If the Tories are responsible for the failing NHS, why is the picture no better in Wales under Labour?

[Namechanged2023]

I have never voted Tory, never will. I don’t support anything they stand for.

But I don’t buy this narrative.

The NHS has been rubbish for years. I work in a different public service, that is also rubbish. Too many people talking instead of doing, no performance management, too much leeway with full paid sick leave.

I’ve had mixed experience of the NHS like most. Some excellent staff who want to help and save time, some of the same role who do things completely differently, in a much more time consuming and resource intensive way (think simple tasks like administering antibiotics to a small baby). Some really empathetic, compassionate staff; some the complete opposite. Proactive GPs, and some who refuse to budge.

Their processes are just ridiculous though. I have waited hours to be discharged. Everything has to be done on paper. Letters sent out for everything. Phone lines only open for 2 hours on 3 days a week, so impossible to get through.

Thank you. I guess we both made our points badly :-) as mine doesn't seem to've come across either.

My point was more about the STRUCTURE of the NHS. Parts of it are too centralised. There is too much management. Too many pay bands and no ability to reward according to performance. Very toxic culture with bullying rife IN MY HUMBLE OPINION (I worked in it in South Wales when I lived there). Too much difference in quality by postcode. Very poor and slow procurement practices. Too difficult to get rid of underperforming staff. Few mechanisms for helping staff who are struggling. Too clinically focussed on point of need rather than prevention. Now encompasses too many services. Makes full use of private sector but doesn't maximise their input for best results.

It needs reforming, Blair tried to make it more responsive to performance but as he said, scars on his back. Andrew Lansley tried to decentralise and got pilloried. It should not be free at point of use for wealthy, they should contribute more upfront according to means test (NOT income test). GP as gateway to services no longer working.

I agree that stopping bursaries was bad BUT the real mistake was making nursing a degree requirement. That is when the numbers going in really fell of a cliff. It should not be a degree we should go back to the two year hands on training.

Agree with majority yanbu.

Because the UK Government sets the funding, sets the workforce plan to grow the number of staff, mostly sets salaries?

I’m fairly certain the devolved nations have tax raising powers and could raise tax. Also, the funding is given over health, education…….. so maybe cancel the free university places and free prescriptions to pay higher nhs salaries.

I actually think prescriptions and education should be paid for, but it is always about competing choices.

Because the problems in the NHS are intrinsic to its flawed and outdated structure, and absolutely nothing to do with party politics. So many people who have worked in the NHS for the last 20 or 30 years would say the same.

Yes, health is devolved, and the situation in Wales in particular has been dire for rather longer. I think its pretty parlous in Scotland too

What do you think Major/a Conservative majority in 1997 would have done differently with the NHS?

Because Wales isn’t a separate country and although healthcare is devolved, Westminster still controls the purse strings and even though Wales gets extra per head, there is also an older, iller, and more poverty stricken population here, plus the same issues with social care. I’m sick of this question being asked and Tory voters being smug about it.

There is of course some mismanagement, but it’s disingenuous to suggest the current state of the NHS isn’t mainly the fault of the tories because it’s gone massively downhill since 2010, it’s no co-incidence. Same with education.

People will tell themselves anything to justify it.

www.channel4.com/news/factcheck/nhs-wales-badly-run-by-labour-or-underfunded-by-westminster

I have been told by an elderly doctor who has worked all his career in the NHS that about 80% of resources are allocated to treating people over a certain age. Also that whereas in the past such people would have seen a gerontologist who would, essentially, advised them on how to manage decline, now they try to fix problems, even though operating can knock all the stuffing out of an elderly person, and although it's much much much more expensive.

I'm not suggesting a preference on approach, but it does suggest that the NHS will come under ever increasing pressure over the next few decades as the population ages.

There's truth in this but you missed out:
Failure to fund social care so that patients cannot be moved out of hospital when they are ready.
Covid. Our stretched system was particularly ill equipped to cope with the additional pressures.

And actually obesity is a huge concern. The levels of obesity are amongst some of the worst in the world and far beyond normal. Obesity and the associated health risks, including the rise in type 2 diabetes, is a genuine and huge concern to NHS planners.

Oh give over. Simplistic tribalism achieves less than nothing and makes you sound foolish.

Raising taxes is all very well, but have people in Wales, which isn't a terribly flash place, got the money to pay then without going into hardship? Also, if my recollection is correct, devolved governments can't adjust the tax bands, meaning the poorest are impacted the most.

Perhaps the solution is attracting more investment etc to Wales - but as Labour have been in ever since devolution and haven't managed this...

The NHS needs an overhaul, it needs better funding and it needs less bureaucracy. The system in The Netherlands is worth looking at, since changing their model in 2006 they risen up to 3rd in the rankings.

en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

A key part is that they’ve brought “sport” under the healthcare banner in government, whereas we have it as part of media and culture. Treating sport as integral to health means better preventative measures can be taken.

Wales isn't really a separate country, anyone suggesting that is being rather foolish, it can't chose how many English retirees decide to live there, decide its own immigration policies to get EAA nationals back in to Wales or NHS staff planning targets & the pay review body is for all AFC staff in the UK... Wales can't decide its own Hospital building or capital replenishment programs.

As for inward investment, thats pretty much died a death since the GFC and fell of a cliff since 2016 & not just for Wales either, apparently Thatcher did well at getting global firms to set up shop in more deprived areas of the UK but that was thrown away.

Anyone have any views on the teacher/education situation too? DC’s class is going to be closed for four days due to his teacher striking. Education is devolved so why are the Tories to blame.

As has been explained several times, and as any grown up should know, finances aren’t totally devolved. Can you just stop with this disingenuous questions? Or carry on, if you so love the Tories. They are failing your child and your family’s health.

I actually vote Plaid Cymru and have never voted Tory in my life.

Hoowhoowho · 04/01/2023 09:04

People spin their own narratives about the NHS, stories they’ve told themselves which often have a grain of truth but aren’t ‘the truth’

Narratives like

people live too long and medical care is too advanced these days. The NHS model isn’t fit for the modern world. Except around the time the Tories came in, the NHS was rated by the WHO as the most efficient model in the world for outcomes for cost.
No matter how much money we chuck at the NHS, it’s inefficient systems that let it down. Except a. We don’t chuck money at the NHS, we spend a lower percentage of GDP per person than almost any other developed nation including the US where the system is predominantly private and b. It’s not particularly inefficient statistically or wasn’t until recently
There’s too many admin staff and not enough doctors and nurses. Actually there’s a severe shortage of admin staff despite them being what makes it more efficient
Patients using wrong services/missing their GP appointments/being too fat/smoking/wanting IVF are the problem. No this is what a health service should be able to manage.

The real truth is the NHS is currently screwed because of two reasons
A. Chronic long term underfunding. If you want a European style system or to improve the current system, you have to pay for it. It’s the elephant in the room but the reality is that we have not funded the NHS as well as other countries fund health for decades. The fact that we’ve scraped by for so long is a testament to the efficiency of the system.

B. Brexit. Brexit impacted the NHS directly in terms of loss of staff that’s probably recoverable from not least if wages raise and we can target recruiting abroad. More significantly though it impacted it in the loss of a massive minimum wage, unqualified workforce who were providing basic care to an increasing number of elderly in their own homes and care homes. That care prevented numerous admissions for falls/UTIs etc and enabled speedier discharge. Without the workforce the NHS is fucked so we need to address that either by improving wages and working conditions in care or looking to allow high rates of immigration again to obtain a low wage workforce to address this need.

Healthcare in Wales is dire but it also has been long term underfunded and Wales is a poor country so there’s less resource to pull even if they chose to and Brexit has hit the care workforce hard everywhere,

👏Well said.

Also, as both an NHS Wales worker and user my experience has been great. I work with a dynamic, committed and passionate team and we offer a service that the vast majority of our patients are satisfied with.

An elderly relative has had to use 111, GP, practices nurses, A&E and other hospital departments- has had brilliant service. Couldn’t be happier (apart from if they didn’t have all the needs that led them there). I have had excellent service and treatment in the vast majority of my interactions with services. Couldn’t have been better TBH.

I think there is a narrative that the NHS is failing. Yes things aren’t as good as they could be in some areas BUT we have just been through a pandemic- some bits are ‘dire’ some are brilliant and some will keep improving - my bit of the service is only just really getting fully back on track since Covid. So many changes to adapt to in a short space of time.

I think we need to build on what’s good already. Not re-start. Privatisation doesn’t work. Profits become the main motive. I’ve seen it in social care.

We need to redistribute wealth in a massive way by taxing wealth (rather than just income) and clamp down on tax avoidance (yes that means you too Government ministers!)

This is spot on @Pinkkite
I wish people understood this

The Barnett formula is used in Wales and that dictates the level of funding for the NHS. From my rudimentary understanding this means that if funding per person goes up in England (or cuts are made) then the same has to happen in Wales. This has been the case since the 70s. Unfortunately this does not take into account the more spread out population, which increases health costs per person. Neither does it take into account the age or poverty of the population, both of which have significant effects on the health of the person. Many people retire to Wales and bring their old, ill bodies with them.

Wales also has a massive influx of holidaymakers in the summer, lots of outdoor pursuits, water based sports etc, this increases the workload of A&E during the summer or bank holidays. The Barnett formula does not take into account the transient population during the holiday periods.

It would be much better to look at needs, ie more pensioners = more funding.

Being devolved is an issue when it comes to funding treatment outside of Wales. If you need to go to England for specialist treatment then funding will need to be applied for. Once that treatment funding is in place then you may need to apply for a different kind of funding for any other issue/need during your time under the English NHS. I know several people this has happened to and this has had a significant delay on their treatment. One clinical specialist told a friend that all of his worst cases come from Wales as it takes so long to be diagnosed and also navigating the bureaucracy to secure funding means the illness is far more advanced compared to English patients.

The other problem with the funding used to be that whilst funding would go up in England and the same raise would apply to Wales, it was not compulsory for that increase to then be spent on the NHS and it could be used on other areas. I don't know if this is still the case.

Basically don't get ill in Wales.

The central problem is that we have an ageing population. Also, new drugs and technologies cost money. And though they keep the elderly alive, it’s often in a weak and dependent (and expensive) state.

I know somebody, for example, who is now 83 and virtually housebound. She is grossly overweight and has to have her blood constantly monitored. In the 1940s, somebody like her would have died by now. But she will keep going for several more years, costing the NHS a fortune. Like so many people, she also makes no effort to do her bit. She eats garbage and refuses to
perform the exercises that have been recommended.

I’m sick of people blaming everything on the Tories. I am especially sick of people who claim benefits and live on junk food (like some of my neighbours) complaining. If people like that actually worked, paid tax, and didn’t abuse their bodies, the NHS would be in better shape. The majority of adults are now either overweight or obese. I think something like a quarter of middle-aged people are obese - not just fat but obese!! I don’t want a society in which everyone is out for themselves, but people forget that socialism (which is what the NHS is) depends on everyone chipping in. It doesn’t mean sitting back and expecting others to take care of you. So many people I know abuse the NHS. They make appointments then don’t turn up, put in for repeat prescriptions that they don’t need (and stockpile the drugs), and then get angry when the high earners won’t hand over more of their earnings in tax.

The NHS needs to be drastically overhauled. So many of their working practices are absolutely ridiculous. They still have people typing out letters to patients manually FFS. Paying way over the odds for basic supplies that any private individual can buy far more inexpensively for their home. Doctors are vastly overpaid and their union is far too powerful. If you were starting a health service from scratch today, it would not resemble the current NHS at all. They need to move into the mid 21st century, where the click of a button which takes seconds can replace countless letters or emails going back and forth and waiting for people to reply.

Modern nationwide IT system linking all GPs and ALL nhs trusts, inc MH, would cost 10s of billions and take years to roll out... many nhs buildings don't have power, backup UPS's or cabling for such systems either.

IT systems for Hospitals have to be 100% reliable, so need a great deal of redundancy, increasing costs further.

& by the time its rolled out, it is out of date.......

Doctors over paid? there is a shortage.. supply n demand.

Meanwhile, the MoD manages to have one IT system that is not only used in crumbling, outdated barracks in this country but all over the world; including places without the infrastructure we have here. There is no excuse for the NHS to not have a singular IT system with the appropriate fall back contingencies in case it falls over. The amount of ridiculous wasted time and effort navigating and sharing info between trusts and settings is just ridiculous. It also means there'd be more merit in recruiting/training and paying a fair wage to internal IT engineers rather than paying excessive amounts to companies which is miles better for service.

Also- tens of billions...no. It would be very expensive but similarly so is the sum of all of the systems, their maintenance, separate patches, deployments, upgrades etc- ridiculous amounts. A single system would be a lot easier to keep updated as well. It'll never happen because a) it makes too much sense, b) it would make life easier for staff and patients, c) they don't want to invest as can't see the end of their nose.

Also doctors are wildly underpaid compared to their counterparts elsewhere in the world, and certainly at junior doctor level to other graduates. If the NHS was dismantled and so competition between providers was introduced their wages would no doubt rise substantially due to market forces.