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?

Immigrants tend to be younger and healthier on average--they're not what's overwhelming the health system. IVF is pennies, relatively speaking, and is quite hard to qualify for.

Everyone loves to bang on about personal responsibility, but that's really useless. Obesity and T2DM are complex medical conditions. Getting people to lose weight is actually quite difficult, and access to NHS resources to do that is scarce. As it stands there's already tough choices about spending money now to help people lose weight that might pay off with lower healthcare costs in future. You can't snap your fingers and tell people to lose weight. It's a myth that people would lose weight if they just tried harder. It's somewhat easier to prevent obesity in the first place, but that requires tackling a host of social issues, and "things would be wonderful if people behaved the way I want them to" is not effective social policy.

A lot of these solutions are effectively rearranging deck chairs on the Titanic. The NHS lacks sufficient capacity to care for everyone who needs care. The UK used to have a really excellent record with diabetes care, for example, because day to day care was handled effectively at primary care level. Now they lag because they don't have the GPs and nurses to deliver that service and the NHS is slow to fund improved drugs & devices. Pumps and CGMs are game changers for many people with diabetes but to keep costs down the NHS is very strict about funding them.

They are here. There’s an out of hours GP next to A&E and people are triaged and sent next door if they need GP care.

Quite a few especially the low income jobs. The insurance scene has changed a lot in the last few years so my memory of things might be outdated but you can get insurance through the government now. But depending on your health situation and age it can run anywhere from $50/m to $550/m as my mother explained to me being in her fifties and having a chronic illness.

The insurance through the jobs I was offered where often providing “affordable” insurance but would cover almost nothing. And the expensive plans which would run around $300/m would cover only some things but usually not pregnancy and delivery or birth control. (don’t get me started that’s a whole other story.)

I also had an employer ask me about my pap smear. Which really offended me and creeped me out so I changed plans immediately. He thought women only got them because of STDs which distantly justifies him harassing women about them.

I’m lucky because I’m insurance literate and can tell what is covered and what is not but many people aren’t so they don’t know what their plan has until they are sick and need it.

Have you heard of a prior authorization? It’s a torture device for sick people forcing them to hang on the line with an insurance company for hours, days, weeks, months being passed back and forth between their doctor and insurance company trying to get medications, surgeries and medical services covered.

How would I know? I worked for an american insurance company. Literally had dying cancer patients sobbing hysterically on the phone because they were told their surgery was covered but after they got the surgery the hospital was holding out their hands waiting for the $50,000 that they were told they wouldn’t need. 😃🤷🏻‍♀️

Have fun with american health care! 👏🏼👏🏼👏🏼👏🏼

How do you know that those among the "immigrants which the gov is paying £6m a day to house in hotels", who end up being granted asylum here, will not be economically productive, net contributors to society?

They may well be. However, we're talking about skilled labour, more specifically in the medical sector. I don't think claiming asylum is the usual route for a medical professional who wants to work in another country. Surely they'd just apply for a work visa.

I don't know which is worse out of that and being left lying on the floor with no help coming!

They’re both very shitty situations. I will give you that.

A friend recently had excellent cancer care in England. Totally in remission and no bills or co pay.

Bring back free movement for European health care workers.
provide free parking , meals for workers. Increase pay , burseries to train new staff. Stop stupid and dangerous diversity policies for the QTI people and use the money properly for care of patients. Increase cleaners and assistants to feed and bathe patients so trained nurses can concentrate on more skilled work. But pay assistants and cleaners better too.

I think I’d rather get the $50k surgery in a timely manner and let the hospital come looking for it rather than not get the surgery at all - or too late- and just…well…die.

@LeccyBillShill Although in the US that can mean both you and your kids end up homeless. Literally on the street.

That is just one of many examples of how people are treated though. You first need to pay for the insurance and navigate the insurance maze to get said surgery.

There’s always section 8 housing and the states have their own version of gibs too, I believe.

@LeccyBillShill I do not know about that. I just know my Aunt would have been street homeless with her husband and three grandkids if another relative had not put them up. Insurance would not pay for her operation to keep her alive - amputation after sepsis. And the state healthcare would not pay as they said she could sell her house to pay for it.

Sounds bad to me. Not a version I’d want either

Another friend in the US had cancer and her insurance covered it, but co pays were paid by an Uncle. She was always worried he might decide to stop paying. And she spent hours on the phone to the insurance company to get authorisations.

That’s not really the case. Poor Americans have Medicaid, otherwise you have to haggle. No one pays the sticker price.

Thy said, obviously nobody likes haggling and it’s a very stressful process.

That’s pretty rough for your poor Aunt. My family all had/have blue collar jobs and their insurance coverage was/is amazing, so maybe that’s why my view is coloured a bit.

@MintyFreshOne I just said my Aunt had to sell her house to pay for her amputation and sepsis treatment. She had insurance who would not cover it. The state, I don't know if that means medicare?, refused to pay as she owned a house and told her to sell her house. They told her they would have paid if she rented.
So please do not tell me it can't happen. it happened to my family and I was horrified as she told me all about it.

I’d be interested to see a comprehensive comparison of Medicaid provision and the NHS. I know Medicaid has an awful rep but the way things are now with the NHS I imagine it’s comparable?

@LeccyBillShill Glad they have good insurance. I don't know all the details of different insurance policies but I have a number of relatives and friends in America. Some do seem to have great insurance, others do not.
I do not think healthcare should just be for the fortunate. I also do not want to have to try and haggle or deal with companies reluctant to pay out when I am already very ill or my husband or kids are very ill. The stress must be enormous.

Exactly. I mean it’s not really my business as I don’t live in the UK. But the american health care is just as broken in my opinion. You trade one set of problems for another. 🤷🏻‍♀️ Either way people are getting screwed. I guess you just have to pick which problems you prefer honestly. Who am I to judge if someone prefers the complicated insurance maze over ambulances not showing up? I get that honestly. That must be terrifying wondering if you will get help. I just know it’s equally terrifying how I felt in the united states. There were many times I was very very sick and didn’t have money to pay to see my GP or I was scared to call 911 and get a huge bill and find out it was nothing or something easily treatable. So I just held my breath and hoped it would go away.

Ok so there is Medicaid and Medicare in the US:

”What's the difference between Medicare and Medicaid? Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.”

and this:

“Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.”

Also, in the past, since few people lived to extreme old age, elderly parents might have needed their daughters (it was rarely their sons who did this) to cook and clean and fetch and carry for them; but they rarely needed long-term nursing care. Acting as your parents' nurse is likely to be far more challenging and physically difficult (especially if you're no longer a spring chicken yourself) than acting as their housekeeper- not that even the latter is a doddle.

@LeccyBillShill NHS and medicare are not comparable. We have zero co pay. We do not have enough Drs and nurses but there are big regional variations. My family can get to see a GP very easily, in areas with shortages of GPs it is hard to see a GP. My father had amazing care in a hospital this year. I can't imagine how it could have been improved, everything from the ambulance to the ward was amazing. My dad kept saying I keep hearing about all of these issues so why am I getting such good treatment. We did not know the answer but we were very relieved. Literally the only way it could have been improved as a private hospital would have been fancy drinks for visitors and expensive art on the wall and expensive visitors chairs. We were just blown away.
But I know in some hospitals wards are understaffed and ambulances have long delays. So it really does vary.

Some of the previous issues with the US system were fixed by the ACA, like plans that don't cover pregnancy.

Medicaid is a funny beast. It's administered at state level so it varies. The tradeoff with Medicaid is that it covers absolutely everything, it covers things no one else does like nursing homes. But it does it on the cheap, it manages by not paying providers enough money. So it can be difficult to find doctors that take it. (Hospitals all do because if you take Medicare you have to take Medicaid.)

The thing about prior authorisations is that no system covers everything. But the US model is that the doctor makes a treatment decision and then the insurer can override it. Every insurer has its own rules, so the doctor can't make decisions beforehand. In the UK a doctor simply wouldn't offer a treatment that the NHS had decided was too expensive or should only be offered in XYZ case. The prior authorisation model makes that more transparent to the user, but also inserts another layer of hassle: having NICE say they won't pay for XYZ or that you can only have drug C after you've failed A & B is seamless for the patient.

The difficulty with cost sharing comes with chronic illness, where you wind up paying your deductible in full every year. Back when deductibles were $250 or $500, that was an annoying nuisance. If you had a family, the odds were you'd meet it every year no matter what. Then insurers and employers decided the easiest way to hold back premium costs was to make deductibles and coinsurance bigger. Now it can be thousands.

I wouldn't recommend the US system even though I work in it, but I do feel that it's used as a scare tactic.