AIBU - the NHS isn't fit for purpose any more and needs to change

[perplexedagain]

Hi, before I start, i know that we are lucky to have the NHS and I don't want loads of posts just saying 'be grateful we have it'.

But I wanted to debate whether there's a better way to deliver healthcare as personally I think the NHS is unsustainable as is and not fit for purpose. So many things are offered free then it costs too much money to deliver so rules come in to limit expenditure or there's rationing by making the waiting lists so long, or making it impossible for people to get an appointment. Then you have the problems of a massive bureaucracy, lots of middle management, and poor administrative systems.

So to give an example, the NHS gives me a voucher towards the cost of my son's glasses. It does not cover the cost of thinning lens down (and DS has a high prescription) - we have to pay for this separately despite the fact DS glasses are pretty much unwearable if we don't thin them down. So the NHS is not free in our case. We can afford to pay - others can't. So why doesn't the NHS provide what's needed or put in a charging policy that's fair for all?

Likewise I've just tried to make an appointment for DS to get his eyes tested. There is no longer any leeway to go in a 1 week earlier than our recall date - the rules have changed. So the NHS is in effect delaying tests by insisting they take place after the set recall date. On this occasion we got a appointment soon after the set date but I can see situations in future whereby we might be waiting 2-3 weeks to get a time with our named optician. GPs do the same by making it so difficult to get appointments. It's rationing because of an unsustainable system.

I think the NHS is broken and sadly think free healthcare for all is a thing of the past.

Sorry can I get this straight Are you talking about using an NHS voucher at a franchised opticians?

It's a private high street optician. You sign an NHS form, like at the dentist, for your child's eye test.

I have never seen the vouchers for frames etc, they manage all that. They tell you what is and isn't covered.

My son's eye test frequency has now dropped to 2 years as he is 15 so if he needs a test in the mean time I will have to pay for that too.

Ok so I do not see how this is the NHS at fault if the optician has a separate pricing structure that includes charging children to have thinner lenses

My point is really the NHS needs to change. I don't know how to do this but I know it needs to. My lovely DPs get loads of things free on the NHS (low income) but I do get cross when I see my ILs getting free prescriptions (and for paracetamol) when they can afford to pay. I don't work in the NHS but I have loads of dealings with it and the waste and bureaucracy is outrageous. My point is that the charging policies need to be fair. I think everything for children u16 should be free and there should be a proper debate about what the NHS should fund and how

I can see the point, but the issue lies with the additional costs levied by the private company

They could include this fee in the lense cost covered by the voucher but they choose not to

I think the NHS is broken and sadly think free healthcare for all is a thing of the past.

Unless people stop voting Tory this will definitely be true.

No one can be prescribed paracetamol anymore. FYI

if within the year anybody (including children) have an emergency or something that isn't right (ie pain, sudden changes in vision either partial or total) than you can go back for free consultation . People have no knowledge of how pathological short sightedness can affect you & the more short sighted you are the more restricted your choice of types of glasses& the cost entailed. Ditto with hearing - without glasses people in these circumstances can be severely disabled

the optician has a separate pricing structure that includes charging children to have thinner lenses

It is nothing to do with a pricing structure. No NHS glasses will get thinned unless you pay for it.

You get an amount for frames, which only covers the full cost of a small number (none big enough for teenagers ime) . You get basic lenses free, but anything e tra must be paid for. Which is fine for "vanity" thinning, but not, imo, for thinning to enable the child to keep the specs on their face!

@MrsBertBibby the NHS are essentially procuring a service via a private company, by issuing the vouchers the company claims the cost back for each patient

When it came to procurement, the private company did not include the ‘vanity’ element of thinning glasses for children/NHS voucher holders in the cost of the voucher

The NHS have a standardised voucher system (same for everyone) which to adapt to cover some elements such as thinning, would be complicated and probably involve an optician having to give their opinion on whether it was essential vs vanity reasons, you would then be applying and granted the cost, or perhaps pay then claim back. This would vary between opticians so patients at one branch may benefit and others at another may not. It would be far too inequitable

The NHS isn’t opting not to spend the money on the patient, the private company is opting to make a profit instead of including this in a child’s lense cost

The NHS also have no control over the cost of the frames, the selection range or the sizes. Again this is down to the private company who are supplying. They may have a specification ie ‘there must be 10 frames NHS frames available’ but outside of that they do not control the size of frames. For a teenager they allow you to choose from the adult frames section

My teenager has free Specsavers NHS glasses and their deal was BOGOF, so she has 2. The 1st pair is ‘insured’ against loss and damage. For my child this was a good deal. She has adult frames from the adult section

This screams of “give it all to me”

A test a week early every year for 18 years is 18 weeks and that makes a big difference really. If there is a problem they will test sooner.

Ds needs prescription sunglasses too (he can’t cope with bright light) so I pay for them myself. I am very grateful that his day to day glasses are free and have unlimited free repairs!

The NHS is far from perfect but I don’t think having to part fund glasses and having to wait til the test is due is in any way an issue

The NHS also offer a complex lense voucher

The HC3 which is what you sign as a patient is a claim form. They send this to the NHS. When you go to an optician no one is working for the NHS, the NHS are not supplying any service or product

The NHS isn't under funded it's just having to do things it was never designed to do - it shouldn't be funding obesity treatment smoking or alcohol treatment sex changes boob jobs etc - it should go back to the original services that it was designed for

I've always taken the eye test recall dates as the minimum unless something urgent gets up, I'm not sure why it should be expected to go before that.

I've seen some debate that rather than the adult prescription pay exemptions we have now, we should just charge everyone less, it was something like £2.50. I can see things like that where it's equalized but lowered or - if bringing it in for appointments - a prepaid card like with prescriptions.

With GPs and appointments, there is a problem when like a previous poster you're having to have multiple appointments due to a HCP misbooking or other errors. Also, and I know this is somewhat a technical limitation (and many at NHS Digital are trying hard to do a lot with what little they have), with the whole 'one appointment, one problem', it would be very helpful if the records could highlight for professionals when someone comes in with possibly related concerning symptoms within a certain time period. I think we can use technology to cut costs, but right now I'm not sure it is there (or that all professionals know how to use what is there).

I've had to have 2 GP appointments in the last month. I only had to have the second one because the first one didn't follow NICE Guidelines, and I only had to have that one because I've had multiple medical professionals tell me so many things are related to one particular diagnosis that I was seeking treatment for (haven't had any yet even though going untreated is a big NO according to NICE Guidelines) as my symptoms have gotten worse to the point of not coping to find out at the second appointment, when the new GP kindly showed me my records on her computer, that while my symptoms suggested this diagnosis, that none of my blood test results in over 5 years had confirmed it. Literally, every professional I've seen, including the one in the first appointment this month, who said my results showed I had this condition lied to me - it literally showed on the screen the ranges for these blood tests so both me and my new GP are very confused how I got this diagnosis.

So, I'm back in the WTF is going on loop while losing my ability to reliably walk among many other things and yeah, if I'd paid for each appointment where I've been lied to, what would the expectation be either for the costs of those appointments or for the rounds of tests I'm having to go through again? If NICE Guidelines had been followed the first time these results came up, I would have been referred on and might not have progressed this far in whatever the fuck is going on.

Pookie people still get paracetamol on prescription, it won’t be prescribed as a new thing but if it was already on your repeat prescription then you can still get it. Stupid really considering it costs the NHS over £10 for tablets that cost less then 50p over the counter.

Personally I think the NHS needs major reform if it’s going to continue to be effective. We have an population surge due to people living longer and people moving into the country, there simply aren’t enough doctors/nurses. Then, to due I think poor management decisions, you get the postcode lottery where one trust can afford potentially life saving drugs where another cannot. There was an article sometime ago about the huge disparity in costs, one trust was spending thousands on printer paper that another trust sourced for a fraction of that price. The NHS needs to take a long hard look at costs and cut back where possible without affecting patient care.

But also we as the patient need to do our part. That includes not wasting appointments by not turning up, if possible buying medication over the counter where it’s cheaper. If we want to keep the NHS we need to help it as best we can

YANBU. God love the NHS, and I'm grateful for them saving my sister's life with treatments which would have cost many hundreds of thousands of pounds but...

I agree it is mismanaged as opposed to underfunded, like most public organisations are, including the BBC who have an absolutely colossal budget - actual billions - but claim to have to slash this that and the other as opposed to actually firing a few roomfuls of identical managers called Graham (no offence Grahams).

Crap management and beauracracy means once a contract has finally been agreed (rubberstamped by all the Grahams) and is in place no one can be arsed to change it EVER AGAIN and consequently contractors know they can absolutely take the piss too, charge the earth, increasing the charges, and deliver naff all, which is why things like computerising the records was a money pit fiasco. Just imagine if the billions lost there could have provided first class maternity wards with private ensuite rooms for all mothers...

There was a TV comedy about the NHS with Joanne Scanlan and Jo Brand called Getting On which outlined some of the failings.

Another stupid example - DM still works at 68yo and brings in approx 40k pa. She often says she can afford her 3 prescription items per month and strongly believes the over 60s rule should be means tested. For the past eight years, she's donated the cost of a yearly season ticket to the neurology unit.

Really, most people with disability aids - which is what glasses are - pay to get beyond the basics for something that functions better. Out of the aids in my house, I think only 1 is an NHS bog-standard one that ended up being modified, most of the mobility aids are ones that have been passed onto me when someone I knew upgraded theirs, and the others I paid additional to get them as I needed.

As much as I wish my care was better, I never get begrudging others the care they get. My ILs got a lot of prescriptions, some odd-sounding treatments (none that have listed in this thread yet but often are when discussing what the NHS wastes money on), so many specialists, but I never thought that it was a waste. There are many other things like poor technology, misbookings, sourcing issues, and other things that have a big impact that need a strong look at before things like charging for appointments.

I go over this a lot on MN

I am employed as part of the ‘reform’ that everyone is talking about that is needed that is already happening. Unfortunately patients are not aware and have seen no impact as it is so new and only just got underway. Primary Care Networks being formed which should change the way health and social care is delivered in your area. I cannot say whether it will make anything more equitable, but it should be focused on the most specific/top 3 needs of the population of your locality I.e high prevelances such as diabetes, COPD.

It is also the pyramid model. The majority of people who cost the most money (top of the pyramid) are high need and get the bulk of NHS resource. This is usually the most frail people.

The second tier is larger and consists of those in less need, but need all the less - such as primary and secondary care. We need to help these people stay out of the top tier as long as possible

The bottom tier is all the healthy people who don’t really use the NHS much and cost less. But there are more of them too, and we need to stop them moving up the tiers.

This is where the NHS resources are going, because there isn’t enough to say, spread your £100 per patient across everyone so it’s equal, some people will cost £100,000 and some people £10. The people who are only costing £10 feel hard done by, because they feel it is unfair. At the same time many of the £10 people are living very unhealthy lifestyles despite so many campaigns and attempts to re educate people, so people are filtering into the upper tiers at a rate that is unsustainable and also living longer in them, so there is no room for movement

Overall, the barrier to moving people out of the NHS often lies with social care and mental health services, which are horribly underfunded. So we are also holding those people in the pyramid with nowhere to put them. The funding in the NHS will only work if people can get to the right place ie discharged back home from hospital with a care package, or MH support so they do not need to rely on their GP so heavily

This is where the focus should be, not just on the NHS

Here is another example:
DM needs to go to the hospital regularly and has a mobility car. The disabled parking is the opposite side of the very large complex to where her clinic is – too far for her to walk. Because she cannot book a porter to push her from the reception to the clinic, the only option for her is to book an ambulance transport to and from the hospital as that way she gets pushed to the clinic.
For want of a porter for five minutes each way, ambulances are needed.

I often wonder this too.

I suppose first off you have to ask what is the purpose of the NHS?

If it is to provide free at point of access healthcare to everyone in the UK, then it is definitely failing.

I see 'healthcare' as a bottomless pit. For one person 'healthcare' is occasionally popping to the GP for antibiotics for a chest infection and having the odd broken limb put in plaster, for another it is long-term management of a complex condition such as T1 Diabetes and for other people the medical profession are the only people who will still offer them even the tiniest amount of support, as social services and local authorities don't have the resources to help more generally.

Other than acute care, my interactions with the NHS in the last 20 years have been depressing and inadequate. I had one child with autism and the care here by pretty much every state provider has been AWFUL. I watched my Dad slowly die and be in geriatric wards that I thought bordered on negligent. I have a thyroid condition that most other European countries would treat - but not the NHS. One of my DCs has a chronic issue that we've had to fight tooth and nail to get properly diagnosed and treated - it has taken years and I've had to become an expert in the condition myself, so that I can persuade health professionals to do the necessary tests.

I love the UK but it isn't headed in a very good direction at the moment, in my opinion. We need a radical re-think about how we want our country to look going forwards - otherwise we will just stumble down the path of semi-private healthcare.

My jury is out on what the solution should be- whether it needs a total reform within the public sector or whether it would be better to allow more private operators in.

Any more private operators holding contracts like Virgincare, will fuck everything over for good.

I'm on immunosuppressants for crohns disease. They do settle it down but they do have side effects. I'm on three monthly blood tests to keep an eye on things.

I saw my consultant in November and he agreed the disease is under control so I can start to wean off the meds. He cut the dose by a third and said to see him again in six months and he'd run a series of tests checking my neutrophils and calprotectin levels. If all looks good, I can drop them by another third. An appointment was duly sent for March.

This was cancelled and I was sent an appointment for April.

This was cancelled and I was sent an appointment for May.

This was cancelled and I was sent an appointment for June.

This was cancelled and I was sent an appointment for July.

This was cancelled and I was sent an appointment for August.

I've just had a letter today saying it's been cancelled and I have a new appointment for September.

I've also got gynae issues. I had a hysterectomy booked in for May and had planned time off work, childcare etc. That was cancelled a couple of days before the surgery date and I'm still waiting for an appointment for that.

I also need a medication review appointment with my GP. This has been outstanding for months. There haven't been any appointments to book online for months and when I ring up, they say it's not essential and ask if I would mind waiting. It just means I can't order repeats online as my meds are greyed out because they need reviewing, so I have to physically go into the surgery and request a repeat so they can override the system. They don't deal with prescription requests by telephone. Then I have to go back and pick it up from the chemist next door. It just annoying making two trips instead of the one trip if I could order online.

The service has been really poor this year and I don't feel well looked after.

I think we should introduce euthanasia. I want that choice for myself. We simply cannot deal with the mass of people who need years of care. People who want it should be allowed to have it.