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.

I haven't read the full thread but I agree. The NHS is not fit for purpose. I live in Malaysia and the healthcare system here is good and something I wish we had in the UK - a public and a private system that function alongside each other. You can go private for pretty much anything and at a reasonable cost. Insurance is not astronomical either. Often your employer will give you insurance but you may have to pay a larger out of pocket charge if you go to one of the more premium private hospitals.

Interestingly I saw a video bemoaning the US private health system and the extortionate prices allocated to various aspects of pregnancy and birth. They contrasted it with the cost that the NHS allocates to the same aspects of pregnancy and birth (everything in the NHS has a cost, just we don't pay it directly). What I thought was really interesting was that the cost I paid in Malaysia for my pregnancy/birth was pretty close to the NHS allocated costs. I don't get why there can't be a private system in the UK with costs like that.

More people in the UK need to use the private system to take the pressure off the public system. Like my parents - my mum's routine mammogram kept getting cancelled but instead of being able to get it done privately she's just waited and waited despite being well off and having private health insurance! And my brother, he has private health insurance but when he got a ski injury he insisted on getting it sorted via the NHS rather than using his insurance. I just don't get it.

My OH (cancer) had a full range of diagnostic tests when first diagnosed, i.e. full body skeletal x-rays, MRI scan, CT scan, numerous blood tests and bone marrow sample. Upon diagnosis the haematologist referred him to another hospital in the next town (same NHS trust), and the first thing the consultant wanted was ALL the tests to be done again as he said he couldn't get access to the first tests as "his system was different". The stupid thing was that some of the tests were done in the same hospital dept as the first lot, i.e. our nearest hospital. Is it really that difficult for test results etc to be transferred from one hospital to another within the same trust!

@user1497207191

My OH (cancer) had a full range of diagnostic tests when first diagnosed, i.e. full body skeletal x-rays, MRI scan, CT scan, numerous blood tests and bone marrow sample. Upon diagnosis the haematologist referred him to another hospital in the next town (same NHS trust), and the first thing the consultant wanted was ALL the tests to be done again as he said he couldn't get access to the first tests as "his system was different". The stupid thing was that some of the tests were done in the same hospital dept as the first lot, i.e. our nearest hospital. Is it really that difficult for test results etc to be transferred from one hospital to another within the same trust!

He said all he had was the referral letter from the first haematologist, and could access no other information at all, hence calling for all the tests to be repeated!

The pandemic has decimated health care across the world. Personally I find it bizarre that people are shocked by this. Since we fund our health service less directly through taxation and by paying less at the point of need than many it’s not too surprising we’re worse off than some.
There’s a consultation about raising age for free prescriptions in line with retirement age and the amount of bad press it’s getting despite lots of chronic conditions and benefits claimants being free and prepayment certificates capping cost at about £10 a month.

@BungleandGeorge

The pandemic has decimated health care across the world. Personally I find it bizarre that people are shocked by this. Since we fund our health service less directly through taxation and by paying less at the point of need than many it’s not too surprising we’re worse off than some. There’s a consultation about raising age for free prescriptions in line with retirement age and the amount of bad press it’s getting despite lots of chronic conditions and benefits claimants being free and prepayment certificates capping cost at about £10 a month.

The NHS was in a sorry state long before Covid though. The pandemic has clearly made things a lot worse, but it's not been "fit for purpose" for a couple of decades. Both my mother and father in law got appalling treatment in the late noughties at the height of Blair/Brown's spending - both suffered clinical mistakes and clinical neglect. Just look at the succession of NHS hospital scandals, or read the excellent "whistle in the wind" book about Lancaster hospitals by the consultant Peter Duffy which laid bare the management incompetence when dealing with crap doctors.

@KenDodd, it's apparently less burdensome than one might think because the admin of submitting the claim with all its documentation is left to the claimant. The insurance receives the claim and processes a repayment.

@HermioneWeasley

We are one of a very small number of countries with all healthcare free at point of delivery. Most European countries have an element of self insurance via mutuals so v affordable.

But nobody is prepared to discuss this massively widely used and successful model as they get up in arms about privatising the NHS.

Quite.

It's either NHS or American. No shades of grey in between. No discussion of a Dutch or German system, or French or Italian system.

Even breathe the assertion that you think the NHS needs totally reformed and the lefties are up in arms and just demanding more money is poured into it.

@HermioneWeasley, exactly!

There needs to be a sensible (ha!) discussion of the options, starting from the point that we already have a fairly extensive range of clinical/medical and outpatients settings ready so the argument could centre on how we'd design it for the best and cost-effective health outcomes if we were starting afresh. It's worth noting that the EU accession countries did not adopt the NHS model.

[quote ExpulsoCorona]@Badbadbunny when did the BMA do this? I don't remember this. Do you have a source?[/quote]
I'll be surprised if that reference is forthcoming. There's a very high likelihood that the comment was total bullshit.

The BMA has no authority to stop or block training places.

When the NHS is good it's really good, Trauma centres being a great example. The problem at the moment, aside from the obvious problem that is Covid, is that we spread the money too thinly and therefore end up underachieving across the board.

What is needed is some really tough conversations by a cross party group in order to take politics out of it as much as possible and to decided what the NHS can offer long term and what services it stops offereing, which people will have to pay privately for, insure themselves for or go without. Then we need to choose what services we will continue to offer but with additional charges, and finally we need to focus on the basic services we do offer and excel in them. Most staff join the NHS to provide excellent care and it is the constant inability to do this though no fault of our own that drives down moral and sees staff leaving in droves, we need an NHS that lets us do our jobs well and enjoy doing it.

Also we need to rethink elderly care and social care and sort this out properly so that DGH arn't bed blocked with the chronically ill other than for those in short term acute crisis.

www.gponline.com/9000-medical-school-places-available-2021-cap-lifted/article/1724173

It's the government that cap the number of places at medical school

Everyone thinks they have the answer. Personally I think it would be a lot more successful if led by people who actually work in the NHS, and largely led by those with clinical qualifications who’ve seen the care of thousands. Stop pouring money into ‘reform’ and management consultations and those from private companies who are clueless...

@privateandnhsgp I'll be surprised if that reference is forthcoming. There's a very high likelihood that the comment was total bullshit. The BMA has no authority to stop or block training places.

I remember something about 20 years ago about a doctors' union objecting to increasing the number of training places. Too long ago for there to be any links via Google. I think it was big news around the time of Blair's botched GP contract.

but the single implied alternative on MN always seems to be "current NHS vs 100% privatised"

This is it though. The current generation of Tories want to see the NHS privatised, not so that they can look around and copy the best of other systems, like the German one, but so that they can have the American system.

I say current Tories - MacMillan and Co realised just how popular the then relatively new NHS was and knew not to change it.

@BungleandGeorge

Everyone thinks they have the answer. Personally I think it would be a lot more successful if led by people who actually work in the NHS, and largely led by those with clinical qualifications who’ve seen the care of thousands. Stop pouring money into ‘reform’ and management consultations and those from private companies who are clueless...

Trouble is that by only consulting "in house" staff, you don't have the same breadth of experience of what happens outside, in other industries, other environments, etc. It just becomes an "echo chamber" consisting of people with exactly the same experiences who know no alternative options.

Other organisations move much faster to bring in new ideas, new technology, etc., so their experiences should be factored in.

What is needed is a proper mix of in-house existing staff/management, together with external people bringing experience of what is achievable outside the NHS.

@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.

Not only that but we write their student debt off. Why there isn’t an obligation to work in the NHS for a minimum of ten years after qualifying, I’ll never know.

@user1497207191 and @BungleandGeorge I can see logic in both your points but would add, from what I’ve personally experienced, there’s a lot of little empire building that goes on in the NHS both from clinicians and non-clinicians. That’s not an inherently bad thing if it’s harnessed correctly but more often than not it’s left to take on a life of its own.

For such a large organisation it completely fails to make use of the large workforce and pool of talent it has and standardise operations. You could work in three different hospitals and they would all run in completely different ways and to different standards. It doesn’t work imho, largely because when something works particularly well there’s rarely knowledge sharing across trusts, certainly in the lower level clinical and non-clinical roles it’s rare for professionals to actively seek advice or mentorship from outside their own trust.

@user1497207191

I did say led, which isn’t quite the same as totally excluding everyone from outside the organisation. In discreet areas it can work well, what doesn’t work is someone from outside coming in and not listenigg no to staff because health care requires very specific knowledge to understand it. Have you ever worked for the NHS? Do you not think that those from within are the best to judge what works and what doesn’t? The NHS moved over to remote working overnight during the pandemic, it was simply a question of investment.

[quote BungleandGeorge]@user1497207191

I did say led, which isn’t quite the same as totally excluding everyone from outside the organisation. In discreet areas it can work well, what doesn’t work is someone from outside coming in and not listenigg no to staff because health care requires very specific knowledge to understand it. Have you ever worked for the NHS? Do you not think that those from within are the best to judge what works and what doesn’t? The NHS moved over to remote working overnight during the pandemic, it was simply a question of investment.[/quote]
No. I've never worked in the NHS. But I have been the "outsider" who's gone into various organisations over my professional working life of nearly 40 years. In my case, it was to implement financial based systems, i.e. stock control, job costing, budgeting/forecasting, financial reporting, internal controls, etc. Time and time again, I've seen grossly inefficient ways of working that the in-house staff are overly protective of simply because they know no different.

I was once on a project that lasted two years to implement a stock control/job costing system. The firm in question had tried (and failed) several times to implement a computerised stock/job control system and had decided to write their own software to do it, hence needing an accountant to work alongside the software developers to tell them how to incorporate the "money" aspects. At the first meeting I saw immediately why their previous software implementations had failed. They had a weird parts numbering system, about 15 characters long and a mix of letters and numbers and other special characters (like a modern password). They thought the numbering system was brilliant as you could tell everything about the part by deciphering the number. I thought they were bonkers, because any half decent stock control software database could do the same based on a random part number but with "tags" attached to give data such as material, length, width, angle, colour, etc. I told them so, but they insisted on keeping their brilliant parts numbering system. 2 years later, a few hundred K spent on software and they were no nearer to having a system that worked as the software designers just couldn't turn their part number system into a workable database. The firm got in a new MD who basically scrapped the in house software dept, bought a stock/job control software he'd used in a different firm previously, and TOLD the parts staff, procurers, design staff etc to use a simplified part number system. Within a couple of months, it was up and running and the "old" staff couldn't believe how well it worked! They'd wrongly believed that their firm was so "special" and unique, that they needed a special numbering system and that an "off the shelf" database couldn't possibly have worked.

It's all about having people who've worked in different environments who have a different view, based on different experiences.

@XingMing

@KenDodd, it's apparently less burdensome than one might think because the admin of submitting the claim with all its documentation is left to the claimant. The insurance receives the claim and processes a repayment.

So it is most costly and burdensome than not having it, as we currently have.

[quote Kendodd]**@XingMing

@KenDodd, it's apparently less burdensome than one might think because the admin of submitting the claim with all its documentation is left to the claimant. The insurance receives the claim and processes a repayment.

So it is most costly and burdensome than not having it, as we currently have.[/quote]
But we DO have a costly and burdensome admin/financing system in the NHS. Next to a nearby hospital, there's a huge building which is the "business" unit of the hospital trust. There are huge numbers of admin staff dealing with the funding of the NHS between different trusts, different providers of NHS services etc. Virtually everything a clinical or medical worker does is "paid for" by making a claim, which then has to go through normal accounting/admin procedures involving multiple staff, leading to payments being made to the end service provider, i.e. the trust or private provider. Every operation, every surgical procedure, etc has a paper trail leading to the funding of it.

And I assume the other systems also have that, in addition.

Elsewhere, KenDodd you get a receipt on headed paper for professional services or test, or from the pharmacy for drugs; assemble the paperwork and submit it to be reimbursed the permitted amount. I presume (dangerous, I know) that not every alternative therapy is covered so you might not get your eg reiki treatments funded.

I'm not confident it is being underfunded, although I see why it's a popular opinion. Commissioning Support Units are working with hundreds of millions of pounds of the NHS budget with no accountability. I don't feel confident they offer value for money at all. And not to mention their dealings with private sector organisations which is completely kept out of the public eye.