The NHS - semi lighthearted debate with friend

[Ozgirl76]

A friend and I were having a debate today about the problems with the NHS and the best ways to fix them. I remember Wes Streeting had said that his preference was that because obesity causes so many issues, it would be best to fix the problems before they’re medical - by basically controlling what people eat.

So we were trying to decide - would it be better for the government to have much more control of our diets, ban smoking entirely, and continue to provide free health care. Or would it be better to continue to have free choice BUT if you met certain thresholds you were made to have health insurance which would cover you if you developed a smoking or weight related disease. We decided that to be fair, if you start the health insurance before the age of (say) 25 and never made a claim for any weight or smoking related disease up until age 70, you would get a lump sum payment back.

What do you think?

We picked smoking and weight because they are the most expensive - and to some extent, avoidable.

You are aware that several diagnoses have an impact on weight. It is not as simple as you make it to be.

Yes but putting that aside because most don’t - looking at the issue as a whole rather than individual cases.

Yeah but if the government started policing chips and fags, people would just end up hiding Mars bars under the bed like contraband. Free will vs free healthcare is such a messy trade-off, I can’t see either working cleanly.

Read the facts about weight related to disability and carers. It may shock you. So, no I wouldn’t be saying charge people that for.

Where would it stop? Sports injuries/ weekend dads playing football? Holiday injuries/ski accidents? Cooking/burns/cuts, dangerous use of implements during cooking? Old people falls - well they should stay in a chair or bed all day?

What if junk food was MUCH more highly taxed, like cigarettes.

Well I’d agree that people who do extreme sports, or even not that extreme but potentially dangerous, like skiiing) should have an insurance that would cover them for accidents and long term effects of accidents.

Shall we have insurance for elderly frail people who fall too? This costs the NHS 2.3 billion annually. I work as part of a team who pick people up - it is all day every day. The cost of equipment, rehab, wound care, broken bones, social care. Where do you begin and stop?

I work in a new community service put in place nationally by NHS England to try and reduce the pressure on acute beds. 2 years later and we are at service capacity every day, we simply cannot deal with the number of referrals. It feels like no matter what measures are put in place demand always outstrips supply.

So the difference there is falls aren’t particularly unavoidable.

Out of interest what was the consensus as to the ‘problems’ of the NHS ie the underlying root cause? It’s so complex, yes we see and feel the impact but that’s different to root cause.

Not true. There are drunk people falling, overweight people falling (legs give way), folk who haven't looked after themselves (poor diets and no exercise) and now have issues with their BP and blood levels. You can direct it back to being their fault a lot of the time if you wanted to point the finger.

We truly are at end stage capitalism territory.

We are pushed a diet of addictive ‘non food’ chemicals, from giant corporations who also own shares in pharmaceuticals and medical suppliers.

And as a society, we demand the freedom to choose these addictive substances that are harming us.

Diabetes management and treatment costs around 11bn every year so that one disease alone would probably be a good place to start.

I did a course once on health and disease. Health is approx 1/3 genes, 1/3 environment and 1/3 behaviour. It suits the paymasters and the right wing to pretend it's all behaviour. Most people can't easily change their environment and no-one can change their genes.

I would sort out primary care and delays to discharge before anything else. I think a lot of the other problems would be more manageable if these two were no longer a problem.
Of course, I've got no idea how I would sort out GPs & carers!

I think it was more of a philosophical discussion about should the govt control the food, cigarettes, alcohol in the first place (through dramatically higher tax) or should people themselves pay through insurance for their own choices and the govt leave us to make our own decisions.

I actually like this idea, but i suppose the problem with it is that someone needs to define junk food. For years people said fat was the bad guy, so cheese, milk, yoghurt etc were vey vey baaaaad. Now the fat free upf laden versions actually seem to be a lot worse!

I do think highly processed foods are a problem. However, in food deserts or among people relying on foodbanks, processed, shelf stable foods are life savers. So it would be difficult to put into place without having unintended negative consequences.

I guess there’s always a risk of doing nothing because they can’t get it perfect means that nothing ever improves.

It would be a start if the NHS behaved like a HEALTH service and not an illness service.

It is currently ridiculously hard to access physiotherapy, counselling, paediatrics, tests to manage long term conditions e.g. cardiac, asthma, epilepsy, all of which can end up with an expensive acute crisis.

I had to pay nearly £600 this summer and do a 3 hour round trip to get a Mirena replacement (I have endometriosis and a load of scar tissue) by a consultant with experience and who guaranteed they'd use local anaesthetic.

In Switzerland, where they have a social insurance system, my friend's kids see a paediatrician every year for a check up as a matter of course and the local clinic also does Mirena replacement without making you beg for anaesthetic.

We put up with some crap treatment and attitudes in this country!

I think there's a big improvement possible between 6m people on the NHS waiting list and perfection tbh.

No, I don't think it has to be perfect, but it cannot cause harm to vulnerable populations.

My falls and weight are due to disability. I have food quirks that are due to autism and a restricted diet as a result. How are you going to mitigate for that? Or will it be yet another badly thought out idea that disadvantages the disabled?

How are you going to make an insurance company take me on?

Weight is not the same as smoking. We all have to eat, nobody has to start smoking. Or do they?
Fat is affected by genetics, medications and other health conditions.

And what about alcohol and drugs? Both in terms of damage done to the individual by consumption but also by subsequent risk taking and violent behaviour causing injury to themselves and others, all needing nhs treatment.

Drinking, smoking, drugs and over eating can be trauma based.

Will people get let off if, for example, they have been abused as children, or have ptsd as a services veteran?

Where will you draw the line?

What about people who can’t afford health insurance?

What about people with pre existing health conditions from childhood?

Also, a huge amount of plain old dislike of fat people is hidden behind the “drain on the nhs” speech.

Yes being fat can sometimes lead to related health conditions which cost the nhs money, but the vitriol is disproportionate.

Not a topic suited to being “light hearted” really.

This is a good point imo, prevention is better than cure, access to services which can maintain people's health is so difficult yet would help prevent crises.
No other country models their health care on the NHS yet it's held up as a beacon of high standards which it plainly isn't.
A reorganization on the lines of European models may help.
For instance, in Europe women see a gynaecologist service for cervical screening, contraception and sexual health as well as any gynae issues such as PCOS or endometriosis.
In the UK this is all managed by at least three services that don't interact and accessing each is a real struggle a lot of the time.

So a definite sense that prevention is better than the cure - this makes a lot of sense. Pick things up before they become a big problem. Higher taxes and stronger prevention have done wonders for stopping smoking so a much harder stance on junk food and alcohol is probably the best way to go.

i remember years ago when smoking was being banned in more places there was an argument that “this is one of the only pleasures the poor have” but this was roundly dismissed as being patronising and consigning the poor to early deaths.

So much higher taxes on alcohol, processed food etc would seem to be the most preferable way to go. Along with more policing of lunch boxes to help to start the healthy eating early. Maybe all schools should ban lunch boxes entirely actually as then at least we would know that all children got one healthy meal per day. But it would have to be a good meal, no processed food at all.

i think this would be quite popular because then if you are healthy and don’t smoke or drink, you can avoid these taxes.