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.

They have been moaning like fuck that people have put on weight in lockdown. They even have a NHS advert running about it. And now they want another one?

@XingMing

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.

Federal spending is 3100 USD so working the same as the uk. Considering that is such a limited amount of the costs incurred by the population as a comparison it's still shocking. The £8000 includes the amount the us population and employers pay in insurance premiums.

It no longer matters how much money is budgeted for the NHS. Management will be the ones creaming it off the top, before that money goes to where it needs to go. NHS management now largely consists of non medical professionals, who are making sure they are earning as much as possible.

The problem isn’t the amount of money it gets. The problem is the amount of money that management wastes.

Covid has just exacerbated this. More and more I’m thinking that we were sold down the river with the “save the NHS” reason for lockdown. The intent really seems to have been - lockdown to enable them to “change the NHS”.

Because that is what has happened. It has changed, and it will never go back. More and more services will be cut. Management will get richer and richer. And the public will be asked to pay more for the “privilege”.

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.
Unfortunately so. And I don't reckon they're going anywhere anytime soon!

IMO very cheap over the counter drugs shouldn't be available at all on prescription

Just to chip in here: sometimes there are valid logistical reasons for this. I get paracetamol on prescription. The reason for this is because the quantity I am prescribed for my chronic condition would be virtually impossible to buy OTC, as there are strict restrictions on the amount an individual can buy at any one time. I don’t have the mobility or the money it would cost in travel to trawl round 5 or 6 pharmacies and supermarkets every four weeks to buy the amount of paracetamol a pain consultant has determined I need.

@OnlyTheLangOfTheTitberg surely a neater/cheaper solution would be a note on the pharmacy system / consultant letter certifying that you need x at y interval? I presume that isn't an option or you'd have done it.

I just moved to Edinburgh. All our local GPs register new patients only in a fixed window each week and take a limited number of new patients (eg 10 new patients per week. You must come to register between 11 and 11.30 on Thursday).

Tried to register last week. Arrived exactly on time and was turned away, as there were already the maximum number of people waiting. Finally registered after I went back this week, arriving 2 hours early. I wasn't the first in the queue either and the first 6 or so of us all arrived more than an hour early after being turned away in previous weeks.

It feels like the NHS is on its knees. This kind of rationing of the service is a really bad sign.

[quote TheWayTheLightFalls]@OnlyTheLangOfTheTitberg surely a neater/cheaper solution would be a note on the pharmacy system / consultant letter certifying that you need x at y interval? I presume that isn't an option or you'd have done it.[/quote]
Bit like a prescription then?

Add to that there are restrictions on how much medication can be dispensed at any one time on prescription as well as buying otc. The best a doctor can do is issue a medication on repeat prescription, usually four weekly. There are good reasons for this (surveillance/monitoring) but it is a cumbersome system designed to work in one with more capability.

I think pharmacists should have more low level prescribing capabilities in general, once an individual has tried self care and otc options it’d be nice to have access to the next level of treatment without having to attend a GP surgery. I would like to be able to obtain antibiotics or oral contraception or certain children’s prescriptions without bothering the GP. I believe there are some but I’ve not come across one locally personally. Whether they’d want to take that on or not is another question.

I agree, however the next step will not be ensuring the nhs is fit for purpose, it will be privatisation. For some that's not a major concern. For somebody like me with a DD and DH both with pre-existing conditions, it's a terrifying thought.

That’s the thing isn’t it @peboh. If treatment is put solely in the hands of private companies they will cherry pick the profit and flatly refuse to take on anything that dents their profits. The Hitchingbrooke/Circle fiasco should be a warning to us all. Privatisation is all very well but we’re not starting at a point of selling off a well run organisation. It’s a doer upper at best.

As an aside, I was chuffed to get private medical insurance in my new job and though I could finally get my back/joint issues properly assessed (joint issues are linked to another diagnosed condition I have). It was rejected point blank as pre existing despite only ever being managed by the GP/private physio and referral onwards being blocked.

The system is on its knees. Decrease in funding, increase in demand. I have several medical conditions and haven't been able to get an appointment for several months.

But I admit I did cringe when I was reading the "worst PFB moments" thread, most of which seemed to be instances where parents have rushed their children into the doctors/A&E for something completely innocuous. And then find it funny years down the line

@Cornettoninja

That’s the thing isn’t it *@peboh*. If treatment is put solely in the hands of private companies they will cherry pick the profit and flatly refuse to take on anything that dents their profits. The Hitchingbrooke/Circle fiasco should be a warning to us all. Privatisation is all very well but we’re not starting at a point of selling off a well run organisation. It’s a doer upper at best.

As an aside, I was chuffed to get private medical insurance in my new job and though I could finally get my back/joint issues properly assessed (joint issues are linked to another diagnosed condition I have). It was rejected point blank as pre existing despite only ever being managed by the GP/private physio and referral onwards being blocked.

It's a terrifying though definitely. When lockdown happened and so many people started questioning the nhs I did some research, and it appears the majority that will not touch a pre existing condition, and the ones that do the premiums are beyond anything I could afford to pay monthly. Of course if that happens we get on and have to, but it's not something I want to see.

That's so good for you, and I do think private has its merits for so many things like that where it isn't a priority within the nhs.

I would second that the Belgian system is very good. It is efficient, quick, and has a mix of private/public. When I fell and damaged my knee, I went to see the GP, who prescribed physio. I rang the physio (self employed), had my physio sessions for which I paid at the end, and reclaimed the cost.

Xrays/scans didn't just happen in hospitals. I went to what looked like a private house, but was in fact a clinic at the front, for a liver scan. Some GPs, in conjunction with a local hospital, funded a dedicated clinic where you could see cardiologists, dieticians, physios etc.

We need a reform of the NHS. There are other excellent systems out there. Co paying, as in Belgium, might be one of the ways to go.

PFI contracts need to be ended now. I think those companies have done very well from those contracts already.

They can find money for ridiculous diversity training though.

@Darnley

They can find money for ridiculous diversity training though.

House!

@Darnley

They can find money for ridiculous diversity training though.

Why would they need to? The NHS has one of the most diverse workforces in the world. This is just more Daily Mail bollocks.

@TheHouseILiveIn

I'd like to know the thoughts of those who think it IS fit for purpose

I know! I can’t believe so many people think it is? Have you rung 111 lately?

@Darnley

They can find money for ridiculous diversity training though.

And lots of very expensive artwork!

The artwork is usually loaned via a charity.

Co paying, as in Belgium, might be one of the ways to go.

This is effectively what we have for dentistry (if you are lucky enough to be able to find an NHS dentist).
How's that working out for us do you think?

Having used the healthcare systems of a number of, mainly European, countries as a resident I have to add to the calls that there is more to healthcare than a free NHS or a bankrupting US system.

Many countries have truly affordable copay systems and they still manage to provide comprehensive healthcare to lower income households. There are many benefits to some of these systems, including the option to go directly to specialists such as gynecologists rather than wading through a GP referral.

At one stage I had (through work requirement) the most comprehensive worldwide health insurance policy you'd ever seen. Almost everything you could imagine, including alternative therapies like massage, was included plus full US coverage. Even that ridiculous policy for two adults cost me 'only' €150 a month, pre deducted from my salary.

@Blossomtoes

The artwork is usually loaned via a charity.

Quite. Or it's done by local GCSE or A level art students. Or it's by local artists using hospital corridors as exhibition space, and it's for sale. But carry on slating the trivial little things, why don't you?

Agree. I have worked in the NHS for 22 years. Pre Covid the NHS just about had its head above water, JUST. Now it's sinking, it really feels very broken where I work. And I really don't think there's a quick fix solution. It needs a total overhaul.

@Blossomtoes

The artwork is usually loaned via a charity.

The case I'm talking about isn't small paintings/ornaments. It's a huge modern art statue firmly fixed in place outside, plus a modern art pattern attached to the entire side of a 4 story maternity unit.

The system worked fine when it was properly funded and had less government interference. Then the Tories decided to introduce daft "reforms" and deliberately run the NHS into the ground.

We dont need a new system, we need a change of government.