To think the NHS is no longer fit for purpose

[alloutofducks]

I have just had a hospital consultation cancelled, following 6 months of extreme pain. I can apparently go back on the list, along with everyone else, in the Autumn. This is "because Covid", as the departmental secretary said on the phone.

The NHS can't cope with Covid. If it can cope with Covid itself, it won't be able to cope with the MH problems caused by lockdown. If it somehow miraculously copes with Covid and the resulting MH problems caused by lockdown, it certainly won't be able to cope with people in extreme pain for other reasons. Or people with long-term, life-limiting conditions.

The NHS was set up at a particular point in history where it worked as a model due to the make-up of the population (among other things).

There was none of the mawkish "our NHS" sentiment: it did its job, and did it reasonably well, on balance.

Now it seems that the increasing sentimentality about it is in direct proportion to its essential failure as a system.

We don't become tearful and pot-bangish about "our education system", for example. While we may sometimes feel like weeping with gratitude about the long-suffering teachers who have to put up with our DC on a daily basis, we expect the education system to get on with educating our children. Likewise, we expect the legal system (again: not "our" legal system) to uphold the law. And so on.

This is not a dig at anyone who works for the NHS (my sister and her partner do, for context). But AIBU to think the NHS simply doesn't work now and needs radically overhauling, preferably in a cross-party way?

alreadytaken spot on.
If I hear another armchair expert demanding that the NHS needs a complete ‘overhaul’ I’ll scream ! That’s the problem - it’s had so much tinkering often for purely ideological gain, Lansley reforms a prime example.
There are issues undoubtedly but this fixation with free market competition and ‘running it like a business’ clearly don’t work.

Bertoldbrecht
Agree. Too much political tinkering
Also trying to make it run like a business created more harm. Thatchers internal market anyone???
It had more power to procure before it was split into individual trusts
And for the third time GPs are private business. They are not employed by the NHS

Yanbu, people dont value the NHS, they miss appointments because they are 'free', they dont want to pay tax for it, tourists get treatment for free. People get drunk and expect ambulances on a Saturday night, all free. Try doing that in most other countries, you'll get a huge credit card bill.

It would be better if people had to pay towards treatment, a bit like with NHS dentists, at least then they may be more respectful of it.

The NHS doesnt need any more "reform" it needs funding at a level comparable to other economies with an aging population

I’m one of the most passionate proponents of the NHS you’d ever find but even I can see it’s crying out for reform.

It was definitely creaking even before COVID. It needs some urgent restructuring and a bigger budget (easy to say I know).

My sense is that the NHS is much stronger on emergencies & acute conditions than chronic conditions. Partly because fund holding GPS are extremely reluctant to refer.

The IT and purchasing and procurement can be improved without dismantling the whole structure and system . .

"Because Covid" seems to be a catch all excuse for everything.

The reality is the most NHS workers are not busy right now, due to people not wanting to go to A&E, appointments getting cancelled etc.

Yet no criticism if the NHS is allowed, feels ver cultish.

The IT and purchasing and procurement can be improved without dismantling the whole structure and system

But that’s not all that’s wrong with it. Care for older people is absolutely atrocious, particularly in hospitals. Essential services are being cut in an incredibly shortsighted way and it’s funding treatments that really should be paid for by the recipients.

We need to go back to first principles, decide what it’s for and how to fulfill that need in the most effective way.

The NHS doesnt need any more "reform" it needs funding at a level comparable to other economies with an aging population.

Those other countries usually have part insurance based systems, they also do not offer as much as the NHS does.

There is a reason why there is cross party support for 'reform'.

YANBU. As someone who's unfortunately spent time in hospital with at least four terminally-ill relatives, I'm well aware of the holes in the system.

Some nurses are wonderful, and treat their dying patients with compassion. It's my experience that when the patient has a less common illness - something like MND for example - the care isn't nearly so good. On two occasions the care of a relative with that condition was bordering on cruelty, and put her life at immediate risk.

As with any profession there are wonderful, and not so wonderful professionals who make it up. But the real problem is the way that it's funded.

If you've spent time in our hospitals, particularly in term's of a relative's palliative care, you'll know that this system is creaking at the seams. It's under-resourced, and it's under-equipped. Junior doctors were striking only recently, because there were real concerns that their overworked, exhausted state posed a real risk to patients.

The NHS is the fifth largest employer in the entire world. The only bigger employers are the likes of the Chinese and US armies. We are a tiny country of 66m people. Demand on a 'universal' system of healthcare is always going to be infinte, and supply finite. Even I, who am numerically-illiterate, know that these sums just don't add up.

The thread is only going to go one way though, OP. You can't expect to criticise the UK's sacred cow and expect an easy ride.

For me, though, YADNBU.

£120 per month for 5 of us. Bloody bargain if you ask me

Good for you, £120 a month is out of reach for many people.

The alternative to the NHS is rather sickening. I recommend the Michael Moore documentary Sicko before skating the NHS. We are incredibly lucky to have it and evidently over privileged as a result.

The alternative to the NHS is rather sickening. I recommend the Michael Moore documentary Sicko before skating the NHS.

He also covers the French system in that film (and he seems quite keen on it!). I’m coming around to that one as a plan. Their system is working much better than ours.

He’s enthusiastic about the Cuban system too, but I’m not so sure about that one

I like the French system and am not opposed to people paying something so they value it more. The idea that it is beyond criticism is ridiculous. It's on the same lines as the Tories 3 word slogans
A chant without reality
Supporters of the NHS still ctiticise it.
And GPs, the budget holders, are private ffs

Here comes an other uneducated thread about the nhs. How many do we need to repeat yet again the same misleading and incorrect information?

The NHS also needs to stop writing prescriptions for medications which are available cheaply over the counter - when I was pregnant they kept trying to give me a prescription for aspirin, which as I was pregnant I would get free - but it's 85p from Boots!!! So I always refused the free prescription

I think there could be a system where if you have a prescription for painkillers, or easily bought items, that you can be sold them over and above usual amounts.

When my friend was dying of cancer she was on multiple tablets of paracetamol per day. She and her husband would have bought them, but there was a point where local pharmacists wouldn't sell him repeated packs of paracetamol. Which is totally understandable.

So they had prescriptions for massive boxes instead. They'd have happily bought that amount, but couldn't. I think they should have been able to present the prescription, or something similar to a prescription, and buy that amount.

Are private healthcare providers still doing face to face consultations?

The ones I usually temp for (in private practice in Central London) are only doing telephone/FaceTime consultations (apart from a very few new patient exceptions) since the lockdown began. I don't know what is happening with regard to procedures/surgery or whether these are limited at the moment according to urgency.

I note someone upthread having got a "fully comprehensive" policy with their private insurer at a very reasonable price. I wonder if this covers both inpatient and outpatient treatment (you are more often likely to need only outpatient treatment and outpatient investigations to sort a problem out and many people find they are not covered for that). Also, does that policy have a restriction as to which consultants/hospitals you can go to? BUPA do this quite a lot on cheaper policies and I have met many patients who, when they have to come for inpatient treatment, find their policy either doesn't cover the consultant of their choice or the hospital he works from so have to start all over again with another consultant. The patients read me the list of hospitals they are allowed to be treated at under their policy - many times it includes hospitals that do not actually deal with the speciality they need treatment in. Those policies are often cheaper because the insurers are using small hospitals in limited areas (that quite often don't have such sophisticated equipment for imaging/surgery) because their hospital charges are lower. Likewise, a lot of their "approved" consultants are the younger, less experienced consultants and have signed up to a very cheap fee rate because they think they will lose business otherwise. The major insurers have CUT their payments to doctors about 5 times in the last 20 years despite doctors not having put their own fees up. So the consultants either have to accept that reduction (whilst their own running costs - consulting rooms rental/equipment/staff wages etc - have not reduced and, indeed, are often going up every year) or charge the patient the balance unpaid by their insurer.

If you are considering private medical insurance, it is important to be absolutely sure what it does cover and where you are allowed to go for treatment (and investigations).

GPS are private businesses not employed by the nhs? Who pays them their wages?

However governments that reacted promptly and effectively can and have made a tremendous difference - New Zealand anyone?

JA and co have done a sterling job.

@girlinterruption they sell services to the NHS, there is an extremely complicated system of fees and allowances. They get a pitiful amount per patient and then extras bring in more money

Are private healthcare providers still doing face to face consultations?

We had a long standing appointment in the diary last week for dd which happened by FT.

I do think people under value what is available and this means waste. I’d like to analysis on charging small amounts for services. I say analysis as I did see a pp on here about the possibility of keeping people away and incurring higher costs.

Op, the reason your appointment has been cancelled is in big part is to avoid the risk to yourself coming in to hospital and becoming ill yourself. Its quite right that routine appointments are cancelled at this time. Clinic space is also often used as extra ward space. A pandemic on this level hadn't previously happened for over 100 years. Cancelling outpatient appointments to manage is sensible practice.

People always talk about 'waste and inefficiency' in the NHS; what is actually meant by that?

Genuinely asking those who have knowledge.

Also, it is true that a lot of ppl abuse it (such as going into A&E when not needed etc.)? Also curious.

I'd be happy to pay more tax if it went to the NHS tbh, I think we need to protect it.

Girlinterruption2020
Are you unaware that public money can go to private companies?

@bettybattenburg. Thanks

@EdwynCollins

No, I’m aware, thanks

YANBU. Having experience of both a state-funded and a private system, I know where I’d rather be ill. I have nothing against the individuals in the NHS (my mother is a nurse), but the system as a whole is not sustainable and no longer fit for purpose.

Those suggesting people watch Michael Moore’s film “Sicko” need yo remember it’s 13 years old now and things have changed a lot here since then.

I saw someone me turn £120 a month for some private healthcare. I’d do that if we lived in the UK. Here I pay $400 a month for both of us and it covered everything. Eyes, teeth, health, prescriptions, even over-the-counter stuff like a box of plasters and a bottle of cough syrup come under insurance here. And my total taxation and deductions from my salary are 9%. In the UK it was 40% tax plus NI. So even my $400 a month for two and with my 9% tax/social security, etc I’m still much better off. Our cancer survival rates are much higher, more doctors and nurses per capita, all rooms in hospitals are private, restaurant-quality meals, more ICU beds per capita and our COVID-19 death rate per capita is lower. We are also testing far more people per million (and no, we don’t pay for the COVID-19 tests).