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.

The NHS is chronically underfunded to ensure that we eventually go to a hellish American system

Well I don't know if that is the intention of the powers that be in the UK but there are so many better alternatives than the American system. We really ought to be looking to Europe not America.

I live in a European country where I can visit my GP within 24 hours or two days at most, for a very modest price of about Euros 23 for an ordinary 15 minute consultation, 75% off which is refunded by my obligatory health insurance (reimbursements are means tested eg the poorer you are the more you are reimbursed). There is not a shortage of doctors and the hospital facilities are superb. You can still call out a doctor to visit you at home. And ime, in towns, you never have to wait more then 10 minutes for an ambulance. And the health insurance in Europe is NOT at all the same as the American model, where insurers wield huge power. Insurance in my European country is mandatory, non-profit-making, and state regulated so no huge profits are made, it is fit for purpose.

The benefits of the system are that by paying a modest amount for treatment, people do not abuse the system. They turn up for appointments and there aren't as many fights in A & E. And they take more responsibility for their own health. And as the op says, you the patient have more power, autonomy and choice when it comes to your own health. You are not a passive recipient grateful for anything you can get.

Most of my European friends have the attitude that their health is a top priority and therefore they are happy (I would go as far as to say proud) that they pay towards it.

They do not understand the English mentality where some people seem happy to pay a couple of thousand to operate on their dog, but are not prepared to put a fiver towards their own health.

It has to be said that it is a massive cultural differences between Brits and Europeans though with Europeans in general being accustomed to having less disposable income than Brits because they are used to paying higher taxes for the public good.

There are some heroic staff and really excellent areas of competence in the NHS but it has been running on emergency measures and good will for quite a number of years now and the current model, with an ageing population and more complex treatments, is not sustainable.

It’s because the Tories have underfunded it for years.
I recently was diagnosed with a condition that has affected me my whole life but when I was trying to investigate it under the NHS I was constantly fobbed off and actually laughed at in one appointment. Eventually I asked for a blood test for the specific thing and my new surgery are great so they sorted it out but my referral for a biopsy would have taken over a year to come to anything on the NHS. My local NHS hospital has shut one of the wards that do those biopsies. Luckily a family member was able to help me so I could go private - I’ve never been able to even dream of paying for healthcare before. It’s just such a shame. Especially when so many doctors and nurses work so hard in a system that cannot work as well as it should.

Its not national either, each uk country has their own NHS with their own rules. You go outside of your uk country and get ill or need assessment you can find yourself being charged, and, worse refused treatment in your home country.

I live in Wales, worked for NHS Wales for years. My conditions cannot be treated in Wales only England. I was forced to pay for a private consultation as NHS Wales refused to fund it, and, my trust refused me time off to attend (I needed a day, they allowed ten minutes). The consultant put me on his NHS list but because I live in Wales I couldn't have the medication on NHS I was forced to pay. It cost £300 for three months. I was allergic to it. It took staff fighting in a&e for me to get treatment because it was "from England". I got referred to a specialist unit, again annual leave, but needed a week off which was denied last minute - I then got a nasty letter for being irresponsible, particularly as a NHS worker. When I eventually got admitted and tests done, treatment recommended it was denied because he was English. When I went back he refused to treat me anymore - he had no understanding that my NHS Wales trust or the, then, Welsh assembly could refuse gus recommendations along with a long diatribe about how he's Indian not English (of course he didn't understand what they meant the grammar being appalling).

I was taken ill in Warwickshire and refused NHS treatment as I was a foreign visitor and must pay. Couldn't pay, sent home to get treatment.

Experiences from working there were people that people just wasted money. Example I wasn't allowed to book hotels for courses online, only direct (waste of money) but the worst was the "essential" meeting I was told I must attend or lose my job. My manager had gone off on leave leaving me with his job and mine, I was up to my neck in it, zero time to spare. I went, a ten hour round trip by train for a "six hour meeting". Turned up, in a foul mood, then we went around the table to find out what was happening. Nothing was the reply from every single one of them. That was literally it. Then it was off to have our lovely four course lunch and chat (as a woman i was asked if I was married, if I wanted to see the bedrooms and that was the end of anyone speaking to me after they got short shrift) for the rest of the day. I was fuming, I'd a pile of work to do and couldn't bring it with me so it went undone. It was an utter waste of time and money, to make it worse my train back hit cancelled half way and I spent the night on a station. When my manager got back he informed me it wasn't appropriate for me to attend national managerial meetings anymore.

I needed a pen. Not allowed to buy one must buy 200 which worked out cheaper (per pen) and leaked. I ended up buying a bic myself for 50p. The box cost them £5 and none of them worked.

The sheer number of senior managers in NHS Wales slamming projects into walls, because it's not like it's their money (yep heard over and over again) just to move on to another. Not only projects but trusts/health boards too. Oh well never mind it's the NHS it's what people expect. Haha.

By the end of my post i was struggling with my disabilities (which I got bullied for, though not by my manager) and the sheer incompetence of people who saw the whole thing as a joke. Very very few saw it for what it was.

Despite working for years before in make dominated industry that was the first time I'd actually I seen 'the old boys network" in practice.

@SchrodingersImmigrant

Of course there are lots of systems other than the NHS or pay as you go, which is why I have asked the OP to tell us how much they personally pay and what it includes. It would be useful to know which country they live in as well, as some systems are still subsidised by the state or the employer.

Actually @Poppitt58 where I live the local MH Trust was given an extra £2.5m in 2016 for CAMHS. They pissed it away on an extra layer of bureaucracy which resulted in no or minimal additional support for young people.

The lack of access reached crisis levels and resulted in an independent review in 2018 which concluded the service wasn't fit for purpose and needed to be transformed. Just like the review said in 2009 and in 2014/15.

And meanwhile community CAMHS rumbles on with the same old incomepetents who tick boxes to cover their own backside and assess and assess to say the same young person who cuts and ods is safe without immediate therapy and after the next crisis (which could have been avoided) and overnight admission via A&E (that costs about £1000) the whole thing happens all over again.

And that was fifteen years ago.
Much worse now.

As a worker for the NHS I have to agree with what a lot of people are saying here, the NHS is totally underfunded BUT it also wastes a lot of money too. There are so many restrictions where we are only allowed to order from certain areas and they know this so they bump the prices up, for example we can get a decent oximeter from amazon for £20 but the ones we have to order are £165! This is just a small example of the waste of money.

Also, it is massively understaffed. I've lost count of the amount of emails and memos that has been sent out asking staff to cancel or reduce their holidays so they can cover shifts etc. I've been onto wards where it looks calm and quiet and staff are standing around doing nothing THEN I found out the "staff" were actually student nurses and didnt have a clue what they were supposed to be doing, didnt have the correct log ins to systems etc

I agree, things need to change but also the general public need to stop abusing the service too

The NHS is crap.

The service it provides is hopelessly inadequate and its problems are not just caused by underfunding, although that is obviously a factor. The NHS is over-bureaucratised, over-politicised, inflexible and stuck in the past. Like all public sector organisations It is run for the benefit of its employees, not its customers. It still wastes tens of millions of pounds a year sending out letters to patients, decades after all other large organisations had moved on to modern methods of communication.

NHS apologists love to point to the US system which provides world class healthcare to the insured majority, but neglects the uninsured completely. What they fail to understand is that both systems ration care in different ways. The US system by ability to pay, the NHS by waitlist.

Britain needs to learn from other comparable developed countries which have far better healthcare systems that we do based on hybrid public / private models and universal insurance schemes. Germany & Israel might be good places to start.

Actually where I live the local MH Trust was given an extra £2.5m in 2016 for CAMHS. They pissed it away on an extra layer of bureaucracy which resulted in no or minimal additional support for young people.

Why are the government incapable of holding them to account?

I’m sad to say but the dismantling by underfunding of the NHS is part of the Tories’ plan to privatise: either partially or completely. They want the NHS to fail or for people to believe it isn’t fit for purpose so that contracts can be handed to their friends or rich Tory donors.

@Bumblecattabbybee and what if your insurance doesn't cover something? You are prepared to fork out on the balance most of the time healthcare is easily accessible and good?

It's massively underfunded , and we pay too little, and will only realise it when rationing really ramps up and have to pay for private insurance on top.

@Poppitt58 because the government provides the funds to CCGs and it's the CCGs who commission the services and are often told utter crap by the Trusts they commission. They are getting better at making them accountable but a great deal more needs to be done.

By the way, just because I praised the European health care model in my post below, does not mean that I have much faith in private hospitals in the UK either. My aunt had a hip replacement in a private UK hospital where no doctors were on site overnight. But that is down to the way the private and NHS systems have evolved together in the UK, as opposed to a privately funded national, state subsidised and regulated European model.

People say the NHS Is underfunded. I don't know if that is actually true, but I don't think the funding is necessarily directed to the right places.

Primary care is clearly a massive issue with access to GPs being so heavily restricted. Before covid there were lots of missed appointments, and people talked of introducing a charge for appointments, but I assume that's not a problem now as GPs are not really seeing people in the same way and doing most calls online/by video etc - and yet people still can't get a slot. Lots of problems could be dealt with by nurse practitioners so we need to train more of them.

The NHS thinks it's doing you a favour because it's free at the point of need, but it is not free, we all pay for it, so that mentality needs to change.

So does the culture of covering things up rather than accepting blame and putting procedures in place to avoid errors as far as possible.

There is no easy answer, we need to pay more for it but we also need to look at how it’s run & make some changes.
We need a more joined up system that links in with adult social care, we need better more joined up admin/booking processes, we should be looking to use tec to decrease the need for unnecessary gp visits (as an example, if you have a simple problem like a rash or ear infection a service that you can email with symptoms and/or photos - they email back saying yes you need a cream here’s a prescription or no you need a gp. This could be centralised rather than having to go through our own gp)

I don't think that people should pay for GP appointments, but I think maybe they should if they don't show up. People do take the p*ss e.g getting paracetamol on prescription when it's 20p in Tesco.

I do think it's massively under-funded though. Since the coalition and austerity it's been starved of money. Remember Cameron saying 'cut the deficit, not the NHS' Ha! And Bojo talks a good game but doesn't give a toss really. But give Dido Harding 37 billion.

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.

I found this attitude quite offensive. A big proportion of NHS budget is on staff and up until then the pay was pretty poor. I was earning far less per hour in my NHS post than in a similar job in the private sector (changed because I went part time).
Increments are not automatic and the annual pay rise has been non existent for several years. Looking at my payslip I get no more now than ten years ago because of increased pension and NI. Why do I stay? - because I work with a fantastic extended and dedicated team.

@Goodallsfolly can I ask you how much you pay for your health insurance, how much is subsidised by the state or your employer ?

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

In excess of six figures? You both earn £1,000,000? Blimey!!

I genuinely don’t have a bad word to say about it.

Iv always been seen when needed and it’s saved a few family members lives.

I do agree that a lot of money is wasted though and I don’t think ALL treatments should be free.

At the moment I’m really not impressed with it. I got a letter telling me to book a smear test so I phoned my gp. The receptionist told me they no longer book appointments by phone and I have to use their online chat to request one. So I went to do this and it’s only open between 8-9am each week day and closes early if they are busy. I still haven’t been able to make an appointment that they asked me to nake. Such poor service and it feels like they are using covid as an excuse to do nothing

The NHS is over-bureaucratised, over-politicised, inflexible and stuck in the past. Like all public sector organisations It is run for the benefit of its employees, not its customers.

This exactly, also the public are pretty bad at accepting change, I would love to see more of the NHS digitalised - do women still have to carry around paper pregnancy notes and then a red book for DC??

I thought that was mental 9 years ago when and I would not be surprised at all if this is still the case.

@Mirrorxx

At the moment I’m really not impressed with it. I got a letter telling me to book a smear test so I phoned my gp. The receptionist told me they no longer book appointments by phone and I have to use their online chat to request one. So I went to do this and it’s only open between 8-9am each week day and closes early if they are busy. I still haven’t been able to make an appointment that they asked me to nake. Such poor service and it feels like they are using covid as an excuse to do nothing

Why can’t you log on at 8 and make the appointment? If you know it’s 8-9 why wouldn’t you be ready to go online just before 8 and make one?

I think the system is broken .

It needs an overhaul. But no political party is willing to do what needs to be done. Its political suicide.

So instead they are letting it die a slow death- if you can pay for private treatment you are ok- unless you need ICU facilities/ A and E.

It needs to change to an insurance/ small copayment system. But no one is willing to do this.