To think the time has come to abolish the NHS healthcare model

[OptimismvsRealism]

Free at the point of use also means denial of care to a lot of people. What torture to know that new medications are arriving regularly (eg lecanemab) but it's only for the very wealthy.

The UK is different from how it was in 1948. We should be brave enough to move on from then.

Not sure if anyone has said this as haven't RTFT but lecanemab has very marginal benefits and significant risks.

I don't resent it as I understand the point of it. What I do resent (a bit like you) are people dodging their responsibilities by not paying or not paying enough.

My in-laws live in France. If they have appointments at the hospital, they have to go to an office to collect their stickers for the paperwork. They have to visit the chemist to collect, for example, the contrast dye for their scan. If they need dressings done by a nurse, they have to go and collect all the creams, dressings, etc., for the nurse. Similarly, post op injections.

They have to pay upfront for treatments. They have to book their room at the hospital and pay for it. If they have a CT scan, they have to take a disc away with them to take to the specialist who ordered it.

It's a completely different system to the UK.

Free at the point of use is vastly better than the US model

the NHS was world class in 2010- this can be achieved again with the right attitude

pay established necessary professions like doctors, nurses, physios, OTs, SALT etc well- restore their pay

dump new nonsense like ‘physician assistant or associate or whatever they call themselves who are poorly trained and paid far more than many doctors and nurses

Can’t get worked up about lecanemab. Be far more concerned about lack of funding to research and effectively treat childhood brain tumours. I’d like my huge tax payments to fund that, not lecanemab.

At the end of the day there is no perfect system. I don’t even claim the US system, which works really well for me, is perfect. There ar sadly going to be winners and losers under all systems. I guess you just hope that there are more winners than losers 🤷‍♀️

Have you seen healthcare in the USA? People die because they cannot afford healthcare!

The nhs has been a cornerstone of our society since it was brought in by labour. I kniw thats why its hated by the tories - it wasn't their idea so now all they want to do is allow people to feed off tax payers money by privatising lots of the services and noone holds those providers to account for anything. My daughters adhd assessment has taken over 1 year. On the nhs it'd have taken less time. She still doesn't have her appointment to diagnose her wtf. So whose letting patients down? The nhs or private suppliers?

@OptimismvsRealism YA massively Unreasonable even mooting this question. Sure the insurance industry could improve it's offering ref private healthcare, but at a cost of £200pcm for emergency care for a family plus annual excess payments, how many people could afford that?! Remember, every working person is in reality just a few pay checks from destitution and then how do people pay for it?

We all need to get behind the new government and help them sort out the Tories mess and reinstate the NHS as the cornerstone of our society.

I think tory MPs and civil servants should be brought to court for crimes against humanity because of the state of the nation. It's absolutely unforgiveable.

So if you want to see a neurologist about your headaches you can just make an appointment with one wherever and your insurance company will cover the costs? Yeah no that's not how it works here and I doubt it works like that in Europe. If someone else is paying towards your treatment they will want a say in how the money is spent.

The NHS didn’t exist for most of the 1940s, it was born in 1948. And it was in pretty good shape in 2010 when the Tories got their hands on it.

https://www.kingsfund.org.uk/insight-and-analysis/reports/high-performing-nhs-review-progress-1997-2010

I don't think it's being free at the point of use that is the problem but the whole raft of treatments now available and expected as normal. As well as the overuse of expensive technology to undertake simple tasks such as taking temperatures and blood pressure.

And the societal and cultural pressures exerted to provide treatment at any cost in order to preserve life irrespective of the quality of life afterwards.

And then there's the unwieldy admin of it all.

The model itself is fine.

Yeah that’s how it works with my insurance plan. I will pay a higher copay for the office visit ($100 vs $20 for a PCP) but I just make an appointment. Some insurance companies require gatekeeping by a PCP, but when that came into fashion a lot of people found the loophole (myself included) I named my OB/GYN as my PCP. It meant no nonsense seeing them for my annual exam and they gave referrals for everything.

Since then (this was in the 90’s) some insurance companies closed that loophole but carved out appointments to OB/GYNs as not needing a referral. It’s largely irrelevant because 9 times out of 10 if you need a referral for something like a bunion or long term headaches you can call your PCP and describe the issue and they’ll refer without a visit if you’re a patient on their roles.

Some may make you come in but I’ve never not gotten a referral because they have no real incentive to gate keep.

lecanemab is a bad example. It's not used by the NHS because the cost is approx £40k per year per person and, on average, it only delayed cognitive decline by four months. That resulted in the decision that is it not value for money - which does appear to be the case.

This report highlights succinctly the challenges the NHS still faced in 2010 and the threats to come including increasing obesity, productivity issues within the NHS, longer life span with long-term conditions and financial constraints. It was evident - even in 2010 - that we were on the precipice of decline if significant funding and redesign were not considered

Aren't we all the post-war generation OP? And what do you mean by "offski" - careful now, you might be accused of being a Russian troll using language like that.

It also shows quite clearly that waiting times were at all time lows on every metric. It was evident in 2010 that the NHS was in its best shape ever.

Yes, of course social care is more than dementia.

Most people with dementia will require residential care at some point.

No objection for paying for things I can no longer do which I have a choice about. Do resent paying £50,000 per year or more for something I have no choice over. Dementia, Parkinson etc isn't an inevitable part of ageing, it's an illness. I resent being kept alive when everything I value in life is lost to me. Being asked to pay for it just adds insult to injury.

We never ask "Why should someone with assets not pay for their health care?"

The old ways of taking temperature and blood pressure relied on the use of mercury and was very subjective.
Pressure sore prevention was by 2 hourly turning which meant waking a patient during the night and on the whole has been replaced by automatic air mattresses.
Other new fangled things include auto injectors so most patients can self treatment rather than coming into hospital for a four hour infusion

To be fair - the drug cost was not the key issue. In the grand scheme of things - if you reduce decline by 4-6 months, that is reducing care needs by that long or more - which would be cost effective.

The kicker is the treatment is delivered via fortnightly infusions - which will need to be conducted in hospital (staffing appointments etc) and also access across the country to scans and tests to identify those with early dementia and identify side-effects that may occur. Those costs to fund an expansion in services made the treatment not cost effective. If it was a tablet you took at home for instance with a simple blood test to detect who was suitable - that would have met the NICE cost effective threshold.

And before anyone asks, yes insurance companies can decline treatment, but there is an appeal process and at the end of the day I can choose to pay out of pocket.

Most denials are over drugs and the usual denial is ‘use a generic’ which if medically necessary a doctor can usually give evidence why the name brand is needed.

My example is my bunion. I saw a podiatrist and he said that insurance companies want to less invasive treatment before authorizing surgery. I described the shoes I’d been wearing for years and he said ‘good enough for me’ I’ll work out the details. No issues with the pre authorization.

@TheLittleOldWomanWhoShrinks thank you for your reply to my questions
Something I see in the NHS is a person will refuse to pay for much needed social care, even if they have the means to do so. They reach a crisis point and are admitted to hospital, on discharge they get very short term 'free' assistance at home, where it is discovered they need ongoing/longterm social care input, they take the short term 'free' assistance, agree to care input and then cancel it very quickly. They then struggle to the point of crisis and need admitting again and so the cycle continues. Quite often a crisis eventually results in catastrophic injury/illness which then requires long term residential care ( funding for nursing care has a very high bar ) and they end up paying a lot more than if they had accepted a care package in the first place !

Can't you comprehend that the progress of today is built upon the past.

Things that were useful in 1940's:

• the use of penicillin
• streptomycin
• invention of the kidney dialysis machine
• malaria treatment
• adding fluoride for dental benefit
• methotrexate - the first anticancer drug used to treat leukemia, breast cancer, lunc cancer
• the first bone marrow transplant
• the early research on the polio vaccine

All those were USEFUL in the 1940's.

And our current NHS is built upon what has happened in the past.

When we lived in the UK you never waited two hours to see a GP at our surgery, 45 minutes to an hour was more typical.

Care varies. The dailies published the performance of primary care networks across the country last year. It varies, but on average, things are dire. GPs are burning out and stressed hence their current ongoing strike (work to rule)

I think some of this has been helpfully 'demedicalised' in recent years.

I'm on a low dose of blood pressure medication, and very stable. I no longer have to book a GP/nurse appointment for a blood pressure review. I can go to a pharmacist, or if I have a home BP monitor, I can take my readings over a few days and email them in.

That is so much better for me, and for them, and for all the other people who actually need to see the GP/nurse.

There are small details they could change though. I am on medication for chronic migraine. Only one clinic runs in my hospital. I was prescribed 3 months of treatment. I'm running out. But they can't see me because they have too many patients who need review. When I suggested that 6 months prescriptions may alleviate the pressure, there was silence.