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.

We need to scrap NI, and go onto a pay per treatment basis. If people had to pay to visit their GP or A & E/call an ambulance, there would be far less abuse of the system. It should be a sliding scale based on income. People feel a huge sense of entitlement with the NHS and I think that's a huge factor in it.

My DD works in the finance sector of a combined local authority/NHS department and said the money wastage due to private out-sourcing is a disgrace.

@spinningspaniels how much would you be willing to pay to visit the GP ?

It doesn't help that there is no joined up thinking between different trusts or even between hospitals within a trust.
When I got sent to a different hospital (same trust) I had to go through all the accreditation for several activities even though the actual process of the job was the same (although the small bits which were different were not part of the training). Had just got signed off for everything when it was time to move on again.
Poster upthread said about time for recruitment - job adverts do not get posted until after person has actually left despite the fact they have handed in three months notice. Then because department is short staffed recruitment is delayed and then the person chosen has to to give three months notice at their current job.

Poorly run, underfunded and grossly abused by it's users.

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 symptoms

This is so true. My FIL delayed going to the GP because his generation very much bought/buy into the 'don't bother the doctor' narrative. He endured awful headaches for weeks, putting them down to sinusitis, which the GP actually went along with when he eventually made an appt. Turned out he in fact had a serious condition closely linked to another which he was already being treated for (!), and which is treatable, but in his case ended up with him losing his sight completely and irrevocably within days. Had he gone much sooner, and felt able to return when the problem didn't resolve, there might have been time to factor in a misdiagnosis before it became too late to treat the condition. I know it's all 'might haves', but there definitely is a culture in the UK of the NHS (marvellous though it can be) doing you a favour, rather than providing a service.

@Bumblecattabbybee can you tell me how much you pay for your healthcare insurance each month ? does this mean you have no upfront cost's if you visit a GP, A&E or hospital or do you have to pay and then claim ? What is included in your cover and are there any limits or restrictions ?
Do you know anyone with chronic or long term health conditions and do they pay more ?
Do you need to pay for children ?

It’s complicated for me. I’m a relatively healthy 30-something. I haven’t used the NHS much and when I did (for diagnoses and treatment of a thyroid issue) actually my GP did a much better job than the BUPA dr I saw through work. And I had my child in an NHS hospital and had a broadly positive experience. I’m now pregnant again and care is substantively fine.

But… takes 2 weeks + to see (well, get a phone call from) a GP. Every - every - appointment runs late, by at least an hour. Lots of chasing / acting as an intermediary between departments (I’m constantly ringing up my MW with “The consultant told me to tell you…” which is inefficient and a recipe for disaster). And when we’ve needed a referral for something the waiting times have been so absurd that we’ve gone private - 5-6 months for dermatology for example, for a baby with skin red raw from eczema.

So a mixture for me but I’m broadly unhappy with the trajectory it’s on, and frustrated with its deification.

The NHS is chronically underfunded to ensure that we eventually go to a hellish American system
I’ve had cancer, have an AI disease and a lifelong chronic condition. Any one of these would have bankrupted me in the US.
Often we don’t need to go to a hospital but we do need to go to a GP. Thick people often cannot be bothered to do so and fill A&Es with neither accidents nor emergencies rather than make an appt and wait to see their GP or purchase basic otc medicine post advice from a pharmacist.
In the US many people know they need medical help, life saving medicine etc and cannot afford help. They are desperate. They want and need help but cannot afford it.
In the U.K. some people are more laissez faire about their health and put off what they need today to do tomorrow. Free will.
These are not the same things and should never be confused

The drip drip of underfunding now thoroughly bashed by a global healthcare pandemic hasn't done it any favours but you must remember that you tend to hear the bad stuff a lot more than the good stuff.
DH got a same day GP phone appointment for a non urgent referral this week.
I've been an outpatient for 23yrs with regular treatment and monitoring and although this year or so has been a bit more trying than usual that's mainly due to them worrying about the unknowns of Covid on immunocompromised patients rather than an nhs thing. Through various forums I know people around the world with my condition and the NHS comes out pretty good in terms of treatment for that condition.

@SchrodingersImmigrant

Problem is that it's just not fit for purpose and needs overhaul. But someone, somewhere made sure that the criticism of the organisation and it's functionality is quite silenced by making people put together NHS and nurses and make it an emotinal issue so when you criticise NHS functionality (or the lack of it) you end up being shit down because "poor nurses work their arses off and you are spouting this poison! Heroes to zeroes, eh!"

It's really like if people were attacking others because they criticise Amazon and that surely means they must hate their workers, iyswim.

Health care system should NOT be such emotional issue people try to blackmail others or accuse them of ruining it by not being healthy etc.
"omg what's wrong with you? People like you are the reason NHS is on it's knees!" is common to see. Shame the people don't realise that it's actually them who are the reason NHS is "on it's knees" because they blame the wrong people for the issues.

Politicians play on these feelings well too. "Save the NHS, stay home". Use of emotive language just makes it easy for them to shut down critics and not having to better the system.

I know many people who pay private in their native countries. At least they get an actual treatment.
Shame though. It's famous for paracetamol amongst foreigners. There are some great gps like my old one was, but overall it's just sad affair. My female friends couldn't believe they can't just go to gyno when they have issues. Many, incl myself once, just fly back to our native countries for gyno care.

I do however think that hella lot of people go to a&e when it's not an issue for a&e, but then I remember that for many it's impossible to get their gp, let alone specialost. Basically, to get a specialist care, sometimes person has no other option than a&e.
Sad.

I come from system where everyone pays a bkt in, it's taken off like your taxes, so free aylt the point of entry. If you don't work, state pays it for you. Like nin here? Never have I heard any of this emotive language in there. Never have I heard someone guilt someone into not taking Healthcare system's time. And while we greatly respect the staff, I also nwver aeen anyone running around with "I 😍Healthcare System" stickers on cars.... Maybe start calling it National Healthcare System instead of NHS in discussions and see the difference how people talk about it.

This is an excellent post. I completely agree. This year I decided to go private. I’ve cut back on some (quite a lot) things and put the money towards private health. My faith in the NHS system is zero

It’s good value for what we pay if you compare across countries but we don’t pay enough for the level of service we want. Taxes need to go up.

I think we should all stop being grateful for sub-optimal services, sloppily delivered, which are free only at the point of delivery and funded by us all for all if us. Some if it is excellent; some of it is diabolical.

Idiocies:
I was diagnosed with thyroid disease in 1990. Every single orescription thereafter was free, not just the thyroid ones.

DH and I have turned 60. We no longer have to pay for prescriptions. We are both still earning in excess of 6 figures.

Do not get me on the subject of child and adolescent mental health. Not only is it unavailable but GPs/CCGs offer no advice or signposting to alternative paid care yet tell you off if you Google something else

I think that if you weedled out the poor performers and the layer upon layer of middle management there would be far more efficiency and funding available.

In Scotland more my net has been poured into the General practice funds to provide physios CPN nurse practitioners and pharmacists to take some of the work from GPs so we can focus on the more complex cases that the hospitals used to manage only there are no physios CPNs nurse practitioners out there so we only have half our allocation of staff...a phlebotomist and some pharmacists(who are worth their weight in gold) so half the money is unused because we have to let the health board employ the staff and it takes months to get anyone in place.

We also have to sign up to certain "pathways of care" for chronic disease which are great but when you have to spend 2 days every 6 months taking GPs out if practice and staff to go to mandatory 3 hour meetings about flow pathways of care when actually a good practice planning session would be far more useful.

There is plenty of money it's just in the wrong place.

My son in law. Highly trained intensive care nurse, ran ITU during the pandemic moved to a job in Scotland and was told he couldn't take blood, or give injections or put in drips because the courses he did in England weren't valid in his new trust and they wouldn't put him on a course "because of COVID" so he was being paid quite high up his band for making tea and doing obs that the health care assistants can do. He has now left. It's an absolute disgrace. Imagine a surgeon moves from London to Newcastle and they say that they can't to the operation they've been doing for years because they trained in a different area, the place would grind to a halt!!!

@NotPersephone

I find the NHS adoration tends to be amongst the young. Once they’ve actually used it for anything serious or seen it neglect/kill a relative through piss-poor care, they realize that a taxpayer-funded service has limitations.

Using the NHS is like walking into an East German supermarket in the 1970’s. Thanks to (willful, at times) ignorance and misplaced British exceptionalism, plenty don’t realize how much better the rest of the world have it. The state of UK hospitals is a national embarrassment.

I was talking to a friend from Belgium about the trans debate over single sex wards. She looked puzzled and horrified by the idea that single rooms are not the norm. That’s an example of the problem.

If the NHS was so good, someone (other than Venezuela/Cuba) would have copied it. We should adopt a European system - I’d be someone who paid a lot more, but I’m happy with that. No amount of tax money will fix the NHS. We saw under Brown that the massive budget increases didn’t get to the front line - it was trousered by hcp’s and often pissed away on vanity projects.

One of the finest posts I've ever read on Mumsnet about the NHS, from someone who gets it. Actually, I don't think anywhere else in the world has copied the NHS.

Some figures on Gordon's budgeting for the NHS: 40% increase in funding produced a 4% increase in output and no discernable change in quality. It went straight into the pockets of staff through the Agenda for Change pay review, which still gives in-band increment rises every year above inflation regardless of the "NHS pay rise" everyone talks about on the news. It is one of the reasons there is so little sympathy in government now for pay rises.

Who made the decision about your ds @Musicaltheatremum?

I have lived in many countries over the years - mainly Northern Europe and North America.

The health care I have received in all of those countries has been miles better than anything I have experienced in UK. In all of those countries treatment has been free at the point of delivery. Costs are covered by (usually compulsory) insurance schemes.

I am constantly astonished at the way the NHS is lauded in UK. I can only assume that none of those people have ever received treatment in another G7 country.

@NotPersephone very well put and I entirely agree. I fully support a European system.

I have experienced far better medical care in France and Austria.

I think it should be better funded. The underfunding is part of the governments plan to make it so crap, that we adopt a system that lines the pockets of the rich.

I don’t think the American system is something we should aspire to, many countries have a private element to their health system, however they don’t go bankrupt due to their diabetes or premature baby.

My experience outside the U.K. is Germany. Private top ups are common, but you don’t need to remortgage your property in order to have heart surgery and people don’t die because they can’t afford insulin.

@Poppitt58 the problem is the extra funds have never been well-used and there is a lack of accountability.

@frumpety

How much would you all be willing to pay for a visit to a GP ? £20 , £30 or more ? If you only need to go once in a blue moon this might not be an issue, if you have a chronic condition that needs more frequent visits, it will be a tax on ill health and most people I know with chronic conditions are still working so would be outside the threshold for free care. Do we decide that certain conditions mean you can get free or discounted care a bit like certain prescriptions are free regardless of means testing ? If private healthcare suddenly becomes the norm, what happens to people who already have chronic conditions or who have recently had an acute illness or have been diagnosed with a life limiting disease ? Will providers have to take them on at reduced rates and full cover or will people be left with no health cover for conditions they already had ? How much can people afford to pay for healthcare monthly out of their wage ? It is unlikely that taxes would go down if a private healthcare route is taken, so you will be paying an additional amount on top of tax and NI.

There isn't only NHS or pay per visit. There are sysyems all around the world which are working.

I would happily pay on top of NI for healthcare.

So the NHS is perfectly funded, and they just spend it on the wrong stuff? Children’s mental health providers just spend it on water coolers and choccy biscuits and the government have no way of holding them to account?

I work for the NHS and the thing that is bringing the NHS to its knees is the attitude of some staff. There are so many shirkers who play the system by going off on long term sick leave and then returning for the required period of time and then going off again when the finance clock resets.
I have witnessed this for the past ten years.

My own mother was taken into hospital suddenly on Monday. Thankfully I am allowed to visit but I am not getting any information from anyone about her condition. I ring and they ask me to ring back. When I visit every day there is no one around and the nurses don't seem to have any information for me and I'm sorry none of them have a good bedside manner.