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.

when I worked in germany I took home about half my (low office clerk) salary. was more than 10 years ago, though.

I have had a good experience of nhs.even when i have been called out of hours i have been treated with respect and people are careful because i am complex. I would rather be kept in because they want to make sure i am ok then be sent home and have to phone an ambulance. I really cannot fault them where i live.

woolyjumpers Public health insurance is compulsory.

Employee and employer pay a certain percentage of salary, unless you are a high earner (think in the region of 60,000 Euros) or self employed in which case you can opt out and go private.

It is basically a social system where those with a high income subsidise those on lower incomes (although there is a cap after which you don't pay more no matter how much you earn).

Non-working spouse and children up to 25 yr without income are included in the insurance and the state pays if you get unemployed (and you have no other regular income from assets exceeding around 400 Euros a month).

Pre-existing conditions are not taken into consideration with this public insurance, but they are if you decide to opt out for private insurance which is why people are encouraged to think hard before deciding to leave the public system.

mousemouse Are you sure you paid 20 per cent health insurance in Germany?

Just checked and DH definitely does not pay more than 15 per cent of salary up to cap.

not entirely sure 'twas a long time ago. but def in the higher teens..

mousmouse I think it is also important to re-iterate that the cost is shared between employer and employee so that you will never actually have more than around half, that is 7.5 per cent, deducted from your pay (although this is probably still a lot more than the NHS gets from the taxes raised in the UK).

littlemonkeyface
The system you describe is the type of system I would happily pay more tax for. I think it would be worth it, even if there is a small co-payment like you describe.

I've been in pain and on medication since nov, scanned in jan, result given middle of jan and now waiting for the hospital appointment to arrive - the GP has warned me there is a "long wait" in this area. I estimate it will be approaching 6 months before I get to see a consultant and goodness knows how much longer before the required treatment (probably surgery) is scheduled.

And this is taken as normal and acceptable for the NHS.

Yes my problem is 'routine' but I'm still in pain and limited as to what I can do. Is this really the best system we can come up with?

And did I mention the lack of choice; being allocated a hospital trust that you do not trust and have had bad experience with already. Being given an appointment date and knowing however inconvenient you cannot reschedule because it will delay things further. The difficulty of communicating with hospital doctors if you have queries (have to go through unhelpful secretaries who don't answer the phone)

to be slightly dramatic it is all rather a touch communist.

I'm convinced there are loads of superb ideas that could be adopted from other systems.

Part of the problem with the routine stuff being so poor quality is that the patients won't complain, because it's free. Some years ago, I attended an arthritis clinic (I was about 30, everyone else much older and talked freely about the horrors of the pre-NHS times). The clinic overran massively, for no apparent reason - there were no emergencies, nobody taken ill or anything. But nobody complained. There was almost a Dunkirk spirit prevailing. Some of the old dears were passing round flasks and scones.

Another time I spoke to a friend who'd had some physio on the NHS. She wasn't at all impressed with the first appointment, and said she wasn't going to bother returning for any more appointments. I asked her whether she'd take that same action if she'd been paying £100 an hour - she was visibly shocked and said "of course not! I'd march up to the front desk and demand my money back!" But because it was free - she saw no value in it and therefore no point in complaining.

There are so many great ideas Limer. I have a load more that I could add to littlemonkeyface's experience eg reminder calls for appointments, repeat prescriptions available within 15 minutes regardless of the day of the week, very short waits in the ER because most people are diverted to out-of-hours that is cheap and efficient, health records available online, etc.

littlemonkeyface the system I've experienced in the US is very much as you describe the German system. It costs us around 8% of our annual salary which comes out of pre-tax income, and includes a safety fund we set aside in case of out-of-pocket costs (if we don't use this fund it rolls over into a savings account). We get almost no subsidies from employer or government for this insurance - when we used to get a subsidy it was more like 4% of our income.

I'd like to see a similar healthcare experience in the UK, but combined with the efficiency of something like the French system.

More great ideas there wobblyweebles. How about charging for food in hospitals? Nobody gets free food at home. I reckon the hospitals could make a fortune providing what people actually wanted to eat. Let's face it, most patients have takeaways/food from home brought in rather than eat what's provided.

Thinking about the resourcing of the NHS, the weirdest double standards operate. Everyone thinks that the deduction on their payslip for "National Insurance" pays for the NHS (even though strictly speaking all the money goes to the Treasury). On the same payslip is a deduction for tax.

For NI, the rate is 12% on earnings above approx £8000 per year, and the employer pays 13.8%. So that's a tidy sum.

Why is it that people will readily criticise the spending of their "taxes" by the government, but in the same breath won't hear a word said against the NHS?

The current UK system is not designed with the patients' interests in mind, nor those of the long-suffering staff at the lower echelons ... All the while we are lining the pockets of those who are profiting, the NHS will remain inconsistent, unreliable, unfit for purpose, poor value for money and a source of anxiety and disappointment to those who need it for acute or chronic issues.

In the meantime 'wonderful' Great Ormond Street will continue with its begging TV ads, which add to the overall impression that the treatments available cannot be afforded ... Clearly with alternative systems they can. Only in the UK do the brainwashed sheeple either grovel for rations of mediocre medical attention & treatment, or take it for granted and demand more.

another thng about the german system: you are billed for calling an ambulance. you will get reimbursed by the insurance if it was really needed but if you call it as 'taxi service' you will have to pay yourself.
for hospital stays you will have to pay a co-pay of some euros per day, and prescriptins are charged by size of pack per medicine.

I don't like being called a sheeple.
Albert dismisses statistics if they don't support their case that the NHS is full of profiteering consultants?
I made a point of citing report sources that weren't UK and shouldn't be biased in favour of any particular system or single country.
Interactive WHO atlases for health stats is interesting, too. Sometimes UK comes out well, sometimes badly.
More stats from another European source about medical doctor salaries for Albert to dismiss because Albert knows better. UK medical salaries about same place in table as salaries for other types of UK workers.
Of course ppl in UK talk about NHS; we believe that we own it and it costs a lot of our money. As long as gross inequities aren't obvious, no need to talk about practices of private companies.

One thing I will say, Scots have a fairly different NHS from England now, can't treat as same.

Its fairly easy to do an internet search on some other European countries to compare prices. I've just done this for the Dutch system, and it seems that you can get what they call the basic healthcare provision from 85 Euros per month. This seems to be similar to what the NHS provides. You can get dental care added from about 12 Euros per month, and all sorts of things like choice of hospital and alternative therapy options added at more cost.

Now, I have a specific health worry in that both my parents died young of coronary heart disease, and although I lead a much healthier lifestyle I have noticed some "changes", but I know that the NHS won't investigate properly - more likely, my GP will recommend statins without doing a CT angiogram. Hence I've held off going. I'm actually wondering whether it would be preferable and cheaper to use a friend's address in a country like The Netherlands and Belgium, take out health care insurance there, because it seems cheaper than private health care here and with far less exclusions, instead.

Albert - and others criticising the NHS -have you read the King's Fund report - link from Sirzy upthread? P22, I think.

The NHS was the BEST healthservice. Germany, Netherlands joint 5th. France 9th, Canada 10th and US 11th. It was particularly good at managing chronic illness, better than France, Germany and Canada, short waiting times and cost efficiency - half what is spent in the USA.

The only category in which the UK was low in the charts was described as 'healthy lives' - basically mortality rates. USA was the worst. The authors emphasised that this was largely out of the health systems' control and due to socio-economic factors. i.e. more diverse population in terms of income and ethnicity. As a pp pointed out, you do not see the same levels of poverty in Sweden as in the UK.

The idea that a sick person should have to pay for a hospital stay is appalling. It's not a hotel and you don't choose to be there any longer than you need be. Being ill in itself involves extra expense for the family. Travel costs, extra childcare, reduced income. People bringing in food for their relatives is third world and a health hazard in itself.

Sorry Chandler, but do I understand that you haven't actually tried asking your GP about your family history of coronary disease and 'changes' in your health? You 'know' the NHS won't investigate it properly so you haven't mentioned it to your doctor?

Words fail me.

Sorry - not the King's Fund - that's the one about Lansbury.

It's the Commonwealth Fund, based in Washington.

People banging on about how much the NHS costs us are seriously deluded. The UK actually spends much less on healthcare than most other wealthy countries (see here).

The US spends two and a half times, the Netherlands one and a half times, and Germany one and a third times as much on healthcare per capita as the UK does.

The NHS is run on a shoestring and has been for a long time. What's making matter worse now is that increasing amounts of money are being sucked out of the service to pay for infrastructure and services provided at excessive cost by the private sector under the Private Finance Initiative.

Yes - who on earth signed off on the PFI deal for new building at one of the hospitals involved in the attempt to close Lewisham's A&E??

There was no way that trust could pay back the money borrowed from private capital. And the attempt to scrape up the money led to staff shortages, low morale and clinical deficiencies.

I really don't understand this idea that the private sector can do the job more cheaply AND make a profit for its shareholders. In every area where privatisation has affected me, outsourcing of services has led to lower wages and inferior provision. I'm thinking of school dinners and hospital cleaners.

The report sirzy linked to earlier makes interesting reading.

I found it surprising that the UK could be declared 'top' but also be bottom of keeping people alive.

On a composite "healthy lives" score, which includes deaths among infants and patients who would have survived had they received timely and effective healthcare, the UK came 10th

Doesn't seem to add up?

And indeed when I looked a little further the study seems to be very geared to using benchmarks of success that work favourably for a system like the NHS.

Anyone interested could read this for starters.

www.iea.org.uk/blog/the-envy-of-the-world-a-closer-look-at-the-commonwealth-fund-healthcare-study

The problem with league tables, as in education, is there needs to be some recognition of the fact that different populations face different problems. On the education analogy, comparing the results of an inner-city school with one that is largely middle class will be skewed by the home-lives of its pupils. Socio-economic factors.

The 'keeping people alive' is largely based on mortality rates. Even 'would have survived if they had received timely and effective healthcare' is likely to be affected by people visiting their GP in the first place, or attending regular ante-natal appointments. It's interesting that the UK and the US are at the bottom for this -the two most disparate health-systems, but far less homogeneous populations in terms of income and ethnicity than, say, Sweden or Switzerland.