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.

100% agree.

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.

It's worse than that I'm afraid. NHS budgets are held locally for local people (great!) but it means the NHS is essentially split it two between commissioners and providers. Somewhere, there are a team of commissioners "commissioning" the local hospital to deliver A&E services to local people. Does this need commissioning? Would you be wandering the streets with a broken leg if these commissioners didn't exist? And then team of contracting staff making sure the hospital has a contract to deal with your broken leg. And it goes on.

@XingMing

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.

In this modern World of the internet, apps, etc., there's no need for any kind of paper based system. It should be an app based system where the service provider makes the claim directly to the insurer, approval/acceptance could be instantaneous, leaving the patient only having to pay the excess and anything not covered by the insurance. The payment by the insurance firm to the provider could also be automatic if within certain limits, etc., and with a slight delay if manual approval by a human for larger/repeated treatments is flagged up.

I am confident it’s underfunded because we spend so much less per capita than comparable countries.

@TheCountessofFitzdotterel

I am confident it’s underfunded because we spend so much less per capita than comparable countries.

Does that include the private treatments paid for by the UK population or is it just the cost of the NHS.

Presumably, the US comparative figures are what the population pay, either directly or via insurance.

The UK figure would be a lot higher if it included all the payments for private dental work, private scans, private podiatry, private operations etc.

More than 56% of voters who voted in the 2019 general election voted for a party other than the conservatives.

Only two thirds of those eligible actually voted.

The voting system in this country requires reform too.

That's interesting to see TheCountessofFitzdotterel, I wonder what it looked like pre Tory. I'm still not convinced, not that I think it's wrong, just need more information. I assume that excludes public health spending, which I'd like to guess no other country is as batshit to separate out.

@JesusMaryAndJosephAndTheWeeDon

More than 56% of voters who voted in the 2019 general election voted for a party other than the conservatives.

Only two thirds of those eligible actually voted.

The voting system in this country requires reform too.

This will be made worse by the current election-rigging bill.

The UK figure would be a lot higher if it included all the payments for private dental work, private scans, private podiatry, private operations etc. Prescription charges... £9 a time has add up to some serious money!

Keep voting Tory and public services go to shit. What else is knew?

*new

@TheCountessofFitzdotterel

I am confident it’s underfunded because we spend so much less per capita than comparable countries.

I wonder why it doesn't show Spain, Portugal, New Zealand, Italy, Israel, Greece etc who spend less than the UK??

The problem with the NHS is that people are living longer and conditions have increased and people think that the NHS should cover them all.

When the NHS was created it was based around the times we were living in. Now we have significantly more conditions which need treating and people think the NHS is a bottomless pit and that their own condition is more important than the next one.

Look at fertility treatment for instance. Not just IVF but the whole raft of testing/treatments. When the NHS was created fertility investigations didn’t exist, and as such they weren’t budgeted for. Now we have testing and HSG’s and blood tests and IVF and the increase in neonatal care because IVF babies are often born earlier if they are e.g. multiples, and obviously the people who are struggling with those conditions feel that they should be treated.

But what has to give for that to happen?

Plastic surgery, counselling, various rehabilitation programmes, and that’s before we get to conditions which already existed but which are suffering because A, other treatments have entered the arena, and B, because even advances in those treatments have meant that treating even life-limiting conditions has increased in cost.

We need to start having honest discussions about where the NHS draw the line at what should and shouldn’t be treated. And IMO treatment should start with existing conditions. IVF absolutely shouldn’t be covered under the NHS IMO, we need to work on dealing with existing lives not creating new ones. Obviously if someone has paid for IVF then the same facilities would be available to them as to any other pregnant woman, but IVF is not economically viable when you consider that it has a low success rate, and is cost prohibitive.

HAving a baby isn’t a right. Having the opportunity to be treated for and survive serious illness is.

@HeartsAndClubs When the NHS was created it was based around the times we were living in. Now we have significantly more conditions which need treating and people think the NHS is a bottomless pit and that their own condition is more important than the next one.

Whilst I agree to some extent, the fact is that NHS spending HAS increased substantially over the decades to cover the expanding population, expanded range of treatments, etc.

In 1959, NHS spending was 3% of GDP. That had over doubled to 7% by 2019. That's a percentage of GDP so is already adjusted for inflation, population growth etc.

Blair/Brown trebled NHS spending over their 13 years in power. That should have been more than enough to modernise it, fund it and form a solid base for the subsequent decade or two. Yet, it was already running out of money a decade ago, due mostly to unaffordable commitments made by Blair/Brown on top of the 3 fold increase in spending.

HeartsAndClubs Interesting stance, I certainly see where you are coming from. The trouble is that infertility is a medical issue, and IVF improves people's quality of life. Which is something the NHS offers in lots of different ways. I'm at that age where many of my friends are having knee problems, and it's almost exclusively those who have spent their entire teenage and adult life exercising a lot. There is no medical reason they need their knees fixing. We don't just treat people on death's door. Essentially, I'm saying there is a much bigger question around non-essential and semi-essential treatments.

A retired GP acquaintance/interviewee (2004-ish) who started practicing in 1959 explained the difference in the treatment landscape in terms of cancer diagnosis. Their view was that if they had to break the news, there was very limited treatment available and end of life morphia would be the GP's best and final offer. Antibiotics in their relative infancy (but no MRSA either); no vaccines for measles, polio etc.; smallpox was not eradicated, TB was rife in poor communities, and there was no oral contraception. The NHS has pioneered medical innovations and techniques that keep people alive far longer than 65 plus two or three years that were normal.

@user1497207191 (I think it was you), the main difficulty with shifting to an internet/app-based system is the presumption that everyone has a smartphone, which cuts out a lot of the elderly people who are most at need of medical intervention. My DMIL could not even deal with an automated voice menu for five years before she went into residential care.

@SpicyJalfrezi

The NHS is amazing.
We need to pay more tax

I lived in The USA and health far to crazy expensive due to over capacity and the cost of drugs will freak you.

Works well in Switzerland but costs 500£ a month!! Insurance

So the nhs is great!

I disagree based on personal experience.Very grateful for the treatment I have received.

Get lost Tory bot

The nhs could be fit for purpose if funded correctly

The uk government spend roughly £3000 per head on healthcare

The USA spends £8000 per head.

It's not lack of taxes, it's lack of funding.

In one of the only "free" healthcare systems worldwide we spend just under the median average worldwide.

@MySixEggs

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.

Do CSUs still exist? They were so unremittingly awful when I worked for one I kind of assumed they’d been abolished. Well, there’s a huge saving right there if they’re still in business.

The healthcare spending of the USA's population averages out at £8,000 per head per annum... but it is NOT spent by the Federal or State governments. It is spent and funded by individuals and their employers' health insurance programmes.

Did you know that many people who saw their GP did not have a medical condition at all, but had a catalogue of other conditions like loneliness and sadness ( from losing their partner, or job, for example).

That is why social prescribing has been brought in, to signpost people to community resources and voluntary groups.

There is a lot of physical and emotional ill health caused by poor living conditions, lack of suitable housing, poor nutritional choices, lack of exercise, a lack of a robust support network like friends and family and lack of money.

A huge toll on the nation's health is from poor or stressful working conditions or domestic environment.

It might surprise some to learn that the biggest killers are cultural and often stem from lifestyle choices from living in that particular culture, which is why there are variations between different countries as well as different parts of the country such as rates of heart disease, dementia, domestic violence and diseases related to alcohol, smoking, obesity and rates of accidents.

However, asking people to take more responsibility about the choices we make, what we eat, what we drink, who we hang out with, who we choose to live with, how we choose to spend our time, is not something that a democratic country can do.

How can a doctor tell someone not to eat so much as it will cause heart disease down the line or diabetes?

How can a doctor tell someone to lose weight or the sheer weight of fat on someone',s frame is going to give them painful joints down the line?

People generally don't want to listen to public health announcements. People generally say when asked not to eat so much that they hardly wait anything when the reality is if they were taken to somewhere like Yemen where there was a true famine they would lose weight soon enough.

So for the most part, there are psychological reasons why people make the poor choices they do and that is something the NHS is ill equipped to deal with.

You will never get good physical health in a nation without good pyschological health.

To get good psychological health you need to have strong communities, strong families, a kind and thoughtful inner circle, a good job and a good environment in which to live and bring up your family.

Only then would the NHS be able to function as intended.