To ask what can be done immediately to take the pressure off the NHS?

[Twinklenoseblows]

I've been reading stories about people waiting 4 days in A&E, people being taken into A&E in the back of a van with a broken hip as there are no ambulances ,and doctors and nurses pleading for something to be done right now as lives are at risk. But what can be done that would make a difference within the next week or two?

Promises of more money and more staff will presumably take years to filter through and make a difference.

I guess what is worrying me beyond the immediate crisis is that some bright spark in government is going to say we need a circuit breaker lockdown to reduce flu and covid admissions for the next few months to take some immediate pressure off. The thought fills me with horror so I'm hoping there is something else.

E.g. as a very short term measure could some people be diverted to make use of any spare private GP capacity to try to reduce the number of people going to A&E who could instead be dealt with by a GP if only they could get an appointment. Or is that madness?

Or voters could just send a strong message to the main political parties that we want a European style of healthcare rather than the NHS or the US style, i.e. insurance based, affordable co-payment, etc.

Who pays more / less than now with this system?

How ? Vote for Rishi and his henchmen ?
Wes Streeting (Shadow Minister for Health) has brought this all up. Let's see what his ideas are and how the tories respond to it.

Insurance type scheme - young healthy well off people pay less.

Insurance type schemes - Pregnant women, parents with babies, disabled people, people with chronic health problems, the poorest, and elderly people pay more.

With US insurance 10 - 20% of premiums and co pays goes directly to the insurance company. Insurance schemes are more expensive because they have to meet their costs of administration and make a profit. It is another layer of bureaucracy.

What has he brought up?

Thanks, is this true for German and French models too?

These seem to be the two that get mentioned

In France the insurance is taken out with a non profit

It’s the social care backlog that means people can’t get beds. MN is full of posts telling people to refuse to help with care so parents stay in hospital for 4months waiting for non existent carers. The same people who are shouting for GPs to work 7 days a week with no time off for the same pay? If your job told you to work for free for good will on the weekend and 7 days straight for the same pay you’d tell them to get fucked.
NHS staff aren’t charity volunteers and when they start getting paid more and not expected to work on their days off then they’ll stop quitting. GPs are also at breaks if point as they are short staffed. There are GPs on weekends, called out of hours. But that is also decided on funding and staffing level.

but if you’re willing to go and work in Tesco for 7days straight or expect your teachers to work on weekends for free or your lawyer to start working for free then ask your NHS.

so many people seeking health care when they should self care

Elderly people having a full-time carer or living in a care home would help. The number is stories of 96 year old Ethel lying in the cold at her house with a broken hip waiting 3 days for an ambulance is getting tedious. Would help if we mitigated the need for the NHS in the first place!

www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/ Seems to make it worse

Extended GP opening, reopen the walk in centres, improve social care provisions, end PFI contracts and have a more robust criteria for A&Es so that those who genuinely need to be there are there.

That would be for the political parties to come up with alternative options to differentiate themselves from other parties and give voters a choice.

@MarshaBradyo I do not know the percentage insurance companies spent in France and Germany. But of course there is a cost. It is adding a whole layer of bureaucracy. And whether private or non profit, that bureaucracy costs.

Discussion of Germany and other social insurance models here.

Social insurance will not provide most of the benefits that its advocates hope for, and that’s because the NHS’s problems run deeper. But even if it was the answer, the path to getting there would be very difficult. It requires an expansion in capacity, investment in new systems and huge organisational change, including the privatisation of providers. This would be hugely disruptive, likely unpopular among staff and perhaps the public, and would take many years. Is it possible to capture some of the successes of other countries’ systems, whether insurance- or tax-based, with a less all-consuming approach?

www.nuffieldtrust.org.uk/news-item/myth-3-we-should-copy-other-countries-and-adopt-a-social-insurance-model

Edwards N (2022) ‘Myth #3: “We should copy other countries and adopt a social insurance model”’. Nuffield Trust blog, 1 November.

How will a cash strapped NHS pay off the hundreds of billions of liabilities on the existing PFI contracts? They're legal contracts, you can't just walk away from your liabilities.

@taxguru so you are suggesting a different system but dodging the hard questions?
Probably because you know that it is unworkable unless you charge heavy users of healthcare such as pregnant women, parents of babies and most elderly and disabled people. Otherwise it becomes like prescription charges where most people do not pay anything.

I would add that in my opinion, immigration is absolutely not the problem. I grew up in a major city many years ago which was very ethnically diverse. Things were not this bad. What we are dealing with now are the repercussions of Covid, many years of Government underfunding and neglect of essential services and the fact of a large aging population. There are other factors.

I think immigration would only ever be an additional factor alongside the many others you mention. But what I do notice is that it's become a sort of 'elephant in the room' topic which people seem almost afraid to discuss. I'm guessing this is because people automatically associate any criticism of immigration with far right rhetoric and Tommy Robinson views etc.

Looking at the stats, last year was the highest ever recorded number of UK visas granted, no doubt partly due to the Ukraine war. The vast majority of the 1.1m were for study or work but there were also 230,000 resettlement visas, 130k of which were Ukrainian.

The remaining 100k doesn't sound like much but it's still a lot when you consider that it never rose above 7k a year between 2005-2020. So it's basically risen 14x higher in the past two years having been stable for the previous fifteen. Potentially that could be an issue if it keeps rising at the same rate.

However, I don't pretend to be an expert on this and am just mulling over the numbers so happy to be corrected.

Ah nice this is what I’m saying. You can emulate but not necessarily needing full reform.

Also agree with pp you can’t just end PFI contracts, there are no new ones but Trusts owe £50bn, unfortunately.

@RethinkingLife It would lead to more staff walking away. In Nottingham this happened when the very specialist eyecare service was privatised. The specialist Drs had warned they would walk if it happened, and they did.
In the UK most staff in the NHS do not go into it to make money. If they had to start not being able to treat some patients properly because they did not have the money to pay, some would just walk.
Imagine not being able to put a premature baby in an incubator because the parents could not afford the co pay. Lots of staff would find that hard to stomach.

Yep, I understand BUPA is also a non profit organisation. It really doesn't have to be a US style profiteering scheme. We still have a small number of other "non profit" firms in the UK such as the Co Op and NFU Mutual insurance - of course, we used to have lots more (like Standard Life and multiple building societies) until the policyholders got greedy and forced them to demutualise and become profit making companies, for the benefit of shareholders. We could do with a whole new raft of "mutuals" in financial services, healthcare, etc to bridge the gap between the extremes of public sector on one hand and greedy shareholders on the other hand.

No, I'm suggesting we emulate successful insurance based systems in numerous other developed countries. We don't hear howls of anguish from, say, France or Italy, or even Australia or Canada, do we?

Are people paid better in those countries ? Do they have the structural inequality
issues that the UK has ? A huge part of the country that is less affluent ?

Canada does, and indigenous people have very poor access to healthcare.

When people say they want change do they mean they want to pay more personally or someone else should?

I’d not reform to a huge extent, just small things. No one mentions this but nominal charges - used often elsewhere but would U.K. vote for it?

If you are suggesting establishing a whole new layer of non profit mutuals to offer insurance based healthcare, the set up cost will be enormous. Far more than simply investing in the system we already have.
I have worked through two companies joining together and even with no change in services, the costs were still scary.