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.

It irritates me IVF is always the go-to as well. If we stop that, may as well stop maternity care and elective cesareans. After all, if you can't afford to pay for care during your pregnancy and birth you can't afford to have a baby.

If they get rid of free prescriptions for children, they should look at means testing based on the parents (so if the parents are exempt so is the child). Only the children of parents who can afford it would pay.

Stopping all elective surgery would be silly as where do you stop? Someone with a bad knee needs a replacement - they are not dying so presumably that stops. What about pre-emptive transplant patients where it is done before they are at rock bottom but save the cost of dialysis etc? Should they wait and run up more costs? Some areas may seen clear cut but not all.

One area that I have found though is on IVF. Not the treatment itself, but donor sperm. I have friends going through IVF on the NHS but need a donor. The clinic are buying in sperm (costing the NHS) but have said they have lots in the clinic already but it has been 'reserved' to other patients including quite a lot for patients who were ready to start and have not been in touch for over a year. Buying in more rather than freeing up with is already there seems such a waste of resources.

"and any elective surgery be made chargeable."

Do you know what elective surgery is?

Really good point CornishMaid1.
It also disadvantages younger people as it is the 25-40 year olds who are most likely to need it, aka the people actually paying for it now.

The NHS really needs better funding, but also better funding into social care and unfortunately that means we need to pay higher taxes, which nobody wants to do!

the 'free' medicine for children should be scrapped

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

So about £375 a year for my 3.

Co -ordination is the key - or a key anyway. Millions of missed appointments, wasted drugs, long procedures to get to diagnosis or surgery that require the input of so many professionals to "rule things out", appointments for the sake of getting sick notes or "medical evidence for other purposes, appointments simply for the purpose of referrals etc etc.

Co-ordination and common sense.

If you need medication to live, will die if you don't take it and are therefore not going to stockpile, the NHS could save some admin costs and give three or six months supply at a time. They'll do it for my contraceptive pill and I'm not going to die if I don't take it, so why does my friend only get a month at a time of medication that is keeping her alive?

I agree with pp that the French system is excellent. I don't know why people in the UK seem to think that the only alternative to the NHS would be an American system
Yes! Exactly this

It is under a huge reform right now which will make a lot of positive changes
If that reform is funded properly. There have been loads of good ideas of the years but they all fall apart because they’re not given the time and money to have an effect.

It is under a huge reform right now which will make a lot of positive changes

When I wrote to our local mp about our children's services being contracted out to Virgincare, I was told what a positive change this would be, bringing about a more cohesive service, blah de fucking blah. That sort of positive change?

When podiatry locally was transferred to virgincare the forgot to sort a contract for children so for six months no children locally could get the appropriate insoles if their feet dared to grow

The new reform will put the money back into the hands of GP’s who know their population better than anyone and will put it where it is needed and have more control

If people really want to make a change or have a say try to go along to public consultations, get on your GP patient group

People are entitled to feel the way they do but I do wonder why the population believes they are all entitled to be in tier 2 of the pyramid and we as a pollination need to face that we are mostly in tier 1 and need to do a lot more to help ourselves. By doing so we will be able to use 2 and 3 more easily

^population

I don’t like Virgin care and I believe they only got tenders through cutting costs. Commissioners made a bad decision letting them run services IMO

Social demographics are forcing change, especially the ageing population. The really hard nut to crack is social care provision, and as has been pointed out, on multiple threads, general taxation is likely to rise to fund it, or individuals are going to have to refund costs from their estates, assuming they have assets to do so. But the outcry when the so-called 'dementia tax' was mooted stifled it at conception.

And the European countries' healthcare models work really well. Instead of needing to attend the health centre for a dressing change in France, you'd just rock up to the local nursing office -- two treatment rooms and a waiting room, take a ticket and wait your turn. It was open from about 8:00am to 8:00pm (with a closure for lunch naturally, as it was France) and the nurses working there organised the building, staffing rotas etc, but payments were refunded by the state or the mutuelle. Much cheaper and faster than going to A&E to have a minor wound cleaned, stitched and dressed, or post-surgical dressings checked and replaced. Like the lab/physio patient's anecdote upthread, the same model could be applied to chiropody, hearing services and other elder-service non-illness conditions requiring treatment. With basic licensing safeguards, such as a full SRN-type qualification and a minimum period of documented post-qualification experience, it would help make treatment more local and would be popular with nurses who don't want long stressful intensive shifts in acute hospital settings, especially once they have children. Very quickly, demand patterns would emerge locally and hours could be varied to reflect.

Here is the problem: when Beveridge set the NHS up, he predicted that Britain would eventually get so healthy, that it would eventually stop being used (know your history).

The complete opposite has happened. THE DEMAND IS INFINITE. For those saying 'give it more funding', NO amount of money is enough.

The issue is how the NHS is STRUCTURED. Too many bureaucrats, worn out staff trying to serve an infinite demand. It is an old fashioned socialist construct which is no longer fit for purpose.

Malificent I do have private insurance which I don't use either, but that is not the point.

I agree with pp that the French system is excellent. I don't know why people in the UK seem to think that the only alternative to the NHS would be an American system

This is the brainwashing I was talking about. People literally unable to think about alternatives before leaping to assumptions of 'privatisation' and getting emotional.

Because healthcare shouldn’t ever be a money making scheme

Yes, everyone contributes via their income, this should be more clearly isolated and a private approach taken. If you don't pay in I.e. work you're not entitled to treatment (unless a minor, disabled, OAP, etc).

If you're a bone idle dole dosser who makes no contribution to the system then you're not entitled to use it unless you pay the market rate. Anyone from abroad who doesn't pay in also has to pay for their care via health insurance as we do.

Taking on board Cornish's comments on maternity services and elective operations, I'd suggest that the NHS should not offer elective Caesareans, only medically necessary/emergency ones. If someone is too posh to push, then you can make that choice, but accept the obligation to pay with it. And while IVF services are already a post-code lottery, NHS help in conception ought to stop short of giving IVF.

Other elective surgery needs to be subject to a stricter cost-benefit analysis. Where a bio-mechanical procedure is needed to keep someone mobile enough to work/live independently, that should be a priority, as early intervention often prevents worse problems, requiring hospitalisation or long term care.

But under age 75, we should all aim to keep ourselves in Tier 1 health. We won't succeed of course, but it ought to be a universal responsibility.

Exactly TF Bundy. And we are going to have to grasp this nettle.

The vast majority of the NHS is funded directly by taxation , at around 98%. The rest comes from small payments such as parking or prescription charges. As every taxpayers chips in, every UK citizen is entitled to ‘free’ treatment at any NHS hospital or clinic. While this may seem wonderful, it does come with some pretty heavy baggage.

The main issue comes with the sheer number of patients using the NHS – 64.6 million people all entitled to treatment by a single institution. While a wealthy minority may decide to go private, the state system remains the first point of contact for the vast majority of Brits.

It’s no surprise, then, that NHS institutions have to deal with a million people every 36 hours in England alone.

Processing that many people naturally leads to congestion. As a result of the massive patient base, waiting times in A&E continue to get longer and longer. 11% of people attending A&E required no treatment last year, while 39% only received advice.

Thus, 50% of patients who visited A&E, a section dedicated for serious emergencies and injuries, could have received the same treatment from a Google search or visit to a GP.

Ultimately, it all comes down to the funding. From the patient’s perspective, they have already paid for their treatment with their taxes. There’s no reason not to go to a hospital or doctor with a minor cough or flu, because they’ve already signed the cheque. While many praise the NHS for providing accessible healthcare to all, few acknowledge the moral hazard this creates.

One thing is for certain, however: the NHS is in dire need of serious reform. The negative trends are unlikely to go away without real changes, and simply throwing more money at it does nothing to address the underlying, structural issues with a single-payer system.

The British government needs to rethink its strategy on healthcare. If we want patients to receive timely treatment at a high standard, the NHS is going to need restructuring, not a pay rise.

No. It needs properly funding. Not deprived of funds so it collapses and no one complains when it gets privatised. The only winners there are the rich. Sit down and calculate the cost of every GP, dentist, procedure and prescription you, your family and friends have ever had. You might be lucky - you might be healthy or rich, but that might change. Anyone can get sick and too sick to work and pay the bills. Anyone could have an accident.

If we can bung the DUP a billion pound bribe we can fund the NHS.

the vast majority of people who need some kind of emergency care are given it. Women are helped to give birth. People are not dying as needlessly as they used to. Cancer services (2week wait) has fantastic outcomes. Life expectancy is longer than ever.

What the NHS is not getting ‘right’ is the secondary elements. Like someone said - dressing a wound. But only a small portion of wounds would need professional dressing and/or stitching but people do not want to attempt this themselves. So we are paying nurses to do something that someone could do

People hurt their toes and want xrays even though there is rarely any intervention for broken toes except a strap. Broken small toes account for a large amount of minor injury presentations. There is a very impatient generation who doesn’t want to wait and see, they want to know now

You have many many many people going to practice nurses or community nurses to get an injection that you could do yourself. Clexane or insulin for example. People do not want to do them. Diabetic patients do not want to self inject so they are using nurse resources to do it.

People are going to A&E with stomach aches and head aches. I see the data, this is true. A headache or a tummy ache is not even something you need to see a GP for in the first instance but pharmacists are very under used

There is also no clear reason why people are not self managing, sometimes this is mental health related and sometimes it is very poor education. I live near a large transport hub and many people who travel from the EU (to work or study) do not register with a local GP they use A&E as a drop in centre. NHSE has done campaign after campaign about self management, it hasn’t really worked. I honestly do think there is a culture issue in GB fuelled by politicians that has led to very angry mob entitlement culture towards the NHS - the rise in attacks on staff speak for itself

How does the Irish system work? Didn’t they go from free to private?

Because healthcare shouldn't ever be a money-making scheme

So how would you ensure innovation in the pharmaceutical sector? I know the arguments about their (shameless) abuses and practices, but it takes years and costs squillions to discover, test and market new drugs, and there would be little progress were it not for the profit motive.

As per TFBundy ^^, it's the fact that most privatisations of services don't result in a better choice for patients that makes the process toxic. And the definition of better might mean closer to home for some patients especially the elderly/poor/disabled, and cutting edge technology for others in different circumstances.