Is this a completely bonkers U-turn by the NHS?

[HappySecret]

My faster is well and truly flabbered. Can this be in any way reasonable? Justifiable?

From today's Times:

The NHS has been shown time and time again to be the best in the world in terms of cost/benefit. So any replacement is either going to cost more or be worse (or both).

I know this is mere anecdote and not "real" but I (American now living in UK but with family and friends still back in the US) know real life people in the States whose health and finance are in pretty desperate circumstances due to the cost of healthcare in America--and this is WITH the availability of ACA. Not everyone is covered by what's available and it is terrible to have to live in pain/poor health because you can't afford to pay.

In short, please don't let any shortsighted greedy fools in any political party trade away your healthcare for profit.

DJ, just to your first link, it doesn't appear that he had any insurance at all. If he was that broke he could have joined the other 72 million Americans on Medicaid and gotten whatever treatment he needed. The hospital social work staff would have enrolled him too, with retroactive coverage for 90 days.

www.medicaid.gov/medicaid/eligibility/

DH broke his finger a few years back in a stupidly complicated way, looked it up online and found a lot of US sites giving advice on how to treat your own broken finger or stories from people who had done that.

If we'd not had the NHS and had tried that he would have lost his finger - luckily he could go to A&E where the staff were astounded at how badly it was broken, the bone was completely shattered, and he needed some fairly groundbreaking surgery that the specialist hand surgeon had only just learned about, complicated by the fact he has a chronic health condition.

I know there are alternatives to the US system, but this government doesn't seem particularly interested in any of them, and that's what worries me.

You don't want the Australian system. Health Insurance rises are way above CPI. Then, after you've shelled out thousands for insurance there's a little thing called the 'gap'. That means, even if you have top level insurance you can still be left with a bill in the thousands. Unless you can afford that thete isn't much point taking out insurance and you're better off taking your chances with the public system.

Maybe if individuals and companies coughed up the real amount of tax they should be paying the NHS could be properly funded.

To whoever wondered earlier if those percentages of GDP included the contribution by patients, they don't (this was part of my degree).
The NHS outcomes are not significantly worse across the board than any other european country and they do clearly win for cost efficiency, cost/benefit and access. They don't rate highly for patient satisfaction, but patient satisfaction doesn't have much correlation with outcomes.
It would help if it were funded to the level of other European countries, but that doesn't seem to be a priority for the government at the moment.
I don't know why anyone would want to turn it in to a health insurance system. It just brings a lot of extra admin (for all involved).

luckily he could go to A&E

We have A&E in the US too, and no one can be turned away from A&E for type or lack of insurance.

Yes you do
uk.businessinsider.com/comparison-uk-nhs-v-us-private-heathcare-2015-1

owl I'm not trying to make the case that healthcare is better in the US than it is in the UK. I don't think that's true. I'm just trying to correct clear misconceptions, like the idea that we all set our own broken fingers or that the government doesn't provide any health insurance. They are by far the largest insurer in the US.

river I doubt that those numbervthat are showing excellent cost efficiency and not worse outcome wouod still be like this now.
You just cannot compare the service the NHS was giving even 3 years ago to what is happening now.

Remember the 30.00 people that prematurely died last year due to lack if funding? The 30.000 That is now 120.000?
If that isn’t a much worse outcome than other European countries, I’m nit sure what it is.....

Lost I’m not sure if you have looked at the cost of private health insurrance. But it’s not in the £30~40 a month......

German system - watched my DH lose most of the sight in one of his eyes because insurance didn't cover one of the essential monitoring tests and no-one bothered to tell him, despite him going to the clinic of an internationally renowned professor and being 30 years younger than most patients with his eye condition.

Who also never bothered to see him as he preferred to see the private patients not the standard insurance ones. On talking to some UK-based German doctors, this apparently would be normal behaviour there.

Now back on the NHS, it's a chaotic clinic but he sees the Prof every time, gets all the monitoring tests he needs, has been enrolled in multiple clinical trials and fingers crossed we'll preserve the sight in his other eye for the rest of his life.

I'm not trying to make the case that healthcare is better in the US than it is in the UK. I don't think that's true.
Ah well that is good to hear, please keep saying that because many of us are sick of hearing from a range of people, including those with vested financial interests, that it is. My feeling is that in the US some people get absolutely best in the world treatment, a sizeable number get very poor or no treatment but most get somewhere between the two, albeit at an often substantial cost. The NHS is far from perfect in my view (having worked for it for a good many years until a decade ago), however the principle it's founded on is absolutely the right one in my view. Unfortunately it is close to crisis for a combination of reasons. Some of it funding, some of it poor planning, some of it the crisis in social care and some of it poor management and constant reorganisation. It doesn't need to be this way. However most large organisations also have their problems, it's just that M&S and HBOS don't directly cause people to die if they screw up and are much less complex organisations with a much less complex workload.

Surely it's better than people dying because there are no surgeons around to perform urgent operations. The people who really need these surgeries from the NHS will get them in the end and those who can afford to self fund will be more incentivised to do so. It sounds sensible to me. The NHS is already hopelessly overstretched. It's quite clear that the government cannot afford to fund it better and will not consider means tested access or part payment systems. Surely this is just failing hospitals trying to discourage those who don't need their services become the straw that breaks the camel's back.

Sad that so many believe the myth of a failing NHS.
Sad it’s not failing but is chronically underfunded. It is much, much cheaper than any other effective healthcare system but delivers better results in many areas.
Sad we don’t recognise when something is being consciously undermined.
Sad we don’t understand what we have. Free healthcare for all at point of delivery. Anyone can pitch up to an ED and they will be seen and treated.
Do people not realise what is about to happen with STPs that are being developed under the radar?

Bluetongue, I've used both systems extensively. You say you might as well take your chances with the public system- well the Australian public system is head and shoulders above the nhs in terms of wait times in my experience. I have recently waited over a year for a pediatric heart appt here, we waited about 3-4 weeks tops for the same in oz when it was non urgent. In addition, yes there can be a "gap" if you take out the lower types of insurance, but there are ways to minimise it, and you can always use the public system. There are also limits on what a family has to pay each year in terms of Gap. (somewhere around $1500 from memory.)

Let's take an example of why I prefer the Australian system.
My sister was diagnosed with melanoma in the UK. It went like this:
She rings GP to make appt because of black mole on thigh. Two week wait for GP appointment as it's not an emergency. Gp says she thinks it's nothing, go home. Sister is worried as she has used sunbeds and the mole is really black so begs GP for an nhs referral. GP agrees after sister almost in tears.
Wait for consultant appointment is seven weeks because she's not fast tracked as gp doesn't think it's likely to be cancer. When she gets there the consultant looks and says probably nothing, watch and wait. Sister begs so they agree to remove it instead. Schedules her in for minor surgery clinic. Appointment comes in- for two weeks later. (at this point it's 11 weeks since she called her gp).
After the removal she waits four weeks for her biopsy results. She gets them in a letter that tells her that she has melanoma and needs further surgery as the margins weren't clear.
She has to google it because she doesn't know exactly what melanoma is, and only discovers that she has a very aggressive cancer via google. To be fair, at this point the nhs speeds up and she has pretty extensive surgery only 7-8 days later and starts treatment.

By contrast, I was living in Australia. Found a black mole on my shin that looked dodgy. Called my GP and was offered a choice of same day appointments. The Gap (what I had to pay) was $25ish. (note, if I was on benefits or elderly I wouldn't have to pay this) Saw him that day and he was worried it was melanoma because it was black. Put me on the fast track to (public) dermatology and I was seen four days later. At the clinic they removed the mole immediately and another one they thought also looked dodgy. The next morning they called with my biopsy results, which thankfully showed it wasn't melanoma. The whole thing cost me $25ish.

I have numerous other examples of similar things in my family. So whilst I had to pay something, I'd rather pay and be seen quickly. Had I gone private it would have cost me more, (the gap may have been $100-200 maybe for that)

Incidentally, after her treatment my sister was offered one follow up check six months later. After that nothing. This is outrageous given the risk of further melanomas and recurrence. In Australia she'd be followed up regularly for years, probably forever. She was told they don't have budget for any more.

Unfortunately it is close to crisis for a combination of reasons. Some of it funding, some of it poor planning, some of it the crisis in social care and some of it poor management and constant reorganisation.

When I read your description of the crisis with the NHS it immediately reminded me of the problems with our Veterans Administration health care system:

www.va.gov/health/aboutVHA.asp

It's a vast, fully integrated medical care system for military veterans that's chronically underfunded, scandal plagued and improperly managed, on top of having an enormously complex mission. It's like an American version of the NHS at smaller scale.

I also agree with you about the stratification of the quality of care Americans receive. I am quite fortunate in that I not only have very good insurance, but I also live within easy reach of some really world class medical facilities in New York City. Not all Americans have those advantages. I also think that we've made major improvements for the cohort that had very poor care. Just expanding Medicaid eligibility poured billions of dollars into the system and stabilized a lot of facilities financially. Many of the expanded care with the money, opening smaller clinic type facilities in their communities to make care more accessible.

Are people in the UK advocating binning the NHS and going to some completely different approach?

"Are people in the UK advocating binning the NHS and going to some completely different approach?"

I don't think so, because many people seem to believe that there are two options- the nhs or the US system and nothing in between. The NHS is a sacred cow in the UK. No political party dares to mention changing it, because it would be political suicide.

I went to a lecture about different healthcare systems and I thought afterwards it was such a shame that we can't have an open conversation about how we could have a better one in the UK. The Finnish and Swiss systems came out on top for outcomes (if I remember correctly). The NHS does some things well, others badly. It wasn't designed for what it's doing now. Treating it as some kind of religion where even asking questions about efficiency is blasphemy is really unhelpful in the current situation. It depends what you mean by 'efficient', anyway. Keeping people waiting so long for routine appointments or surgery that some recover/pay privately/die/give up and put up with pain or disability is actually pretty efficient in terms of use of public funds (assuming you don't then have to spend on them as an acute case later on) but rather awful if you are one of those people!

Ah yes. The ACA that Trump was elected to get rid of.

But has failed despite having a majority in the house and senate because he can't even get his own party to support him...

I had to take a student to the ER (A&E) in Washington DC after a minor accident on a school trip. We took food, things to read/listen to and prepared ourselves for a long wait. It was the most efficient and fast hospital experience I have ever had. The thing that was most different to the NHS was that the communication was excellent and no-one was annoyed if you asked a question. They even explained clearly where to wait and told you what would happen next.

Recently I waited 5 hours in a eye casualty unit in the UK and while I was (eventually) seen by a perfectly nice and competent nurse, then a doctor, I was given no information at all during the 5 hours and had to follow staff into clinical areas to find out if I was likely to be seen soon/in a hour/two hours (as 5 hours is a long time not to be able to eat or go to the loo for fear that you'll miss your turn). It was okay for me. I can look after myself. It was not okay for the elderly lady sitting in a wheelchair for most of the 5 hours, as her transport had been messed up.

There never was a “Good Old Days” in the NHS.
Twenty years ago I was put on a waiting list for surgery when normal life became impossible due to unbearable pain. I got my operation 22 months later.
Public expectations are far higher now than in the past.

Keeping people waiting so long for routine appointments or surgery that some recover/pay privately/die/give up

We get a lot of non US patients who come to NYC for cancer care, often because they can be seen and treated right away.

Memorial Sloan Kettering Cancer Center for International Patients