To think its time to reform the NHS

[ScreamingLadySutch]

There was a brilliant post on a dog who is telling H there is something in his abdomen, but I didn't want to derail it.

But someone talked about access to the GP: "Good luck. We get the Spanish Inquisition from the surgery receptionist whenever we try and book appointments. You could tell them you have blood dripping from your arse and they'd still be reluctant to give you an appointment. I'd love to see how they'd respond to "my dog keeps sniffing me"."

• which is why the NHS needs to be reformed. The NHS is a socialist construct. Therefore, the provider 'decides' which supplicating peasant is worthy. That is what socialism does (The State will Decide), and it doesn't work!

If the provider is linked to the consumer, then the whole system gets more responsive. In capitalism, if a service is not provided, the provider doesn't get paid. Its forced altruism.

I don't know why the British treat the NHS like a religion (Do Not Question God!!!). It is complete brainwashing. Reforming the NHS to create this link does not mean privatisation (I was hospitalised in Germany and the whole thing from X-rays to overnight stay cost me Eu37 - and they don't have the NHS structure). Nobody longs for the days when there were waiting lists for telephone lines before BT, do they.

I also never understand GP emergency appointment. A GP isn't for emergencies, it's for minor and routine appointments. If you have an emergency go a&e
Yes it’s clear you really don’t understand emergency GP appointments.
If you have an acute bacterial infection then you do need a same day appointment it won’t wait. Same for elderly people with an escalation of illness. Some conditions need urgent care but are not emergencies.

My Ds is waiting for a speech and language assessment for ASD. We have been waiting nearly a year and we still don't have a date. He is 14 and starts year 11 in September. He really needs this assessment as the wait for it has had a significant impact on his mental health. I have phoned and told them how much he is struggling, the school have contacted the NHS to tell them too. We need help and it just isn't there. I understand the pressures that the NHS are under but to see my child who has coped for nearly 15 years without any support fall apart is heartbreaking. It feels like it just isn't important, I'm pretty sure if he had a bad leg he would have been seen by now. Not sure why our children with neurodevelopmental issues are so low down on the priority list.

As controversial as it is, I also believe that ivf should not be offered as an nhs service, anyone wasting nhs resources should be charged for it (as in missed appointments, hoax 999 calls), the 'free' medicine for children should be scrapped and any elective surgery be made chargeable.

Agree completely. I also think that GP appointments would fall immediately by 20-25% if we even had to pay £5 an appointment for one as people wouldn't go for stuff they thought would clear up anyway. In other countries they do this and those on low incomes still manage.

Also empower pharmacists to for basic diseases, for instance I really had to argue with a pharmacist to give me a eyedrop for pink-eye which she said she could give to my child if over two but not when they were under 2 (they're nearly 2).

I think if a prescribing pharmacist was attached to each gp who could deal with the coughs, colds, skin rashes etc, leaving gps to deal with illnesses that may need to be referred.

I would much prefer a system where healthcare was subsidised so cheap, but not free. Another post recently was about someone who paid a small amount for a healthcheck (the sort of thing not available under the NHS or would cost about £700 privately) and commented on that not being available here.

Countries with this sort of system just seem to take better care of themselves, like a dentist check up people have regular gynae checks, mammograms etc, they have to pay but its not much and they accept its their responsibility to get checked.

Here we have poorer survival rates because detection of cancer etc is poor and people take less responsibility for their health as there is an expectation that everything is free and done for them.

GPs are the gate keepers to all the other NHS services. It’s how the NHS has been set up since 2006(?) health and social care act.

@ tiredsloth

I don’t think I have been brainwashed by seeing the NHS save my dd’s life on several occasions.

Yeah, this is it though. The NHS: Brilliant JN an emergency; patchy for everything else.

I hope those advocating Charging for children’s medication don’t include those children who need multiple medications daily just to stay alive?

Yeah, this is it though. The NHS: Brilliant JN an emergency; patchy for everything else
Because of chronic underfunding. Acute medicine gets all the money out of necessity when we should be investing in community care and preventative medicine.

The OP points to the German health system as an alternative. I'm not sure why (other than ulterior motives or lack of understanding) the only alternatives discussed are the NHS as it is - or fully private provision US-style.

True story. I'm in France. I have hurt my back, and I've been feeling really run-down and tired, so I make an appointment with my GP. I do this online, and get an appointment in a couple of days time. I go to the appt, the Dr examines me and gives me three prescriptions - one for anti-inflammatories, one for physio and one for blood tests. I hand over my Carte Vitale (national health card) which links me to the government health system and I pay 25 euros for the appointment.

I drop into the pharmacy on my way home. I hand over my prescription, my Carte Vitale and my mutuelle (top-up insurance) card and pay for the medication.

I also drop into my local Laboratoire and show them my prescription. They say that my blood tests need to be done first thing in the morning, without eating or drinking, so I can't do it there and then - but I can come back any morning that week btw 0730am and 0930am - no appointment needed.

Once I'm home I go online and look for physios near to my house. I find one that's close by, and I make an appointment that fits round my other commitments. If that one doesn't have any available appts then I look at the others around me until I find one that suits. I could also ask the Dr or friends for a recommendation and then make a rdv with them - but I like the convenience of booking online.

The next morning, I skip breakfast and head to the Laboratoire before work. I'm met at the door, my details are taken, and I am taken to an individual treatment room where the nurse takes my bloods. When I'm done, she tells me that once I've paid, I can come back the next day to collect my results. I pay - again having handed over my Carte Vitale and mutuelle card - and leave. The next day, I drop in and collect my results - and make another GP appointment to discuss them.

I go to the first physio appointment. Like most physios, she has her own office, treatment room and gym - all private, just for her. Our weekly sessions will last for half an hour each time, and includes massage, exercise and other treatments. The sessions come in blocks of 8. If I need more after that, no problem: I can extend this.

Again, I pay the physio up-front for the sessions once a month.

For all of the above - GP appt, medications at the pharmacy, physio sessions - I am reimbursed in full. The government (through my Carte Vitale) will reimburse up to a set amount, and my mutuelle will reimburse the rest - all direct to my bank account. Yes I need a certain amount of money to pay up front and yes I pay a monthly premium for the mutuelle (and it's a lot less than private health insurance), but by and large I am willing to pay that for the level of healthcare provided. My mum has been to an NHS phsyio - waited months for an appointment, then the "treatment" consisted of 1 session and a badly photocopied sheet of exercises to do at home.

It works this way for virtually everything that our family has needed over the years - pregnancy and birth, broken wrists, speech therapy, dentistry, x-rays, blood tests, etc. There are some treatments that aren't fully reimbursed, and the up-front charges depend where you go (public hospital v's private clinic), but by and large I am really happy with the healthcare here.

It's a half-way house btw private and state care in that the providers are more or less private - laboratory chains, pharmacie chains, individual care providers like phyios and nurses etc - but the cost of using them is covered by the state. So the state doesn't have to get so involved in the actual provision of care.

There are provisions in place for those on very low incomes, they can apply for a specific Carte Vitale.

Why are people opposed to private healthcare ?Or a system like Germany ?

@Firstimpressionsofearth if you can't afford ivf, you can't afford a child. And the 'free' medicines for children costs a lot (think of the admin alone) a bottle of own brand kids paracetamol is £1.

@givemesteel I agree completely re the pharmacist, it would be so much easier to access basic and simple advice if pharmacists had more power. The amount of people I've seen in gp waiting rooms or talking about seeing a gp for things they could treat at home is shocking, a push of either a small charge for appointments or to go to a pharmacist could make a huge difference.

Preventative care, and individuals taking responsibility for their own health is desperately lacking.

Ok OP. So what are you suggesting? Which model would you go with.

I’m a hard working NHS consultant, and I really despair at this sort of bollocks NHS bashing. For what it’s worth, I also despair at the poor funding and constant politicising of the NHS by those worthless ogres in government. So don’t worry, I’m an equal opportunities despairer.

I’m of the view that the NHS is an absolute, fundamental good. It’s a social leveller, a moral absolute. It is, in Britain’s rather chequered history, the best thing Britain has ever done.

I don’t dispute that, in many ways, it is really struggling. But I do dispute your solution. Our politicians could chose, in a moment, to adequately fund the NHS. But instead they chose to fritter away untold billions on nuclear weapons, finance, brexit etc.

Introduce the privateer vultures into healthcare and you won’t get better healthcare. You’ll just get profitable healthcare. And I’ll be damned if we start making decisions on healthcare based on profit.

@codenameduchess

Ivf is a one off cost of thousands. A child adds a small amount to your monthly expenses. Just Caz you don't have £5k to drop on ivf doesn't mean you can't afford a child.

I was thinking about prescriptions only drugs, not over the counter drugs like paracetamol. For example a child needs a prescription for eczema but mum doesn't have £9 . So the child has to suffer.

In my experience what the NHS really needs is a MASSIVE overhaul on wastage. My mil used to 'stockpile' her drugs (she was on 14 diff meds). No one checked up on whether she was actually taking what she was prescribed. She used to supply her friends. When she finally died it was found that there were 14 NHS-provided zimmer-frames in her house and three wheelchairs. When my ds & also friends kids have been given crutches the NHS doesn't want them back afterwards! This is utter madness! Colossal wastage.

@Sirzy

To be fair if that was the case you'd just pay the £10.40 a month for unlimited prescriptions.

NHS needs more investment. The government is deliberately driving it into the ground so it can find political justification to privatise it.

GPs are the gate keepers to all the other NHS services. It’s how the NHS has been set up since 2006(?) health and social care act.

Actually not. Some people have a consultant appointed by the hospital who arrange care and referrals. You can also self refer kids for some therapy's.

I agree that we treat it like a state religion. The only bit of the Olympics 2012 opening ceremony that jarred with me was the North Korea esque bit about the NHS.
I have had some positive but mostly dreadful experiences. The birth of my daughter was the event that changed my mind. I would have had better, safer care in a cave surrounded by wolves.
But turning to practical analysis, I think we need to look at other European countries and see how they do it.

The issue with charging for appointments is that while you would indeed deter time wasters and missed appointments, you would also inevitably deter a small number of people with things like potential cancer symptoms (weight loss, change in bowel habit), particularly if they're from lower socioeconomic groups.

What you should have is a punitive system where if you persistently waste time, miss appointments fail to attend for scans a 'fine' is levied against your NHS number and you become liable for full cost prescriptions lose access to routine and elective services until it is cleared. That way, people will gradually be re-educated to use the service responsibly. The problem we have is that the NHS had pandered to increasingly wide demands - transport because it's easier than asking a relative to take a day off work or pay for a taxi, time and effort for letters for holidays, schools and a million other things outside of the remit of direct care provision.

“Just £10.40” a month. So that’s £120 a year to keep a child alive, often a child where parents have had to give up work so are surviving on DLA and the Awful carers allowance. Families that are probably already spending £50 plus a month on car parking (and then petrol on top), who already have to pay a premium for most activities others take for granted.

Yup, the answer to save the NHS is to make life harder for families and individuals already struggling.

You only have to look at campaigns by groups like asthma UK whereby people just aren’t taking medication as they can’t afford it to realise charging for medicines for chronic conditions is probably a false economy anyway.

@Firstimpressionsofearth I didn't say prescriptions, I'm talking about the over the counter medicines people claim they are entitled to for free - you'll note I cited calpol and sudocrem. If a parent doesn't have £9 there's another problem there.
If you can afford a child, you can save a few thousand for ivf. Having to wait isn't an issue but waiting for cancer treatment because of lack of funding is an issue.

People insist on having paracetamol on prescription when they could buy a 30p pack themselves.

The NHS should be for actual needed medical care. My mother has been desperately seeking help for a condition to stop it worsening but she is continually told that they won't do anything until she is immobile- which is the exact situation she wants to avoid- because there isn't the focus on prevention.

Having experienced both the NHS and the US healthcare system, I definitely feel that there are positives that can be learned from the US model.

The care provided by the US system is all encompassing, and very complete. The NHS offers limited choice and options

People insist on having paracetamol on prescription when they could buy a 30p pack themselves.

This is supposed to have been stopped hasn’t it?

There are obviously times when things like paracetamol do need prescribing but on the whole it’s not needed. That side of things got way out of control when the fb post kept getting shared so too many people felt entitled to that bottle of Calpol (then complained at getting the equally as effective generic bottle) - sadly again this means those who do need it will miss out.

I agree with pp that the French system is excellent.
French pharmacies are a very good first port of call too.
I don't know why people in the UK seem to think that the only alternative to the NHS would be an American system.
IME, having lived in USA and worked in a hospital there, is that their system is expensive, wasteful and very unfair.

@Sirzy

I agree I don't think we should be charging for prescriptions for kids, but I'm just pointing out that if you need multiple prescriptions you don't have to pay for them all individually at £9 a pop.

@codenameduchess

The post I originally quoted said nothing about calpol, it just said scrap free kids prescriptions.

By waiting to save for ivf, you could render conception impossible due to age.

I just think scrapping ivf makes having kids (for some) only for the rich. But I also don't think ivf should be funded for people that have the means to afford it themselves.

We already have massive discrepancies between the haves and the have nots and then we're going to add to that by saying the less well off don't get the same chance at having kids as others.