to think that the NHS is really quite shit and that not everyone who works in it is an underpaid hero?

[Adenosine]

There is a strange British preoccupation with the NHS which I think prevents honest public dialogue about its many shortcomings. At the time it was set up it was innovative, but now there are many other universal healthcare systems most of which are better than the NHS and many of which cost less money.

It's ranked low globally and really quite shit yet few people dare criticise or. AIBU to think that we really need to be far more critical?

The NHS really is a sacred cow that you're not allowed to criticise. But at the moment it really doesn't work.

You have to fight for a GP appointment, chase for a consultant appointment, chase for an operation date which then may well be cancelled on the day. Cancer deadlines are being missed, very sick people are being stacked up in A&E departments - last time I was there it was like a war zone.

Our local hospital has recently been keeping people with broken limbs waiting for two weeks for surgery and is experiencing 'significant pressures' around cancer surgery, with all the stress and misery that brings to people. 'Never' events have included administering anaesthetic block to the wrong leg and inserting a feeding tube into the wrong place - leading to a death.

We don't get it for free, if we work we pay in through National Insurance contributions. Absolutely we need to keep the NHS but it needs to be better because at the moment it is not fit for purpose.

So what do People WANT ?

Which other funding model is the best one, and why that one, and what will you accept in order to have this superior alternative? For most people there would probably be some or even all of below:

Copay (almost everywhere)?
Mandatory private insurance (Germany)?
Ambulance carriage charges (Australia)?
20 hr waits in A&E (SKorea)?
High risk of over-diagnosis and unnecessary treatment (USA)?
Variable rate presciption drug charges (USA)?
Reduced access to prescription drugs (accusation in Germany)?
21% of households having to choose between getting medical care or paying other bills (Netherlands)?
Limited coverage (Italy) ?
Promotion of woo & other homeopathy (Germany)?
Higher rates of general taxation (much of Europe)?
Poor continuity of care because of high choice & lack of record sharing (Australia)?
Knowledge that those on benefits are getting the same level of care 'for free' without copay or mandatory insurance (most of Europe)?
Lack of Universal pharamcare (Canada)?
11.3% of GDP spent on healthcare (Germany, not 9.6% like in UK)?
Long waits for non-urgent procedures (in Canada, like UK)?

Which set of potential drawbacks and changes are the right ones to accept?

I don't know but at the moment it is near impossible to see a GP where I am.
I think I'd be happy with anything other than the absolute lack of faith that I have at the moment that the NHS will look after me correctly and not bloody kill me off.

@Retrieversarefluffy
*
The NHS really is a sacred cow that you're not allowed to criticise. But at the moment it really doesn't work.

You have to fight for a GP appointment, chase for a consultant appointment, chase for an operation date which then may well be cancelled on the day. Cancer deadlines are being missed, very sick people are being stacked up in A&E departments - last time I was there it was like a war zone. *

Don't disagree with the analysis, but part of this down to ageing population and huge levels of unsustainable immigration of which little planning was done to address

If you can't make one, you cancel it. It's that simple.

Which would be fine if the NHS was efficient enough to record that. Unfortunately, admin in the NHS is a disgrace. We've had a few occasions when we've cancelled an appointment but it's not been recorded and it's been recorded as a "no show". Once was my GP when he gave me a real rollicking for missing an appointment the day before - the appointment I cancelled at the same time as I re-arranged it for the next day (the appt I did attend). Another was an audiology dept appointment where I was on holiday on the day they made the appointment for, so again, I phoned up, cancelled & made the appointment for a couple of weeks later, but again, down on the system as a no-show. Far too much paper-chasing and things being passed around from one person to another. Desperately needs streamlining/organising etc to reduce the sheer waste and inefficiency.

@MarieG10 - without immigration nhs would be far worse because a large part of the workforce is immigrant or immigrant-descent. That is not even counting carers in the community.

Immigrants tend to use nhs less because of demographics - they tend to be younger.

Agree that the administration systems are incredibly inefficient.

As for which model to adopt, I don't know for sure but an element of copay and insurance works well for other countries. We could also do with increasing base government spending on healthcare to bring us in line with other countries. At present government spending in relation to GDP is quite some way behind the rest of Western Europe while our private spending and levels of domestic household debt are relatively high. Taxation changes would go some way to rectify this - we're all paying less income tax now that the threshold has increased, for example, which represents a regressive and non targeted tax take descrease which given the above levels of private/public expenditure was on balance a mistake.

We absolutely should not adopt a system based on copay and privatisation. That's the last thing we should do.

Just to clarify at the start, I have worked in the NHS for 24 years.

My feeling is that when the NHS was set up, it didn't have to cater for some of the very complex and expensive conditions and treatments that it does now.
So it is struggling to cope with demand. And people who are very sick often get very specialised and good care, while the more mundane amongst us don't!!

However, I've had 3 children, the first of whom was stuck and we both could have died, I received excellent care. He subsequently developed epilepsy and again, his care was first class..

We have just been to stay with friends in New Zealand. My friend is a GP. She doesn't love her job there any more than GPs here love theirs. DH forgot to take his blood pressure tablets with him, and they couldn't be prescribed there - he was able to get an alternative but much more old fashioned (cheaper) drug. She can't prescribe at will, just a limited list of drugs that are approved.

I work in a hospital one day a week in addition to my main job, and I see excellent staff doing a really good job in difficult conditions. No one is deliberately bad at tgeir job in my experience, it's like anywhere, not everyone is perfect.

As an ex nurse myself to a point I agree.

BUT no system is perfect, I certainly would far rather keep the nhs even in its current state than end up with a USA or even Australian system from what i know of theirs.

As a patient, relative/friend of patients though I have experienced and witnessed the most appalling lack of care, poor practice and plain neglect. I’ve had run ins with hcps who’ve neglected to wash hands after cleaning up a patient with diarrhoea or who’s vomited when they’ve moved immediately to handling myself or a loved one including wound Care! Who’ve tried to switch from a branded med to a genetic or even vice versa, yes in theory same Med but in these cases it was more complicated than that inc an anaphylactic allergy to the dye/coating of one of these meds it was pure luck I was there at meds round in that case!

Like quite a few other mners from posts I’ve seen I’ve also seen utterly filthy wards where detritus has lain on the same place on the floor for days at one point over a week.

When I trained the mentors we had were very much “old school”, rules on certain things were starting to be “relaxed” I think supposedly to make hospitals a more “welcoming” environment, but these changes were in my and their opinion detrimental to patients -

Longer visiting hours - meaning more noise, bustle, and visitors getting in the way of the staff

More visitors allowed - adds to the above

Not changing bedding daily - increases infection risks

Not making beds “hospital style” - increases infection risks and also in my experience made restless patients less comfortable as they’d end up cold when covers fell off

Allowing visitors to sit on beds - increases infections risks, makes it harder for patients to maintain boundaries/bodily autonomy, I’ve witnessed visitors doing this to patients in casts and with catheters etc and hurting patients!

Not maintaining strict cleaning regimens to the same standard - again increases infection risks, also makes it hard for other staff to plan and carry out tasks. It’s also what’s led to things like patients encountering blood smeared showers etc

As I say this was all coming in toward the end of my training/first years working and the older more experienced nurses were saying ‘watch hospital acquired infections rocket’ and right enough within about 18 months we as a nation saw the big scandalous outbreaks of mrsa and cdfiff.

This was under a Tory govt.

BUT if we didn’t have the nhs I’d be screwed!

I’m disabled, seriously mentally ill and currently unable to work.

On all the threads about different healthcare systems I’m yet to come across a poster who has personally experienced a non nhs system as an “indigent” themselves. Some are able to link to the official information of the support for the poorest in society - who are the ones who usually need the most healthcare! But when I’ve asked they have been unable to say how well or not it works in practice because that just isn’t their experience.

That’s what worries me the most both on a personal and a wider societal level because these are the people that need the most support and good access.

As I’ve seen reported many times on here the nhs are great in an emergency crisis with physical health, I’ve also had my life saved in such instances, but they’re appalling with chronic and mental illness.

Personally I have found its primary care that’s the worst but I’m well aware of mners having dreadful experiences with secondary & even tertiary care.

Re “missed appointments” having experienced being told the wrong day/time, appointment letters postmarks dated AFTER the appointment occurred, even being sent for dd TWO different dates and times for the same appointment in the same envelope! I do wonder how many supposedly “missed” appointments are actually due to inefficient admin!

Philcornwall, if everyone paid between £1-£5, that would be the Trojan horse. The principle of paying would be established, and within a few years the sums would bolt upwards.

It is interesting that these debates suddenly seem so pressing on Mumsnet and I think they are politically motivated.

*user1497207191

If you can't make one, you cancel it. It's that simple.

Which would be fine if the NHS was efficient enough to record that. Unfortunately, admin in the NHS is a disgrace. We've had a few occasions when we've cancelled an appointment but it's not been recorded and it's been recorded as a "no show". Once was my GP when he gave me a real rollicking for missing an appointment the day before - the appointment I cancelled at the same time as I re-arranged it for the next day (the appt I did attend). Another was an audiology dept appointment where I was on holiday on the day they made the appointment for, so again, I phoned up, cancelled & made the appointment for a couple of weeks later, but again, down on the system as a no-show. Far too much paper-chasing and things being passed around from one person to another. Desperately needs streamlining/organising etc to reduce the sheer waste and inefficiency.*

This is exactly my experience. I have cancelled apts within a suitable time frame and then got a bollocking for being a no show.
It's not a one off it's happened at least 3 times. I've left answer phone messages, I've spoken to a person and I've emailed. The hospital is a 40 min drive. I'm not going to drive there in person to say we cant make the appointment and they probably still wouldn't record it anyway

@Auberjean not based on copay or insurance but with an element of it. Right now we don't spend enough and we don't get good results for what we do spend. I think with any monolithic system, whether it's completely dog eat dog private like the US or supposedly fully public like the UK, there's a problem of unregulated shady third party facilitators lurking around exploiting the fact that no one looks too closely at the edges and there's a lot of waste and corruption there. A mixed set-up invites greater scrutiny due to properly competing interests and different income streams maximises revenue.

Also agree fully that the state of the NHS has directly led to an equally poor quality private system offering a narrow range of services with little unifying overview which could be more meaningfully integrated and regulated within a system that has an element of copay/insurance.

Can nobody see that things they’re complaining about have been made so much worse since Austerity?

I’m really confused by this thread/conversation. The NHS has been run down every time the Tories have got in. Labour try to build it up again but then the Tories purposefully run it back down.

Why are we discussing the NHS as if it were privately owned and unaffected by funding coming from Central government?

I agree that the NHS needs streamlining. But it’s firefighting at the moment. There’s no energy, staff or time to restructure.

And there needs to be a plan from the government. Said government just wants to shut it down so no plans will ever be forthcoming.

The previous Labour administration spent more money yes but most of it was wasted due to trying to apply ill thought through and economically unsound principles to a public model.

Can nobody see that things they’re complaining about have been made so much worse since Austerity?

Err No. The things I'm complaining about happened during Labour's 13 years of splashing the cash, including losing both my father and MIL after a long term succession of NHS cock ups (2008 and 2010) - you can't blame Austerity for that! People have short memories or may be too young to remember - the so-called Golden years of Brown/Blair splashing the cash wasn't anything special. GP's got a whacking pay rise for doing fewer hours. Lots of shiny new hospitals with atriums paid for by the next generations via PFI schemes. The best treatment my dying father got was at a crumbling old hospital built in the 1920s where the staff actually cared despite not having an atrium - PFI meant a shiny new hospital was built and earlier this year, it hit the news due to a poor treatment scandal where several people died unnecessarily - the shiny atrium didn't prevent that did it?

And agreed that all public provision including the NHS has declined with the decline in spending - our government spend is shockingly low compared to GDP and it shows - but this is I think exacerbated by inconsistent and half arsed plans and we need to take a clear eyed view of this rather than chanting about it being the envy of the world staffed by angels who selflessly save lives for scant financial reward.

Incidentally on a micro level HCPs aside from HCAs are more than adequately paid. The care they provide is sometimes substandard. This isn't going to get better unless people get over their indoctrinated gratitude at not being left to die in the street and start thinking about what they want from their financial investment in the health service.

Which of the alternative systems provide a guaranteed service for those without the means to pay upfront or pay for insurance? And where those people can get the same quality of medical service as people with money.

Because that is what we have to compare. Or just the service for those who can pay.

I duuno. Most countries with an element of personal funding including the US will provide basic emergency treatment for all at least. Which is admittedly what we get here although in a lot of instances it really is bloody basic and the level of care and facilities can be diabolical. For me though the more important issue is yes we have access - as do most other countries - but standard of care, outcomes and crucially timescales are below what they should be. The timescale is very important here. We're a nation of queue-ers and we are accustomed to long lists but these long lists and failures to refer in a timely fashion are impacting on people's quality of life and indeed in some cases causing their deaths.

The cost of medical and nursing training should be free, but in exchange, doctors, nurses and radiographers, physios etc should be required to work within the NHS for a period equal to the duration of their training (eg surgeons would work for a minimum of 10 years while nurses could leave after three). Obviously, this work would be paid at the standard rate.

A point that has been made repeatedly on this thread is that UK-trained staff are emigrating in large numbers to Australia and NZ, and probably other countries.

If the NHS could be de-politicised it would help, but it's far too valuable as a political football for this to happen.

And yes, the NHS is struggling to cope with a health and care environment that has changed out of all recognition since its creation. An ageing, obese population, effective but costly medicines and procedures, among other factors, have altered the landscape. Not a medic, but I feel that eventually a co-payment and/or insurance route will have to come, and the NHS will become free at the point of delivery only for acute treatment.

(Warning - mini-novella ahead)

Let's get rid of the NHS. Great idea. I mean, it's not like it's going to unduly penalise those stupid enough to be born poor or disabled or people with a chronic health condition or anything. You know, people who probably should have been put down at birth, like my dad, since they were a drain on the state; or friends who should be put out of their misery, having developed Parkinson's and MS in mid-life after years of paying taxes and NI at not-inconsiderable levels.

Getting rid of the NHS would definitely sort out the poor, ill, disabled and infirm. No more free vaccinations for kids or subsidised dental care (the link between teeth, diet and health is stronger than you might think on the surface). I mean, what could possibly go wrong if, say, measles vaccinations were removed? (Yes, I know it's now the MMR. I'm just using it as an example.) It's not like that exact situation has now caused an epidemic in a couple of remote South Sea countries or anything....

The NHS is not perfect. But it's better than some of the alternatives - and yes, I have lived in another country where they had a nationalised health service. I really enjoyed having my dental treatment and other minor procedures in a room where we all lined up without even curtains between us as the staff moved from one to the next.

Yes, there are some absurd jobs in the NHS, especially on the PR side and some other areas (some of the public health campaigns leave me mystified as to how they can possibly be cost effective). But those thinking that the NHS could ONLY run with doctors and nurses might like to take a look at places like our local hospital where the management decided it was a jolly good idea to get rid of the ward clerks. Guess what the medical staff ended up doing, to avoid complaints from patients? Yep, answering phones and tracking down medical notes, until the ward clerks were reinstated (shared between several wards, I might add). Every hospital is like a village, and every hospital, every ward, is different.

Over 1 million people work for the NHS; it's one of the biggest employers in the world. Some of them may not always do their job perfectly. But those of you criticising without qualifying that criticism, assuming you work, can you do your job perfectly, when you're constantly short-staffed, and everyone is constantly at the edge of exhaustion due to being underfunded and under-resourced, leave being cancelled at short notice because the government has decided another set of arbitrary targets in one of their cosy little civet-coffee fuelled meetings in central London or Leeds?

Not to mention people living longer with more co-morbidities, due, in part, to better healthcare, diet and sanitation over the last few decades? And with people (ie the media) constantly telling you you're lousy at your job? If you are one of those perfect paragons of virtue, I'd love to know what industry you're in!

I do agree that a long hard look needs to be taken at some of the pharmaceutical companies and the whopping great profits some of them are making, though, and then you just might like to look at which politicians have vested interests in those companies. Just saying.

The NHS is used disproportionately by the young (babies & parents); the old (because as you get older, the machine starts to wear out); and those with chronic conditions (because if you have a chronic condition, you need more care). If you're in the middle, aged between, say 15 and 65-ish, in general, unless you're involved in an accident as an example, most people are not going to need the NHS anywhere near as much. If you do, it's likely to be for something like an injection for travel - and these days, you can get lots of those at your local pharmacy.

Those of you who think BUPA or any of the others would be better - off you go then. In my 20s I did a lot of secretarial temping. One of the worst (and thankfully shortest) bookings I had was at a BUPA hospital. I have never seen such a mess of paperwork and tangled tapes. And that was just the admin. (The whole secretarial staff, I discovered later, had walked out en masse as they were so badly paid and treated.) It put me off BUPA for life. Of course I'm sure they're MUCH better now.

www.historyextra.com/period/20th-century/nhs-history-pay-healthcare-free/ is NOT political in any way and has some fairly useful information. There are plenty of others out there.

And as a final note, I'm sure there'll be much rejoicing over this news....inews.co.uk/news/health/nhs-treatment-ration-tests-1328653

I’ve used the NHS for 20 years now for a chronic condition. Appointments now are yearly and guaranteed to be cancelled even then. Under Labour at same hospital I was seen regularly every 3 months.

I’ve seen many other negative changes. The NHS literally is crumbling. As are schools where I work and now have children. That is another conversation.

Don’t lie and say Austerity has made no difference. You are as bad as the Tory government in doing that.

I've had plenty of dealings with the service as a patient in the last few years, and I've been very lucky. Nearly everyone has been great.

How would insurance work for people not in work (eg chronically ill or pensioners - people most likely to need healthcare)? Would they be paid benefits and then insurance deducted? Would that basically be like national insurance?

The people who need the nhs most would find the insurance hardest to pay. On the other hand, additional payments from middle/higher earners for nicer rooms etc may be able to subsidise poorer people - though a lot of bureaucracy and infrastructure would have to be in place for it to work.

Perhaps funding nhs to levels that other European countries do would be a starting point...