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.

Because you live in the UK.

Serious question, why do you not move to somewhere in Europe with better healthcare?If you are very well paid I assume you have highly saleable skills; are they only saleable in the UK?

Well lets hope Labour will not hold back for fear of upsetting many people and they choose to benefit the people rather than keeping votes.

Many peoples attitudes have changed towards the NHS particularly since Covid, they are experiencing too many difficulties access the services and care they need and complaints are at a record high, and many people won't complain

Free at the point of delivery is not worth fighting for when the service provided is not fit for purpose

There has to be radical change, Labour have to take the step. They made the radical step with forming the NHS they can be as radical now by working towards a fit for purpose insurance based model (as in France and Germany) new healthcare system that is right for this day and age

I hope Labour shall be brave enough

@RosesAndHellebores "In fact next time I suffer severe delays for which there is no apology I may go as far as to comment, "how interesting you are still running 90 minutes behind, despite a Labour government."

Do you really think that the Labour government is going to be able to magic up the thousands of doctors required overnight? Or that the number of nurses, radiographers, physios and other vital medical professionals is going to dramatically increase in the next 3-5 years?

All of these improvements, and the investments required in healthcare facilities and equipment, have a lead time of at least 5 years. Turning around the NHS and getting it to the point where it is functioning well is going to take a decade or more. Getting it to the standard comparable to the leading European countries will take far longer and many billions of pounds of investment.

That's fine, but don't expect it to be sorted in 90 days - only fair that you give them 15 years.

@HRTQueen There has to be radical change, Labour have to take the step. They made the radical step with forming the NHS they can be as radical now by working towards a fit for purpose insurance based model (as in France and Germany) new healthcare system that is right for this day and age

Do you realise that the French and German models (and most of the other countries that have public health insurance models) differ from the UK in more ways than just the insurance payments.

Firstly, healthcare insurance is compulsory and is deducted at source (just like UK National Insurance), is ringfenced for healthcare (the German system even operates with a cash reserve fund) and is administered by Health Insurance Funds which operate to some extent independently of the government. The degree of government involvement differs - in France there is more government involvement than in Germany, where the government is more hands-off.

Secondly, the actual healthcare is provided by a number of different providers. There are public hospitals and GPs (just like NHS hospitals and GPs) but much of the healthcare provision comes from hospitals, GPs and other professionals that are not owned or employed by the government or the Health Service - i.e. they are private providers. Most hospitals are non-profit organisations (with some being historically linked to charities or religious groups) but there are also private providers that operate for profit. One key element is that the Health Insurers negotiate fixed rates for various surgeries - so for example they will only pay the providers a fixed sum for a hip operation regardless of whether that is a public hospital, a non-profit hospital or a private hospital or private provider such as a physio. If the patient wants a superior service (better food, longer recovery time in hospital etc) then this is paid for separately by the patient, and private medical insurance is available to cover these costs if people want to take this sort of policy.

This is totally different to the situation in the UK, where the government holds the purse strings and is the de facto owner of the facilities and the employer of the staff, and where politics (such as Hunt demanding that Trusts prioritise balancing the books over treating patients) gives power to politicians who are not sufficiently qualified to make decisions and where major errors in policy can take years to rectify.

@Havanananana 1000’s of doctors? My impression was that there are plenty of doctors. Just no training places. There are FY2 doctors with no job. Like now.

I really don’t understand the obsession with changing the funding model. Surely what we should be aiming for is a functional health service providing high quality and timely care and continuing to be free at the point of delivery.

@FixTheBone @havanananana Whilst I appreciate it may take more than 90 days to bolster resources, I don't think it should take 90 days to learn to say "I'm sorry you have been kept waiting" or to start providing clear communications about the anticipated wait. There is much that better management could put right. Not least the arrogance of some in your speciality.

I don't think an ortho registrar mumbling his name and when asked for it again to say very slowly: WIL EE AM FA ROW BEE (William Farrowby) (obviously not that name) and in response to "my back pain is only responding to naproxen but I have read it can interfere with bone union" to reply "you need to get your head out of the Internet, it's full of nutters" has anything to do with resources. Hopefully it won't take more than 90 days for some NHS employees to learn some manners, if the scummy old public is expected to pay more for their services.

Respect works both ways in my experience and funnily enough episodes like that don't happen when I pay at the point of delivery.

Yes, there are doctors who cannot find training places which is the result of the last government's poor decision-making that has created a bottleneck but the NHS is currently short of nearly 11 000 doctors, a 7.2% vacancy rate. The vacancy rate for nurses is 10% - yet there are unemployed nurses and Trusts are having to lay nurses off (or freeze recruitment) because there is insufficient money in the budget.

Even if every doctor vacancy were to be filled tomorrow, the UK would still only have 31 doctors per 10,000 population - far lower than many other European countries. Austria has 54 doctors per 10,000, Germany 42, Spain 45. Belgium has 62/10,000 - i.e. twice as many doctors per capita as the UK.

I am aware of the vast differences. Changes can not be made overnight and it will take years to implement full changes.

It simply isn't working and has not been for a long time. Radical change has to be made.

I would prefer our health system is moved away from politicians making decision as its is always used as a political football

Labour are in a position to start these changes. Throwing vast amounts of money at the NHS did not work before it shall not work again and at some point we have to learn from past mistakes

@HRTQueen "I would prefer our health system is moved away from politicians making decision as its is always used as a political football"

While I can't disagree with the sentiment, one of the major issues is that the politicians most recently in charge of health and social care (Lansley, Hunt, Hancock, Barclay, Coffey and Atkins) made one bad decision after another, driven by a political view that keeping taxes low was a higher priority than treating patients and the health of the country in general. No country in the developed world has over 10% of the population waiting for an appointment or treatment.

"Labour are in a position to start these changes. Throwing vast amounts of money at the NHS did not work before it shall not work again and at some point we have to learn from past mistakes"

Compared to other European countries, the UK does not throw vast amounts of money at healthcare. The UK does not spend enough money to even keep the service running effectively, safely and efficiently on a day to day basis, and the underinvestment in buildings, equipment, staff, IT and facilities means that there is a backlog of repairs, obsolete equipment and systems and a shortage of every type of staff that can only be addressed by investing more.

I was referring to when Labour was last in power huge amounts of money was allocated to the NHS it was not sustainable as a huge amount was from very high interest loans

What done is done we can not undo that damage the Tories did

Invest in what a system that is broken that has not worked efficiently for years its far more than investment that is needed. Thankfully people have wised up than an extra 1p to the rate of income tax is not the answer

I have had excellent NHS care. Emergency and otherwise.

I’ve had a very quick mammogram when I found a lump and have had several scans and tests to rule out various things. Excellent maternity care and when I had other issues. Several members of my family have too. Mostly in Wales.

We are putting the system under unprecedented strain due unhealthy lifestyles.

Nope - GPs are private providers. Not employed by the NHS. And there are now tonnes of AQPs (any qualified providers) delivering NHS care. They are also private.

Fact is the government is already privatising the NHS. The public would just rather pretend it isn't happening. Fair enough

NHS GPs are self-employed (and have been since 1948) and almost all are contracted exclusively to the NHS. In almost all other business settings, this would make them de facto employees, as anyone who has faced an Inland Revenue IR35 investigation will attest.

The AQP initiative was only limited to certain services and has not been a success and in the last 10 years, use of AQP has decreased.

AQPs provide 60% of all cataract surgery in England. Cataract surgery is the most commonly performed operation in England. Wes Streeting said he planned to use them even more to address wait lists - across specialties. So not sure where you are getting your data from. Very mistaken

https://www.health.org.uk/publications/long-reads/waiting-for-nhs-hospital-care-the-role-of-the-independent-sector-in

https://www.patients4nhs.org.uk/private-companies-involvement-in-the-nhs/

And yes - GPs are self-employed- so not employed by the government

"Serious question, why do you not move to somewhere in Europe with better healthcare?If you are very well paid I assume you have highly saleable skills; are they only saleable in the UK?"

Even more serious questions

• why the fuck is UK healthcare so poor and underfunded compared with most of the rest of Europe?

• why can I see a doctor just by walking in, and see a consultant within 2-3 weeks of getting a referral, and have minor surgery within another 2-3 weeks in the country where I live, but my brother in the UK cannot get a GP appointment, has waited months to see a consultant and will wait many more months to actually have any treatment?

• why does the UK population put up with having over 10% of the population on a NHS waiting list (and that's just those who have actually managed to see a GP)?

• Why does the 6th wealthiest country on the planet not also have the 6th best (or better) heathcare service?

I'm a GP Call Handler

I'm paid ~ minimum wage

The admin system is on it's knees as there are too few people prepared to answer and direct calls, type up referrals, send letters, send text messages and do all the general admin-y stuff needed to oil the wheels

GPs are doing their best, but when a referral spends weeks in an Inbox because the secretaries only work half days, the patient access teams at hospitals rely on part timers, the admin teams for all the specialties are only part time and the secretaries who type up clinic notes and investigation reports only work part time, then it will take weeks for the whole process

In all honesty, and I am as guilty as anyone, why do we not have civilian volunteers stepping up for some of the admin tasks? I am retired but my brain hasn't. I know a reasonable amount about medicine and I could probably be reliable backup support for two or three afternoons a week of making calls and sending referrals for one doctor. Instead of wasting hours on MN (much as I love you all), I could do more valuable input helping out volunteering (free of charge) just making the calls that there isn't capacity for. However. There's always a however.... Data protection issues prevent me volunteering because I would have to know more patient information in many cases cases to be competent in directing their cases. At some point in the medical system we have to stop stressing about data protection. Do you want the right care? Quickly? Efficiently delivered? At which point I think it becomes the patient's responsibility to say over to the doctor.

I can do loads of the admin, but only protected from the public because I am not willing to answer calls from them.

Yes of course we should. And the sensible thing to do is to understand how other countries consistently provide high quality patient centric healthcare more effectively than we have done for generations. Even when the last Labour government poured cash in and burdened the NHS with PFI contracts and debt, it stil delivered worse service and outcomes than the best heath care systems in the world.

I really don’t understand why we wouldn’t look at what has been proven to work around the world, and why we should be afraid of learning from that. To blindly do what we’ve done before, knowing it leads to worse outcomes, is letting ideology trump what’s best for patients. And that’s wrong.

The admin system is on it's knees as there are too few people prepared to answer and direct calls, type up referrals, send letters, send text messages and do all the general admin-y stuff needed to oil the wheels

Gingernaut - are there GP practices where this is all more or less automated and others where it isn't? Because some seem to be very efficient and others that are notorious for their delays.

I absolutely agree with you Tryingtokeepgoing

Many GPs are going to a Triage system, where patients (or call handlers) fill in online forms, detailing issues

The form is submitted, triaged by a medical professional, who then decides whether the patient needs to be seen that day, the next day, that week, within two weeks, or whether a pharmacy, walk in centre, urgent treatment centre, same day emergency care or emergency department are more appropriate

However, although it's fairer for patients who can submit requests from 8am to 4.30pm and not desperately scramble for appointments at 8am, relying on us to guess how urgent it is and where to fit them in, the call queues are immense, as many patients don't have Internet and they now have to havr an excruciating call, where we ask questions prompted by the forms, while the patient may be in a relatively public place, detailing private issues for the form

We're doing our best, but the doctors are overworked and we're handling hundreds of calls

Obvs not a socialist. Let's get the US private companies in to make a few zillion bucks like you want. As did the Tories