AIBU to ask your thoughts on the NHS

[Bumblecattabbybee]

Don't get me wrong. I love and totally support the NHS. But the way it is right now just doesn't seem to be working as well as it should, and people are getting really sick, not getting treatment they need, often unable to even see a GP in good time when they have serious symptoms, and having to wait months for appointments for treatment. The whole thing seems to be falling apart.

Another issue is that a lot of the time, people don't really feel comfortable or free to use the NHS without judgement. The amount of times on here I've seen people listing some serious and scary symptoms that they or their child has and questioning whether it's okay to go to A&E/the GP. I've also regularly seen people criticising others who were in A&E/the GP for symptoms they didn't consider serious enough.

When I started working abroad, the difference really hit me. When I was sick or had a small injury or problem, I wouldn't go to the doctor because I was so worried about wasting their time, and I found that other British expats were the same. We have had it drilled into us that unless our sickness is of a certain severity or we seriously think we might have a serious, life threatening problem, or until a problem has got to the point where it's seriously affecting our wellbeing/mental health/quality of life and we can't cope anymore, we don't the go to the doctor because it's seen as a waste of NHS time, money and resources.

All my non-British friends here thought this was absolutely ridiculous - the way they see it is, when you're sick, you need to go to a doctor. You don't take risks. You don't put it off because you're afraid of wasting the doctor's time. This isn't how it should be with healthcare. You just go. The risk is NEVER worth it. Whereas I recently read an article about how this issue of people not wanting to waste doctor's time is a genuine issue in the UK - especially among older people, who end up really unwell because of their reluctance to see a GP when they first experienced symtoms.

A close relative of mine was recently diagnosed with cancer and luckily they're going to be okay, but the two issues above meant that they almost weren't. Firstly, the pressure to not waste NHS time meant that symptoms weren't investigated as soon as they appeared because relative felt the need to give it time, not make a fuss, see if things got better on their own. By the time they realised it was actually serious enough to warrant use of NHS time, it took SO long to get an appointment to see a GP. Weeks. So I've been thinking about this a lot recently - what a close call it was.

I used to be so proud of the NHS and in many ways I still am, but the above two issues really, really scare me. And from what I've seen, it's just getting worse and worse. I recently heard of someone who was given an appointment for a hospital procedure for a date at the beginning of 2023! I constantly hear of people waiting weeks for a GP appointment, and in some cases, a period of weeks can mean the difference between dealing with a small problem or a big one, dealing with mild symptoms or serious ones, and even be a case of life and death.

Here, I have to pay for heath insurance but I know that should I have any health issue, I can see a doctor that day, have tests that day, scans that day, if we can't get it all done that day then I'll come back tomorrow, and I never need to question whether it's serious enough to waste a doctor's time on because there's more a sense of, the doctor is providing me with a service which I am paying for, whereas the NHS always felt more like a privilege to use. But I can't help feeling this huge injustice over the idea of healthcare being a paid service in this way, and this scares me too.

Is there a solution? What do you think? I'm just curious about other people's experiences and thoughts.

@Tuscancat

Germany pays 50% more per person for healthcare, France 30% more. That is the difference. Jeremy Hunt is the architect of many of the issues we face today with the NHS so I wish he would bugger off and stop dispensing his wisdom.

In reality it started way way before Hunt. It really starts with thatcher.

Not me, I haven't got any choice but to use it and it appalls me that I'm at the sharp end (as are the clinical staff) of shit decisions being made by managers. The amount of maternity scandals across the country the last few years, and trusts getting downgraded, and yet it still goes on.

If I made decisions at work that could actively harm people I wouldn't be in that job very long and that would be long before an external inspector came along to tell me so. Seems to be a huge lack of accountability, unless you're a clinical member of staff that makes a mistake.

What is horrifying reading these threads is the number of people convinced they know what is wrong with the NHS, even better, know how to fix it, when it's obvious from reading their posts they don't have one bit of an idea of how the NHS functions.

Then again, tends to be the same people who know everything about education, the police force, research, and of course politics. They are amazing expects who just know it all and can't understand why no-one ever listen to them!

@Tuscancat

Germany pays 50% more per person for healthcare, France 30% more. That is the difference. Jeremy Hunt is the architect of many of the issues we face today with the NHS so I wish he would bugger off and stop dispensing his wisdom.

Hunt didn't act in a vacuum, he had full cabinet approval.

Personally, Hunt is very much Poacher turned Gamekeeper.

Year on year the Tories have always underfunded the NHS, just a little but over 10 or 20 years it adds up and we see the effects now in staff shortages, maternity, cancer, AE etc.

We pay NI for the NHS. Since Ridley Report (late 80s) governments have slowly been cherry picking easy & profitable services from the NHS into private hands. Your GPS are privatised already.
The NHS is not a money pit, it's not a behemoth, it's a source of equal healthcare chances but many of you just don't want equity for people.

It needs a thorough overhaul

I have just taken out private health insurance

I work for the NHS

We pay NI for the NHS.

NI isn't really for health service as far as I know, but a social security. Only the tiniest bit of NI goes to health service, most of it is funded from taxes

It wasn't just the Tories. The Blair government exponentially expanded PFI and established the Primary Care Trists as a vast layer of additional and unnecessary bureaucracy just as GP fundholding was beginning to work and have a positive impact. The abolition of SEN and SRN was also a huge error, especially the levelling up aspect of those without the baseline training. To have replaced SENS with HCAs on very low salaries and with minimal training has had a shocking impact.

The nature of working for the NHS attracts a higher proportion of liberal/left wing ideologists who will always be diametrically opposed to any Conservative initiative whether it is right or wrong and supportive of Labour introduced initiatives.

GPS were always opposed to the NHS and were persuaded by Bevan with money. They have always been independent of it to an extent and running their practices as small businesses.

It was the envy of the world historically but a pp made an interesting point earlier, that no other country has followed its example. The principle was brilliant but the practicality started going wrong in about 1948.

Maternity care and post natal care in particular has gone backwards in the last 20 years. We have not had a majority Conservative government for most of the last 20 years 1997-2010 Labour; 2010 to 2015 Con/Lib coalition, Conservative from 2015.

The greatest enemy of the NHS has been public gratitude from the outside and the closing of ranks from the inside when something goes wrong. PALS needs to be taken out of the hospitals/Trusts and given greater independence.

I agree both parties have mismanaged the NHS

Because what the NHS was set up for soon became unmanageable

We have to decide what the NHS is for and what it is not. Then it’s not really the NHS any longer it’s a different health service

And neither party is willing to do that

Politicians use the NHS as a political pawn so mostly have short term plans at best some medium ones. The NHS needs some serious long term planning that goes way beyond a political term. Tbh I would love to see the politics taken out of the NHS, but I am not sure how this could work in practice?

@SunShinesBrightly

What a load of rubbish. About 10% of the £119k will be spent on the NHS. Double that will be spent on pensions just to give you an idea. If he fractures his hip and has a stay in ITU because he has an element of renal failure the costs are often unaffordable, even for people on 300k per year.

I never understand why people who are insured feel so protected. I deal with insured people, often. Generally, when healthcare gets complicated or expensive, they increase the premiums so they become unaffordable or they transfer care to the NHS.

We are all in the same boat. People who have to earn a salary that is. In my experience, it's only really people who have income streams that mean they have never had to work and still have expensive houses, schooling, etc that can afford really very common healthcare issues over a prolonged period of time.

Those of you earning 200 - whatever K in finance feeling aggrieved because they can't get a GP appointment on a Saturday, aren't worrying about the really scary stuff , in my view.

I think the NHS needs a complete overhaul. People like my family should be paying a token amount for GP visits. We are a 6 figure income household and I would happily pay £10/£15 for a GP visit. We don't have any chronic health issues and think those should be protected, but I do think people should pay a token amount for visits when their income hits a certain threshold.

We have private health including GP access through my husbands work and that gives me a lot of peace of mind tbh.

Yet another 6 figure earning household 'happy' to pay for a gp consultation but has no chronic illnesses . What would be the point at which you pay ? £20,000 ? £30,000 ? What about the poor sods on the cusp of those salaries ? What if it's taking numerous appointments to get a diagnosis ? And then pp drops the bombshell that they have private health insurance so would never pay it anyway. I suspect these types of posts are just opportunities to stealth boast about hubbies pay .

The thing about going private in the UK is that almost anything expensive or complicated gets dumped back on the NHS. Effectively, private medicine is a concierge service. It's not really expandable based on the current model.

So for maternity services as someone asked upthread? If your baby needs special care, they go back on the NHS, so I'd never do it except in the private wing of an NHS hospital.

Other countries do have some level of copayment for services as opposed to being 100% free at the point of service. For example in France the Assurance maladie reimburses 70% of the scheduled fee, though you can buy top-up insurance or if you are poor there is the CMU (and chronic conditions get 100% reimbursement). Sweden has an annual cap on how much you can pay out of pocket for doctor visits and medicines, also.

There's an old RAND study from the 1970s about how small copayments does discourage wasteful use, but the contemporary evidence from the USA where cost-sharing has accelerated dramatically suggests that as they get higher, they simply discourage patients from seeking treatment altogether. Charging £10 for a GP consultation might discourage people from wasteful consultations but you have to weigh that against discouraging necessary treatment: how many wasted consultations for viruses or hangnails are going to be avoided?

(I have never had private insurance when living in the UK.)

We don't pay NI for the NHS. We pay 20% of our ordinary income tax for the NHS . Although some NI may go to the NI the vast bulk is from income tax. NI is also used for state pensions and state benefits. en.wikipedia.org/wiki/National_Insurance

I didn't say Hunt was solely responsible for the demise of the NHS but he is hugely responsible for many of the things he pontificates about now. The only reason he does so is because he knows it is a vote winner and he stills harbours ambitions to be PM (god help us). But pandemic planning failures, huge demoralisation of staff, doctors and nurses leaving in droves... all on Hunts watch. www.opendemocracy.net/en/ournhs/what-did-jeremy-hunt-do-to-the-nhs-and-how-has-he-got-away-with-it/

One of the problems is, I think, that people still hold on to the idea that their NI payments pay for "them". They don't. Look at DM, and probably most of the women of her generation in their 90's now. They didn't pay anything into the system at all, most didn't work. They are now costing a lot in health and social care. The problems go back decades. Previous governments knew this was a time-bomb waiting to happen, they didn't really expect life expectancy to increase so dramatically, and never planned early enough in regards to pension age, tax requirements, and future costs. This was know about in the early 80's and just kicked down the road.

So we now are in the perfect storm of a large elderly population, with exciting new, expensive treatments, extending life, and no real plan to pay for it. We have extended pension age, but not fast enough, and then everyone complains that they were not warned, or are entitled to 40 years of retirements, when this is completely unsustainable.

A really simple health example is second Hip and Knee replacements. They are now common. They were never designed to last more than 20 years, no-one thought people would out-live their replacements. They now do, and in increasing numbers.

I quite agree with @BigWoollyJumpers except for the point about the pension age increases. There was widespread media coverage about that from the early to mid 90s. People simply chose not to heed it.

Personally I am thrilled to be able to work until I am 67. Under the old rules I may have had to retire already - it is unthinkable. It is ludicrous, however, that I get free NHS prescriptions when I am still working. Indeed even when I do retire my occupational pension will be more than average earnings so there does need to be an element of means testing involved. Perhaps that revenue could be redirected to CAMHS.

@Effybriest

Yet another 6 figure earning household 'happy' to pay for a gp consultation but has no chronic illnesses . What would be the point at which you pay ? £20,000 ? £30,000 ? What about the poor sods on the cusp of those salaries ? What if it's taking numerous appointments to get a diagnosis ? And then pp drops the bombshell that they have private health insurance so would never pay it anyway. I suspect these types of posts are just opportunities to stealth boast about hubbies pay .

You'll see I said those with chronic conditions should be protected. I have no idea what the threshold should be for paying for appointments, 6 figures in the SE means a very different lifestyle to someone on 6 figures in the NE.

@Effybriest

Yet another 6 figure earning household 'happy' to pay for a gp consultation but has no chronic illnesses . What would be the point at which you pay ? £20,000 ? £30,000 ? What about the poor sods on the cusp of those salaries ? What if it's taking numerous appointments to get a diagnosis ? And then pp drops the bombshell that they have private health insurance so would never pay it anyway. I suspect these types of posts are just opportunities to stealth boast about hubbies pay .

And you're making huge assumptions about my 'hubbies' income. I said our insurance comes through his work, I mentioned nothing about where the household income comes from.

And no, it doesn't effect our nuclear family as much because we are fortunately in good health and have the insurance to call on when needed. But a poor healthcare system effects society as a whole. My family don't live in a bubble. Underfunded health (and particularly mental health) services have a huge negative impact on the community and I really give quite a lot of shits about the community I live in.

It's chronically underfunded. That's the issue.

Staff are doing way more than the job they're trained to do. It's unsustainable and overlooked.

It's the governments fault. They need to invest. There is money to do so. They can start taxing more for a start (their millionaire mates could contribute a lot more!)

The Tories are running it down deliberately so they can privatise it.

NHS is not fit for purpose and very badly man. Glorifying it only makes it worse

*managed

@katsounds

It's chronically underfunded. That's the issue.

Staff are doing way more than the job they're trained to do. It's unsustainable and overlooked.

It's the governments fault. They need to invest. There is money to do so. They can start taxing more for a start (their millionaire mates could contribute a lot more!)

the top 1% now pay a higher share of Income Tax receipts than at any time in past twenty years. Close to three in every ten pounds that the government receives in Income Tax is paid by just over 300,000 individuals

Well possibly. But those 300,000 are very few. Everyone needs to pay more, including those on basic income, but that's not a popular thought is it?