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.

I agree with you woolly, that was my point, it's absolutely not free. The waste is heartbreaking.

TempsPerdu great post.

This bunkum about needing to pay more tax is ridiculous. Marginal tax rates for a lot of people is currently 62%. It sucks and it makes the NHS poor value. No one who is currently sucked into that marginal rate will argue to pay more into a failing system. Our local General hospital doesn't even have enough bed linen.

I can see both sides. I have a chronic condition and due to patchy care from the NHS have chosen to go private, at £150 each time I see my doctor. This is because I know he will give me the care I need, I no longer trust the NHS to do that.

It does upset me though when I see decisions being made on cost, not what is best for the patient.

I experienced this myself when I needed an urgent operation, the Nhs would have left me to get worse for a lot longer, and possibly resulted in permanent disability.

I had to sell my car to fund one injecton of the medication I needed (avastin) and then find £6k for an operation. I wasn't willing to risk permanent disability.

The NHS is better than nothing though

YABVU - the NHS is bloody brilliant - try living in the US for a couple of years. I lived there with the very best government sponsored healthcare but still had to drive 700 miles for an appointment with a specialist.

I incurred a $500,000 bill too for a six month hospital stay involving ICU and heart surgery.

As a family we have private healthcare and have never used it. A specialist travels from London to our local hospital every six months for my daughter.

We should be very very grateful for our NHS and all of the people who work in it, very grateful.

For people who were asking about healthcare elsewhere in Europe, my experiences of the Netherlands (where I'm from) and Ireland (where I live). Having never lived in the UK I can't compare to the NHS.

In the Netherlands, having private health insurance is essentially obligatory. The basic package covers all the essentials and costs around €100 a month. Insurers are not allowed to charge more for pre existing conditions etc.

You still are expected to cover up to €350 or so each year yourself. Most people will also pay more to cover for extras that are not in the basic package such as dental work and so on.

Your employer also pays a chunk of money towards your insurance, and you are taxed on your wages for it too. Allowances are in place to make it affordable for those on benefits or low income. About 15% of the GDP goes on healthcare.

Although my experience is now years out of date, having emigrated, care was excellent. This is what I hear from relatives too. People see their GP for most things, who can refer you on. It was usually easy to get an appointment and referrals were quick. When I broke my foot ten years ago I had an x ray, check by a doctor and a cast in less than two hours. There was no one waiting in a&e. This in one of the biggest teaching hospitals in the country. I was, however, upon arrival, asked for my insurance details.

The Dutch system still relies on the younger, working generation to subsidise those who are not net contributors. Now that the baby boomers are retiring, the system is cracking.

I now live in Ireland. Worst of both worlds. I think the system is supposed to be like the NHS in theory, but it's bloated and overcrowded. I pay €55 for a GP visit. I pay for all medication. Actually, I don't, as I can't afford to go to the doctor unless it's very serious. On the upside, the GP can usually fit us in same day when needed. We do also have private health insurance, but that doesn't cover much until you're looking at hospital procedures. This is mostly to deal with serious illness so we won't be stuck in the endless waiting lists of the public system. I didn't use it to have my children either, as we couldn't afford the €2000+ it would still have cost, plus I wanted a midwife and private care is consultant led only.

The only time one of the DC was ill enough to require the doctor, OOH GP advised us over the phone to go straight to hospital. A wise precaution. It cost us a hundred Euro, which of course we gladly paid. All follow up care has been free though.

Hospitals are overcrowded, often filthy. People waiting on trolleys for days. All that stuff. It's really not a great system.

There are many people in Ireland who have medical cards and get free health care. There is, I think, abuse of the system by some that qualify, similar to what you get in the NHS. My BIL freely admits that he wouldn't take his children to see the GP nearly as often if he would have to pay, but he might as well get them checked out since it's free anyway. I don't begrudge him and SIL their medical card, as it's not their fault they're struggling, but it is nevertheless intensely frustrating that we, as tax payers, cannot in fact afford much of what they take for granted healthcare wise.

What does upset me, is that when I try to get private medical insurance I am excluded for pre existing conditions, as I have diabetes this impacts on lots of other illnesses, practically everything is more common in diabetes.

\I can understand this from a profit perspective but it still sucks.

Luckily I found a health cash plan that would cover me for pre existing, which is how I can afford to see my private doc at £150 a pop, up to 4 times a year. I see him for diabetic related eye disease which is very scary.

Otherwise the cost would be astronomical.

He says he has known nhs patients go blind because they couldn't get treatment in time on the nhs.

Still as I say better than nothing. In other countries people cannot even afford to pay for their children's insulin.

we are very lucky to have anything at all, it's not perfect but then you realise other people get ill/disabled/die eg in third world countries, and life can be very cruel.

I knew of an American student with my condition who went blind because her insurance would not pay for sight saving treatment.

I think first world countries have a duty to look after the sick.

Why do people always trot out the "we're so lucky not to have the American system" on these threads?

Lets compare closer to home (Sweden and Netherlands both described on here very favourably).

The NHS is very hit and miss. I've seen really good life saving stuff and horrific neglect. Its a common theme. Great emergency care, shocking treatment when it comes to the mundane stuff eg feeding the elderly/vulnerable.

I wonder how many of these impressive life saving heroics could have been avoided if people had received better/quicker care from their GP's.

maggiethemagpie we are very lucky to have anything at all, it's not perfect but then you realise other people get ill/disabled/die eg in third world countries, and life can be very cruel.

"very lucky" - well, we do live in the First World and we pay for it - and handsomely. I am not sure people stuck on lengthy waiting lists for waiting lists feel that lucky when their conditions are deteriorating, or their conditions are missed entirely. I would feel luckier still if we had a system where I could simply pay for private health care, which I do for most things now anyway.

Insurance would be cheaper and most likely subject to rules like in The Netherlands and France where insurers cannot charge more by law for pre-existing conditions. The market would become more competitive and I'm pretty sure pointless beaurocracy which doesn't achieve any results would be rooted out. I also suspect that more people would benefit in a positive way than at present. But the UK is tied to a notion of the NHS free at the point of delivery.

I've also had excellent treatment in The Netherlands using my EH1 card/whatever its called now. Was simply treated like another insurance company and paid for most things I needed, other than the medication, most of the cost of which I was able to claim back at a later date. Almost no waiting lists, queues and very prompt, high quality treatment.

I trotted out 'we are so lucky not to have the American system' because that is what I have experience of - that and the NHS.

We have always been very happy with our treatment, including a specialist travelling to within 20 miles of our home from GOSH. We experienced a far longer delay privately (6 months) in the US for a particular specialist than we have ever experienced here.

Nothing is perfect - people moan and abuse the system but I am really proud of our NHS.

My FIL is a retired brain surgeon in the US who spent a lot of time in the UK, he views the NHS with something approaching reverence, because the system he worked under didn't allow him to treat a poor person with a brain tumour.

I wouldn't want to see insurance based medical care here. A means tested contribution is probably not too far away on the horizon and could help to limit abuse so I would be in favour of that.

I lived there with the very best government sponsored healthcare but still had to drive 700 miles for an appointment with a specialist. I incurred a $500,000 bill too for a six month hospital stay involving ICU and heart surgery.

You had insurance and you still had to pay $500k in out of pocket costs?

Or you had insurance and it paid your $500k for you?

My insurance paid the $500,000 costs, I paid absolutely nothing but I received a copy of the bill which was very frightening.

But even then - a 700 mile drive and two nights in a hotel isn't free - not everyone can afford that.

I think it mighf be useful to see how much treatment costs. even if you don't have to pay.
like gp app 60(?)£ nurse 35£ (numbers just guesses)
a&e 150£
asthma inhaler 26£
and so on...

I agree Mous - but, the minute insurance companies become involved there is extra admin and their shareholders are seeking a profit and that A & E bill becomes £300. That is why premiums are so high in countries where medical care is insured.

Doctors work privately and spend vast amounts of money on medical malpractice insurance, I know, we have a few in the family, all of these costs are added onto the individual's bill.

We received a bill for $40k for one day in a leading university hospital in the US, my daughter had a procedure carried out by a very senior (in his field) chap. We arrived at 9am, left at 4pm, $40k. The man we see from GOSH knows this doctor, worked with him for a while. Obv we don't pay to see him here and he travels to us.

Moral hazard applies with the NHS.

If GPs could charge £10 per appointment, we'd then see who is ill and who is taking the piss.

I think that's a good point mousmous. From online research when DS was put onto his current inhaler I found that (according to the bnf) one of his preventer inhaler is £60. That is just one of his medications so I dread to think the total cost just for his medication each month which (until he is 18) is all free with no worries about being able to afford treatment.

But even then - a 700 mile drive and two nights in a hotel isn't free - not everyone can afford that.

Indeed. That's not really very typical though.

Have been absent from this thread because it's bad for my MH. I'm off sick at the moment with my depression, I'm a NHS nurse and this kind of stuff just piles on the guilt and hopelessness.
WiltsWonder. No, we wouldn't. We would find out who is poor and who isn't. Read up on health inequalities. Once again, it would be the sharp-elbowed middle class that benefit.

I think a fairly long drive for a specialist, in our case a paediatric heart surgeon can be fairly typical, 700 miles was closer than some of the other options offered to be honest. We had a 200 mile drive and a six month wait to see another specialist - compare that with GOSH where the senior consultant travels to us.

Random many of us appreciate you more than you know.

don't take it personally random I think it's more about the system, that is not fit for purpose rather than individual staff.
I hope you getter better soon.

RandomNPC
Does your situation not just prove that the system is broken? It doesn't work for patients and it relies on abusing the goodwill of NHS staff, to the point where it causes people to be unwell and leave.

Having spoken to family members who work in the NHS they say one of the big problems is clinical staff have been treated so badly for so long there is no goodwill left. The cracks are starting to show because people will no longer go that extra mile - they can't , they are exhausted and at breaking point. Then politicians come along and whip up higher expectations and increase demand.

I think this is one of the reasons there needs to be an upfront fee - to make people realise the value and cost of healthcare.

Wiltswonder

And there would be those who'd put off going for minor symptoms who'd then end up in hospital with something major.

There was a recent campaign encouraging people with a cough to see their doctors in an attempt to promote early diagnosis for lung cancer. And the same applies for ov-ca.

Read Mrs De Vere's post upthread re how it would work out financially. They'd have to charge much more than £10 to cover the admin costs.

It's the same demoralising effect that we have in education. If you freeze pay and keep teling people how rubbish they are, don't be surprised if they end up going off sick or leaving. It's all part of the 'it's broken' narrative. But throwing it away and getting another one isn't the answer.

We shouldn't be relying so much on agency nurses, at huge expense, and profits to the agencies. When there is a bed shortage, it's not the beds that are in short supply, but the staff.

Random - hope you feel better soon.

Thymeout
They'd have to charge much more than £10 to cover the admin costs.

What are these admin costs people keep talking about? GP surgeries are already charging for non-nhs work like letters, sick notes, HGV medicals, etc. I paid for a letter using a chip & pin card at my surgery; surely most have facilities like this to take payments.

Assuming it is not some crazy system with loads of exemptions, how difficult and expensive can it be to take £10 of somebody before seeing the doctor/nurse/HCA? Card or cash, issue a receipt and bank the money.

I'm not understanding where the admin costs start to exceed any reasonable fee amount?