Everyone was worried about the Tories and the NHS

[Puzzlemad]

https://www.bbc.co.uk/news/live/c0qejx03zjnt

Yes - this. There is no incentive for a proper service. Just a converter belt where they want rid of the patient to get to the next.

I think some sort of system that encourages better treatment of patients and work practices linked to salary and bonuses is a good idea.

Why should they be able to get away with underperforming when it wouldn’t wash anywhere else ?

Can I ask, do female consultants behave like this?
A friend of mine used to be a theatre nurse, she said one (male) consultant said 'in here, as far as you are concerned, I am God'. I said that I bet a woman wouldn't say that.
In contrast, another (male) surgeon I heard interviewed about his work on the radio says he tells all new colleagues in theatre, regardless of how junior, that if you see something you don't think is right, speak up immediately. People make mistakes, even senior doctors, so if you see something, speak up, they will not be in trouble for it in his theatre, even if they are wrong. He also says he asks them a question 'who is the most important person in the room?' The answer is the patient.

It's only anecdotal of course, but I have a friend who's a manager in a NHS hospital. She has hilarious nicknames for all the staff, based on either their most annoying or endearing traits. Based on that the female consultants are just as bad!

@GenderRealistBloke I said I joined it then, not that i left it then 😂

This absolutely, there’s a focus on saving life, without thinking of the quality of that life. A good friend of mine works in this area of care and is adamant she doesn’t want to be kept alive should she be unfortunate to ever get to a point where she has no quality of life because of some of the horrors she has seen.
This situation is complicated by families fighting tooth and nail for the “best care” for their loved one. Of course, what adult child could look themselves in the eye, and feel like they’ve somehow let their mum down because they didn’t fight for them until the very end? This is something my friend is coming up against constantly in her work- the “there must be something you can do?” fight.
But sometimes the best care is a dignified and pain free death, and as a society we tiptoe around this.

I used to work in the NHS and I’m still in the wider health system. I also have a lifelong health condition so need regular care and see it from the other side of the fence.

Managers and feckless patients are simple catchy solutions but the state of the NHS is a complex issue. In my experience, culture, outdated services and systems, outsourcing and a lack of patient centred care but they don’t come with a simple fix.

They all feed into clinical negligence though and Darzi flagged in his report that spend on these claims equates to 1.7% of the entire NHS budget. Solving the big issues and some of the quick wins like duplication (e.g I confirm I’m attending on an app but still always get a letter too) could easily deliver enough surplus budget to fund the more expensive reforms needed.

I really hope the next step won’t be to bring a large consultancy like Deloitte to oversee the reform. I’ve seen it so many times and it’s pointless. There’s so many people within the NHS that would be far better placed to work on this and considerably cheaper!

Nail on the head. My OH has cancer and needs monthly blood tests, reviews and monthly prescriptions for chemotherapy drugs (and a whole package of others such as anti bacterial, antibotics, anti fungal, anti sickness, and several vitamins - strong doses such as iron). Every sodding month they cock it up. He's been going through this for 6 years now, and never a month goes by without a blood test appointment being made for the wrong day/week, or the drugs not being ready at the appointment made to collect them, or the monthly consultation appointment being fouled up (too early or too late). It's not rocket science. Blood test 2-3 days before the consultant appointment and then prescription collection 2-3 days after consultation (consultant needs to approve the drug issue). Like I say, not rocket science. The fools making appointments can't even work out the four weekly cycle - just look at a damn calendar and count four Monday's. How difficult can it be?? The sheer number of times the appointment for the blood test comes through the week too soon or a week too late (i.e. after the consultant appointment and drug issue!). Even when appointments are made at the right time, they often get cancelled at last minute, and the adjoining appointments left unchanged, or he turns up to find it cancelled without being told.

This is life saving cancer/chemotherapy. If they can't do the simple things right for chemotherapy, on a simple 4 weekly cycle, there's no hope for anyone else.

I really hope the next step won’t be to bring a large consultancy like Deloitte to oversee the reform. I’ve seen it so many times and it’s pointless. There’s so many people within the NHS that would be far better placed to work on this and considerably cheaper!

I really hope do too though it’s definitely hope over experience. Governments of all political persuasions do seem to think that ppl working in the NHS need some extremely highly paid management consultants to tell them how to do things differently

I also think that unless you’ve worked with or in the NHS, ppl have no idea how such absolutely basic things like a decent laptop, access to decent wifi and a decent printer are not guaranteed. I’m absolutely boggled at the shit level of infrastructure there is - I don’t know how my NHS colleagues cope

Changing those basics is a huge cost that's the problem. Just really old tech and badly joined up stuff

So this reform without extra funding? not sure how

Exactly! That’s just one really small thing but across the whole of the NHS it’ll cost millions

and you know how the optics would look. I can see the daily Mail headlines now “cancer patients face agonising waits for care while nhs managers spend millions on the latest laptops”

@DadJoke

"The NHS can easily be funded through taxation using the current model."

I don't think it can which tax rises did you have in mind?

Tax as a share of GDP at 37% is at its highest in nearly 70 years.

Increasing national debt is not an option as Liz Truss found out the hard way and interest payments alone on the debt are roughly the same as is spent on the entire education budget.

Alternatively you could cut public spending in other areas but most other spending is quite small in comparison to the NHS budget. So cuts there would have to be really drastic to make a difference. The only other area with a similarly large expenditure is the state pension bill which is also going up significantly. But cutting that or raising the retirement age would be massively unpopular.

No, that's not correct. France's health system is not insurance based.

Much of the cost of healthcare is funded by the state. Long term serious conditions are funded 100% People can take out top up cover to fund any gap when the state doesn't pay the full 100% and to allow them a wider choice of non-state funded hospitals. The cost of that insurance is very carefully regulated and it's provided free for lower earners.

The public are very much in favour of increased funding for the NHS and are willing to pay for it. Any other model either requires compulsory insurance (basically a form of taxation) or results in the NHS no longer being free at the point of delivery, resulting in differential outcomes by wealth.

Truss failed for lots of reasons, but the primary one was borrowing to fund tax cuts.

Increasing national insurance, treating capital
gains as income, rebanding council properties and socialising social care costs are examples.

No one wants the “solutions” proposed by right-wing think tanks.

The public are very much in favour of increased funding for the NHS and are willing to pay for it.

I don't see that as if it were the case the GE would have been run on increasing funding and extra to pay for it.

Labour very much talked about no tax rises and 'fully funded, fully costed'

The other issue with tax rises is Labour need growth to do much at all and if they get it wrong tax will keep rising and spending cuts will increase

Where I agree is the model is not really the problem, more money is needed if reform is on the cards, I think the electorate and the economy may be at the limit of increasing payments for it though

So what to do? I don't think Labour would be in the position they are had they look at the EU pre GE but that's out. So what else..

Funny how you think raising NI is part of the answer. That's yet another tax rise on workers. How about in income tax rise on everyone instead? So the burden is spread more evenly over the whole population, not just workers?

Or how about imposing NI on ALL income, including pensions, rental incomes, interest, dividends, etc??

Whatever the "answer", it can't be only on the shoulders of workers who are already creaking under the pressure.

I agree @taxguru , but manifesto promises..........

The only other area with a similarly large expenditure is the state pension bill which is also going up significantly.

This is incorrect.

The only expenditure item equal to healthcare is welfare which does not include state pensions

@nearlylovemyusername

So often the figures for welfare / benefits budget includes state pensions so it's difficult to split out what proportion is for pensioners and what is for working age and families.

I did however manage to find this pie chart on percentages which does split it out:

Welfare absolutely includes state pensions. They are a benefit and the DWP's biggest single expense.

Mmm, any government track record on delivering IT programmes ???

If they're serious about improving health, they need to add/increase VAT on "bad" foods such as those with little nutritional benefit and those high in sugars/fats/carbs, etc.

I.e. remove the VAT zero rating on "unhealthy" ultra processed foods, remove zero rating on crisps, biscuits, packets of breakfast cereal, etc. Just maintain zero rating on unprocessed foods such as basic meat, veg, fruit, dairy, etc.

Increase the VAT rate from 20% to maybe 25/30% on takeaways, fast food, pies, pasties, chips, etc, sugary drinks, etc.

Never happen of course - just think of all the sad faces that would be all over Facebook and the media! Osborne tried a relatively minor change on VATable status of pasties and pies (a la Greggs etc) and got absolutely slaughtered by the media forcing a U-Turn!

A double win - more tax revenue and also maybe a nudge for people to eat more healthily meaning less future strain on the NHS! What's not to like??

@taxguru

"If they're serious about improving health, they need to add/increase VAT on "bad" foods such as those with little nutritional benefit and those high in sugars/fats/carbs, etc."

So currently there is no VAT on food.
Rather than add VAT to "good / bad food " how about adding VAT to luxury food like quails eggs or asparagus? Or to say food from Waitrose where the same food (for example fruit and vegetables) costs considerably less at say Lidl?

We need to stop giving wealthy people tax breaks allowing them to shop either for luxury food or at luxury supermarkets when there are perfectly acceptable standard foods available from Lidl.

It's also damaging to social mobility, life expectancy and equality that rich people get to eat better quality food than poor people.

(Note: tongue in cheek post referencing the same arguments used in favour of VAT on private school fees).

The public are very much in favour of increased funding for the NHS and are willing to pay for it.

No, judging by MN alone, the public are very much in favour of increased funding for the NHS providing it is other people paying for it.

No doubt as with every other thread on this subject, people will post virtue signalling bollocks saying they're willing to pay more tax but when asked how much they'd be willing to pay or when told they can pay tax to the treasury voluntarily they either shut up or start saying that large corporations should be paying more etc etc. (Amazon and Starbucks usually get a mention.)

True.

The issue for Starmer and co is 'other people' may not do them the favour and choose to opt out instead

If there's no planned for growth a whole raft of pledges fall down

Labour have been accusing the tories of underfunding the NHS for years. Now they're in power and have suddenly decided the NHS doesn't actually need more funding.

Personally I think the whole concept of a free NHS is now unworkable. The envy of the world that not one single country has copied. I have a few horror stories of my own from my family's recent contact with the NHS. Third world is the term that springs to mind.