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?

There are thousands of stupid things that the NHS does to try to save costs whilst piling them on or mismanages what it has, probably on the advice of consultants.

• My local hospital buys in all its food despite having a massive canteen (that it just reheats bought in food in). I cannot understand why it needs to buy in certain things that would be cheaper and healthier to make on site (not to mention the listeria issue of a year or so ago).

• Some of the managerial posts are about trying to put a person in place to manage resources where really if they had just invested in clinicians they wouldn't need to manage the resource.

• The chronic mismanagement of a budget of 20bn to try to sort out an IT system, so that it still sends out letters to people and people miss appointments they cannot attend. In France, my father had cancer treatment - he was able to (and expected to - the system doesn't do it for you) book his doctor, anaesthetist, hospital bed etc from the budget allocated to him - can you imagine how much resource that saves when the patient books themselves in?!

• The fact that the NHS is a massive monopoly purchaser but seems to get stiffed on lots of items from a procurement perspective. And the PPE system is just proof of how broken it is really - totally lacking in ability to be nimble and respond quickly. As a state operated service it has very (overly) strict procurement rules in place that makes it difficult for it to purchase from small less established innovative companies.

• The fact that I have seen the best local consultant privately, who wanted to work fewer hours in his 50s and go part time with 2 of his colleagues who between them could have covered all of the work, but instead the hospital said no to all of them, thereby losing their services and all the knowledge they could have passed on to juniors - he truly is a wonderful doctor and would love to work in the NHS, but has gone to a private hospital to be the director of services there because frankly the NHS cannot even be flexible enough to keep its talent - this man wasn't looking for more money, just a bit more time with his teenage kids.

• the not strictly necessary operations - cosmetic surgery, transgender surgeries etc- that should not be publicly funded.

The NHS is underfunded, but it is also hopelessly inefficient and inflexible. People worship it, but if they could only see what they get in other countries in terms of some of the care - yes, people pay for it, but it is immeasurably better.

@BritWifeinUSA

Why is USA having the same PPE shortages for healthcare staff that the U.K. has seen when it’s so well funded?

What happens to the 16% of Americans that don’t have health insurance?

Why did the WHO rate the USA healthcare system as lower than that in the U.K. when comparing healthcare around the world?

Why are these improved cancer survival rates etc. not universal across the country but depend on your ability to pay for effective healthcare?

The NHS isn’t perfect and has A LOT of work to do to become more efficient but I’d rather that then see the most vulnerable in society denied healthcare and having far, far worse outcomes than the privileged.

The NHS is coping beautifully well with Covid.
A&E departments are finally being used the way they were intended to be used, for accidents and emergencies.
There are plans in place for non emergency care.
most of all, in a global pandemic, people are still getting the right care for what is basically a biblical plague.

Yes, OP, I really don't get all the sentimentality, misty eyes and swaying. Yes, it's free at the point of access because it's paid for indirectly via the tax system. It's not "free". And as for the standard of care, let's get real. It's not universally good and that's not a new thing. Remember Shrewsbury and Telford NHS Trust?

"Clinical malpractice was allowed to continue unchecked over a period of 40 years, with repeated failings by doctors, midwives and hospital bosses, according to a leaked internal report.
The investigation singles out the deaths of at least 42 babies and three mothers at Shrewsbury and Telford Hospital Trust (SATH) between 1979 and 2017."

There are many more stories. It's the cover ups that make me

www.google.co.uk/amp/s/www.independent.co.uk/news/health/shrewsbury-maternity-scandal/nhs-maternity-scandal-shrewsbury-telford-hospitals-mothers-babies-report-a9207176.html%3famp

I think that there should be some services that are free eg maternity, all screening for early intervention, pediatrics and then some more but I haven't thought about it enough.

GP appointments - emails could be free, face to face appointments a nominal charge so to address the DNA rate.

Private health care to become the norm like pensions for everything else.

We already have a two tiered system based on money. If you have ever been private for anything and suddenly seen what happens if you have the money to pay. To limit the NHS and channel more of us to private healthcare would actually equal out the system imo.

Private health care to become the norm like pensions for everything else

You still get your state pension as well.

If you have ever been private for anything and suddenly seen what happens if you have the money to pay

Nice en-suite room, better food, no waiting list. The care’s exactly the same.

We get that nice middle class educated professionals will have the time, opportunity and contacts to get just the right insurance package for their families. Financially they will probably be able to set aside a couple of hundred a month towards it and no doubt have an accountant to sort
something out for them too so they are not paying over the top. For the rest of us it will probably be not so good and the poorest will end up as usual
with something far inferior to the extent that they'll stop engaging with gps etc altogether and even greater health inequalities will arise.
What I can't understand is why this nhs bashing has started up now of
all times - first we had a nurses dancing thread, then nhs workers dancing and pushing to the front of queues when most of us don't deserve it anyway, then why are the wards quiet and the nurses twiddling their thumbs, and the piece de resistance why is the NHS so shit...

@ChrissieKeller61 there’s no private medicine being practised at moment.’most NHS Trusts have banned their consultants doing it, and many private hospitals commandeered by NHS. If you were sold Insurance recently I hope they highlighted.

@Bertoldbrecht I think you're taking this a little too personally. You might be an exemplary member of NHS staff; passionate about the work you do and work your fingers to the bone. But you are just one person who works for NHS, you are not the NHS.
I personally feel some criticism of the NHS as an institution is fair. I also think its fair to be a miffed that ALL NHS staff gets perk when, lets be honest, some are undeserving.
The criticism isn't aimed at you or individuals. Its more to do with how it's being run and this sudden religious worship of the whole NHS.
I understand why you have taken offence bit it really isn't aimed at many individuals of the NHS.

Why is it that whenever a thread dares to say that the NHS isn't perfect, someone always pipes up with "but what about the US" as if there's just a binary choice between the two. There are other options you know!

FTMF30 perks lol
Sorry but going to the front of a queue is hardly a perk is it !
I agree there are massive issues with the NHS, particularly regarding nurse training and understaffing of wards, equally people take it for granted and abuse it, but now it just seems odd for a plethora of threads criticising it to suddenly appear Nurses dancing, nurses twiddling their thumbs... just seems a bit divisive really.

I've experienced private care abroad - it was an emergency where treatment was delayed while forms about payment were completed in triplicate before treatment would be started. Treatment was less than optimal. Fortunately it didnt affect the outcome.

Two of my extended family have had private care. Both have needed repeat treatment to sole the problems of the first attempts at treatment. It's well known that systems (like America) with private fees per treatment result in unnecessary intervention. Not impressed by the quality of private care.

The NHS is deliberately under-funded and over-worked and exhausted staff make mistakes. It used to be the envy of the world for its value for money and quality of care.

This is just propaganda to try and hide the governments mistakes.

It's not underfunded, its over-reaching and mismanaged if anything, but no-one wants to have a sensible talk about that, because anytime you do talk about that, and talk about reorganising, you get the baseless shrieks of "privatisation" and the only alternative available instead of the current NHS is an American health care system, ignoring all the other healthcare systems around the world. It's all or nothing, as this thread demonstrates so easily.

OK, the statement people seem to throw out willy nilly is that it's underfunded, if it's underfunded then you must have an idea by how much is it underfunded then? How about a figure? How much more money are we going to throw hand over fist unquestionably to a flawed system that was established over 70 years ago. Hasn't the budget for healthcare went up by about £20 billion over the past 20 years as well?

The only truth in saying it doesnt work is that the government invests way less in public health and the preventative medicine that would reduce the people with diabetes, cardiovascular disease and chronic lung disease becoming morbidly I'll to the point were they are a strain on the NHS and social care system as people become unable to work and care for them selves. The government has consistently funded with a short term vision in mind which forces the NHS do do mostly reactive medicine on its budget.

We spend a lower % of GDP than any other European country. That looks like underfunding to me. And yes, it needs reform too.

I don't think we should start paying for services, I would like the spirit of the Nhs to continue, but some sort of reform might not be A bad idea. Someone earlier pointed out procurement problems and yes that must cost an awful lot. Hospitals prefer to manage their own departments costs and equipment, could probably save a fortune in bulk buying if all hospital used same standard equipment but instead they all sort it out separately. Now isn't the time however. The NHS has been underfunded by he government for 10 years, it makes sense it would be struggling now.

All you middle class Tory voting wankers who can afford private insurance carry on and get yourself some. You can buy yourself shorter waits, nicer food, a side room just the same way you buy you kids private education. Knock yourself out. No-ones stopping you.

But don't destroy the NHS for the rest of us.

The NHS is free at the point of access and that is the wonderful thing about it that must be preserved. It's not for you lot who can afford it. It's for the poor people who actually have the worst health outcomes. It's for people with life long health conditions like schizophrenia who have no chance to have a lucrative career. It's so they can have great care that they could never pay for themselves. That's the mark of a good society that it takes care of its vulnerable people and that's a reason I am happy to live in the UK.

The NHS provides very good care for the money spent. That's not my opinion it's the WHO. We are about mid table on their quality rankings. Less good than Nordic countries (do you want to pay their taxes?) about on a par with most European countries and far better than the US. However we spend way less than all other European countries. We have less Drs, nurses, hospitals and scanners per head population.

That suggests the NHS is actually very efficient. It does a good job for less money than nearly all other countries. Not my personal opinion. Actual statistics.

This would self evidently be true due to economies of scale and bulk buying power of a large unified organisation. The US would love the NHS to be broken up and lose its monopoly on drug pricing that keeps prices low for us all.

Is there waste and inefficiency? Of course there is. I hope we learn from this crisis that some of those cancelled OP appts were not necessary and we do more on the phone and internet. I hope we do question some practices and stop doing things that aren't actually needed.

But overall the NHS has done a really good job at coping with this crisis and overall it does a good job. You can always find some bad care if you are dealing with a huge organisation but if you leave it to the private sector you get Winterbourne View and some of the other horror that happens in poor quality private care homes and secure hospitals.

Also don't forget that the private sector is staffed by Drs that the NHS trained. In a private system who pays to invest in education and training for the next generation of staff.

How do people think that an insurance system would improve the NHS? The only way it would is because overall people would pay more money. That is the case in Europe and Australia. Their systems cost more. It would just make things more complicated and risk reducing access to the poorest and increasing social inequality. Do people seriously think there is some way to get more for less? Show me a system better than the NHS and I'll show you that it costs more.

I challenge anyone on this thread with their vague anecdotal 'what about Europe' stuff to find one that costs less per head and is better.

There used to be central procurement so that the NHS obtained economies of scale - there are still standards that must be met. I no longer know what the procurement method is exactly - it's been "reformed" to involve the private sector, involves "just in time" (which means not in time at the moment) and probably costs more than before. No allowance is made when looking at costs for the benefit of keeping purchases within your own economy.

Only 328 "people" have voted on your rant, wonder how any are genuine.

Watch the documentary “Sicko” and then bash the NHS.

“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 left US in 2015 and they were just as bad as what Sicko showed.
Only thing that’s changed since 2015 is Trump making healthcare worse and more expensive.

Btw, it’s impossible for your total tax rate to be 9% because the lowest federal tax bracket in existence is 10% and is if you earn less than $9,700 per year. That tax is in addition to state income taxes (0-13% depending on your state), Medicare (1.45%) and Social security (6.2%) taxes.

The absolute minimum taxes if you live in a 0% state income tax state, would be 17.65% and that would be if you were living at the poverty line.

So, sorry but I don’t believe your story about paying $400/mo for two in health insurance and getting over the counter plasters and cough syrup for free.

“I’ve been quoted £120 for fully comprehensive private health insurance”

U.K. private insurance is really a top up added to the NHS base. If you were in the US you could quite easily add a zero to the figure.

I just can't get over how plumb wrong OP is

The comparison with education is just plain wrong. Did you notice schools have shut? They are not doing business as usual. Nor are courts. All services are affected.

The NHS IS coping with Covid. It's coping very well. We have not had scenes like in Italy and New York. That is what not coping looks like.

In order to cope with a global pandemic once in a generation health emergency we had to shut down non-urgent stuff to redeploy staff to deal with Covid. If we hadn't done that we would be overrun. It was necessary.

Now there is spare capacity because things have gone better than expected. No-one had a crystal ball. Would you not rather we were over than under prepared??

We can't just open everything up again right away because:

1. It might be too early if there is a second peak after lockdown is eased. It's not easy to make the huge changes to practice that were required and it won't be easy to reverse them. We can't just flip flop back and forwards.

1. Opening clinics risks spreading Covid in itself. Do you really want to sit in an overcrowded waiting room mixing with many strangers and be examined by the same Dr who examined all of them? Sure she'll wash her hands and wear a face mask but there is a risk to you from that exposure and to the hcp from all of you. At the start of the epidemic many people were infected by one G.P. who had it.

Have you seen how many NHS staff have died? Notice they are not mainly ITU/ Covid ward staff they are mostly very ordinary NHS staff eg HCAs, porters, midwives, GPs and mental health workers who were exposed in the course of their day to day work to people who probably had no idea they had it.

So for you to have your OPC there's a risk to you, a risk to staff and a risk of starting loads of new chains of infection and stoking up the pandemic again and that is why you have to wait until the risk is lower.

Yes the OP is completely wrong about the NHS.

The system does need to be returned back to full nationalisation. Most of the waste and inefficiency comes from having privatised pieces of it and the disaster of the Private Financing Initiative (PFI) era. But those failures were forced by underfunding in the first place.

Finally, Americans are really suffering. Millions have lost their jobs with Covid and that means they now have no health insurance. So if they do catch Covid, they can’t pay for any medical care. See this BBC video.
www.bbc.co.uk/news/av/world-us-canada-52450086/coronavirus-one-thing-that-makes-job-loss-in-us-so-painful

Not read full thread, but totally agree it needs better funding. I think some of that could come from fewer non-medical managers and returning to the original set up of matrons running their wards. There should then be less disparity, nurses and junior doctors should earn more and some of the 6 figure salaries at the top capped.

They need to stop the waste and cull about 75% of the needless managers.

^This