To think our NHS isn't working?

[Nhs2022]

In many ways I can't fault the NHS, they saved my son and my mum's lives. They gave my aunt 4 years longer than first predicted with AML.

However, I also think there needs to be a conversation about the less life threatening and more mundane services of the NHS. The ones that won't kill you but significantly impact quality of life. These have absolutely fallen apart and the system isn't sustainable.

Why is it so wrong to say key aspects of the NHS are no longer fit for purpose and adults and children are being left miserable but alive?

Is there any sensible solution?

I think I'd happily go for a part and part system.

I went into hospital under a labour government and came out 5 months later to a conservative government. I had gallstones, it should have been simple, 12 years later I'm still taking medication daily and my health is shit. The NHS has been failing for years regardless of government, it's lost its way and needs a bloody good shake up.

en.wikipedia.org/wiki/List_of_largest_employers

It's number 8 on that list.

Could it work better? Yes. Does it need more staff (not agency or doctors running private work at the same time), yes.

Should we just keep throwing money at it like a bottomless pit? No.

Can we remove some of the levels of bureaucracy that make it bloated? Maybe.

Can we remove some of the expenses?
We probably can't touch the pensions
www.nhsbsa.nhs.uk/sites/default/files/2021-07/CCS001_CCS0521624740-001_NHS%20Pension%20Accounts%202020-21_Web%20Accessible.pdf

Or the Compensation payouts
lordslibrary.parliament.uk/negligence-in-the-nhs-liability-costs/#:~:text=Annual%20cash%20payments%20have%20quadrupled,are%20forecast%20to%20continue%20rising.

Consequently, the wage bill for the NHS makes up a substantial proportion of its budget. In 2019/20, the total cost of NHS staff was £56.1 billion which amounted to 46.6 per cent of the NHS budget.

For an individual at a major A&E department who receives more complex investigation and treatment the costs start at £359.
Can we reverse the trend of people going to the A&E instead of a GP? Perhaps if we triage people off to a GP surgery at the door.

A recent study estimated that, in 2020, the average 9-minute GP consultation costs £39.23. (How do they calculate that cost? Rents/Bills/reception staff etc?)

n June 2021 there were 123,727 doctors, 332,341 nursing staff (including midwives and health visitors) and 33,907 managers in the NHS out of a total workforce of 1.2 million
So there's 710,025 other staff involved in getting the NHS to work. (Cleaners, porters, reception? who else. I would like a better breakdown of that)

All NHS hospitals are managed by acute, mental health, specialist or community trusts
Sounds like management speak for "have more bosses than workers" to me.

What does "have a paddy" mean?

Not being able to get GP appointments easily is not helpful for the A&E situation.

I recently had to get DS's school nurse involved as I needed a GP appointment to complete an aspect of a referral form. Receptionist absolutely wouldn't let me book an appointment. I tried 3 times, then asked the school nurse who went direct to the GP. Receptionists shouldn't be able to determine what qualifies for an appointment.

People are mostly ignorant of how health care works in eg Netherlands or Germany and determined to believe NHS is better when it manifestly isn’t. It’s one reason I’m making plans to leave in 4-5 years time once DH can retire and live in France. I don’t believe it will be fixed in my lifetime and I’m sick of being let down by NHS and then told I should be grateful for it.
I had a life threatening condition in 2014 that manifested as agonising stomach pain. I couldn’t eat for 8 months, dropped to 45kg. Was repeatedly ignored and fobbed off until I went private, had an MRI, was diagnosed and had surgery. Pain free and able to eat within 7 days from seeing private surgeon. I’d have died if I hadn’t had insurance because the NHS were passing me from pillar to post.
More recently I have been diagnosed with a chronic illness which affects mobility and which is treated with surgery in most EU countries and US/Australia. Only surgery can help, there is no medication or conservative treatment that works. NHS denies any treatment for the condition, citing that it needs more research to be done while thousands suffer and lose their mobility. So again I went private for the surgery.
I am also infertile and because my DH has adult kids, I was denied NHS help to have a baby. Again, I had to pay. Why should I contribute anything to a service which has done nothing but let me down?

Some services are amazing, I found a breast lump on a Saturday evening, by Monday evening I’d been referred to the breast clinic and had a text from them to say I’d be hearing from someone soon. By Wednesday I’d been seen by a doctor, had a scan and a mammogram. Amazing service. My chronic disease, not even a hope of seeing anyone anytime soon. I’m just grateful that my condition is stable since a major surgery 5yrs ago. I think how grateful I am it’s not now that I was having constant endoscopes / ERCP’s and appointments as it would have been a nightmare

I think the nhs rocks tbh!

i have a superb GP
i have received superb treatment and during my pregnancies
and I am eternally grateful for fact they saved my daughters life

90% of the care DS has had over the years has been fantastic. Most of the issues come from lack of joined up systems and the bureaucracy.

he had blood tests done at one trust meaning a consultant from another trust couldn’t access them without having to make multiple phone calls

he has to wear a specially made suit these are massively expensive to the NHS but the amount of time wasted because it has been made wrong is amazing.

even stupid little things like not being able to order his medication online because of his age so having to spend ages in a phone queue to do it doesn’t make sense

The NHS haemorrhages cash, and has done so since long before the Tories (as much as it's convenient to blame them). Increased funding isn't going to help, it already gets the lion's share of taxpayer funding. What it needs a massive overhaul to focus on how the money is spent, so much of it is wasted on administration.

But it's sacrilegious to criticise the NHS. It's the closest thing we have now to a state religion.

So how will a european system magic up new nurses, docs and better services ?

It's no better in Australia or Europe at the
Moment. Go for it though! Pay for your own treatment

In my expat FB group this is a conversation that comes up all the time. The majority definitely Hayes the NHS

I've said this before but the nightingale in Manchester was a disaster because they put the contracts up for grabs and private firms who had never set up a hospital before were charging the nhs 3k plus vat a day to help set up a hospital. The only thing the nhs got out of that was a bill and allowed them to glean some good info about the nhs

My father has just received excellent care but only because it was an emergency. I've just had to go private for a skin lesion. As they didn't think it was melanoma I've been told up to a year wait for dermatology. It might still be cancerous. I don't have insurance so it was a huge chunk of money to find but I did find it.
As a public health student we spent many a lecture on health inequality and whilst it's too simplistic to say that inequality is caused by profession and habits there is a lot of emphasis on this. I was lucky enough to have the means to go private. There is zero chance for the lowest incomes. There's your inequality.

Mental health services are woeful.

Each and every operation is costed to the nth degree it's scary how much stuff costs, there is a cannula that costs £900 maybe £1500 if it's a certain brand. My colleague dropped 3 in one operation one after another and the surgeon was losing his mind at her because it's coming out of his budget and the perfusionists!

During the worst peak of Covid we had to turn down pregnant women who needed ECMO (massive heart lung machine that gives the body a break by oxygenating blood outside the body) because nhs England only agreed to pay for 8, it took a massive argument with top surgeons to get them to increase our funding, at one point we had 20 on ecmo after that but we've been left with the bill as a department.

This. The proportion of GDP it eats up is unsustainable. It’s literally devouring other critical public services (the criminal justice system is on its knees). Choices have to be made.

^^This.

The more open to profiteering the system is, the less it'll actually benefit patients.

If the system is funded, staffed and managed properly it's much better to have it free at the point of use. But it's a huge system, different areas working all a bit differently etc.

You still have the option of paying for private appointments, if you can afford it.

And the NHS has clearly been neglected and poorly run, plus the last few years between ill staff and those deciding to leave has made it horrendous for those that I know working in the NHS.

I’ve worked for the NHS for over 30 years and it’s pretty much been the same. The political party in charge makes no difference.
‘Lots of the NHS is already privatised, including the area I work in, and I’m pleasantly surprised by how well we get to do our job and how much better we are treated by our company.
My opinion has always been that we need to go back to basics, to stop doing things that should be paid for by the patient if they choose to have it done.

You’re absolutely right. I say that as an NHS nurse. Funding is dire. Yes wages account for a lot of the budget but that’s because NHS wages are low and so retention is poor so they use agency staff. I used to earn £14 an hour as a band 5 in theatres and could’ve earned £35 an hour on agency. 10 years ago when staffing wasn’t as bad.

There are so many managers I have no clue what they all do. What happened to just having a ward sister and a matron covering a directorate.

A&E is overwhelmed because of lack of GP services because there aren’t enough GP’s.

Unfortunately prioritising the life or death stuff is how it has to be in such a bad state.

social care was never the problem that it is now because people died younger of diseases that are now treated by the NHS.

'Social care' was often provided by the NHS in the form of long stay elderly beds, these all closed down and the onus of responsibility passed to local government via their social services departments. The majority of that care is now outsourced to private providers and the cost is spiralling.

lowdownnhs.info/analysis/long-read/the-history-of-privatisation-second-in-a-series-by-john-lister/

As for dentistry, I went private last year and yes it cost a fortune for work I needed doing but why do we feel £150 is too much for a filling and we should be entitled to it much less on the NHS but many of us are happy spending that on a couple of family meals out. Our mindset is wrong.

NHS dentistry I feel should be means tested because of the state it’s now in with hardly any NHS dentists.

I agree - we need a system more like Germany where everyone has to have private insurance but the government provides insurance for those who can't afford.

@ChrisReasBathEggs I wonder how much they would reduce our taxes by if they do that or what they will do about the years I have been paying into it, only to have to fund my own care in my later years when I need it? What do you think?

I'm with @ChrisReasBathEggs here, who decides what the cut off for the 'can't' pay is?

There really will be no incentive to work will there soon. Paying more and more taxes then get told 'actually all that tax means nothing, you now need to pay insurance as well, or privately and be bloody GRATEFUL and do it happily or you'll be told you are wanting other people TO DIE YOU EVIL PERSON.'

The squashed middle, as ever fucked over, and told to feel happy about it.

I left the nhs 14 years ago. The tipping point for me was seeing one department doing totally unnecessary cosmetic work to use up its budget so it didn't lose it next year whilst critical care couldn't afford the life saving monitoring it needed to replace.

Pooling budgets in this scenario would make far more sense. Maybe things have changed now, but I doubt it

That's untrue. It's much better in France for example. The other day I had a GP appointment, OP XRay and the results, all in less than 24 hours. Not an emergency, and no cancer suspected.

That process would have taken at least 6 weeks, and probably much longer in the UK.That's entirely usual, I could give you many more examples.