The NHS is collapsing - what can we do?

[FedUpWithTheNHS]

First of all, I am not interested to do more bashing on GPs, NHS, nurses and whatnot. I sincerely do not think the issue is with them. So let's leave it at that.

But I have been trying to get some support for myself and struggle to get anywhere.
I have family members who have been waiting months, turning into years for severe issues and they are left in pain and scared.
I read threads on here (the one on sepsis, cancer scare etc...) and it's more of the same.

The system is collapsing but there isn't a private sector to pick up the pieces. I had to wait 4 mnths to see a cardiologist privately.... And now another 6 weeks to be able to have the prescription from my GP (At more than £100 per month, I just can't afford to get said prescription privately).
It very much feels like we are left to die, from no healthcare, tbh.

So far, I have written to my MP.
I am supporting groups working against the 'privatisation of the NHS'.
I'd vote Labour but tbh, just now, I can't say theyve filled me with confidence they will actually do what is needed. Which is increasing funding and ensuring doctors and nurses are staying in the UK and the NHS (at the very least)

What else can I, we, do?
I feel like we need to start shouting. LOUD. Very loud. But I am at loss as to what else I can do :((

The US 'system' doesn't work because it's not a system; it's a Frankenhybrid that gives some people brilliant care and others nothing. The US also has really poor records on many social determinants of health such as poverty, systemic racism, lack of maternity care, etc, and doesn't invest enough into high quality primary care.

There's a long record of research on co-payments. The initial research on it was promising (lower utilization without worse outcomes) but the payments were quite small. The more recent research says, effectively, it does reduce healthcare consumption but as cost shares rise, outcomes get worse. It's often a knowledge problem; since the average patient is not a professional, they often don't know which care they really need. Also, what winds up happening with copayments is two-fold: One, concessions get made, for example, for the very poor, children, registered disabled, elderly, etc. These can correspond to some of the highest utilization groups. Result: Not much money is generated. (See: NHS prescription charges.) Or, as with US Medicaid which is generally free at the point of use, you get people using the ER as primary care, which is extremely expensive and not very effective. The lesson is that consumer directed approaches to reducing healthcare spending don't have a very good record. It's much more effective to (as in the Medicaid example) have access to primary care and urgent care clinics and educate patients to use them as a point of first contact. This is also why A&E is overwhelmed in the UK; patients can't access their GP. Usually, if someone is willing to wait in the ER/A&E to be seen for a minor ailment, there is a reason for it; either access or social conditioning.

Most of the "personal responsibility" ideas sound nice but aren't effective. The economic impact of obesity is actually quite complicated (yes I saw last week's analysis) as it imputes all of the difference in cost to weight. If telling people to lose weight worked, people wouldn't be getting fatter. We don't actually have a successful approach to weight loss, and moreover some of the causes of increased obesity are, again, social determinants of health. You could also say that the UK should invest properly in housing (damp and mould are a real health problem), access to fitness facilities, improved benefits so people can afford to buy healthy food and aren't chronically stressed (simply being poor has a negative impact on health!) And all this costs money. It's not simply the Tory approach to health care that is broken but their approach to society and poverty.

The biggest immediate crisis in the UK is lack of staff to deliver an adequate service and that wouldn't go away if the NHS were replaced with an insurance based system.

Oh, and NHS spend on 'luxury' issues people keep bringing up like IVF is not even a penny in the pound. Sterilisations and vasectomies are cost effective, as is contraception. The cost is more than recovered by the reduction in additional pregnancies. The budget for health and care spending in England is £180 billion. In a 2018 BMJ article it says the NHS spent £68M on IVF (this might be the entire UK). That's 0.03% of the budget. You wouldn't shave 1% of the budget looking at this sort of spending.

I work in a mental health NHS service.

I go private where I have to, and would happily support co-payments as I am unable to access a number of services otherwise. After years of providing more for less and being increasingly creative on budget, there is simply little left.

The constant argument 'good free NHS vs bad expensive private' means free healthcare is - and will be- very limited and difficult to access for majority of us while private sector is a bit of a gamble as partly poorly regulated and partly seen as a necessary evil. It continues to amaze me why people don't see the need of both working together and insist on plodding on hoping things will just change.

They already pay 13.8% employers NIC which has risen a few times under the past 25 years. Trouble is it's a cost on employment and just forces firms to hire self employed instead to avoid it.

@Artgalleryloner

This will reflect how we vote and how much tax we are willing to put into it.

Trouble is that no one, personally, is willing to pay more tax themselves. They want "someone else" to pay it, whether it's "the rich", companies, OAPs, workers, etc. It's always someone else!

I don’t know what the answer is but perhaps the reality that the NHS can no longer be free. Just because it has been, doesn’t mean it should continue to.

I am not sure if that means more tax which is specifically for the NHS or PAYG.

First past the post voting creates governments who only think short term. We have voted in government after government who have failed to plan ahead for an ageing population. The current lot hate state funded services and want them to fail so they can privatise. They don’t pay hospital staff properly and so there are huge numbers of vacancies. They don’t properly tax people not on paye or non doms. Their voters are the elderly who won’t countenance selling their assets to pay for social care. So when the elderly get sick they stay for months in hospital beds. We have 90 year olds on chemotherapy and people in care homes rushed into hospital for infections and falls for months, to prolong their misery. There is a culture of life preservation despite poor quality of said lives. It’s going to get worse as time goes on as younger people are in poor health due to relative poverty.

They already pay 13.8% employers NIC which has risen a few times under the past 25 years. Trouble is it's a cost on employment and just forces firms to hire self employed instead to avoid it.

Is that the case in Germany where employers are paying over 19% ?

The nhs isn't free

It's what a large share of your taxes go to

Think of it like public (badly) managed health insurance

It's free at point of use
Sone countries do make a charge at point of use - stops time wasters but can also stop genuine problems -

like you already do if you have an nhs dentist. They do exist. As you can see it doesn't make the problem go away because the government didn't use out money to supplement the system ...

Other countries also get people to pat more in - this would require a tax increase of sone kind - across the board or on inheritance tax - which may also cool the housing market

Don't say "we couldn't afford it " followed by "private insurance " because except in a few heavily regulated counties you pay a lot more for private health service

The bottom line is we pay less per head of population than is needed and less than other countries pay

It’s nit free though.
It’s free at the point access. Meanwhile we are paying for it with our taxes.

And just now my question is:
Are we getting good value fur money when we are paying 2 or 3 times the price if what we use to pay because ‘we’ve gone private instead’

Im surprised how so few people question the fact it is not cheaper to provide care through private companies vs state funded NHS.

Yes poorly worded. Free when you’re there but you still pay via tax which is why I said about paying more tax.

I do have other issues with the set up though. DH had a heart attack. He was taken from home to another trust, not the local hospital. When discharged he was referred to a cardiac nurse in a third trust. A week later he had another heart issue and was then sent to our local hospital. Out of all 3, computers don’t talk to each other. Neither do staff really. It was and still is frustrating as, for check ups, not one of the 3 are willing to see him or take responsibility for him.

Too many net drainers, not enough net contributors.

And we're shifting further towards net drainers everyday. More and more services will keep getting cut as a result.

It's not good value for money now. Even as a basic rate taxpayer I still pay ~£6k per year on the NHS. So maybe £250k over my working life, and maybe £50k over retirement.

Return those funds, let me spend it for my family on private healthcare. Or buy insurance if I haven't got enough capital saved up.

Removing personal responsibility for so many things in our society is the biggest reason for the British demise. Won't get better until that mindset shift happens.

Another thing about training and retention, a lot of nursing students are describing how awful it is on the wards, they get very little actual hands on training, are basically used as another HCA, which is fine for some of the time but they also get dumped in the deep end when they qualify with minimal support and then burn out very quickly.

Even as a basic rate taxpayer I still pay ~£6k per year on the NHS.

@Reality25 how do you break that down ?

Is that your contribution today or you expected lifetime contribution/ expected life ?

You don't know what you're talking about. The NHS isn't free, we all pay into it. That's why it's a NATIONAL health service. This is what the Tories hate about the NHS - it's because it's an egalitarian institution for everyone, regardless of income . Labour definitely would save the NHS, I don't know why you suggest they wouldn't.

Labour definitely would save the NHS, I don't know why you suggest they wouldn't.

That is some strong support there. How will they fund it? When you look at the population change and extent of requirement who is paying more with Labour?

At 46k a year income you will pay about 10k in tax and insurance

Roughly 20% of total taxes goes to nhs
(216 or the 947 raised as taxes )

So 2k not 6

Double that to account for. VAT spending makes 4k

Income tax increase of course! Who in their right mind wouldn't pay more tax for the NHS?

Obviously getting the tories out is part of it but people actually waking up and taking responsibility for themselves and how they use the NHS is just as important. People run to the GP or A&E for anything and everything and then complain about wait times or lack of appointments. It’s far too complex to just say change the government and give the NHS more money. The service needs to be run differently too, I’ve worked with them in the past and there’s money wasted like it’s Monopoly money and the “leadership” have no commercial or financial sense.

We can’t do anything.

Increase for everyone?

I don’t know if people are that keen to increase tax, I certainly hear people on here talking about tax being high

If the choice is higher tax or an American style system when the poor can't get treatment - where they die from lack or insulin for example - which would you prefer ?

To be fair higher taxes need not be uniformly applied - there is a lot of value in inheritance which may be the least painful approach

I totally agree. We have been using the NHS for very minor complaints and have to get out of the habit. I was in hospital recently and the doctors and nurses were great. Run off their feet, but wonderful. But there were support staff who did sweet fa apart from hide around corners looking at their phones. Believe me this is true. I was in hospital for a week and didn't have much else to do but watch! There were also a lot of older people in beds who weren't really ill but couldn't be sent home because of lack of social care for them. There's a lot of waste in the NHS. That's why I'd trust Starmer when he says he's going to change it. I hope there's an NHS left by the time labour get in. The Tories want it gone, and make health care a profit organisation.