level.

There is an element of education, or lack thereof, down the line. There is gender stereotyping. There is an element of lack of staffing, recruitment and retention issues impacting on wait times and waiting lists. There is an element of Brexit contributing too is expect, and ridiculous expectations and data targets to meet.