To think the NHS isn’t fit for purpose?

[SpicyJalfrezi]

It is in no way a criticism of individuals who work for the NHS. It’s the system. It isn’t working at all. I don’t really understand why we aren’t facing this as a nation.

@TheHouseILiveIn

Can't we use the £350M a week we are saving by not being in the EU?🤔

@XingMing

While the NHS is free, it becomes an option for the elderly and lonely and bored. Which is why the phone receptionists are dragons: my SIL reckoned she got timewasters just wanting someone to chat to, the same 15 people day in and day out.

That tells me we've not got society right, as a whole. If out elderly and vulnerable weren't lonely they would be looking for human interaction at the GPs surgery.

@XingMing

The NHS is losing its trained staff wholesale to Australia and NZ, people that we have all contributed to training. I have no problem helping to train the profession, but I think they should not be able to emigrate or resign for a few years after completing the training.

Tuition fees are pretty high now for medicine. By the time the trained staff leave the UK, they have already paid off the cost in overtime and goodwill. Junior doctors work way over their contracted hours and get nothing for it apart from a worsening in their contracts and a kick in their teeth. Of course they'll leave.

An A&e doc friend I knew went to NZ. She was working all hours & couldn't afford to save as her rent was shocking.

It costs the UK £163,000 to put each student through 5 years of medical school (this is after taking account of tuition fees paid. Medicine is a highly oversubscribed subject. I can’t see why asking graduates to either work for a set period of time for the NHS or repay the training costs isn’t anything but fair.

There is a reason why even more socalist governments haven't followed the UK model, it's easy to say it needs more funding and pretending the rich should pay more.

Labour wouldn't want to be in power to introduce the nordic model, thats the situation we are in while MN is filled with 24 hours to save the NHS style posts on every election. It's become a sacred cow which cannot be critisiced in any shape or form.

The nhs has been underfunded so much that it operates inefficiently.

Eg
You need well staffed rotas to run clinics/services. If people leave (due to overwork, retirement, other opportunities) you have a gap. For emergency rotas this gap need to be filled - by v expensive locum agencies, which get a cut. Existing staff overworked, which means they are more likely to leave. I met people who became agency nurses so that they could have a semblance of family life (as both parents were nurses and hospital would not give them flexibility with shifts).

No decent IT service download an image taken at another hospital? Do another scan.

Covid exacerbates this.

The NHS has become a "keep everyone alive as long as possible" service. Personally - and doubtless this won't be a popular opinion - I think we need to accept that people die.

I'd like to see more explicit and overt and thus fairer rationing.

Of all the systems to choose from, why the fuck would the tories lust after the US model (see graphic for how comparatively "successful" it's been over 40 years). Oh, could it be because it makes lots of money for private interests?

SophieHMS

The NHS has become a "keep everyone alive as long as possible" service. Personally - and doubtless this won't be a popular opinion - I think we need to accept that people die.

I'd like to see more explicit and overt and thus fairer rationing.“

Yes, of course people die.

In what reality though Is it acceptable to leave an 88 year old lying on the floor in agony for 10 hours waiting for an ambulance?

The reality is there could be tens of 80 and 90 year olds in the area lying on floors, in roads, with chest pain, wandering confused, accidentally overdosed, unable to get out the bath, etc etc etc. As a district nurse I've seen it. Many of whom should really be in care but have insisted on staying unrealistically in their own homes, muddling on dangerously and dare I say, refusing to pay for help.
Of course that situation isn't unacceptable but the sheer volume of them is often unrealised by many.

@SophieHMS

The NHS has become a "keep everyone alive as long as possible" service. Personally - and doubtless this won't be a popular opinion - I think we need to accept that people die.

I'd like to see more explicit and overt and thus fairer rationing.

Hmm. People say this, but I'm not sure they really mean it if applied to themselves or their own child.

The UK system is already doing less than other countries' systems do. Our life expectancy is already lower than other countries - you want that gap to worsen? That's your aim for our health service - people dying earlier?

Do people really want a higher chance of dying early from cancer than in other countries?

Personally, I want to be aiming for good treatment, which needs proper investment.

cptartapp

The reality is there could be tens of 80 and 90 year olds in the area lying on floors, in roads, with chest pain, wandering confused, accidentally overdosed, unable to get out the bath, etc etc etc. As a district nurse I've seen it. Many of whom should really be in care but have insisted on staying unrealistically in their own homes, muddling on dangerously and dare I say, refusing to pay for help.
Of course that situation isn't unacceptable but the sheer volume of them is often unrealised by many.

All sound and valid points. We are where we are though and waiting hours for an ambulance in an emergency situation is unacceptable whatever the age of the patient.

@Kendodd

Shortage of hcp has been an issue since I was a child. Successive governments just haven't trained enough, and I agree they should then have to work for the NHS afterwards or repay the full cost of the training. I think governments have decided it's cheaper to import doctors than train them.

I think criticism of the NHS as the moment is a bit unfair. In that early this year we had 40,000 people in hospital with covid while simultaneously delivering the biggest vaccination programme in history. To expect other services to be unaffected by this just isn't realistic.

There was a time when the BMA refused to sanction an increase in the number of doctors being trained! It's not just been a matter of successive govts not wanting to train more doctors etc - there's been union opposition to doing it!

@Badbadbunny when did the BMA do this? I don't remember this. Do you have a source?

Haven’t RTFT but YANBU. They were truly excellent when DH had cancer three years ago.

However, reading the thread where they’ll refer to ENT for a hearing aid because someone has a blocked ear from swimming just demonstrates the insanity that appears when it’s not a life-threatening condition. What an utter waste of time and money, especially when a hearing aid isn’t needed in those circumstances and there’s a cheaper and faster solution.

It's a system that's run in a way not hugely compatible with people's lives and expectations now - from how long we live to health/obesity issues to the expansion in treatments available etc. The "yes you can have an appointment but it'll be at 11.45 on a Tuesday eleventy weeks from now and screw you if you're a train driver/zero hours worker/carer for a disabled DC, and you'll actually be called in two hours later because reasons" approach does not work and is infuriating to many.

I'm troubling the NHS quite a lot at the moment - pregnant, 3rd trimester with twins. So there are scans, consultant appts and MW appts at least every two weeks (I have two this coming week). They are very good at flagging up concerns and sending me off for further tests/monitoring. I feel very well taken care of. But I often find I'm waiting hours and hours to be seen. So a mixture really.

And things like - as reported on MN - reluctance to dole at paracetamol or stronger because it costs £10 on the NHS but 35p at Tesco is absolutely wrong and seems like no human with a brain has looked into procurement. I suspect there is more to it.

Nudge theory in action.

The procurement baffles me, they should be able to get it cheaper than the supermarkets as they are placing huge quantities

The procurement baffles me

I think the NHS is actually brilliant at procurement and its size is a real strength in this. Its able to get drugs and medical devices much, much cheaper than the open market, so much so that some American manufacturers and politicians are real pissed off about it. I agree that there are some anomalies though. IMO very cheap over the counter drugs shouldn't be available at all on prescription, neither should things like gluten free foods. Although, even banning low cost drugs has its problems. We have really shocking and shameful levels of poverty in the UK, it's very possible a mother of a sick child wouldn't have even £1 to buy medicines for them. Nearly 90% of prescription in England are free.

As for our very elderly, I think families have unrealistic expectations sometimes.
I heard somebody on the radio a while ago complaining that their 89 year old mother was 'allowed' to die from covid. This person (not a medic) was angry that her mother wasn't put on a ventilator in hospital when admitted. She described her mother as 'fit as a fiddle' while also saying she'd been living in a care home with dementia for the last two years.

@TheVolturi

How much is health insurance does anyone know? Like they have in America for instance, do they pay a set amount and then pay per Dr's appointment /hospital visit or is it all covered? Here, with the NHS, especially at the moment it seems like you've got to battle to get seen for anything.

Not in the US but in a country where public healthcare is awful and anybody who can afford it has private healthcare in a US style system. I paid 500$ for this years insurance, it would have been about 700$ if I had chosen to pay monthly but instead I paid upfront and got a discount. This insures me up to 1million$ for inpatient treatment or outpatient treatment following an inpatient diagnosis. Any outpatient treatments I have to cover myself so visits to the GP, nurse, minor injuries etc. Basically the insurance will cover me if I have a major accident, need surgery, get a serious illness. There is also an excess of 750$ to pay before they will cover anything. My DP has a much better policy as he gets a discount through work he paid 1000$ premium but that covers inpatient with 250$ excess and outpatient with a 50$ excess. Both policies exclude maternity (would be a 6 month holding period if we where to add) and also exclude with no option to add on complications caused by contraception, mental health treatment or physical treatment as a complication of mental health (they won't help if you self harm, try to commit suicide etc.) The NHS needs some serious reforms but the US system is not the answer. I am lucky that I can afford to pay out of pocket for GP visits, blood tests etc. Many people can't and end up relying on overstretched charities, poor government options or bankrupt

There's a distinction to be drawn between the COMMERCIAL health insurance model that operates in the US and the SOCIAL health insurance models that are used in Europe, Australia and NZ.

The US model is fairly nakedly money-making, as are most of the hospitals, and I'd be the first to agree that this is not a road we should consider emulating. I worked in NY for a non-profit company that provided health care coverage (including a health maintenance organisation alternative similar to the Israeli system) to school districts, universities and educational institutions, so it's not even the only version used in the US. Medicare/Medicaid covers the old and unemployed but is only a safety net for emergencies, which is where the hardship comes in.

The social insurance model requires everyone including pensioners with an income above a modest level and employers to contribute a %, and the insured claims back the cost of appointments, tests and medicine. The insurance is non-profit and because it's universal, the risks are spread across the population. I believe that there's no wiggle room for insurers to exclude pre-existing conditions, and that maternity and children are always fully covered. Dental and optical extension cover is fairly common, especially optical in France.

The social insurance model requires everyone including pensioners with an income above a modest level and employers to contribute a %, and the insured claims back the cost of appointments, tests and medicine. The insurance is non-profit and because it's universal

That sounds like a massive amount of extra admin and cost that our system just doesn't have. Can you explain why it would be preferable and better?