Why doesn't anyone have a proper plan for the NHS?

@MissFortune1 Why would we train doctors at £1/4 millions go and more to work in management? Of course others should be doing this role but it should be collaborative. Medics really should stay as medics and not reduce the workforce even more.

@Spendonsend
I always liked the german system which is insurance based but doesnt seem to have that no pre-existing conditions or bankruptcy element the states has - but i imagine it would be a hard sell for labour.

German here, and would disagree it's a good model to emulate. Yes, patients get excellent healthcare with at-will specialist access but it's also exceptionally expensive at system level, as well as ridden with extreme social inequities. The vast majority of the population pay income-based insurance contributions enabling run-of-the-mill care while the richest ten percent get to opt out into private insurance at often lower cost (because of cherry-picking healthy/young patients) and with better benefits (shorter wait times, private hospital rooms, nearly infinite physio appointments.)

Much better models would be Sweden (tax-funded), the Netherlands (reformed insurance system) or France.

Funding, incompetence, ageing population, people surviving that would have died and needing ongoing care, people not caring for themselves. Around 10% of the NHS budget is used for type 2 diabetes. My family are genetically predisposed to type 2 diabetes, my Mother managed by being careful to not go down that road and she lived in to her 90’s. Of my siblings three made no effort, one died from kidney failure because of diabetic complications and the other two are on meds. The other three of us have made an effort to not be fat, not drink, not smoke. We all had the same knowledge and warnings.

When I was at my GP very recently they had a sign up. It’s a six Dr large practice it said last month 290 people missed their appointments, please remember to cancel. Of those I’m sure there may have been a few genuine emergencies, terrible though.

What I always find strange but fascinating at the same time is that, when you look at the leadership structure, the C suite and main decision makers in the hospitals/trusts, is that I often see they are not medical professionals. They are executives form big firms who found themselves working for the NHS. And these non medically trained people are making decisions on how hospitals should function, they probably also decide how the money are spend (budget) but please correct me if I’m wrong….

In the country that in from this would be unthinkable. The decision makers, leadership teams in hospitals are actual doctors and/or medically trained professionals who moved up to be in the leadership.
Dont get me wrong, the care is not perfect and waiting lists are also long for some specialists but I often wonder if some of the NHS problems could be fixed by placing into leadership teams people who are day in day out at the frontlines… they understand like no one the challenges, problems, they see firsthand what need to be done and so on.

We already do. And systems exist like that in the U.K.

I was in last week to have a troublesome ovary removed. 20 ladies between 50& 75 arrived at 7am checked in by one nurse, got themselves into surgical gowns slippers and walked to anaesthesia. Hopped on a trolley, keyhole surgery, woke up, proved I could pee, eat & walk and was collected by driver (dsis). Home by 4pm. It was all very efficient.

I think we also need to think about healthy life span rather than just longevity.

I believe it. I remember huddling round a camping stove as a child and living on sandwiches as we had no means of cooking. No heat or light or power. Just the camping stove and candles.

I actually think we need to stop gp’s being gatekeepers to private insurance. Where I live you just turn up at a private hospital with your insurance card, pay your excess and off you go. In the UK it’s ridiculous that you need your GP to sign it off.

@TizerorFizz Life was objectively much harsher in the 1970s, but a large percentage of MNetters will never believe it.

@Papyrophile I was working during the 3 day week. My employer gave us candles! During the 70s it felt like the UK really was failing. Much worse than now for lots of people.

And before everyone jumps to the conclusion that it has all been sunshine and butterflies, I lived through the three day week in the 1970s, then spent 1980-85 in NYC (when it was bankrupt and DANGEROUS). Now that I am ageing, I don't want to go back to it, but I acknowledge that I need to contribute personally to the cost of my health care.

Unless society decides that having earned more than £000, I should be taxed at a higher rate. I don't resent paying tax on my basic state pension. BUt it seems daft to pay one partner c£13k and then tax it back.

@TizerorFizz I do agree with you. We have been fortunate. We were born at the right time into a buoyant economy. We had (or I did) an effectively free university education, and parlayed that plus/via overseas experience into 20 years of decently paid self-employment. Via a work project, I explored the pension landscape and all the options. And made decisions (25 years ago) that now look clever. They could have been bad decisions. I/We could have lost everything and been on SP with nothing more. My pension was tiny; DH had none (no auto-enrolment then). I have both parents still (89 and 90) and am unlikely to inherit much from either.

But the two most important words in the paragraph above are self employment.

https://capx.co/broken-britain-is-driving-everyone-out-even-our-immigrants/?utm_medium=email&_hsmi=85099509&utm_content=85099509&utm_source=hs_email

Not good news for the future of UK healthcare.

How do you improve the fitness of a 98 year old? You cannot. It’s just waiting to die in the best way you can. In hospital
is the absolute worst. It’s actually better to have loads of things wrong as GPs actually see you. If you just decline into old age you are just a statistic. Then hospital looms and you don’t even get anyone talking to you.
@Sunnnybunny72 I do not see why older people with money should be exempt. They have the best pensions, money through buying houses at the right time and pretty big nest eggs if they sell up and downsize . Why do we keep thinking they cannot pay but working families can?

People are living "too long" everywhere in the world that you'd want to live. They're not waiting on trolleys in A&E corridors for twelve hours everywhere else.

Yes improving the general fitness of our elderly population, along with a revolution in social care to reduce blocked beds and falls, would help NHS resources go further, but other health services are doing better (aided by substantial additional cash from higher earners and employers).

Because the major cause is unpalatable. Too many people living too long with multiple co-morbidities, very poor quality of life costing absolute millions.
The 'charge for missed appointments' theory for example, wouldn't work, because the young and the old would be exempt, penalising the poor sods in the middle yet again.
Nurse of over 30 years.

I don’t think it’s a bad thing to keep expensive equipment fully used though. I’m also aware of the Kings Fund research. Lots of evidence flies in the face of popular rhetoric. What must be addressed though is why there is low productivity. Our admin costs are lower than other countries apparently (so an expert said on radio 5 this morning) but we don’t seem to get the through out of patients we should.

I agree with @Kendodd . If you see some of the wards with elderly people in them, you do pray with all your might that you never end up like that. I’m also tired of hearing how others think we should stay alive when we don’t want to. I want to make my own decisions.

Always a good place to see costs/benefits etc. Contrary to popular belief there are now way more doctors and nurses than ever. Admin/managerial staff has stayed constant. 45% of budget on salaries though, next biggest drugs.

https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/key-facts-figures-nhs

In some cases, it IS about money. Hospitals/trusts get paid for treatments, so they have an incentive to do work if they get the extra funding to do it.

My OH was sent to a different hospital (same trust) to see a highly specialist consultant for a stem cell transplant. He (and his stem cell transplant co-ordinator) were all over us at first, showing us the state of the art equipment, re-assuring him, giving a tour of the department. It really was like some smart sales presentation. When OH started showing uncertainty after the tour about the serious and length of the treatment, there was a distinct reduction in interest from the consultant, and they both seemed disappointed and were pretty quick to show us the door. It really was like going into a car showroom, getting offered the coffee and cake, and then being ignored when they realise they've not got a car you want to buy and lose interest.

We mentioned it to his own oncologist and she confirmed that they get funding (huge amount in the case of a stem cell transplant) so the more transplants they do, the more funding they get! OK, not going into his pocket (hopefully) but it does show that some things in the NHS are financially motivated, and that any "gaps" in the number of patients going through the stem cell transplant process means they get less money, so it's in their interests to keep their beds and equipment fully utilised!

In this case, it's not even about the money, it's just plain cruelty extending horrible, painful, lives like this with endless medical treatment. We do it because we're to cowardly not too.

Spot on!

This of course should be off set by the number of people from overseas (mainly EU) living in the UK who go 'home' for medical and dental treatment. I have got to know a lot of Ukrainians, they mostly go back to Ukraine for medical/dental treatment because provision in the UK is so poor.

Save money? This is the problem. Healthcare, good healthcare, is expensive. It’s more expensive than we are currently paying. We know this because the health systems in other comparable countries cost more. And we have a massive backlog both in throughput and infrastructure to work through.

If we want it, we will have to pay for it. The discussion needs all to be around how much of it we want and the best way to pay for it. The fairest, and the most efficient.

But we’re not having the conversation because political parties are either scared (Labour, currently) or pro-US model (Tories).

The European 'same per capita funding' is not all from the government as far as I can see. It includes the insurance based contributions. Surely there can be some state guaranteed not for profit insurance based system. I agree the wastage needs to be cut. Charge for missed appointments, fewer free prescriptions for things that cost pennies at the pharmacy, stop the triplicate of work andcthe clunky systems. I work in the public sector. ( not NHS). We waste huge amounts ofvtime on admin because instead of spending money on proper systems, we have several cheapo systems that don't work together properly, which is incredibly frustrating. I can imagine it's 10x worse in the NHS.

Claiming back overseas patient bills is interesting. I was recently in Spain and met an ex pat who came back to the UK last year for a hip replacement. She's been living in Spain for over years and hasn't paid tax in the UK in all that time! She told me that all you need is an NI number and to give them a UK address (she used the address of a family member) and they don't charge. She told me that a lot of people regularly travel back to the UK for treatment as they never get charged and although the hospital treatment is good in Spain the language can be an issue.

I'm sure this is true as when my aunt was visiting from overseas a few years ago she needed some hospital treatment and offered to pay as she hasn't lived here for years she was told not to worry!

Health tourism is a big problem.