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.

But people have given reasons for saying NO

Fines, co-payments and fees to see the Dr will all restrict access to those who need treatment the most ie the chronically ill, elderly and poor (poverty is a big determinant of ill health)

We do have some rationing in the form of NICE and I think that is fair and good. Perhaps we could have more and could stop offering some procedures but it is controversial.

If people do want a European insurance system I still fail to see how compulsory insurance is much different from tax and NI we already pay or how the vulnerable will be protected.

There is waste and inefficiency in the NHS but it is hard to tackle. Privatisation did not work for Circle. 10 years ago hospital trusts were bombing vast fees on private consultancy firms to supposedly improve efficiency but I didn't see much change from that either.

We need to do more preventative health care. Stop people from getting so Ill they need hospital which is the most expensive kind of care. Recognise when people are dying and let then die at home ( if that is their wish). The Darzi report recommended this years ago.

Social care cuts and cuts to benefits are knocking on to health. Many determinants of health are social eg sanitation did much more to prevent disease than vaccination ever did. The smoking ban will cut deaths from heart disease better than any statins. Restricting sales of paracetamol and safe gas in ovens prevent more suicides than I ever will as a psychiatrist.

The current strain on the NHS is a reflection of austerity and the recession as much as it is anything else

I don't understand the view point that if you suggest making people pay a nominal fee for healthcare then you are automatically 'uncaring'. We all have to pay for other services vital to life; food, water, electric, housing, etc.

Is there not an argument that a small fee would make people think a bit more and reduce no shows and time wasters? Perhaps it would encourage people to take more responsibility for their abuse of health services whenever possible.

There could be a work around to protect the very poor but without making the exempt. Perhaps a cap on the number of times a co-pay is required and/or an increase in certain benefits to match that cap.

Prescription charges are accepted so why not this?

YABVU, the NHS has saved my life & got me walking again.

FrancesNiadova
very insightful. YABU because poor NHS care nearly killed my relative and then left him permanently disabled.

Perhaps people who need to use the NHS a lot are able to see that top up fees of any sort would be a disaster for so many who have Chronic/terminal illnesses?

I have used the NHS more in the last 5 years with DS than I did in the 26 years before he was born. We are ar the stage now whereby we are realising his "asthma" is pretty likely going to be a lifelong problem for him and will impact his life forever. The only reason I can work is because I have parents who are able to look after him when he is ill, even so I still have to take a lot of time off unpaid and it very much restricts my career prospects. Add onto that the costs involved in a trip to the hospital and it is easy to see how having a chronic illness leads to finaicial struggles for a lot. To start adding in top up fees would literally kill some people and would be a massive extra stress for families who are already going through a rough time.

Now compared to a lot of people DS is lucky but even with him it is a massive strain both emotionally and financially.

Anyone can find themselves in a position where they are suddenly reliant on the NHS to keep them alive. We are lucky that it is there for everyone and there is no need to worry if you can afford a trip to the doctors or the medicine which will keep you out of hospital.

Also think that the final salary schemes will be next for NHS workers. They are not sustainable.

My FIL retired from the NHS at 60. He worked all his life in the medical profession. His private pension alone makes him a higher rate tax payer. He comes from a long line of people living well into their 90's.

Do I envy him? Yes - but we cannot carry on like this.

Mrs d - some people don't pay.

Nice

I would be interested in other EU countries and how they manage. About 10 years ago a relative fell ill in Greece. What they did comment on was the expectation that families would come in and feed, wash and dress their relative or injured friend.

What would happen if there was no one I wonder?

Most people do not in fact pay for prescriptions because once you take out children, the elderly and exemptions for chronic disease and certain benefits you cover most people who actually need a script.

If you exempt almost everyone from the charge it is hardly worth having and is outweighed by the admin fee.

Undoubtedly some people waste NHS resources but I expect very few of them realise they are doing it.

I was once accused of this myself when I took DD (3 at the time) to A&E in the middle of the night because she was coughing and coughing so much and couldn't stop. In retrospect perhaps we should have gone to the GP in the morning but at 4am heavily pregnant and sleep deprived I thought it was an emergency.

Thus I tried not to judge the man in the next cubicle when I was last in A&E with terrible pain (which turned out was a proper emergency cause). He appeared to have basically cricked his neck getting off the sofa! He thought it might be serious and I guess he knew no better.

I don't think most people who are time wasting know that they are. Worse still perhaps some people with cancer red flag symptoms are put off by thinking they are time wasting.
GPs are excellent at sorting out what is serious from what is not. There would be a lot more wasted investigations etc if GPs did not gatekeep. We need to resource GPs enough so that people can get a quick appt and be reassured and perhaps educated on self management not rushing up to A&E

Does anyone know how Sweden runs their health care? I know high taxes go some way of course but we have a very high rate of teen pregnancies and obesity.

How does Sweden manage.

I live in Europe, people pay for health insurance direct from their pay, it is the law to have insurance. There is a cap on what you pay - based on your income and your employer pays the rest 50%) - This is public health insurance. For a higher level of service you can pay for private insurance which gives you access to head consultants, side rooms, enhanced services. On the public health insurance many services have been cancelled or reduced in the last few years so not so different from the uk.
My daughter has weekly physio all year round for ehler danlos - she would not get that in the uk. We are on the highest level of insurance as a work benefit. Quite dread living back in the uk for this reason.

The government is way ahead of you on the pensions.
They have already started to chip away at it. There are no more final salary pensions for new entrants now. It is 'career average' which is obviously going to be less!

Anecdotally, from listening to radio phone-ins, people ARE willing to pay for the NHS - but through increased taxation.

Free at the point of need is an incredibly important principle. On a basic level, when you or your children are sick, the last thing you want to worry about is money. But I'm proud of the principle that taxes from the healthy pay for curing the sick. That's the sort of society I want to live in.

And since we're in the run-up to a General Election, I'll just point out that at the end of the last Labour Govt, figures for public satisfaction with the NHS had never been higher.

Now?

I've had 7 major operations in the last 4 years.
After all of my ankle surgery, when I felt my breast lump, I probably wouldn't have gone to the Dr if I'd had to pay for it or if my health insurance premium had gone up. It's a good job that I did because a mastectomy later & I'm now breast cancer free.
After an unusual smear, I'm now having biopsies & more tests done as the Dr s are aware of my very recent medical history. Oh, they've also thrown some counselling in as well to try to keep me sane during the Kafkaesque situation that is my life at the moment.
So, for me, the NHS is not cr@p, it has put me on my feet again, (literally) & has saved my life.
So, to me, YABVU.
(Was that insightful enough?)

idefix

Could you tell us a bit more about charges relative to salary and other taxes at all ? An example ? Doesn't have to be you ofcourse just if you know of an example ?

I am also very interested in how other countries in Europe or Australia do healthcare.

Sorry, 7 ops in the last 3 years. Typo.

God forbid we get Ed Miliband in. He will bankrupt the country. Labour left no money last time they left office.

I think the party who will surprise us is UKIP. I wouldn't vote for them and a few years ago no one would admit to supporting them. Now it's a different story.

Mamadoc, you make a really good point about social care. I worked in an amazing service which provided crisis rehabilitation to elderly people who were coming out of hospital. Hospital got them better, we then took them on and gave them intensive rehabilitation in their own homes until they were at the point where they could cope with council provided social care. But social care simply didn't have the capacity to take them and we couldn't abandon them so we wouldn't be able to take any more discharges which would block us up and the hospital.

It really frustrates me that Labour in particular just want to fling money at the NHS as some sort of sacred cow when it's so much more desperately needed by social care.

mamadoc surely no one expected the use of consultancy firms to actually do anything positive did they?
I thought it was just wealth redistribution.

Lem that's great really because that's the system we've got

so on average how many years are you prepared to loose? (i.e. how early do you think most 'middle class' people would be willing to die)

how much more are you prepared to pay for this excellence of clinical care?

how far are you willing to spread the net?

these are all questions that need to be asked, if we/you accept the system is going to fail then we can either wait until it does or do something pro-active about it and start the discussions early

I will now throw into the mix the need for appropriate expectations one small way I think some paces cope better is that people don't seek solutions to all sorts of barely /non related things from the health service.

I'm in Sweden. What do you want to know?

We pay high taxes and do pay token amounts for some healthcare. For example, I pay £8 to see my occupational therapist but because the hospital is so far away I get my transport costs back (£10). I go every week because I have autism and this is the autism support clinic. Once I pay over a certain amount (£100 I think) I get a card and then all healthcare is free for the rest of the year. I believe the amazing post diagnosis support I get here is non-existant in the uk.

Perhaps the Prime Minister's Challenge Fund pilot will provide the answers for NHS reform?

I think the issue is around too much demand on secondary care services. Reformation of primary care could help. We certainly need more early intervention.

www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/pm-ext-access/

Moan - you are right about the decline in social care services which has led to more strain being put on hospital beds.

One of the first things the Coalition did was to cut grants to LA's, which, in turn, meant they were unable to fund social care to previous standards.