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.

@newmummycwharf1 "The difference per capita is more than that. Try 10/16% in 2022 and 2023...."

"The answer is not more money - the government has invested. The NHS is underfunded but if you look at the data, the difference in funding over the years is much less than you would think. Health foundation report (attached)"

We're splitting hairs - the point remains that some countries spend far more per capita on healthcare relative to their GDP per capita. Even if Germany's GDP per capita is 16% more than the UK, Germany still spends over 30% more per capita on healthcare - i.e. it prioritises healthcare investment higher than the UK does.

There's nothing in the report that supports your statement that the difference is less than one would think - in fact, the report points out that France, with a similar GDP per capita, invests 26% more per capita than the UK. The difference is significant and the impact is cumulative - every 3 years the UK falls an entire year behind Germany, and every 4 years it falls a year behind France. Hunt's years as Health Minister were a disaster, and as you point out, the impact of under-funding is clear to see - "There are over 7 million people - 7 MILLION! on waitlists" (and that figure is just for NHS England)

"More money is needed but how that money is raised and how it is spent is really key. If people paid directly for aspects of their own care - use and waste would reduce and personal responsibility for health would improve. As Bevan said - we have to continue to re-evaluate."

So you agree, despite what you wrote in the first quote - more money is needed? More funding is not the only answer, and it is not the magic bullet solution, but some of the problems are simply down to numbers. The UK has fewer doctors per capita than most EU countries, but recruiting and training new doctors takes 7-10 years. Then there is the need for more nurses (thousands of nurses are part of the tail end of the late 1950s / early 1960s baby boom and are due to retire soon) and training takes time. Ditto for technicians, lab staff, physios etc. Meanwhile many hospitals are crumbling and outdated, and much of the equipment is likewise obsolete or in need of repair. Even if the government decided to start tomorrow, it will take a decade or more before the damage done by the last government is close to being repaired.

As for people a contribution paying for their own healthcare - millions are living in poverty and can barely pay the rent, heating and food bills (and these are also the least healthy people in the population) while thousands of others (many of whom are posting here) are happy to pay hundreds a month into schemes so that they get priority private treatment, but seemingly don't want to pay more tax so that everyone has the chance of better healthcare.

There are many ways of measuring/considering healthcare funding. I use the benchmark model (not perfect but none of them are). If we say the NHS was appropriately funded in the 90's, early 2000s, healthcare spending in the UK grew by 3.5-4% year on year then.

Between 2010 and 2019, healthcare spending in the UK grew by <2% per year. So relative underfunding.

However - given the attitudes to healthcare use by the public (10-12% DNA rates for example), even with that funding plugged - we would still be underperforming.
The workforce situation is complex. Training a specialist takes a decade but in that time, the resident doctors are delivering the bulk of the care at cut-rate prices. The training could be compressed. It doesn't need to take that long but the government then has to deal with paying consultant pay for many more medics exponentially

There is poverty in the UK (for a G7 country, the levels are ridiculous) - and economic growth is the answer. However, most people are able to afford to pay towards their own healthcare. £10 for each hospital appointment, £5 when you see a GP - I bet the DNA rate tanks - that is 10% more appointments almost immediately.

Increase in tax across the board may work but that does not foster personal responsibility for one's own health. Just pouring more money into this basket of holes won't work

Wes Streeting already intimated that more money is not what is required to improve NHS productivity. Looking forward to Lord Darzi's review - let's see what he finds

I think this is true. A few years ago, I read of a study which found that moderate physical exercise could reduce the risk of breast cancer recurrence by as much as 40-50% (another study found a more modest reduction of of 20-30%). If this was a drug, it would surely have been greeted with great excitement and hailed as a breakthrough.

There are probably many flaws to this idea but what about a healthcare model that was means tested? So those that can afford healthcare are required to pay but those who can't afford it will still receive treatment.

@newmummycwharf1

given the attitudes to healthcare use by the public (10-12% DNA rates for example)

First, we need to evaluate how many of those DNAs are actually the fault of the patient and could have been avoided.

Many reasons for DNAs.

I.e. confused elderly people who forget, patients with chaotic lives due to mental health issues, those where the patient never got an appointment letter, etc.

I'd hazard a guess that genuine DNAs from people who literally couldn't be bothered or decided they were busy doing something else is very small indeed.

For my own and OH's point of view, and our son, we've never deliberately missed an appointment that we actually knew about and hadn't cancelled. Yet, there are several instances where we'll have been put down as DNAs. Only a couple of weeks ago, my OH missed his "appointment" at the oncology department to pick up his monthly drug package - he knew nothing about it - they'd made an appointment and hadn't told him! - he didn't expect such an appointment anyway as it was the wrong week to pick up his drugs - they'd fouled that up as well! When DS was young and had a GP appointment, we had to phone to cancel and re-arrange as it clashed with a hospital appointment - at the re-arranged appointment, GP was livid and challenged us why we'd missed the earlier appointment - the receptionist hadn't cancelled it when giving us a new appointment. Many other instances in a similar vein.

Before we even think of charging for GP appointments or DNAs, there needs to be some proper research and statistics as to "why" the DNA occurred. I know the NHS loves to "patient blame", but a lot of the time, it's their own inefficiencies that cause the problems, not the patients!

You do mean in return for tax/nic reductions I assume??

It's completely unacceptable for even more taxes/costs to be put upon the already over burdened workers.

I guess you'd exempt children and OAPs automatically wouldn't you, then exempt the disabled and unemployed, so you're (as usual) left with the rump of workers to carry the can. Again.

@taxguru I don't know. Like I said, there are probably many flaws to the idea but it's just something I thought about when reading through all the responses on here.

I agree that more taxes would be unfair.

OAPs are a grey area really because some of them are quite well off but of course there are others who are struggling.

So many inefficiencies in the nhs.

I'd start by scrapping PAs and giving every consultant an assistant capable of doing all their admin, scrapping revalidation and appraisal and massively reducing the burden of annual mandatory training.

I trained for 20 years to become a surgeon. The amount of paperwork and lack of theatres means I operate on 35 days in the year. Surely there's a better way?

Can you believe that pilots have been done where people are called to remind them of appointments and DNA still occurs?

There are definitely DNAs due to poor administration (including changes to digital appointments which patients can't open for example or letters arriving after the appointment). But the rates due to late cancellation or not bothering to cancel are significant

Maybe AI scribes will help here.....one day

So there has been proper research and statistics then? I.e. patients contacted after the DNA to find out why they missed? And broken down into the different patient categories, i.e. by age, disability, etc? I'd love to see the statistics if you could point me in the direction of where they're published.

How clueless are you?

Critical illness and chronic illness/disability are not the same thing at all ffs. And even if there was a way to insure against the latter, it would be out of many people's reach because, funnily enough, chronic illness/disability have a tendency to affect a person's earning capacity. Who'd have thought it?!

And I call BS on your claim that you have 'a lot of empathy with anybody who is struggling with their health' given your airy, and inaccurate, assertions elsewhere on this thread that the 'vast majority of ill health' is preventable and merely a matter of adopting a 'healthy lifestyle'.

Your posts on this thread, besides being ill informed, are incredibly offensive towards the chronically ill/disabled, or 'these people' as you so charmingly call them. I just hope you never have to count yourself among them.

But it works in reverse too. My last apppointment, scheduled for an infusion that had to be given within ten days of a two year course of injectables, was arranged two months in advance. I took the day off work and scheduled in some other personal care stuff. The apt was on a Friday.

On the Wednesday someone not with clarity of speech called to say, "is it OK if we move your appointment to Tuesday next week as the clinic has has been double booked? I had to say no because of the 10 days and because I had already arranged a professional diary round it.

I was not confident about how things had been left so telephoned the department the next day. It took an hour to get through but I was assured all in order for 3.30pm Friday.

At about 11.15 on Friday I received another call asking if I could get there earlier to help them.manage their workload. I was sitting with a full head of foils but agreed to get there by 1.30 which was the earliest I could do and cancelled lunch with a friend.

When I arrived at 1.30 the department was almost empty. Three staff, two patients. Evidently they were really pleased I could make it early because it meant they could finish the clinic early and end their shifts.

And we are supposed to swallow the guff about our over worked nurses and hospitals who are messed about by rude patients.

I think not. That experience is not unusual and it's a level of poor service that needs to cease.

Most NHS Trusts audit their DNA rates and break it down by demographics to determine causes. I have seen these Service evaluations and they have been used to devise actions to combat DNA rates - which accounted for over 7 million missed appointments in 21/22.

As agreed earlier - there are system and patient factors involved. Published data suggests patient factors are responsible for 8%-45% of DNAs, depending on the study. So not negligible

This isn't patient blaming though - some of the factors causing this intersect with social determinants of health and health inequalities.

https://www.ncbi.nlm.nih.gov/books/NBK260108/

www.england.nhs.uk/long-read/reducing-did-not-attends-dnas-in-outpatient-services/

Agreed - the service provided can be better. As with any service in any sector but in general - staff are overworked and still strive to deliver an excellent service

@RosesAndHellebores

But it works in reverse too. My last apppointment, scheduled for an infusion that had to be given within ten days of a two year course of injectables, was arranged two months in advance. I took the day off work and scheduled in some other personal care stuff. The apt was on a Friday.

Yes, OH has had similar with his chemo infusions. The oncologist is very particular about the days they have to be done and it involves meticulous scheduling of a blood test x days beforehand and then each infusion has to be a specific number of days after the previous one and each course within y days of the blood test.

The amount of times they phone up to try to change an appointment by a day or two is ridiculous, usually trying to bring them forward from afternoon to morning, and completely disregarding the effect on other infusions before and after, I.e. if his infusions are scheduled Monday and Thursday (to allow time between for "recovery", they try to reschedule the Thursday one for Tuesday and he has to patiently explain to them every sodding time that it has to be a certain number of days before/after and he can't have two chemo infusions on successive days and then leave it almost a week before the next. They always act surprised as if they've never heard of it before and didn't think about the effects of a change - these are oncology dept staff. The mind boggles!

Same with his blood test appointment. He has to remind them that he can't have the blood test in the morning of the afternoon appointment as there isn't time for it to be processed, results sent to the oncologist, oncologist to approve the drug issue and then the drug to be issued, all within the same day. Again the staff on the oncology dept don't seem to understand that each step takes a little time to do. They must be doing blood tests, infusions, etc, many times each day, so it beggars belief they can't work it out for himself that things have to be done in a specific order, on specific days, etc.

He often jokes he'd be dead by now if he was elderly/confused who wasn't on top of it himself as he'd be constantly missing appointments, attending on days when the treatments couldn't happen, etc. Every sodding month they mess up something. None of this is the actual treatment itself, it's the piss poor attempt at administration/management of the treatment.

He DNA'd last month because they made an appointment for him to pick up his drugs on the wrong week and didn't even tell him - no phone call, no ping on the app, no appointment letter. Even if he'd turned up (maybe using a Ouija board to get the message), they couldn't have issued the drugs as he'd not had the required blood test that week so the oncologist wouldn't have issued the prescription. So he's a "statistic" for last month, but 100% the fault of the muppets making the appointments.

Sorry are you saying the staff I dealt with were striving to provide a better service? How is messing the patient about and actually lying to finish early striving to provide a better service? If it were a one off, one could giggle, but it isn't.

They had time to phone me up to try and get me to rearrange and then had time to ring me up and get me in early - to an empty clinic.

And these are members of a highly qualified post graduate workforce. Read Taxguru's post for more examples of not joining the dots.

When my DH travels back from the Yorkshire on the train (former Nationalised industry) nowadays if the train is 40 minutes late he gets a 50% refund. It never happened when the railways were still Nationalised. People complain about services now, but on the whole the communication is better, the trains are clean and the staff are polite.

@taxguru I'm sorry younare going through all that and hope your DH's treatment helps him recover and reach remission.

I am saying NHS staff IN GENERAL are striving to deliver an excellence service - in typically difficult circumstances. And on average, succeed. That will mean there are instances where that is not the case.

There are over 100 million appointments occurring per year in the NHS. Some will fall below the levels of excellence expected. Your experience is one of those

And I also believe that reorganisation of the service - including some elements paid for at the point of service will improve the service delivered. Because that often changes behaviour on both the supply and delivery side.

Who asked you? I doubt very much whether anyone on the ward had any idea what a packet of paracetamol costs the NHS. (The price in the BNF is list price, not what is actually paid).

It is of course cheaper for the NHS if you buy your own, because they aren’t paying at all…

If “more taxes are unfair” where will the money come from to fund the healthcare you want?

Where I'm from we don't have free health care at the point of use. It is affordable and if you're low income it is possible to be excused from paying. Medication is also not free but there is a max per year you have to pay in attempt to make it fair for those who has chronic conditions. Also private insurance is affordable so those who can pay is able to use private health care. Also employers are required to pay for health care. The minimum is to cover work.place accidents but most employers who want to be competitive they provide specialist health care. The system is far from perfect but another example that there is something in between of totally free and bankruptcy.

I agree with this, the NHS loves their “watchful waiting” approach and leave people with long term chronic conditions in extreme pain and discomfort until it ends becoming so far gone it’s almost untreatable or requires major intervention/surgery/amputation/transplant when if they had just treated the symptoms when they first happened it could have all been avoided.
This goes for both physical and mental health problems.

@SnakesAndArrows a midwife, why would I make it up?

@SnakesAndArrows what is the cost to the NHS for a pack of paracetamol?