How Can We Save the NHS ?

[LuluJakey1]

Just that. I am interested- having been discussing this with DH, SIL and BIL tonight (we get a bit wild here on Saturday nights)- in what your thought are on how we save and protect our wonderful NHS so it remains 'free at the point of delivery' to all citizens and continues to provide high quality, cutting edge health care as well as more mundane but very necessary healthcare.
This is what we came up with as ideas on the basis that it will inevitably cost us all more and should if we want to protect it. We (DH and I) do, we don't want to see it privatised and us all having to have health insurance and ending up like America.

1. Remove some common items which can be bought cheaper at the chemist without a prescription from being available on prescription eg calpol, paracetemol, asprin, E45 and various creams etc. There would be a list.
2. Every person over the age of 18 to pay a yearly one off NHS flat rate charge of £200. No exceptions. Deducted at sources - wages or benefits or pension. Anyone under 18 to pay £100 (parental responsinility to 18)

On the basis of some stats we found from the National Data Office online, there are 15.6 million under the age of 18 and 52 million over the age of 18 . If we work those figures that would raise almost £12000million every year. OR We all pay an NHS monthly contribution based on our family size and income eg 1% of salary per family member and 2% for any family with an income of more than 100,000 but everyone pays, no exceptions. OR We pay £10 for each visit to a GP and £100 for each hospital stay, flat rate, prescriptions on top.

1. No one working in an NHS hospital or as a GP should earn more than £150,000 a year - this is to stop the ridiculous salaries of NHS Trust Executives.
2. Deals must be done with drugs companies so the NHS is not ripped off by them charging extremely high prices for life saving medication.

5 Plastic surgery, vasectomy, sterelisation, breast enhancement (apart from following cancer) , breast reduction (apart from in cases where it affects health) in fact any surgery done for cosmetic purposes or want rather than a health necessity should not be available on the NHS.

1. Smokers and alcoholics and drug addicts should not be treated for illnesses related to their addictions.
2. Anyone who calls out an ambulance for unnecessary reasons should be charged for that ambulance or at least fined.
3. Drunks should not be treated in A and E.
4. Drunks should not be picked up by ambulances.

Now I know these are provocative. We did not all agree on them but they were suggestions. They were not instead of National Insurance- that would continue.

Interested in your ideas .

Means tested charges. There isn't enough money and people taking advantage for unnecessary issues like non emergencies in the A&E or GP appointments for a minor cold and missed appointments. Charging a reasonable Co pay determined by income levels will provide more funding for the NHS and ease the burden by discouraging people from taking resources unnecessarily and by encouraging higher earners with a large Co pay into the private sector.

I think what needs to happen is unnecessary waste needs to be cut out.
Don't make a ward or group use up all their budget just so they get the same next year and don't lose out on money.
Have a properly integrated IT system that gps, health visitors, and hospital staff can all access.
Link social care to health care.

Redneck How would your system work in these scenarios?

A) A person develops a long term serious health condition eg a lymphoma that will require ongoing chemo for the rest of their life to keep it in check. I am thinking of a friend of ours who is in his mid-30s. He has chemo every two months with a one year break every two years and a whole series of blood tests, hospital visits every two months and sometimes scans.

B) A child who has a whole series of infections as children can easily get- tonsillitis, the flu, stomach upsets.

C) An adult who has a car crash injury eg complex broken leg and arm which require several surgeries over a couple of years.

D) Recurrance of a cancer several years later.

Would they all be treated free every time? Would there be a cost every time? Would their insurance go up if they used healthcare more than other people?

One thing I would do is invest in cottage hospitals.

Also, make sure the patients have at least two text reminders about their appointments and if they can't be bothered to appear or cancel properly then charge.

'Enthusiasm' What do you mean 1p or 3p more? 3P on every pound you earn every year? So if I earned £30,000, I would pay an extra £900 a year for example?

LuluJakey1

The system I outlined is what we pay now in the US (I am British living in the US) so under our system each of your examples would pay the first £6k of there treatment each year. Once they have paid that the insurance takes over.

Therefore in any year, no matter how many injuries or hospital visits you have the maximum you pay is £6k a year.

And if you use the insurance a lot do your premiums go up?

How do they calculate your premium in the first instance - health questionnaire? Medical?

No your premium does not chance, it’s flat rate.

We had a basic questionnaire but not intrusive. No medical.

Other insurance companies may be different but that’s how ours is, not that we get a choice as it comes through DH’s work

Yes from every £1 of the tax you pay. Yes the 1p is often bandied about to save the NHS but it’s needs more that that

3p even 5p but for most they simply couldn’t afford that and Ann increase in income tax impacts the increase in general costs so everyone pays considerably more

I'd written a massive reply to this ...but then realised how outing it is!!!! Decided against ..... OP you have no idea or insight into some people's real lives !!!!

In the US doctors specilose in one area so if you need sun damaged skin growth you would see skin doctor, colonoscopy? Bowel expert.
We should have specialists centralised so skin experts Birmingham and Newcastle, bowel expert Edinburgh etc and get transpor system set p up for this. I live in a rural area and we can’t get doctors - no work for their professional spouses, no good schools for their DCs. But young doctors specialising could learn state of the art treatment if all the money went to one specialist unit.

Kezzie200 Do what my GP in Belgium does, have a debit card machine on her desk. She bills me there and then and I pay.

Alternatively, have a debit card machine when you check in and you pay when you check in at reception.

The Belgian system is a combination of state and insurance, with all the requisite help for those on low incomes. It is a fast and efficient system with many tests coming back the next day. It falls down in GP follow up though - I had bloods done in December, and the GP still hasn't contacted me about the results.

As others have said, the choice isn't binary between the NHS and the US system - there are those systems in between. We also need to start charging those who come into hospital from abroad - again, the Belgian hospital I attend takes all your details at either A&E if that's how you arrive, or at the central reception point, where everyone, Belgian or not, has to register for their appointments, sort out how they will pay when they are billed, and can then go to their appointments. This isn't a small hospital btw - it is a large and ever expanding university teaching hospital.

Almageddon of course we already have specialist doctors in the UK. The whole NHS is set up around clinical specialisms.

Your secondary suggestion that we polarise specialisms into different of the country is just daft and unworkable. Transport and hotel costs alone are the least of the issue. A cardiac patient that falls ill in Cornwall would die long before reaching a specialist Centre in say, Kent.

I think, as a society, we need to be asking what we want from healthcare and what can be realistically provided. Is it really a good idea to keep people going artificially, for years, with no quality of life, just for the sake of it? This is where the money is going - and on managers as well in all likelihood.

mrscholly but trying to have experts in their fields everywhere is surely expensive, and specialised theatres/ scanning could be in one plCe and the latest equipment. Obviously urgent cardiac surgery needs to be done but hip ops, knee replacements, could be in one place. I would rather have THE national expert in liver cancer treating me than someone who combines that with various other surgical skills. And getting round the country isn’t so bad assuming you went somewhere for the initial op and treatment, in fact that is already the case for people with rare cancers.

scaryteacher What would happen in Belgium if someone arrived at a hospital in urgent need of medical care and with no means of paying?

What happens to people who can not pay a GP? What does each visit cost you?

To have all the knee and hip ops done on one place it would need to be a big place. My daughter works on the osteo emergency ward there are 53 beds out of the 53 patients today 40 of them where waiting for surgery with two theatres working since 8 this morning they won't all get done and that's only emergency. Tomorrow it will be 4 theatres working for routine and emergency combined. There are only 500 beds in the whole trust.

Alma so if the best liver team was in London, everyone would have to travel to London for a consultation? Or to Cornwall for bowels? Or Newcastle for neonatal intensive care? Who pays for the travel and accomodation? As someone who lives in Northumberland, the cynic in me tells me most things will be based in the south east- as with everything else in England? What would happen to Wales and Scotland who run their own systems?

Make health tourists pay! It's appalling how many people come here and receive it for free!!

Some of these posts are laughable. It’s like a bumper edition of the Daily Mail ‘inside hospital guide’.

I’ve worked in the NHS for 25 years - have been in a senior nursing post for the last five years.

Until we have a fully clinical led service, ie removed from the governments clutches, we will never move forward. We need clinical leadership to direct the l pathways that benefit our patients across all the systems.

Oh and please don’t say ‘sack all the managers’ that’s a really short sighted, immature view. We need strong infrastructure to deliver care and we need highly skilled non clinical staff to help deliver that.

IceBear You would be surprised. I keep saying I have been deliberately provocative. I am trying to promote discussion- the NHS is , along with Education, our biggest public service. They are very diffuse, complex systems, set up many decades ago when society was a different place. They are struggling to cope and fucking politicians who know nothing keep interfering in them with stupid ideas that don't help and cause chaos.

We are at the point where fundamental change will have to happen to retain quality and provision. The questions are how will we raise those funds? How will we ensure high quality? What will that provision look like? It will be unpalatable to many and we have to face that. A system is not about you or me. I have revealed some details about my life and family in this thread. I also worked in one of the most deprived areas of the north-east until I had DS in a secondary school where the levels of poverty children live with are beyond what most people think exists in this country today. The life expectancy in that area is only a year higher than it was 50 years ago and for men is almost 30 years below the national figure. Poverty has a huge influence on health.

I am not personally living in poverty but I understand the dire circumstances some people live in and the impact of cuts on their lives. There will be more to come. Since 2010 the only people who are wealthier are the already wealthy. The poor are much poorer. The country is more divided in all kinds of ways.

There is no appetite- even on this thread- for people to pay for a more equal society and that is what it would take. But people who earn more don't, on the whole, want to pay more in any kind of taxation for those who are less well off to benefit from and that is what would have to happen for us to keep the NHS. The money has to come from us and from the people who can pay so that services can be maintained for those who can't pay. The alternative is services are cut even further if you can't pay for yourself. Blunt but true. Us all contributing pennies makes no difference. We are talking about billions needed every month of every year, increasing all the time.

People are saying 'Oh that's terrible/ridiculous/disgusting, you can't do that!' but if we ask every person to pay £125 a month medical insurance for every person in their family, plus a £6000 a year excess, are we all going to find that acceptable? I suspect not.

Do we find going to a GP and hospital visit with our debit card at the ready for the Dr to run it through their machine there and then acceptable?

Do we find the idea of getting on a train and travelling to Exeter or Newcastle or Canturbury or to see a kidney specialist acceptable? If it was your mum would you want to go with her? You'd no doubt have to stay over. You are talking about hundreds of £s in travel and accommodation- the NHS won't be paying for that. What if you are by yourself and unwell?

But unless we have the open discussions and come to an agreement about the difficult options we'll end up in another Brexit mess where a path forward for huge change will be taken and then people will see the reality and not like it.

You could do initial consultations online then travel for pre op assessment then to specialist centre for op and follow up. Perhaps have some simple accommodation for post op care. I don’t think Cornwall would be ideal but the main cities could be. We could open up services to paying patients. If it’s streamlined with the most experienced and skilled staff working like a conveyor system it might save money long term. Don’t most hosts close down at 5 except for emergencies? That’s expensive equipment unused for 16 hours a day.

@AlmaGeddon urgent cardiac surgery is something you would indeed want done in a limited number of super-specialised places....and that is why it's precisely what happens already.

'The national expert in liver cancer' you'd wait to see would have a waiting list so long you'd die of your disease long before you even made it to clinic (which would, in a manner of speaking, solve the problem of too many people wanting NHS treatment, but would take some selling to the population at large!). Also, that national expert is not someone I'd want anywhere near my abdomen without knowing that s/he had those 'various other surgical skills' to manage the many and varied other intra-abdominal disasters they might encounter intra-operatively.

So many people get hip and knee replacements each year that you'd probably die of old age before making it to the top of the list in a single-centre of excellence (unless of course that centre of excellence had as many theatres in it as were used daily across the country for these operations).

Alma I think you would then have areas of the country considered 'remote' from London where there would be few services centralised because people from Lndon, the south east would not b3 prepared to travel to them and because from p,aces like Cornwall they would b3 far too remote- south west of Bristol, North of Leeds - Cumbria and the north-east, particularly Northumberland. There are children who have to board at a state secondary school in Northumberland the county is so big and rural. It would take them 3-4 hours to travel to Newcastle by public transport, never mind then London to a consultant. I think you have little idea how neglected some areas of the country have become in terms of infrastructure,roads and transport. There are already some specialist centres of excellence - for example Newcstle and Leeds have a children's heart unit. I am not sure how far that has spread in other specialisms.
London is the focus of everything as far as the government is concerned.

Well you’d have a team of specialists and a load of theatres. Streamline it , maybe in 3or 4 cities so the other specialities are there too. If one huge department had loads of consultants rotad then there’d always be an expert on hand . Probably half the pop is a few hours drive from a major hospital now. And then work a longer day, no empty theatres except after eg 11.
I suspect the unions won’t accept that though.