to think the NHS is a bit crap

[eyebags63]

And because it is treated almost as a kind of religion nobody is allowed to say anything negative about it at all. And actually just because it is "free" (a mere 110bn a year) doesn't mean we should be eternally grateful for bad treatment.

My experiences are of elderly relatives being mistreated in hospital, non-existent services in some areas, screw-ups, buck passing, treatment delays, being treated as a number with no dignity or privacy, a significant number of staff that appear not to care one little bit. I could go on.

In other health systems people can get referred and treated within days or weeks. Here we accept that waiting for months on end in pain is normal. We accept exhausted staff, lack of access, dirty hospitals, ambulances queuing outside hospitals and restricted treatment resources.

Yes it is "free at the point of use", but isn't that half of the problem? Walk into any GP surgery or A&E and you can witness so many abuses of the system. On the other hand genuine patients are often seem to be treated as a nuisance.

I'm not saying the NHS should be scrapped but surely it is about time we at least looked at different ways of doing things.

What I think needs to happen is that we need to close some hospitals.

Especially in London.

However I realise this is a hugely, hugely unpopular opinion and really nearly impossible to do (see lewisham)

The reasoning is this:

Most of the people in hospital are elderly and have multiple, chronic conditions. Acute hospitals are not good at looking after these type of patients hence all the scandals about bad care. Acute hospitals are good at emergencies, one off acute conditions, elective ops. Old people who are frail and confused are vulnerable to infections and more confused and de skilled away from home

They need much, much better 24-7 community services so that frail, elderly people can be kept at home and nursed at home. We need to move expertise, staff and money into community services.
The only way this will happen is to close hospital beds and re-invest the money in community services.

In my view that will make the single biggest difference to the NHS. Move money and resources to the frontline to GP practices and community drs and nurses.

Mrsdevere - just because I don't agree with what you say doesn't make me wrong. I have a different view to you and I think you should respect that rather than shouting at people that don't agree with you!

There you go again. Different views to your own are allowed you know....

YABU - they saved my life! And have kept me well-stocked in anti-bonkers pills for the last five years for the bargain cost of £8 a month.

I love the NHS.

I don't want to get rid if it. It is great in some ways. But we have to accept you have to spend more per head to get good all round care and the tax payer isn't willing to fork out that money. I don't like the American system as in the long run we would all pay more - yes some things would be better but they don't get value for money in the US.
I work for the nhs so have a love hate relationship with it. It does treat it's staff like shit, especially clinical staff and they are underpaid in proportion with other western countries. Think more privatisation will introduce more healthy competition and force them to treat staff better.
I have had to go private a few times. My son had severe infected eczema which the gps did not know how to treat ( and didn't recognise at first) I was initially fobbed off with a useless "gp with special interest"who did not
Manage to get it under control. My son was in agony for months up paying to see a top consultant who got it under control within a few weeks. He did put me straight on his clinic on nhs after seeing him as he recognised the urgency and the need to prioritise him. I feel let down by the system as he was not treated as a priority case ( my mum got to see a derm within week because of a funny mole but my baby was allowed to suffer for months). I feel horrendous guilt still because he suffered for so long and because of all the steroids that were heaped on him in the first weeks of his life - he may have some long term skin damage.
So yes some things are fantastic in the nhs some are really terrible. Anything not related to cancer is generally shoved to the bottom of the pile.

I kind of like the idea of a top up system.

YABU

We are currently funding FiL's medical insurance to the tune of £350 per month. It's either that or a public hospital where it's highly likely you'll contract HIV. DH's family are in South Africa.

You are living in cloud cuckoo land. Go private if the NHS pains you that much. Mind you, expect to be back in the NHS if you get knocked down by a bus... Private sector doesn't cope so well with emergencies.

Mama - that is a good idea. I do think you are on to something. Be prepared to be called dim, wrong or stupid by those that don't agree with you!

Mamadoc
The Lewisham exampe is a BAD one on hospital closures.
Lewisham is a good hospital that breaks even
but it has the misfortune to be in the same trust as QEH in Woolwich that is crippled by PFI costs

Part of the cost justification for PFI was the tax to be paid but the money has gone offshore so the PFI vampires are bleeding the NHS dry

Hillingdon
Your current taxes are paying towards the geriatric care of those older than you.
You'd better hope and pray that your kids are able to pay taxes to support your geriatric care.

But what if you can't afford to top up?

Being chronically ill makes you poor. It already blights your life chances and reduces your earning power and quality of life.

Then on top of that you have to pay for treatment.

In the words of Vintage Trouble 'that's not alright by me'

Clarinet I would suggest middle class people worship the NHS because they don't just care about their own self interest. I want to live in a country where everyone can get good quality health care and I think a national health service is the best way to deliver that.

YABU maybe we should go to the American model???? ( most expensive, least value for money) because when the NHS is privatised you will be charged for every possible unnecessary test, procedure etc not based on evidence but based on profit. We have something amazing that despite huge cuts and constant reorganisation struggles on to provide healthcare, of generally very high quality, free at the point of need, no it's not perfect, but it is certainly something I'm very proud of.

phlebasconsidered surely you know it's 67

Your not interested I am afraid. You don't want to pay anything more than you are paying now. If that means others don't get better care well so be it. Which is the issue we have overall, more demands on the NHS service but no one actually wants to personally pay any more.

TIP I did expect any mention of lewisham to be controversial.

I do not know the details intimately I confess.

My point really was that there are too many acute hospitals and especially there are too many in London. Maybe it should be woolwich to close but one of them should. However no one ever wants it to be their local hospital that closes. No local MP can ever vote to close a hospital so it never happens.

Now that Circle have withdrawn from Hinchingbrooke I wonder if it will close. I am not sure that would be a bad thing. It is 30mins in either direction to Addenbrookes or to Peterborough (normal driving not ambulance) I don't think that's unacceptable myself. If all that money were reinvested into community geriatricians and hospital at home services it would be revolutionary.

Under the pay your way model, one of my close family members was given a kidney transplant on Medicare after a 4 year wait.
But medicare will not cover the anti rejection drugs that do not have side effects.
So the person has never been well enough to work ever since
and is back on dialysis
and will never work until they die (in their 40's)

On the NHS, that person would have been given proper follow up care, be back at work, paying taxes.

Which is a better system?

So as far as I can tell the answers given to charges to see a doctor are a NO. Any type of top-up fee or co-payment is a NO. Fines are a NO and would be difficult to implement anyway. And restricting services (e.g. IVF mentioned above) is also a NO.

Basically any change from the status quo will be vehemently attacked and resisted, despite the fact that almost everyone here seems to acknowledge there are significant problems.

This is a big part of the problem. NHS issues always seem to come down to left vs right and a personal insult slanging match.

Try living on one of the Favela's in Brazil and you would be very thankful for the NHS.

Speaking to some of the residents in one of the biggest Favela's in Rio - they were shocked that we had a health service that was free at the point of use and that people complained about it. If they need to see a Doctor, they have to pay, if they need medicine, they have to pay, if they need an operation they have to pay.

Most families can't afford insurance or to pay for healthcare or medicine and considering they live in poor housing, with open sewers in the street and only have a water delivery once a week, their chance of becoming I'll is quite high.

I have had good and bad experiences of the NHS (consultant punctered my lung, which then collapsed), but I wouldn't want to change it drastically. I think persistent 'no shows' should have to pay a fee. Waiting lists may not be as long then.

Mamadoc
There are indeed FAR TO MANY surgical units.

What the proposed closing at Lewisham was the whole blerdy lot - day care, walk in, minor A&E
just because the PFI payments at QE are off to Bermuda in ever increasing amounts.

But YYYYY
Heart Units
Cancer Units
Burns Units
should be specialist and the decisions taken out of the hands of politicians

eyebag
Name the healthcare system that you think has it right if you think the NHS has it so wrong.

Eye - you have sumed it up perfectly. People who need to use the NHS more (and it could be any of us) see no need to change the system. Get that 'someone' else to pay and that's fine. Whether that be the rich pensioners, the high earners (they do already) or the state.

There is so much waste with the admin of the NHS. They have not been able to move with the times and utilize technology like other countries have been able to. Simple things like online appointment scheduling so GP offices can go online and book appointments for patients with the consultant at the local hospital would cut a lot of waste.

I think there has been huge mismanagement from lack of medical school places for at least 3 decades, minimal investment in hospitals and no real thought about nursing needs. Working practices for those on the front line are poor too. I hear horror stories of A&E staff having to put up with abuse. Sorry not acceptable. Those people should have to pay for their treatment as if they are private patients. Also foreigners should have to pay in full at proper private rates for their care. I say this as someone who is a foreigner and had to fight to pay!

As someone just starting my career in the NHS it is really disheartening to see the amount of GP bashing on here. I'm a mature medical student who will be significantly in debt by the time I graduate (as this is my second degree). I am hoping to become a gp, and shock gasp a part-time gp at that. I'm not doing it for a massive salary and I'm under no illusions that compared to hospital doctors, especially those doing private work alongside their NHS job, GPs, for the most part receive less money. (GP partner salaries can be much higher, but they have the additional costs of running a business, so their salaries are not on the same scale as hospital consultants.)

Disappointingly even current GPs I've spoken to have tried to convince me to choose a hospital speciality instead as they are facing burn-out and scapegoating everyday. However I'm, naively perhaps, attracted to the cradle to grave aspect of GP and as I have a keen interest in public health matters I think that's where I could feel like I'm making a small difference to patients. I just hope that by the time I start my GP training (hopefully) in three years that it's not got any worse in terms of public opinion, media bias, and deflated and demoralised staff.

I've worked in both the public and private sector (not healthcare) before now and neither were without problems. Nepotism in the civil service was absolutely rife, and the bureaucracy in terms of absence procedures meant that not an once of common sense was used, ever. The large betting company I worked for loved zero hour contracts, minimal statutory benefits, and low wages.

And anecdotally my DSis worked for a private hospital doing admin and the number of times they would have a patient prepped for theatre, about to receive their general anaesthetic but no surgeon in the hospital because they had an NHS on-call list that day and were still operating in an NHS theatre was absolutely shocking.

I don't think the NHS itself is perfect, but I do feel lucky to have healthcare which is free at the point of delivery. Seeing patients, especially but not only elderly ones, who "didn't want to bother the doctor" despite being very unwell shows that a nominal charge wouldn't work. The people who really need to see a doctor would not go, and then they would become sicker and die. And we have enough income and health inequality in this country without making it more difficult for less well-off people to access healthcare.