To think our obsession with the NHS has got out of hand?

[HFJ]

I think we’ve got to the stage of faux outrage, thinking that if the NHS did its job properly, old age would be cured and there’d be no deaths whatsoever.

This article caught my eye https://www.telegraph.co.uk/news/2024/06/20/ae-waits-cause-plane-load-of-deaths-every-week-doctors-say/

Essentially, according to the article, delays at A&E are causing 250 extra deaths a week. You’d expect these extra 250 people to show up in the national statistics. So I checked and found the answer here: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending7june2024

I attached the key image. It very much looks to me like deaths are lower than average.

My worry is that this outrage is just being used to prep us for huge increases in tax ‘for the NHS’ and this will be at the expense of spending that would benefit young people, young families who are really struggling right now.

A social contract is not the same as a constitution.

When national insurance was brought in, and the NHS, a new understanding was developed about there being a contributory system whereby everyone (most people) pay in and everyone has the benefit of free at the point of delivery health care and a state pension. That is the social contract around this matter.

We don’t have a true insurance system as the level of funding (or premium) bears no relationship to the cost of delivering healthcare. In the UK we have the same organisation (the Government) controlling the funding and the delivery of healthcare.

A proper insurance based system such as that in France, a country that spends more than us per capita on healthcare but performs better that the NHS on all key indicators, separates funding from delivery. Delivery of healthcare in France is mainly private. Funding is mainly state, via a proper funded insurance scheme run by the state. They spend around 20% more per persons, and deliver better outcomes. The French healthcare system is widely recognised as one of the most comprehensive and efficient in the world. It has a a strong emphasis on universal coverage and quality care, and is widely recognised as one of the most patient-centric service heath service is in the world. Likewise Germany has a similar model, though also using not for profit organisations for deliver.

Thats why many of us who have lived and worked in other countries, and certainly in my case, due to my late husbands many health issues, experienced what state healthcare care can be like, recognise that fundamental reform is needed, not just more money. We have spent more money, and not improved anything. It’s pure arrogance, and stupidity, to believe that the NHS is the best healthcare system in the world or indeed can ever become so structured as it’s is. Nothing centrally funded or controlled will ever be patient centric.

Performance of most EU healthcare system is better, and funding is better. There are two big differences. Firstly structure. No healthcare system that delivers good results is structured like the NHS. Secondly, putting the patient in control. Those systems that deliver better results and are most widely praised are those that deliver healthcare in a patient focussed way. More money will not make the NHS more patient centric - Blair tried that and failed. And that’s what’s at the heart of the problem - a huge disconnect between the patient experience and those who work, run and fund the system.

I think you're simply making the point others are arent you? The spending is more, so the funding is higher and so the outcomes are better?

And we used to have better outcomes than other countries despite lower levels of funding than those other countries, what changed is that the funding for our NHS didnt continue to match need.

Well not really. The NHS can't be responsible for public health unless the legislation is changed. LAs commission the NHS, and other providers, to deliver services on its behalf.

So much time, effort and money goes into the commissioning, I'm uneasy with the internal market in health and social care.

I agree with others that an insurance system is looking more and more attractive. I'm thinking French, not US of course! A system that is measurably better than the NHS, which makes me very sad to say as someone who worked in the NHS for decades

My worry, OP, is almost the opposite. That it's being used to attract support for removing healthcare free at the point of use and moving us to an insurance model.

Well yes really! You've just said that if the commissioning/legislation/instruction is changed, the brief will change, thats why I said it can be whatever we want it to be. Those things arent set in stone

Why not cost the plans and put it to a votes/individual decision

Ie
Options 1 - everything include - basic rate tax 25%
Option 2 - co pay of X per treatment and non essential treatment (dental/optics/cosmetic not included)- basic rate of tax 18%
Option 3 - (what is provided to those not paying tax) - life and limb saving care only. So chronic conditions covered but no nice to haves we take for granted like hospital food etc All appointments are at assigned times etc.

I really don't want to pay more tax but am happy to pay top ups for NHS services like faster wait times or choose/book appointments.

I take no issue with society being healthy. I just don't think taking other people's hard-earned money to achieve that is a good idea. I think it's quite rude, actually. Nobody looks at their payslip and thinks "Boy, I really ought to be paying more tax." and if they do think that, they're more than welcome to write to HMRC and offer to pay a big fat cheque straight to The Treasury. I'm not sure if it goes to them, but you get the idea.

To be honest, I think most people understand that the NHS is hopeless and not fit for purpose. How to fix it is another issue.☹️

The phrase 'fit for purpose' irks me.

Everything is fit for purpose if it's used for that purpose. Whether it was designed to be used for that purpose is another, entirely different matter.

The NHS can be fixed, but it's going the take a kind of political will that most politicians don't possess. It will collapse eventually, it's too big and can barely function.

I have no problem with people worshipping the NHS. Providing free healthcare is a beautiful and noble thing. However, instead of constantly blaming the government for inadequate funding, I'd like to see more shaming of those who exploit it.

For a start, we should call out those who smoke, eat garbage, refuse to lose weight, and just generally slob around. I accept that some people struggle to lose weight, and that others are overweight through no fault of their own (medication, mental illness, whatever). But people who have no excuse, and yet remain obese, should be told "look Mr Smith, you're being unfair to other patients. If you don't at least make some effort to get into shape we're going to charge you for your next appointment."

There is a certain type of person who is almost 'professionally ill'. I don't just mean that they live on benefits. I mean they actually like going to the doctors. They treat it as a day out. The slightest niggle or twinge and off they go. I can think of several people (actually, several families) like this. In many cases none of them even work. Then you get others who treat the whole system with contempt. They put in for repeat prescriptions they neither want nor need, and they make appointments they fail to keep – without even bothering to cancel. And their instinct is always to find fault with their treatment. Plus, of course, they love to tell you how they put some tired, overworked doctor in his place ("so I said to him, I did, I said, I'm not taking that muck, you find me something better" etc).

There is a horrible instinct in people (myself included, I suppose) to grab anything that is free. Evolutionary psychologists would probably put it down to the fear of starvation. Chimps and wolves (both pack animals, like us) will "snatch and run." If there is food, or some other desirable object, their instinct is to grab at it and then hide away from the rest of the group so it can't be taken from them. I wish those on the left would read a bit of evolutionary psychology. Too many of them have a silly and naive view of human nature. I suspect the NHS really is a black hole. The more money you pour in, the more people will take. It's a beautiful thing, but it will only work if you're realistic about people.

@Willmafrockfit your comments in this thread show zero understanding of the NHS, ever heard of Trakcare? I truly hope you're not an NHS employee!!!

I’m also surprised to see people constantly complaining about neurodiversity assessment waiting lists when they’ve had a 500% increase in applicants or something 🤷🏼‍♀️

The NHSs outcomes have never matched those from properly run and insurance funded health services. And patient centricity has never been a priority. So I am making a very different point. The structure of the NHS needs to change to enable the patient to get the benefit of improved funding.

I’m going to take a wild guess that you are not in London.

I have just had to pay for my own smear test because my surgery told me last week it was going to be a five month wait until I could be booked for one. My daughter had an asthma attack three months ago and was treated in A&E because there wasn’t a bed for her. It took 14 hours. My partner needs an investigation for a recurring urinary tract issue and has been told it’s an 18 month wait. We are exceptionally lucky in that we can pay. Millions can’t.

In many parts of the country NHS primary care has effectively ceased to function.

Yes emergency services still do well in a crisis and yes if you are on a cancer pathway it’s a different matter. But it is literally impossible in many places to see a GP physically without an elaborate online triage system which usually fobs people off with a phone call.

I acknowledge that most frontline NHS staff are dedicated and hard working people who are doing absolutely the best they can in incredibly difficult circumstances. But I am really tired on the gaslighting which goes on.

You say no one mentions the positives but in my experience the opposite is true. The canonifocation of the NHS and the quasi religious awe in which people still hold it is stifling our ability to have a mature conversation about how to fund this. It’s still impossible for a politician to openly criticise the NHS or to suggest a different approach. It’s impossible to say anything negative about it without being called a Tory.

People have become so used to this incredibly substandard level of care that they tell themselves they are lucky.

But the bottom line is we are heavily taxed for a service which fails to provide a minimum level of healthcare and I am sick of having to pretend it’s adequate. And I am a card carrying Labour Party member and committed supporter of public healthcare. It’s just not good enough.

It's not going to change. Just because 'we' want it to be something, legislation is heading in one direction, and whilst that legislation is bringing more integrated working across LAs and the NHS, public health won't be going back to the NHS any time soon.

The NHS is no longer fit for purpose. We've been lagging behind other countries in heath outcomes for decades. Life expectancy and healthy life expectancy, mortality rates from specific diseases, infant mortality etc however you look at it, we are failing.

Clearly the number of training places needs addressing, that was my point.

@Wishyouwerehere30
it is true,
why question me about this?

i also hope you are not an NHS employee

I agree on your first two points but not the third. What treatment is your DC on a waiting list for three years?. I work in the NHS and I 'now there are no waits anywhere near that for essential treatment.

Yes the NHS is a shit show. The reality is shovelling more money into it without wholesale reform will just be an utter waste of time. Many of the senior managers haven't a clue having started as very junior staff and worked their way up. They have only ever spent time in the NHS and are clueless about understanding demand and efficiency. Procurement is also an utter joke.

The state of the NHS is very much related to the state of everything else I think - most people I know (me included) are over-worked, exhausted, struggling with bills and feeling pretty hopeless. I have a chronic health condition that would be improved by more rest, but that isn’t going to happen - I can’t afford to drop hours. People are getting sicker through less exercise and unhealthy diets, and stress. I can’t remember ever feeling so exhausted or bleak.

Only children? You completely side stepped the rest of her points. The 12 hour waits in the back of an ambulance to get seen in A&E (if we're still alive) and waiting years for surgery? Or are we all just faux outraged about that too?

Yeah I'm sure it would work perfectly well for all the tens of millions of people who can't get fit to save the NHS because their conditions aren't actually anything to do with just not being fit enough. You really aren't thinking this through are you? Children born with cancers? Any congenital condition you can throw a stick at? Accidentally breaking a bone? Yep, get fit to help the NHS, that should do it!

We had all about “saving the NHS’ through Covid. It’s getting worse and worse, despite that and despite the billions thrown at it.

The whole situation is unacceptable,

It needs a complete root and branch reform, but I doubt any party will be brave enough to do it.🤷‍♀️