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.

why are people advocating for US style healthcare when there are so many healthcare systems in the world which function better than the NHS and people don't go bankrupt?

I would look at our European neighbours first. I have lived in Germany and their healthcare is far better; it is also universal and everyone is covered. Its a health insurance model but it is based on how much you earn; and unemployed people are covered through their benefits.It is more expensive but no one is going bankrupt due to healthcare costs!

Paying for a GP visit is as reasonable as paying for food and rent, and it's absurd we've created an environment were so many people expect others to pay for them.

Well that's not really comparable is it? Every human has a basic need for food and shelter, which they will be given because we're not barbarians. If people want more than that they have to work for it.

But humans don't have the same basic healthcare needs. Some of us have barely any contact with the NHS until we're very elderly. Others have cancer, diabetes and many other conditions, some from birth, that mean their healthcare needs are enormous.

Do we pool our resources via taxation and think we're lucky if we never need to use them, or do only the richest of us get the high cost medicines? NB. insurance premiums are just a tax with a cut for the bureaucrats.

Aristotlesdeathday - got any shares in private healthcare by any chance?

@homeappliances

Aristotlesdeathday - got any shares in private healthcare by any chance?

Not individually no

why are people advocating for US style healthcare when there are so many healthcare systems in the world which function better than the NHS and people don't go bankrupt?

I have no idea - most of what Ive heard about US health system often from US citizans who have lived in other countries isn't good.

I do agree with PP if we can't talk about the NHS being reformed and what's palatable to UK population then we will be much more likely to sleep walking into the US system by default.

Better invest in some then!

The Tories, who have private healthcare friends, decided to under fund it with the aim of making it look worse.

Total bollocks.

@stairway

DdraigGoch if you are really hungry and only have 50p would you really choose a bag of carrots over 2 packets of biscuits?

I can't actually remember the last time I bought a pack of biscuits.

They could put it back on track to being a decent and useful service but the reality is running the shit show it is now makes too many people too much money and the greedy cunts don't mind watching it suffocate further.

And by making people money I mean the drugs side of it which goes without saying but also the massive elephant in the room which is the reliance on agency staff for literally every department, making agents a mint because we can't be arsed to invest in training and recruiting a basic level of staff.

@Intheshit1 if you have Bupa, go to the osteo or physio. They will nerve test you and can diagnose disc and nerve issues. They can then refer you for scans if needed.

Just check with Bupa before booking an appointment, as they sometimes have a list of accepted osteo or physio clinics to choose from.

As @Floundery says: it's not a binary choice. The systems most admired on this thread (German, French, Austrian, Australian and a few others) for combining universal access and quality of care are co-payment models that deliver a choice to the patient/consumer.

I'd add the Israeli model in as another possibility. This operates like the NHS but patient care is delivered via four competing and overlapping Health Maintenance Organisations, which are also widely used in the USA. (I was registered with one in 1984/85, when they were added to the choice of services covered by my employer, which was then a major non-profit pension fund and insurance company. I'd guess it was what the instigators of NHS Trusts and the competitive market had in mind, or close enough.

Covid didn't do this, and until that is acknowledged nothing will change. The NHS has been fucked for decades. It doesn't work. It needs urgent reform and funding. Covid is merely a convenient scapegoat.

@Floundery

Do we pool our resources via taxation and think we're lucky if we never need to use them, or do only the richest of us get the high cost medicines?

It's not a binary choice though is it? The best systems utilise both - giving patients choice of providers, the options to co-pay while not precluding access by the poorest?

It's ultimately very persuasive that no other nation has copied the NHS. Most left-leaning folk are quite opposed to British exceptionalism in any other context (such as Brexit) but when it comes to healthcare, they must all be barbarians!

It's not about British exceptionalism at all. It's about wanting a system that works for everyone regardless of their resources, and doesn't waste resources feeding an expensive insurance system.

I don't want a system which costs the most per capita in the world yet in which people die because they can't buy insulin or lose their house to pay for their chemotherapy. That's the direction of travel.

A simple reform would be to ban prescriptions of OTC medicines by the NHS. I had a private prescription a few weeks for a skin condition (not for an OTC product) and it was £2 cheaper than the cost of an NHS prescription. Surely, it is bonkers.
This is already the case. I had Piriton, or it's equivalent, prescribed in hospital last week and I was told to buy it. No problem. There's signs up everywhere

Some parts of the country are worse than others but generally yes it’s screwed.

It’s not only the tories and brexit to blame, the general public are massively at fault here too. It has been abused horrifically to the point of no return.

@DdraigGoch

people unable to afford nutritious food

Why does this myth keep being peddled? Food in general is cheap in this country (which is why farmers are struggling). Healthy food in particular is cheaper than junk, a single chocolate bar is more expensive than an entire bag of carrots for example. Convenience is the major factor in people's choices, combined with the addictive nature and marketing of the junk.

Wanna trip to my grandsons school on a Friday and witness the long queue for the schools food bank!?

Well what do people expect if they keep voting Tory? The Tories have always hated free at point of use NHS and did everything in the power to try to prevent it being set up in the first place.

@WiseUpJanetWeiss

I'd take the German system over the NHS any day. Or the Swiss. Or the French. Or the Australian.

But these all cost more per capita than the NHS. Wherever the healthcare comes from it has to be paid for. And if your healthcare is provided by a marketised insurance based system those bureaucracies need their cut, which drives up costs without necessarily increasing quality.

It's past time for a proper conversation about what healthcare we want and need, and what we are prepared to pay for.

At the moment we're sleepwalking out of the NHS frying pan into the US fire. No-one has to do anything much for this to happen. No big policy decisions or public conversations, just more middle income people starting to use private provision and continual squeeze on the NHS. Look at dentistry, and think of the calamity this will bring to low income people with serious medical conditions.

I quite agree. I work in an adjacent area and I know that many European countries have perfectly good healthcare systems with better outcomes than the UK in many areas, albeit at a cost. But everything still needs to be paid for, and if you go for a private-led system then you also need to pay for an entire ecosystem of billing, pricing, and return on capital.

I don't really understand the people who say that the NHS can't work because of infinite and increasing demand. Private systems are still going to have to pay for gastric bands, life-prolonging but unbelievably expensive cancer drugs, quadruple bypasses, long term diabetes treatment. You might be able to get away with a few fewer people getting prescriptions for free Calpol but I'm unconvinced that that's costing a huge slice of the pie.

An eye-opening Saturday night spent behind the scenes in A&E in a rough town showed me just how much of the problem on the front lines relates to social care for the elderly. I didn't see a single one of the "Pissed And Fell Over" young men I was expecting, but I saw a lot of confused old ladies on oxygen.

It’s different in every hospital.

Yes it was bad leaving your elderly relative on a trolley with no family around, with terminal cancer, but when resources are stretched staff often prioritise the patients with rehab potential, those they can cure or give a good standard of living to. Have you considered a hospice if she’s end of life? A busy hospital is a grim place to be by that stage.

Don’t judge their maternity facilities based on their care of one person. I’m 23 weeks pregnant and have had excellent antenatal care from the beginning, partner allowed into scans, extra scans, obstetrician appointments, midwife appointments all on time and regular. I have no worries about giving birth there.

The time you really don’t want to give birth is September, when there’s a baby boom (Xmas conceived babies) and labour wards are at their busiest and most short staffed!

We should all be paying more to get a system like France. The huge barrier to this is living costs in particular housing.

We have an ageing population & the next decade the shift is going to be quite dramatic so something needs to be done.

Blanket Free prescriptions for the over 60s defo needs to go.

Good healthcare is expensive. Everywhere. The debate is around whether we all pay something on top of our taxes, or whether we ration out the basics that our tax affords. Which begs the question of the criteria used for rationing. Like it or not, there's inevitably some choice
involved. It could be crude like age or ability to pay, or limiting the menu of treatments covered to emergencies/acute cases, or offering a restricted choice of therapies deemed to provide adequate value for money with only palliative care for the rest. Do we continue to use general practice as the custodians of the gate? Is there a reward (faster access, perhaps) for anyone who takes regular exercise or maintains a healthy BMI?

Any and all of those suggestions would have the proposer crucified because in a first world country the only palatable course of action is to do better. The demographics say that that's only possible if more resources are committed to health care. And given the NHS already accounts to close on 40% of government's spending, the options are going to demand compromises.