To think the NHS is screwed

[jaspercabbage]

Elderly relative had cancer related surgery before Christmas. The surgery went well but there has been no follow up appointment with an oncologist since. Recently they have taken ill again (clearly to do with the cancer) and have been to a&e four times in two weeks. They are treated for the sickness then sent on their way for the same thing to happen a few days later.

They were admitted again earlier in the week and have been stuck on a trolley, in a bay, in a&e for two nights now due to no beds in the hospital. This is an elderly person quite possibly now requiring end of life care and they can't even have their family with them. I just can't believe it's this bad.

I'm also due to have a baby later in the year, could be complications and to be honest I am shit scared about staff shortages and aftercare. What if something goes wrong in labour and there is nobody to deal with it at the time?

How can things have got to this point? The people are crying out for life going back to normal clearly haven't had to visit hospital lately. Although this is probably to do with a lot more than covid - underfunding, Brexit at so on.

Just a rant really but interested to hear other peoples thoughts.

@Bywayofanupdate

Yanbu, we have just taken out private health insurance as if something serious happens to one of us I am not risking being stuck on an NHS waiting list.

Unless it's something really, really serious, like a stroke, or getting hit by a bus...

Private sector wont help you then, well, not until they've waited to see if you survive, then they can offer you some enhanced physio and outpatient rehab.

@newstart1234

I personally don’t think it’s the ‘best’. I don’t think there is a best. But I do think it’s the best of the alternatives for the uk. It’s context specific.

Our "context" is that the concept of the NHS is fundamentally flawed, the product of juvenile politics that sees the role of the state as being the redistributors of wealth. It needs replacing.

No amount of reforming, tinkering, Tory blaming, or extra money will save it. We could cut funding for every other public service to the core and chuck the surplus at the NHS, it would just gobble it up, continue to misperform and hold its hand out for more.

A continental-style insurance system would be a huge improvement, but almost any healthcare model would be better than the one we're saddled with.

@NotSoLittle

HRTFT but USA isn't the only model for a health system - France and Germany seem to have excellent outcomes (apparently for similar costs). Maybe we could look at what they're doing that works?

Absolutely we should. We must in fact.

But so many people are happy to see their relatives, friends and even themselves die prematurely by its hand, just so they can blame the dreaded Tories!

No the context is the society that the health system operates in. Social care provision, education, housing, labor market are all relevant.

The German system has grown organically to the way it is now, as has the nhs. Both have problems in their function and design. Changing from one to the other would be very hard I don’t understand why you’d even bother - the work would be better spent improving the one you have.

I don’t have any problem understanding how markets work but food and healthcare are not comparable.

I don’t think money should be thrown at the nhs. I (And people I know who work clinically incidentally) think we should think about what areas should have money put in and other areas cut back. Social care provision also, prevention (sugar tax etc). That’s not throwing money at the nhs at all.

I don’t have any political loyalties. I’ve heard this is typical of millennials; i don’t feel personally connected or disconnected from any party. I would never rule out voting Tory or any party tbh. They at the moment seem to just smash things to pieces not try to improve anything.

[quote Alexandra2001]@lightisnotwhite since when did 2001 become the "late 2000's?"[/quote]
Oh sorry missed the “late” reference. This is 2018. The worst A&E performance since records began.

nhsproviders.org/the-real-story-of-winter/introduction-and-overview.

I don’t have a view as such. It’s always been pretty good on the odd occasions I and my family have had to use it.
The point was only every single year there are complaints the NHS is screwed and as I said it’s been for the last 50 years I remember.

[quote XingMing]@Alexandra2001

for those that say "insurance funded model" how does that work for millions with pre existing conditions?

European government health service insurance have to accept everyone regardless of pre-existing conditions... they are not allowed to pick and choose. But it is often cheaper for younger people to buy their co-payment element in the private sector because the premiums are lower thanks to the risk profile. Like car insurance, but the other way round![/quote]
European countries operate many different types of healthcare

The vast majority of healthcare in all Eu countries is done via taxation and employer contributions.

Plus of course, they have grown up with their systems, if we changed to a private funded insurance system, which private company would want to take on older people and/or people with complex health needs?

Each and every year we fund the NHS approx 1% less in GDP terms than comparable european countries, that adds up.

One of my bug bears is the total lack of preventative healthcare measures.

@lightisnotwhite

2018 was after 8 years of austerity.

I found the NHS pretty good from the mid 2000s onward but there is no getting away from the 1% yearly increase it has had over the last 10 years compared to the historic avg of around 4% - that has a knock on effect and one reason it has been so badly affected by CV.

Why the 'dreaded tories' ? They haven't managed it well. No one trusts them to handle any major changes, let alone regarding the NHS.
If Labour did try to reform things the press would absolutely be on their back.

YANBU
I've known for a while it's in a state. And it's not the clinical or nursing staff at fault, it's the management teams
When I had DS, at 28 weeks, I was told I may have to go to a hospital in a place 3 hours away, where I knew no one and had nowhere to stay as hospital couldn't accommodate me. I also had DD who was a year and a bit so needed me too. They said nothing they could do, they had the space but 6 of the incubators were awaiting fixing or replacement. Luckily, just as I had DS one became available as baby went into normal cot, but they were so short staffed they forgot to give me medication to trick my milk into coming in.

Recently, GP has sent me for a hysterectomy. Literally would be life changing for me as I have so many internal and hormonal issues. Been told this is the best course of action.
She sent me as urgent referral in March last year. Was told to call in May by an alert on the NHS app as I hadn't had an appointment through yet.
When I called, was told they had triaged it as non-urgent. Finally seen in January this year.

First thing the consultant said was "I know you're here for a hysterectomy, that's the best thing for you, but you won't get it because they won't fund it unless you have a coil fitted first.

I point out this wasn't possible due to my internal issues and injuries. That I was told my insides are so screwed up, it would perforate me. That because of other issues, if it didn't it would be enveloped by scarring which is overactive in my body.

She agreed with all this, but said the management lot would say I had to risk it first and then they "might" consider the funding. She even tried to put a positive spin on it by saying "if it does go wrong you've got more chance then eh?"

I walked out in disgust.

Similar, we've tried 4 times to sort a Cahms referral for DS. They've lost the paperwork every time, variously blaming me, the GP, the postal service and school. Our hospital knows he has Aspergers but you have to get it rubber stamped by Cahms here regardless.

He also has no firm diagnosis for his lung issues. None at all. And we've just been discharged by our 4th hospital as I "cope well" and they "have a waiting list" so need his spot back. Without a consultant I can't get access to his steroid drugs as GP will only give them when he has this. The same GP who didn't put his in the shield group and now won't do his jabs as a vulnerable patient as they refuse to see him as such.

I hate it all. It's terrible and it's deliberate because the government wants us to get to the stage of saying it had a good run but it's no longer working. With money it would be.

The NHS is unmanageable, regardless of who is the gov of the day.

Labour, under Corbyn was keen on statism. Corbyn wants everyone working for the state to be directly employed by the state and he wants to nationalise a lot of industries so that the state has more control over them.

People claim that Corbyn's Labour nationalisation agenda was very popular. I imagine that's because most of the electorate haven't lived with nationalised industries. They're crap through management inefficiency (they have an infinite amount of money and they spend it) and political interference. This is why people would be on their back. Or very suspicious of their intent.

Converting the NHS into a better more efficient model has to be a gradual conversion over a fairly long time period, say around 50 years beginning with a health ticket of a limited value to be spent into the newly evolving market initially. Fair means, those who are the most productive will get the best available and those who are unproductive won't - they will require to fall on the charity of others. In other words a system that does not force other people to sacrifice their lives for yours, nor yours for theirs.

It's not so much underfunded as poorly organised and over used. A lot of the middle management is clinicians that wanted to climb the career ladder and don't have strategical leadership and management training so systems are poor and inefficient.

In the UK our general level of health is poor. Look at the junk people eat and feed children. It's laughable how few people eat 5 fruit and veg a day. No one eats fresh decent food and exercise levels are shocking. So so much of the cardiac, obesity, hip replacement, cancer, bowel etc could be reduced by better lifestyles.

We need to start Incentivising good health and not funding treatment for things like obesity.

@Imnotafemistbut

The NHS is unmanageable, regardless of who is the gov of the day.

Labour, under Corbyn was keen on statism. Corbyn wants everyone working for the state to be directly employed by the state and he wants to nationalise a lot of industries so that the state has more control over them.

People claim that Corbyn's Labour nationalisation agenda was very popular. I imagine that's because most of the electorate haven't lived with nationalised industries. They're crap through management inefficiency (they have an infinite amount of money and they spend it) and political interference. This is why people would be on their back. Or very suspicious of their intent.

Converting the NHS into a better more efficient model has to be a gradual conversion over a fairly long time period, say around 50 years beginning with a health ticket of a limited value to be spent into the newly evolving market initially. Fair means, those who are the most productive will get the best available and those who are unproductive won't - they will require to fall on the charity of others. In other words a system that does not force other people to sacrifice their lives for yours, nor yours for theirs.

I have lived thru nationalized industries, the trains were better and afordable, the buses outside london were better.

everyone knows the tories run everything down to sell it off to their mates and private is only interested in how much money they can fleece both off the government and the customers.

@newstart1234

No the context is the society that the health system operates in. Social care provision, education, housing, labor market are all relevant.

The German system has grown organically to the way it is now, as has the nhs. Both have problems in their function and design. Changing from one to the other would be very hard I don’t understand why you’d even bother - the work would be better spent improving the one you have.

I don’t have any problem understanding how markets work but food and healthcare are not comparable.

I don’t think money should be thrown at the nhs. I (And people I know who work clinically incidentally) think we should think about what areas should have money put in and other areas cut back. Social care provision also, prevention (sugar tax etc). That’s not throwing money at the nhs at all.

RE: context. How is our society so different from Australia's, for example ?

Why would a basic public service combined with private insurance model be impossible for a gov to introduce over a measurable period of time, here?

I too have lived through nationalised industry and I remember the strikes, the power cuts and the violent intimidation and the thuggery quite well. Having said that, this isn't a left v right issue for me.

The essential point is that nationalised industries are a means of control of part of the economy. All gov'ts use them to this end, Tory and Labour. Mrs Thatcher arguably used government control of Coal to defeat the NUM by laying in coal stocks for power stations in a probably uneconomic way which was politically necessary.

All gov's exploit the levers of power they are given but Labour have statism as a philosophy.

So nationalisation is a poor strategy for at least two reasons:

• the public sector is intrinsically inefficient
• politicians will interfere with the function of the nationalised organisation for political reasons.

@Imnotafemistbut you seem rather over-invested in a private sector healthcare model but woefully ignorant of the implications of your half-baked proposals.

I would ask if you have shares in a private healthcare organisation, but since you say you can't afford to fund your own private healthcare I guess not.

Honestly, fools like you are falling right into the Govt's trap by asking for the removal of your right to free healthcare.

It's like Brexit all over again....

@Imnotafemistbut I think you are actually Jeremy Hunt or Raab, Truss etc

Invective is always the sign of a weak argument. Once again - there is no such thing as "free healthcare", not for me anyway - I'm a net contributor to the useless NHS.

The function of the health care model I've outlined earlier, if that's what you're referring to via your petty insults, are the ones that are used in France and Germany.

So if France and Germany's health care systems are indeed "half baked", you could explain to us why they turn out vastly better health outcomes than the useless NHS ?

I can’t explain Australia unfortunately. I don’t know anything about it for one but also I have better things to do right now. I was more giving my two pence worth about some systems which are often mentioned as better that I have experience and some knnowledge of like Germany Netherlands and denmark.

Tbh I think it’s a moot point as I can’t see any party being elected to get rid of it. I think it needs changing though.

@tiredofworking

I've worked in nhs for over 20 years. It is absolutely broken. Staff are leaving in droves. We cannot recruit. Newly qualified staff are getting out within a year or so. Management at my trust are bullies and do not help staff in any way. The labour ward is meant to have 10 midwives but now will run with 5 on a regular basis. What other industry would carry on with half the required staff? It is dangerous for patients. There is no care. I am looking to leave but difficult to find anything else I'm able to do.

Go into private practice where you will be welcomed. People say how terrible it is that those who pay get better treatment. They don’t - or shouldn’t - the treatment for any given condition follows international medical protocols. But when the system is overcrowded standards drop. The UK is a rich enough country to put more money in to the NHS - but part of the problem, money or not, is that they can’t get enough good staff. The work is often thankless and the rewards (in terms of job satisfaction and gratitude as well as pay) and status are simply not there. I don’t know what the answer is but private healthcare can help to offload the system. It’s not a case of rich people getting better treatment so much as those who can afford it taking themselves off the NHS waiting lists.

@Imnotafemistbut

Floraflower3 The subject under discussion is: how a better healthcare system can be brought about ?

There are probably other threads better suited for anti Tory rants.

I haven’t been on an anti-Tory rant?

You were a bit Flora. You were on about "wars" and "billions going into Tory mates pockets" or something.

Your post had nothing to do with the subject as far as I could see, that's why I said you were on a rant.

@Imnotafemistbut

You were a bit Flora. You were on about "wars" and "billions going into Tory mates pockets" or something.

Your post had nothing to do with the subject as far as I could see, that's why I said you were on a rant.

That's rather rich given that every other post is your pro-Tory anti-NHS rantings.

What gives you the right to tell off another poster for expressing their views anyway?!

I agree with much of what's been written here.
The NHS needs a major overhaul and streamlining. All the different trusts, CCGs, integrated care boards--makes my head spin. All have different paperwork, uniforms, protocols. Not to mention the different software and systems they all have!! As PP have said, management/senior administration versus clinical is ridiculous.
Many non-essential services should have a co-pay (podiatry, for instance) and many people do, indeed, need to start taking responsibility for their health. Long-term condition-means tested co-pay.
I think many people expect so much of free NHS services without willing to pay for it.

Oh, and address working conditions. I don't feel it's the pay as much as being run ragged without a toilet or tea break , having to work past your hours without overtime pay, and poor, unsafe staffing levels, that is causing clinical staff to leave