The NHS is not living with COVID, it's dying from it

[EmbarrassingHadrosaurus]

Most people (including many in the NHS) are so tired of it that they are wilfully pushing it to the back of their minds, but now is the time to face the fact that the nation’s attempt to “live with covid” is the straw that is breaking the NHS’s back.

In 2020 and 2021 the NHS coped with pandemic peaks by stopping or slowing much of its routine work. 2022 was meant to be the year of full speed recovery, when we would build back better and fairer, when record waiting lists in elective care, cancer diagnosis and treatment, and mental health would begin to reduce, and the workload on primary care would begin to ease.
…
Above all, the government must stop gaslighting the public and be honest about the threat the pandemic still poses to them and the NHS. Being honest with the public will have two positive results, it will encourage the public to modify behaviour and, we hope, provoke urgent reflection about how the NHS is in such a mess so soon after the nation was applauding it on their doorsteps.

Joint editorial from major Health Services journal and the BMJ. Free to read: www.hsj.co.uk/coronavirus/the-nhs-is-not-living-with-covid-its-dying-from-it/7032824.article

What measures would you be prepared to support to get the NHS back to some form of functioning for everyone who needs it for non-COVID reasons?

www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13

Figs 31and 32

How should society deal with an increasingly aging and ill population?

The nhs is the biggest employer in Europe. It is huge, unwieldy and no longer fit for purpose. We have an aging population and have had lots of very expensive medical advances since it started. I think we need to look carefully at the systems in other European countries and make changes to how we do things. It would be politically unpopular though, as it would mean many people would have to pay more for their health care.

As a nation, we are old, we are unhealthy, and we are fat. The vast majority of people in a UK hospital on any given day will have some form of health condition arising out of one or a comorbidity of those. But we’re all expected to pretend that none of that is true, and that all of us are contributing to an overburden on healthcare. In addition to that, we have a system which encourages people to believe that the taxes they pay anywhere near covers the healthcare they’re likely to need in a given scenario, when the reality is that only higher-earning child-free people will ever really contribute as much as or more than their family unit receives back.

Bluntly, in answer to your question, I pay a fortune in tax and don’t get much back from the NHS. I’m not supportive of anything which curtails me further to help people who won’t help themselves and pay very little.

I thought that there was a fair amount missing from the editorial. I'd like to see at least an attempt to quantify the benefits/costs of reinstituting pandemic control measures before they are called for by influential journals and editors.

I'm not sure this view is shared by all NHS workers. I have four friends who are hospital consultants and they don't want to see pandemic control measures reintroduced. If anything, they'd like them to be relaxed in some medical settings at least.

They would like to see consistency across Trusts so that medical staff aren't sat at home isolating needlessly when a family member has covid or their tests are negative but they're not allowed to return to work.

From what I understand, it's not underfunded, it's just mismanaged. I do think we have to stop misusing it though. I know it would be hugely unpopular but I would bring in a small charge for a GP appointment. My Mil uses her GP as a friend that she needs to catch up with for a chat at least once a month. She's not ill, she's bored. My FIL is a diabetic and will not follow any advise given, is always losing his needles and needs repeat visits to the GP for self inflicted reasons. It really frustrates me, when I tried to make for my son who hadn't seen a doctor in 16 years, we had to wait weeks. How many GP surgeries are full of my patients like my IL's who don't need to be there.

It’s not underfunded, it could happily afford to double the amount of bureaucrats over the last 2 years and on Friday a new job Director of Diversity, Equity and Inclusion in the North was advertised, Salary of up to £108k per year - you could get 3 paramedics for the same amount. It’s an absolute shambles of an organisation

I disagree it doesn’t need money, it does but spent wisely and looking at a much bigger picture.

Covid requires a speciality in itself; wards, follow ups, treatments all need to be part of a dedicated department which means existing hospitals and accompanying staff are needed. A lot of money needs to be thrown at training staff up in all areas.

more widely, as we’re committed to the community care model, there needs to be the same funding thrown at training and running community support services and care homes to minimise boomeranging and decent levels of staffing.

The nhs is the biggest employer in Europe. It is huge, unwieldy and no longer fit for purpose. I think we need to look carefully at the systems in other European countries and make changes to how we do things. It would be politically unpopular though, as it would mean many people would have to pay more for their health care.

I agree. I wonder if we would pay more or whether it might reduce some of the time wasting (such as turning up to A&E unnecessarily) and therefore costs.

Or, if not, whether people would be willing to pay a bit more for better healthcare? Plus Trusts would be incentivised to offer a good service in order to attract patients (I think this is how it works in some continental European countries).

Nearly everyone I've met in various European countries thinks their state healthcare system is far superior to the NHS. Meanwhile NHS staff are leaving the profession as they're trying to do the impossible every day.

I wish the politicians could form a cross party group to consider alternative systems.

No measures whatsoever, the NHS doesn’t work, it’s outdated. It’s rose-tinted fondness that keeps it going, but it’s had it’s time

I thought that there was a fair amount missing from the editorial. I'd like to see at least an attempt to quantify the benefits/costs of reinstituting pandemic control measures before they are called for by influential journals and editors.

Quite

Anyway, Covid's only one piece of the puzzle. There was a lot wrong with the NHS before Covid, it's issues are far bigger than Covid now and the whole thing needs rethought from top to bottom. Expecting the rest of society to take measures (all of which have some degree of cost to someone) to maintain some illusion that its still limping along is ridiculous.

I've been involved with the NHS in various capacities since the 1960s.

Two things always strike me, one is the waste: thousands of pounds of equipment lying around in corridors with minor faults, large packs opened and one item used, things that could be re-used in the moment discarded and so on.

The other thing is the number of people wandering around, often with a clipboard, generally bearing a badge denoting them as some kind of manager, interrupting staff who are dealing with patients. I've eavesdropped, unwillingly, on many a conversation initiated by these people, and it's rare that they seem either relevant or urgent. It seems to me that while the clinical staff are chasing their tails there are many non-clinical staff with not enough to do.

I went on a cruise after lockdown. I met many people who worked for the NHS and told me that NHS staff were given a 50% discount. The only person I spoke to who was at all customer-facing was a pharmacy manger who confessed that her husband was a fund manager and she felt a bit bad about her reduced fare. All the other NHS I met onboard had worked from home during the pandemic.

I also have friends who are doctors in various countries around the world. They are all shocked that we don't have to make any payment to see a GP. None of them find that people who really need care don't get it because the fee to see a GP is beyond them or puts them off. They are also shocked that our 'free' appointments aren't automatically the same or next day.

This. I wouldn’t go back to the nhs. I’d rather stack supermarket shelves. It was heartbreaking, backbreaking, soul destroying and utterly thankless.

I’m not a huge fan of Blair, but I think they did actually do this very well. The NHS was a great place to work with really good flexible working and family policies, and the pay wasn’t great, but it wasn’t awful either. It’s been eroded under the tories and they haven’t kept up the pay either, so now it’s an Uber-stressful, shittily paid, neverending job where you hold people’s lives in your hands. Who wants that?

they can’t wait to privatise it. It’s their magic money tree. They’re deliberately running it into the ground to justify breaking it up and selling to themselves and their mates for fat profits, to make even fatter profits. It’s abhorrent.

Okay, but if we’re transitioning into something new then perhaps it’s time that the powers that be put our their money where there mouth is and get on with it.

None of this fannying around selling off bits and bobs whilst certain people cream off huge swathes of public cash and still fail. Those who support something other than the NHS need to start demanding an actual replacement rather than just vague predictions and belly button staring. It just enables large scale fraud and syphoning of public money.

for the record, recentish experiences of private healthcare weren’t exactly great. My prediction would be that it’ll end up like the railway networks and back publicly owned in all but name.

people would have to pay more for their health care

Yes we do. It's a political hot potato though - increase taxes - but on whom? Facing a cost of living crisis, do we tax corporates (and risk them moving operations (virtually or otherwise) overseas, individuals (but probably only the additional rate tax payers (or do we just make everyone earning over 90k be an additional rate payer) or shall we increase VAT/ IHT?
I have chronic health issues and the NHS is horrifically bad at dealing with things - allowing conditions to deteriorate, subcontracting out drugs supply to companies who turnover billions (yes billions) in NHS derived revenue but whose service is diabolical. I could go on and on about inefficiencies making me worse.
If I am kept well enough - I can work (at director level), pay a lot of tax and would happily pay for extra health care benefits - Like online GP consultations, faster access to my consultant and team - but you can't have a two tier NHS and private doesn't cover chronic illness.
Secondly if the NHS continues to fail in my basic care, I deteriorate and then will not be able to work (I'm part time already), won't be able to pay my mortgage and will quickly become homeless and require benefits with my 4 children.

Covid has a lot to answer for - if general health deteriorates either after repeated infections, long covid etc, this impacts not just on the NHS directly but also indirectly - people can't work, don't pay tax and also need state support.

totally agree with what you have written there @ComtesseDeSpair and @Hannakl. Charges do need to come in and frankly people need to realise it isn't free.

A lot of nhs staff are poor performers but it is nigh on impossible to get rid of them. This means poor service and demoralised teams. Nhs staff get far too much sick leave fully paid which means too many of them use it and this leads to increased agency costs. Nhs pensions are huge which need to be funded. Staff are the biggest cost. There needs to be a brave shake up of nhs staff benefits and performance management. Sadly they are not all living saints.

It is tricky. I was chatting with a consultant friend (paediatrics) who said they now work 2 days a week at home. before covid they were in every day they were paid and on wards, seeing patients at clinics etc every day. They, of course, think it is great, but have fewer outpatient clinics now. Am sure every hospital is different.

Yes, evidence that the measures he's advocating would actually achieve anything helpful is conspicuously absent. This is particularly important because they'd come at a cost. Why is it better to spend money on the reintroduction of universal freely available testing than on other areas of the NHS? Has he thought at all about the reduced tax take if gatherings over a certain size are banned again, and how this might impact on the NHS? These are not measures that exist in a vacuum.

Ah yes too much paid sick pay how aspirational to want it cut.

As an NHS nurse I agree the NHS is broken beyond repair. Covid has just accelerated what was already there.

I would love people to take responsibility for their own health, people are living with self inflicted conditions from lack of exercise, over eating and addiction. I don't know what the answer is not necessarily more money just better use of technology and prevention, providing services at home so admission is for the truly sick. It would be great if the NHS ran its own nursing homes as we would have more control over beds.

I would pay for GP appointments and I think free prescriptions should not be applied to all pensioners. My parents could easily afford to pay these.

It is not a great place to work although I disagree with a pp saying that lots of has workers are poor performers, and that our benefits should be revised. Do you realise these 'benefits' are there because the pay is so poor for the role we provide. Take the benefits away and they would have to increase our salary and that's won't do.

There are poor performers in the NHS and I do agree they are hard to get rid off but, these are few and far between and really not the answer to the NHS crisis.

Ah yes too much paid sick pay how aspirational to want it cut.

Well the bottom line is it's very expensive. I work in a small private sector company that couldn't dream of paying that level of sick pay.

And of course it's nice to be able to provide that, but we do need to have honest conversations about how all this should be funded.

Sick pay is the same across the public sector, are you also appalled by that or just the NHS? The truth is that it's emotionally and physically demanding, people do get sick and need time off- often in relation to factors at work, so why shouldn't the workplace offer a reasonable 'benefit' such as this? Also pretty sure if people who can't work for a stretch all left instead of have time to recuperate then we'd be paying a lot lot more for agency staff, they're already used to plug the gaps and that will just keep increasing. If you can't afford to support your staff properly then that's no one else's fault :)

I think that’s a good point, and further justifies fully funding training for various health professionals. It’s the same with carers. You end up using less than desirable levels of skill because there’s such a shortage of qualified people to replace them. Then you have the further consequence of raising standards by getting the right people in place and improving cultures.

I worked in the NHS for fifteen years and absolutely agree that there are a significant number of people who are making up the numbers or place holding.

Sick pay is the same across the public sector, are you also appalled by that or just the NHS?

Where did I say I was appalled?

In fact I said it was a nice thing to provide.

But we can't keep having these highly emotive interjections without some more factual discussion about what the nhs should provide and how it should be funded. Because the current model is falling apart. The reason for referencing the nhs is that this thread is about the nhs.

A good start would be removing free prescriptions based on age alone and making it means tested.

If you're taking more than one medication you can get a pre pay certificate for around £11 a month, which is absolutely within budget for many over 60s.

A 60 year old will now potentially have 30 years of free prescriptions from the NHS. If they used a PPC that would be nearly £4k per person. Still massively less than it costs to prescribe 6 regular medications.

Anyone who's done a home visit and seen boxes and boxes and boxes of totally free medications in an elderly person's house because they just keep re-ordering them will see how much is wasted.

If people pay they assign more value to something.

Over 60s are the main users of the healthcare system yet get the most for free.