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?

Having to endure the NHS regarding both of our elderly mums, I can honestly say that I despair. So many complaints, so little response.
I would love a government to find a new way forward . Current situation involves limitless funding yet limited treatment options.
Given the volume of patients and the longevity of many and the vast costs of new treatments and medication, we need an alternative way of funding. NHS can’t go in under current low funding levels.
Would suggest an increase in Tax but that would be a lead balloon moment.

Having used both private and NHS, I would say that Private over-treat and NHS under-treat. Neither leave me feeling good about their approach.

I’ve used private and found it excellent but they did ask if it was acute or chronic before saying yes. Not sure if that’s all private or just the policy I have.

Also not emergency. So the NHS still covers those (not withstanding the private A&E mentioned previously)

I lived in Germany. Everyone has access to state healthcare there but some choose to have a private insurance plan. The state provided health care is excellent, but Germans pay a lot of tax. When I worked there, about 50% of my salary was taken for tax - I was gobsmacked when I saw my first pay slip and pretty annoyed ... but the payslip also showed a break down of what percentage of that 50% was going to education, what was going to health, to infrastructure, etc. And all of those public services were pretty good - Germans are happy to pay higher taxes and have a better quality of life as a result - it’s not rocket science. And as for the private healthcare there - not convinced. When my husband and I left our contracted jobs and went freelance while there, we had to take out private healthcare. Our premiums were calculated based on our risks - I paid double the amount per month as my husband because I am a woman (pregnancy is expensive) - I found that so annoying - the sperm providers don’t have to pay! Also - there is a real problem with over treatment. Go for a gynaecologist appt on state care - get a thorough consultation, but fairly usual. Go as a private patient about one issue, get a scan, a swab, a smear, a urine test, a breast exam ... because they can charge the insurer for all of these tests. It results in people being over-treated. The NHS is pretty amazing and deserves proper funding. The Tories will never do that. If we were prepared to pay more tax, it could be amazing ...

Although I will balance my last post with for the most part the experience I’ve had with NHS has been good.

I think the problem with the supermarket analogy is that there is a limited pool of qualified workers. You can complain about staff - some will be poor and perhaps should change to a different sector. But there are not enough of them. I believe we don’t have as many drs or nurses per capita as other developed countries.

Either you improve working conditions, or you get more immigrants or you train more people (though in the latter case you waste money unless you also retain them).

Namenic,

Is there actually a shortage of qualified staff or are the qualified staff underpaid and under appreciated (doctors and nurses)? There does not seem to be any shortage in the private sector.

I would take huge issue with the idea of nursing degrees (certainly for all nurses). I know someone with DDE at A level with a nursing ‘degree’ who is now an NHS manager on 90k (maybe more now). I am sure she was a fabulous nurse but a fabulous manager, I really doubt it. Aside from anecdote, you go on university websites who typically say that they only take students for their degrees with (eg) ‘AAB A levels (except for nursing)’. Nursing is a highly skilled craft where learning is best done in wards with other nurses. I am not disrespecting nurses, some of whom are truly amazing, but I do think nursing is about skilled care and we need to retain a clear separation between nurses and doctors.

Medicine, on the other hand, is a hugely expensive degree where demand (to be a doctor) way outstrips supply, hence the minimum requirement of AAA to study it. This lack of university places could easily be remedied by funding more degrees. After all many less academically able (though still fantastic) doctors do the 10 year route via a degree in biomedical sciences and then medicine. And we take overseas doctors in far less onerous criteria. Many schools are now advising these pupils to apply to overseas unis to study medicine.

If we stopped nurses going into management (unless they had the A levels and literacy that would get them an interview in the private sector) and recognised that not all doctors needed to be brilliant academically (although, clearly, some do) we could address the ‘skills shortage’.

@Graphista,
I never said it was condition, I said it was the biggest cost to the nhs.

Don't you think that a condition that costs the nhs £25,000 every minute, YES minute, not hour, isn't a significant issue that we, as a nation, should focus on? Something that in most cases is preventable?

Treatment of diabetes cost 10% of the nhs budget, what a difference it would make if we reduced it to 2%!

But as always, we've got 21 pages of people finding gratification in criticizing an establishment with hardly no posts discussing what we, as individuals, could do to make it better. We don't like the latter, we want others to take responsibilities for our failings.

@ScreamingLadySutch

We already pay into a central pool - ie part of our taxes goes to running the NHS.

The health insurance would go into a central pool. Because there are more healthy people than unhealthy, it would be affordable.*

That's how the current tax system works.

Personally, I would like people with illnesses such as smoking, obesity, type 2 diabetes etc to have a cost imposed on their lifestyle choices - but by the market, not bureaucrats.

Who is the market? What if someone with T2 diabetes refuses to pay or says, I run 3 miles 4 days per every for 7 years and don't eat fried foods or red meat so my type 2 diabetes is not caused by my lifestyle choices, it must be a genetic disorder?

I'm guessing by the market you mean pharma businesses. Well I'd rather pay NHS administrators than Pfizer's.

Personally, I would like people with illnesses such as smoking, obesity, type 2 diabetes etc to have a cost imposed on their lifestyle choices

Type 2 diabetes is caused by a genetic link as well as environmental factors.

The NHS is the best healthcare system in the world in terms of accessibility and affordability. However it fairs less well with eg cancer survival rates and preventative medicine which is why in some lists the NHS fairs less well.

Privatising the NHS would be a disaster as would letting the big American companies dictate pharma prices. More funding into the areas we do less well is needed.

@larrygrylls

Certainly not all medical students decide to enter medicine or become GPs, they can end up working in the pharma or other business sectors with a tenuous link to healthcare.

I would agree with looking at funding GP and medical doctors degrees so long as they repaid some funding if they left the NHS before 10 yrs!

Type 2 diabetes is caused by a genetic link as well as environmental factors
And this link is a very small percentage compared to the above causes.

I don't agree with imposing a cost relating to conditions as indeed, exceptions will be penalised. However, our nation need a kick in the backside stopping to blame everything and everyone for their lack of taking responsibility for their health and acknowledge that funds that goes on to treat what they could have prevented is money that is not going to people with conditions who could have done nothing to avoid.

Larrygrylls very few nurses move into management at the level you have mentioned.
Nursing is far more clinical than it used to be, nurses routinely give chemotherapy and it might be a nurse that inserts the PICC line to allow the drug to be given. It will be a nurse who monitors and cares for that line. Some nurses are able to prescribe, so in palliative care or long term conditions for instance. Every specialism has examples of nurses now doing things that were until relatively recently the preserve of the medical staff. When I started my training only medical staff could catheterise a male patient on the wards in my Trust. Now it is routine for nurses to do it.
Does a degree make someone a 'better' nurse ? not necessarily, some of the most compassionate and skilled nurses I have worked with were trained before degrees were available. They are excellent at what they do, not only because of the knowledge they have, but just as importantly, the way they treat the people they are caring for. Can the latter be taught ?

Personally, I would like people with illnesses such as smoking, obesity, type 2 diabetes etc to have a cost imposed on their lifestyle choices

They do. There's high duty on alcohol and tobacco products. VAT on takeaways, fast food, sweets, crisps, fizzy drinks. The new sugar tax on sugar laden fizzy drinks.

£20bn per year raised in tobacco and alcohol duties.
£120bn per year raised in VAT

I sort of agree with you @Adenosine

I think that having coverage for all is important, but many countries achieve this through a mixed model with some subsidy and some insurance, with the insurance premium for the most needy being met by the state (and in some cases the insurance being partly an employer cost). The US model is totally crazy, but criticising the NHS does not mean supporting the US model.

When I had my daughter, I had abysmal maternity care by midwives, but good care once I had finally, after two days, managed to see a consultant, who was able to give tailored advice rather than the "one size fits all" pathway (which, incidentally cost them far more money to induce me and keep giving me midwife interventions rather than simply spotting the issue - which I had tried to raise earlier in the process but my experience of the sensations that I was having was belittled and dismissed - and going straight to section).

Often, the system is stuck in a passive mode where, because it is under resourced and experienced diagnosticians have so little time with an individual patient, some of the caring is done looking at a patient in terms of the overall aims of the system and a general profile of person and treating on the balance of probabilities rather than taking more time to look at them as an individual. E.g - one issue per appointment at GP, but some of the issues could be interlinked so treating together may provide a far better picture and care quality. I think that is part of the reason why the UK system is so terrible at diagnosing cancer and other serious illnesses. It is in part underresourced, but there is also a culture of systemic and individual lack of care (perhaps because some medical professionals get ground down by feeling that they don't have the time or money to be more than reactive, which then becomes a pattern - to be honest, if I felt that I had no choice but to fail some patients for no fault of my own, I would not perform my best either!) - failure to give sufficient attention to interventions and diagnostics early on then costs more money in the long term. Perhaps if patients were also to a degree customers, money would flow better into these earlier interventions and this might help with a shift away from reactive medicine until conditions become very chronic (same can be said for social care, which is why I am very keen on the idea that people should pay something where they can - in the right system, it it gives them more power in the early stages, where their needs are less severe). Another issue is the gateway of the GP system - most sensible developed countries allow for women to see a gynaecologist and for children to be able to get specialist care from a paediatrician, which is takes pressure off GPS to triage every condition known to man and privileges specialist expertise.

Going to A&E frequently involves a wait (have been twice in two years with my daughter, who in each case needed an IV intervention), but the quality of emergency care once you are top of the pile is very hard to fault in my experience (if you could get rid of the abuse by people who do not need emergency care but need a diagnostician to assist them at a GP or pharmacist level, you would be golden). Once admitted, it is again about resources plus quality of care from individuals - I don't mind having to wait around for a doctor. I do mind being admitted after an initial examination, then put in a side room (as I have been) and then ignored by nurses who are chatting at the desk whilst my daughter's temperature is over 40 and then having to beg someone to come and assist ( which I got, with extremely poor grace). But most nurses I have come across have been brilliant.

Then there is the fact that some of the overall design of the system is just totally hopeless. Having to carry about your hard copy maternity notes, only for someone to fail to pick out the most important bits of information when you produce them because it is all over the place, inability to access notes electronically between hospitals. Someone spent over 20 billion on an attempt to address this and wasted it all - there must be a degree of incompetence in those who run the system high up for this to have happened. I fractured my arm five years ago and went to the nearest hospital - they gave me a CD to take to my nearest hospital with my initial x ray on it for my follow up appointment because there was no easier or better way to ensure the sensible transfer of the information. Crazy!!

I would take huge issue with the idea of nursing degrees (certainly for all nurses). I know someone with DDE at A level with a nursing ‘degree’ who is now an NHS manager on 90k (maybe more now). I am sure she was a fabulous nurse but a fabulous manager, I really doubt it.

If shes on 90k shes in band 9, the highest agenda for change band. This is chief nurse, director level pay not just a manager. It's unlikely she got there by ot being good at something more than just nursing.

I do agree with your sentiment that not all nurses make good managers but I doubt t many get beyond the bottom end of band 8.

*Personally, I would like people with illnesses such as smoking, obesity, type 2 diabetes etc to have a cost imposed on their lifestyle choices

They do. There's high duty on alcohol and tobacco products. VAT on takeaways, fast food, sweets, crisps, fizzy drinks. The new sugar tax on sugar laden fizzy drinks*

I am obese and I don’t eat any of the above.

I hate sugary foods, I don’t smoke or drink and I stick to around 1500 calories per day, sometimes less.

Some of us post menopause get fat for other reasons.

I have been under the dietician at the doctors.

At my first appointment I got shown the pyramid and told I would have to give up all the items in the top triangle of the pyramid.

I don’t eat any of them because I don’t like them.

I said I have an allergy to wheat and dairy (it brings me out in a rash)

His thoughts for my breakfast was Wheatabix with milk

Then when I said again I am allergic to wheat and dairy he looked perplexed and asked what was wrong with wheatabix and milk.

He then said try beans on toast.

With a sandwich for lunch.

I did a bit of research and found a thing on the menopause through YouTube about cortisol levels going haywire because oestrogen levels which keep cortisol levels in check diminish and high cortisol levels link to weight gain.

So far I haven’t adjusted my diet apart from swapping my coffee for decaf.

Instead of hovering around 15st 6lbs I am now hovering around 14st 12lbs

I have never managed to lose that sort of weight before.

I also have dreadful insomnia and on the odd occasion I manage to sleep 8 hours (three times since August 2017) I have lost 4lbs from one day to the next.

Sometimes it isn’t the calories we eat but other things that are going on.

The calories in/calories out might be a reason for a lot of people but for a few it doesn’t work like that unless we give up eating altogether.

Type 2 diabetes is largely genetic too. Plenty of people will have an unhealthy lifestyle and NOT develop diabetes.

It's far from perfect but its free for all and it is the best we have. With a cash injection to match the increase in demand then it could once again be amazing. As for it not being full of underpaid heros, I agree.

I agree. But it needs more than more money. It needs a complete and thorough overhaul. The management is terrible, the processes (when they follow them) are over-complex and timewasting. Proper nurses no longer 'nurse' and too many people treat it with contempt e.g. not turning up for appointments, or assuming it's there for every tiny little physical or mental inconvenience. But it is still better than most other countries have.

Sounds accurate @Oliversmumsarmy lack of sleep and caffiene increase cortisol levels. If you can swap to decaff out for something else lower in caffiene again you may find even more drops off. I have silly high cortisol levels so no matter what I do I always have huge swings in weight when I'm stressed.

Oh another thing, get your TSH and antithyroid antibodies checked. If your tsh level is above 2.5 and you test positive for antithyroid antibodies you may have hashimotos and need to be seen under Endocrinology rather than the GP. Many GPs dismiss the symptoms as menopause and so many women go untreated.

This is chief nurse, director level pay not just a manager

No it isn’t. Director level jobs aren’t on Agenda for Change scales, they get Very Senior Manager salaries.

Type 2 diabetes is largely genetic too. Plenty of people will have an unhealthy lifestyle and NOT develop diabetes
No, it is not largely genetic, it is both genetic and a little issue but even when genetic, it doesn't mean that diabetes can't be controlled by adopting a healthy lifestyle.

No it isn’t. Director level jobs aren’t on Agenda for Change scales, they get Very Senior Manager salaries.

In my trust posts like director of nursing, director of inpatient services etc are all paid within agenda for change. Obviously the executive and board level directors are paid outside of this.

The director of nursing is a mandatory board position so you must have worked in some very odd trusts.