To think the NHS has already failed.

[Goingforplatinum]

5 hour wait for a cat1 ambulance for a child. Unresponsive patients being taken to hospital by neighbours. 90 hour wait in A&E, unsafe staffing on wards, 7 month wait for coil or implant fitting. The NHS isn't failing. We need to admit its failed

.... its meaningless, we cannot rip up the NHS and start again, the disruption would be massive and very long lasting.

People keep saying "oh no one has copied the NHS" as well as not being strictly true, who has exactly copied Germany's or France's health systems or anyone else's for that matter?

The NHS has worked relatively well in the past but if you have decades of lower funding than e.g. France.... then expect much lower levels of service.

What we need is evolution in health care.

The problems in the NHS are fixable... Social Care, retention i.e pay, fund to france germany levels over 15 to 25 years and open up the NHS to anyone from EU, without visa health insurance requirements.

However, none of that will happen.... even yesterdays announcements weren't new money, the £250m for additional beds etc has to come from current budgets... so something else will be cut.

Doubtless in 2024 we'll also vote Conservative again too... followed by years of moaning about the NHS or whats left of it.

We are at the bottom of equivalent countries and we pay less and we have a more unequal society with a larger gap between rich and poor

These are all interlinked but until we all accept higher taxation ( Germany has 3% income tax just for social care) it can't get fixed

The NHS conversation should include comparisons to other countries which are culturally close to us and which have come up with different solutions to the same problem.

I honetly have no issue with that @yubgummy , especially as from a selfish point of view, as nurses are generally much better paid in other countries

Also @yubgummy , how does elderly social care work over in Australia ? Because you can't discuss one system without including the other as they are so interlinked, or at least they are in the UK because of our acute and general bed numbers.

I am not suggesting ‘ripping up the NHS’, @Alexandra2001 and I do not recall other thoughtful PPs pointing out that systems generating better outcomes may have something to teach us have suggested this either. Misrepresenting us helps nothing.

The steps we want to explore do represent evolution of the system.

All the systems generating better outcomes tend to spend more and have more beds per 1000 people. It isn't unreasonable to suggest that if we had similar resources the NHS might work better than it currently does. I do think it is good to look at how these other systems function, for instance whilst Australia has a much smaller population than the UK, it has a very similar demographic, which is why I asked a PP about how social care for the elderly works over there.

One big issue I can see with fragmenting the NHS is that it would lose its negotiating power with pharmaceutical companies ? This doesn't seem to get mentioned a lot on the NHS threads.

Many posters have said "rip it up..." etc...

To go from what we've got now to a French, let alone a German style system would involve dismantling the NHS and starting again.
Plus creating whole new private insurance and health industries.... which in its self would involve changes to legislation & regulation.

Before we even think about reform, we need to get what we've got working to (at the very least) 2019 levels... that will probably take 3 or 4 years.

Its only by talking to my DD that i realise what an utter shambles the NHS is in and this Govt, as Tory MP Edward Lee said yesterday has no plan to change anything.... so to the 3 or 4 years i mentioned earlier, we need to add 2 more years until the next GE (assuming Labour win)

Paying people in social care more and giving them company vehicles, is hardly reform... it could be done tomo.

Social care is also run on a public-private basis. Aged care (either in-home or dedicated facilities) is government-subsidised but there is a means-tested co-payment component. (Of course there are also fully-private providers too.)

www.myagedcare.gov.au/

There is a separate scheme called the national disability insurance scheme (NDIS) which funds disability-related support for people of all ages - this is more tailored and depends on situation obviously.

Australia isn't the perfect comparison, they have some challenges we don't and vice versa. But it's worth looking at to challenge some of our assumptions about the constraints we have.

And I think fear of introducing any level of privatisation has led us to the point where we are now: discreet, total privatisation only for the very rich, and no mechanism to allow middle-income people to add private funds into a public/private mix and increase overall funding.

Thank you for that @yubgummy , like I have said I have no issue with exploring a co-payment system in principal and we already have a two tier system for many things if you can afford to pay.
I suppose my biggest concern is we are not very good at privatisation in the UK from a consumer point of view, our track record is pretty shocking really, so I can't see this particular privatisation panning out any better. The parts of the NHS already outsourced aren't always great as it is, I am in touch with such a provider on an almost daily basis and they are quite frankly rubbish, fail to deliver their service, very little interest if you contact them and we are stuck with a substandard service until their contract finishes or they figure out they can't make enough money out of it !

@Alexandra2001 Any meaningful changes, even small ones, will involve legislation. We could easily begin to bring in small elements of the French or German systems tomorrow, without ‘ripping up the NHS’ if we had the will and the skill I do not wish for that. I do wish to begin exploring the possibility.

You seem to be saying that we lack the skill. I don’t disagree but I don’t see why that should be a permanent state of affairs

Yes they were made up numbers. Dying within 28 days of getting Covid is not the same as dying of Covid.

You are right - the 28 day cut off is clearly too low

But the excess deaths tracked the covid deaths well - a bit higher as a result of the short cut off - despite us knowing that there were hugely fewer accidental and asthma deaths

Even now they think part of the excess deaths today are covid deaths

@poetryandwine Yes we lack everything.... ... we don't have cooperative funds that are genuinely not for profit, we don't have enough staff, buildings, equipment or the people to maintain it all.... then there is the money, we are talking 100s of billions... which we can't borrow for and people wont pay the taxes or in many cases, can't afford it.

In practical terms its beyond us, with planning for new buildings and training plus retaining of staff, we are looking at 15 plus years to get to a system like France/Germany.

BUT none of that can happen, because we have one party that wants an NHS and another that does not, so whatever Labour do in 2024 (if they get in) will be undone 5 or 10 years later when the Cons get back in.

Barclay can relieve pressure on the NHS by funding social care... he wont or even discuss pay for nurses to avoid strikes.

Agreed, @Alexandra2001 . But either party, when in power, could choose to make a small start by exploring ideas such as co-pays, NI for pensioners who pay higher rate tax, etc. (Perhaps on a sliding scale) If anyone wants to issue with these particular ideas that is fine: that’s what debate is for. There are loads of others. The critics should try coming up with some

As you said earlier, evolution. The NHS is too big to tear up and rebuild.

@poetryandwine 100%

We aren't starting from scratch...

My DH is an UK trained specialist, now also working in Australia. Consequently, we have family in the UK, including a young person with a complex disability. He can’t help but compare the early intervention and specialist involvement that his relative is getting (poor) to that which is accessible here. Australia has pretty good, government funded, community based therapy for children with disabilities.

Yeah because they're willing to pay for it.

Look at average healthcare spend per capita in Australia vs. UK.

In the UK we vote for governments ideologically opposed to paying for it.

In the UK we've convinced ourselves that we couldn't possibly pay any more.

In the UK we've convinced ourselves that we couldn't possibly pay any more

I agree this is part of it, but also that “our wonderful NHS” is so revered that no government will risk a major overhaul.

Been several major overhauls i.e. change to trusts, health and social care act.

But they don't work because they do not address long term funding, aims, staffing and integration of social care.

Whatever one Govt does.... gets redrawn by another 5 years later.

But now we have a situation where we wont tax more, tax take is falling, GDP is shrinking and the UK cannot borrow... so whatever happens after 2024.. the NHS wont improve and major reform, by their very nature will cost a fortune for gains many years hence... who is going to do that?

George Monbiot reports in The Guardian online today that the UK has lost 9000 hospital beds since 2010. There are about 13000 cases of bed blocking currently obstructing the system. In other words, the bed blocking problem, while very real, could be reduced by over 2/3 if the Tories had not cut hospital bed numbers.

GM has a further discussion of the £10B the Tories have quietly allocated to reserving beds in private hospitals for the next four years, instead of putting money into increasing NHS beds. He calls it the moral equivalence if the PPE scandal

I bet he hasnt mentioned the vaccine mandate.

9000 beds? in a period when demographics should have meant an increase of 9000...

Anyway, the Cons want the NHS gone.. to be replaced with nothing at all.

After all we all managed before the NHS......

Bed blockers, generally elderly, should not be in hospital beds at all. It is bad for recovery, it's stressful, they degenerate, and loose independence. You need to put the money into social care beds or home care.

The case for increasing hospital beds then diminishes. Acute hospital beds are generally not long stay, the majority, in modern medicine are for short stay post operative observation. Most people even after fairly major procedures can now go home after a couple of days.

But in Australia you don't bet everything paid for I believe. I think I have seen other posts where you pay something towards meds, you pay for ambulances, you pay for dental care. So, the difference is in what they (government and tax payer) have chosen to fully fund, which in this case is disability therapy. We could choose to do the same, but there is an entrenched inability in this country to even countenance paying for anything medical related.

YANBU but people voted for this. I certainly didn’t!