To be upset about my mum’s attitude to the NHS?

[Beautifulblues]

She’s turning 64 this year and so has benefited from the NHS all of her life.

She came from a fairly poor background, council house, working class, she had to leave school at 16 to get a job as they needed to contribute to the household. She shared a bedroom with her siblings until she was 14, very little in the way of luxuries.

Despite all of that she’s now a staunch conservative and she has said several times recently that she believes the NHS is no longer fit for purpose and we should be looking towards a health insurance system like other countries (she referenced France here but I have no idea of their healthcare system). I’m feeling very angry about it…she’s benefitted this long but doesn’t want me or her 4 year old grandson to benefit from the wonderful NHS as he gets older.

We can't fill the 50,000 nursing vacancies already in existence. If they were filled then it would be easier.

The reality is that this is in many parts an international health service, both in staffing and patients. In some trusts, the majority of clinical staff are recruited abroad. Many trusts employ teams or agencies abroad in developing countries to recruit their staff (trained with their little resource they have), pay their visas, flights and meet them at the airport to then put them into months of training as their nursing qualifications do not meet British standards. They are then working to treat patients, a fair % of whom should not be and are not entitlement to be in the U.K. Trusts generally refuse to check people attending hospital that they are entitled to free nhs treatment unless it is totally obvious, ie landed at Heathrow 6 weeks ago pregnant!

Unfortunately, our free generous healthcare, along with benefits system is a magnetic pull for unqualified migrants and until it ceases, the immigration issue will not reduce. I say reduce as it will never cease but reducing from a 1 million inflow has to happen as it is simply unsustainable.

So yes, the NHS is broken and needs radical reform. I'm afraid when Bevin set it up, he didn't envisage us treating vast numbers of other countries population

Those senior managers need to be damn good if they are going to be able to manage the huge and complex behemoth that is the NHS. The NHS is one of the largest employers in the world. To get good managers, you have to pay good money. And it's split up both by function and geography.

My local hospital trust alone has over 7,000 staff, just for one city and the surrounding rural area. In my county alone, there are approx 20 networks that oversee primary care, a separate trust for mental health covering 2 counties and a city, plus the ambulance service which now covers 4 counties and a bit of a fifth.

When something that huge is disaggregated both by function and geography, I don't see how one person can be held accountable for the fact that Mrs Jones in Basingstoke can't get a GP appointment.

And social care is a huge part of the problem. When councils don't have enough staff or money to put care plans in place, people can't be discharged from hospital until they do. Those beds can't be used for acute admissions or for people needing planned surgery. If you have a long wait for an operation, an ambulance, or to be moved from A&E to a ward, the cause of the problem is just as likely to be down to the council as the NHS. (Which is why I think social care should come under the NHS, so it doesn't have to compete with schools, roads and every other local service for funding).

And if you want to complain to the head of the NHS, google tells me her name is Amanda Pritchard, and her email address is available online.

And the NHS and social care benefit from migrant workers. There's a hospital just over the county border from where I live that has so many Filipino staff that among themselves they call it "Little Manila".

A friend works in a dementia care home where they're bringing in staff from south Asia because they can't recruit locally (although they might not find it so hard if they paid their staff more than they can earn in Macdonalds).

@MarieG10 Yesterday went to my local district hospital, rough estimate, 80% were elderly, same when i sit in my surgery waiting room, no migrants.

Not saying it doesn't happen, of course it does but i would look at legal migration i.e 5m Chinese invited to live and stay in the UK, the ones who have come to my part of England are old, so will be a drain on health resources.

40k relatively young people crossing the channel is not the issue here.

But the way the NHS is run, most certainly is, doesn't need to be privatised but it does need to be run more along the lines of the best private sector companies with more focus on investment, efficiency and flexibility.

From the little I know of French healthcare I believe it is a system with elements of free care and compulsory insurance via the social system ( though happy to be corrected).

That's my understanding, too, @MerlinsButler . I have a friend who lives in France, people pay a state insurance in addition to income tax, and pay a fee to see the GP, unless they're on a low income. Any tests or hospital treatment after that are free.

And the fee isn't massive, something like 10 or 20 euros.

We are living through a period where privatised gas and electric services need reform. Privatised rail and postal services need reform. It's interesting that everyone still thinks privatisation is the answer.

Any insurance based system will mean that some people will not get some aspects of care. Biological therapies for example, may be hugely expensive. They may also extend your life expectancy. Some people won't be covered.

We need to have an honest discussion with the public. The population is increasingly elderly because healthcare in this country has been a success. Many people in the NHS expect a level of service that isn't available in the private sector. It's remarkable.

There needs to be more investment in preventitive care and a discussion about whether people at the end of their lives really need medication designed to prevent things that are unlikely to have much benefit.

The UK hasn't enough people to fill the vacancies it has in healthcare, if you took those McDonalds workers, even assuming they had the means to work in community care, who would do their current job?

I ve asked my local labour MP where Lab intend to get all the people they need to fill all the promised extra staff, surprise surprise! no answer.. Labour are just full of hot air, just like the Tories.

A rich developed country shouldn't be taking staff from SE Asia, they either need them in their own countries or need to go to other developing countries.

We are short staffed because it's more lucrative to work for an agency, rather than work for the nationally set NHS pay bands.

That's true in social care as well, but I wonder how much more the overall cost is compared to directly employing staff.

When staff are directly employed, the employer bears the cost of employer's NI, pension contributions, annual leave, sick pay, maternity pay, training and probably a whole host of other things I haven't thought of. With agency staff, although the hourly rate is more, part of that will be offset by lower oncosts.

Genuine question: is the saving an ongoing one? I.e. you have change the system and now the system will cost e.g. 40k less per year to run? And won't need that team doing that work? This is the only way this could make sense to me.

having lived in France for 15 years, id chose the healthcare system here over the NHS any day. It’s not always completely free to the user, though there are free options. We are on fairly modest incomes and are always able to access private-level healthcare. We haven’t actually used a public hospital in all that time, we use the private clinic / hospital just round the corner, we chose our own Dr / physio / nurse / lab for tests / surgeons / gynaes / midwives etc and make rdvs that are mutually convenient and we are reimbursed for the great majority of the costs.

some things though that are standard in France:

ID cards and health cards. If you don’t have your papers, treatment is harder to access. There are options for the truly destitute / homeless / sans papiers, but they obviously are pretty basic.

Health insurance - pretty much everyone pays for a mutuelle, which tops up the govt reimbursement of healthcare costs. Ours is about €200 per month for our family.

Children are legally responsible for their elderly parents care. Not actually doing it but organising and sometimes paying for it. My impression is that this avoids the bed-blocking that happens in the UK - families are a bit more proactive about sorting things out.

we pay considerably more tax.

we pay up front for most healthcare costs, and are reimbursed. So you need to enough money to do this.

And it usually is.

I have a friend who spent 10 years nursing in Australia, mid-80s to mid-90s.

When she came back to the UK, she did agency work in the NHS for a while. She was so horrified by how decrepit the fabric of the buildings had become, the decline in the standard of cleaning and the drop in staffing levels, she said it was like working in a 3rd world country (disclaimer: she is prone hyperbole). She declared she was never going to work in the NHS again, and pretty much hasn't.

She has recently had some experience of hospitals, both for herself and her mother, and has declared the NHS unfit for purpose, not enough staff, squalid conditions, long waits etc and says it has gone down the shitter since her mother last needed admission in 2009/10.

She votes Tory, always has and always will, but cannot grasp that both the periods in which the NHS has declined have happened when the Tories have been in government and that there may possibly be a connection.

I agree that we do need those honest (and difficult) discussions about expectations. But at the same time as a nation we also need to be honest about the investment that is needed in healthcare, and that if we want a decent service may need to pay more tax to fund it.

I think that's possibly true of the older elderly, but they raised children in an era when childcare wasn't widely available, women's wages were significantly lower than men's and it was generally expected that women with children would stay at home. I can't recall a single friend from my childhood whose mother worked f/t, and very few whose mothers worked at all while their children were school.

I'm a boomer, none of my friends of the same generation took years out of the workforce to be SAHMs. I'm in the first tranche of women who had to wait till 66 to get my pension. I've worked since 1972, save for 2 years when I went to uni, and am still working and still paying tax. State pension is taxable, so anyone with a private pension of more than approx £3k pa will be paying some tax.

We can't help the fact that life expectancy is increasing and that comes with costs in terms of pensions and healthcare. Older people will always have more health issues than younger people, overall. But short of introducing euthanasia for us old farts, I can't see any alternative to universal provision for all but the wealthy elderly, because the cost of private insurance would be prohibitively high.

Some form of contribution would be sensible. People value things they have to pay for more than things they get for free.

No shows would drop if either they had to pay £20 for an appointment or £50 if they didn’t attend.

OAPs should pay NI as well. It’s just another tax and should simply be rolled into Income Tax.

But YABU OP because you know nothing about alternatives but still think she must be wrong and the drip feed about immigration was just desperate

Late to this party, but op, she sounds like every other low-education person from deprived backgrounds who has trusted the messages coming from moneyed and political elites delivered by a destroyed and corrupted system. I was similarly annoyed by every older person going on about Corbyn being a communist after they had benefitted from decades of the post-war socialist-leaning system in Britain. If you figure out how to fix it let me know, because I’ve given up hope for Britain.

Cancel her paper subscription or change it for one with decent content.

@Thebestwaytoscareatory who in the UK government is a ‘boomer’?

At most the vast majority are Gen X or Y

To add quickly - the only ray of hope is movements in America, because Britain gave up its sovereignty and independence when it dropped the protection and shelter of a confederate EU. We will follow what the US and EU decide eventually, although there will be an almighty fight to drop the corruption following the money from Asia. By ‘eventually’ I mean in decades.

I think by looking at the NHS we're going at it backwards. The biggest problem, IMO is social care. We're an aging society, care of the elderly is going to get more and more expensive and nobody wants to pay for it.
Having to sell property to pay for your care is a vote loser, but I can't see any alternative unless tax is increased hugely to pay for it.

What?

Maybe she isn’t BU. I’m assuming everyone would still have full access to the same health services (so wouldn’t need to pay insurance premiums if they don’t earn enough) so it could be there is a better funding model which would give everyone better outcomes?

I know how you feel 🙁

We can’t really compare our healthcare system with France’s because we don’t spend as much on it per capita as the French do.

Why not try funding the NHS to the same level as the French system, then we can compare them and see which is better value for money?

Oops, quoted the wrong post there 🤦‍♀️

Report out today (Age Concern) says the over 50s (who need it) wait on average, 6 months for a social care assessment and 79 people A DAY die before getting the care they need.

That has nothing to do with the NHS, it lies solely at the door of the Government who have consistently underfunded councils and social care over the last 13 years.

Just image if a double decker bus full of the over 50s burst into flames every day with no survivors, would be just sit back and say "So what, they were old and sick and would have died in any case"