to be worried about "4% tax rises every year for 15 years just to keep the nhs functioning at its current level"

[traciebanbanjo]

According to a think tank. But even if it's only 1/4 of that it's still a huge amount. I don't know how I would ever affod that much.

And they say that's just to keep it at its current level. It's the main headline on LBC and in all the papers.

I'm very worried about coming tax rises

@Childrenofthesun

The report your citing is from an american lobby group who want the US to move away from their privatised healthcare system, and 11 is such an arbitrary and selected number so its not necessarily a clean report.

Another report also not so clean puts us 14th in Europe

www.theguardian.com/society/2016/jan/26/nhs-comes-14th-in-europe-wide-survey-on-health-systems

Again, thiat report has its roots in a pharmaceutical company.

The WHO have us at 18th
thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

The report you state still has us low ranking for efficiency, as do the others.

An important metric that we come out near the bottom of on the report you state and others is healthcare outcomes.

Sorry about the spelling.

And before you start mentioning money, the WHO did their report in 2010, before the current Government or coalition took power and was after the years of influx of money from Labour.

We still was scored down for efficiency then and no austerity in sight.

At the coal face (im a junior doctor) we dont have enough non clinical staff, especialy out of hours.

I spend hours of my shift chasing notes, registering patients on computer systems, chasing xray reports/appoitments/social services/medications, answering the ever ringing telephone (no receptionist on weekends or after 5pm), opening the (locked) ward doors, taking patients to xray, taking bloods to the lab, taking drug charts to pharmacy, finding clean sheets/drinks/tissues and last week fixing a leaking freezer!. Doctors are often critised for thinking they are above that stuff. I'm not, I dont mind doing any of it and I often have the best chats with patients. However when there are 5-10 patients wating to see me its not the best use of my time when you could employ someone non medical to do these things.

Its worse on a senior level, experienced consultants in my unit are spending their days calling round trying to fill staffing gaps, in endless meetings about the budget for the unit, etc when they could be seeing they ever increasing waiting list of people to be seen

we need MORE managers and more administrators/ porters/housekeepers /cooks/ receptionists etc

ending up with a postcode lottery, there could be a central purchasing group who negotiate a price for hospitals across the country to get the most economical treatment.

There used to be, it was called the Purchasing and Supply Agency. The coalition government closed it down and about a year or so later they were criticising the NHS for not utilising economies of scale when purchasing.

The NHS needs a complete overhaul and can we really afford free at point of service healthcare from cradle to grave

It has to change not only how it’s funded but how it’s run look to Europe not fear partly private/insurance healthcare and to not get hysterical over a US type system

But it won’t be the NHS anymore will take a brave political party to makes real changes that will mean we don’t have the NHS but a health service that yes will cost more but will be efficient

@Splodgeinc - so what you are saying is that current ratios, where 2/3 of NHS employees are not medical, is not enough, ie that the 2:1 support to clinical is insufficient. What number of staff, per clinician, would you estimate would be enough, do you think? Already, about 1 in every 60/65 people - actual people, not workers (so including children, the incarcerated, the elderly etc) is employed by the NHS - how many more are required in order for clinicians to focus their efforts best etc?

I'm interested (as I say, no particular expertise in the NHS) because I wonder, actually, if the problem is just that we can't afford the sort of NHS we are trying to run. I'm not saying this is the case, but if we're already mobilising such a large proportion of the population, and it's insufficient for our needs, then the solution may not be to increase staff.

Originally, when the NHS was set up, you could have your eye tests, dentistry, glasses etc free at point of use. With time, the "less essential" elements have become hived off and means tested. It may be, with increasing life expectancy, improved outcomes, babies being able to survive earlier and earlier etc that we have to accept, particularly with the massive increases in population density, that everything currently available free at point of access is no longer viable. It's not that tired old trope of stealth privatisation, but rather, an acknowledgement that the UK in the 21st century is markedly different to the UK of three generations ago, and as a result, our expectations of the NHS also need to become markedly different if it is to endure.

I know it's a hugely unpopular opinion on MN, but I have never thought ivf should be funded, for example. And I am also not convinced that just because we can do something, we should. I am a huge fan of the NHS, despite personally having a considerable number of shoddy experiences as a user. I want it to survive. But I really struggle to see how it can, without really radical change - hence my question of what an ideal staff ratio would look like.

he coalition government closed it down and about a year or so later they were criticising the NHS for not utilising economies of scale when purchasing.

You're massively glossing over the fact that operations were already being wound down for over a year and in the mid 2000's labour stepped in and outsourced a ~3bn a year contract to DHL/Novation.

Until people stop using the NHS as some sacred cow and using it as political football we will not get the NHS that everyone wants.

I do agree with ivf not being funded, I've been flamed on here for aging that. But a child is a gift not a right. All this extra funding is to keep it afloat, what will happen with peak boomer health conditions develop?

Why on earth do people keep fixating on IVF - it's such a tiny part of NHS expenditure? I don't want to get into an argument about whether or not it should be funded, I just don't see why it's used so much as an example of NHS 'waste' - I can't find a figure for how much the NHS currently spends on IVF, but if it implemented the full NICE guidelines across the country - which is very far from the case, most areas offer well below this - it would cost 0.3% of the current NHS budget. As I said, it actually costs well below this currently. Banning IVF on the NHS would, it seem, make a lot of people feel better for reasons I don't understand, but it would make sod all difference to the overall running of the NHS.

Why has no-one mentioned personal responsibility? Surely the biggest issue we face is obesity and the associated problems/diseases. Before any tax rises, I would like to see:

• stricter controls on health tourism. If I go the US without insurance I won't get past the reception desk without a credit card, it should be the same here
• cut waste
• stop supplying pain killers, antihistamine etc, people must buy their own. Paracetomol can be bought for 20p!
• people being expected to do more for their relatives.
• overweight/obese people being advised more openly by their GPs of the issue

A lot of this is down to personal responsiblity. Everyone seems to look to the government to provide for them instead of thinking 'what can I do' first.

The government don’t know what to do with it. Everyone seems to think that by keep throwing money at it, everything will improve.
There are no beds. No one is building lots of hospitals to keep up with the demand of the service like they are with the housing industry.
There are more and more doctors and nurse leaving the profession. It’s like a war zone. The government have now stopped the bursary for nurses and the money that junior doctors are on is appalling.
There is a lack of social care and many people access the hospitals as they haven’t anywhere else to go in a time of need.
Throwing money at it isn’t going to do anything but the government and media don’t seem to listen to the workers!

niccyb

I agree with your post that more money isn’t the answer (would help some areas)

I am astounded how much money is wasted and how much time is taken up in meetings, the allowance of poor performing staff (I am well aware many are working incredibly hard) it’s NHS culture that has to change

The biggest issue is ageing population! People shouldn't be blamed for getting old. Modern medicine can mean decent quality of life even as your body wears out. But only at high expense.

Bottles of OTC meds are never a big cost; expensive scans and prescription drugs & procedures are very pricey.

Lack of social care is huge issue, too. Bed blocking b/c a poorly (probably elderly) person can't go home with their medical needs and there's no care home space for them, either. This is not NHS fault, but NHS pays the bill.

Sorry if someone has pointed this out already, but it's NOT 4% tax increase year on year. The NHS needs at least 4% increase in budget each year (actually, should be 5% front loaded according to articles outlining report yesterday).

This increase is suggested could be funded by penny on some of the various taxes (income, VAT) and employer contributions. So, NOT 4% tax. That is a scaremongering headline and you OP should probably ask for it to be amended (but I doubt they will).

A friend in the Netherlands told me yesterday that they pay about £100 per adult per month (kids free) for health insurance ON TOP of tax. And that doesn't cover 100% of all visits. You can pay even more to have 100% coverage. I don't know from her salary how much they pay in taxes but it's higher than the UK.

So that's £2400 per year, plus excess, plus taxes!

It would seem that UK households paying £2000 a year is far cheaper. Perhaps partly because there are no insurance companies to pay on top of it.

Brits are so used to getting healthcare for free that they seem to forget that insurance companies are for-profit organisations!

Staying In Australia, we have a dual public and private system. Bulk billing doctors (i.e. free at the point of use, often used by lower income families or for people simply getting repeat prescriptions) and doctors which have a copay system. For example, the consultation might be $60, but you get $30 back from Medicare.

Similarly, we have public and private hospitals. Anyone, even those with health insurance, can use the public system and it's free at the point of use also. However, private hospitals exist alongside public ones which can be used by those with private hospital/health cover, and which lessens the burden on the public system.

I pay $16 a week for private health and private hospital insurance. I don't think that that is extortionate. And, being that I can afford it, I think that I should pay that to decrease the burden on the public system. If everyone had the attitude of, "Well, why pay when I can get it for free?", the system would implode under the weight.

The system here works. You have to partially pay for consultations unless you go to a bulk billing doctor. You have to pay for prescriptions unless you hold a healthcare card (low income earners and children) or have prescriptions as an extra on your insurance. It's a progressive system, like the tax system. Those who can afford to pay for PHI are encouraged to in order to decrease the burden on the public system and make it sustainable, efficient and easy to access by those who cannot afford PHI.

If we need to spend more money we need to spend more money.

We all want first class treatment we all need to pay for it.

Maybe insist that people who come to the UK need to be here 5 years before they are eligible to use the NHS or get any benefits.

In France & Germany do people need insurance? What happens to those who don't have insurance ?

I've sat on my couch, not in pain just lethargic and breathless. I had a GP appointment for that afternoon but couldn't be bothered to go was seriously considering cancelling the appointment.
A friend popped in to visit and called my GP out. I was in a worse state than I realised and in turn ended up spending a week in hospital on oxygen etc.
If finances meant I'd had to pay for either the GP. I'd be dead plain and simple.

I think Australian tax rates are lower than the UK however. What would happen here is we'd all have to pay for the NHS unless on benefits plus our taxes would not go down either - the usual lose/lose. Gordon Brown put 1% of everyone's national insurance and said it would fund the NHS for a generation. They lie through their teeth to get a bigger and bigger state with more and more tax and we never seem to get lower taxes.

I'm more worried that the Government will never raise taxes and just continue to cut public services.

Avoiding are you saying you couldn't afford the GP or you just wouldn't go because you'd have to pay?

I'm torn over the NHS. It's a great concept but the reality especially in London can be long delays to see your GP, needing to really push for specialist appointments.

Dd1 has been complaining for 2 years of chest/heart pain. She's 7 yo and they told me last time to monitor a little longer. My nephews have genetic heart conditions and see a specialist yearly in Aus. I had to really push to get the referral which we finally have.

What I'm saying is money didn't play a part. But if I'd had to consider cost I would probably never have allowed my friend to phone the GP. (I didn't have the strength to argue).

I'd hate for anybody to be sitting in need of care questioning where the money will come from.

Although sometimes the NHS means we benefit from lack of intervention where US doctors keen to earn the extra money push for loads of unnecessary things, extra C sections, loads of breast scans (the NHS has warned women that scanning is not necessary the best thing for you eg)