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.

I was just about to say the same thing @LostGardens! I've a friend who does my exact job (teacher), gets paid the same headline salary and is the same age as me who is just moving back from Germany. She got good healthcare when there, and excellent public transport (amongst other things) but her tax bill was unbelievable. I really don't think most middle earners in the UK can imagine it - they'd certainly not be able to afford their current mortgages!

Yes the lack of control people with my condition have do their care is astonishing. Their life is at the whim of insurance companies owned by shareholders.

Not with social insurance.

It’s not a predictable part of ageing, it’s a lottery as to whether you need it or not. And it isn’t a consequence of your choice, like childcare. No-one chooses dementia. It’s more akin to your house burning down - which, while a dreadful experience, is covered by insurance.

I don't know who you are speaking to. The vast majority of people I know are receiving good treatment - sometimes same day visits to GPs (where a physical visit is required), usually a call back within 24 hours. Of course waiting times are longer but that has been a variable thing over the past 40 years.

Your 'sample' population is one thing. My 'sample population' is another. It doesn;t make either of us right.

The NHS pays so much to employ agency staff because there are gaps (not vacancies) in medical, nursing and other clinical staffing because of poor organisation in numbers of junior doctors training posts and not advertising for replacements for people leaving or going on maternity leave until the person walks out of the door - recruitment takes about four to six months by the time they have selection, interviews, pre-employment checks and worked notice. Also will retain experienced staff if they allowed more part time staff as clinical staff have childcare, elderly care and just haven't got the energy to do a 48 hour working week like many doctors do

Re:
OptimismvsRealism · Today 20:04
"The department of health would decide
Fucking obviously"

That's an answer to the who question...

*@OptimismvsRealism Any ideas / answers for the rest?

"In your vision for the UK healthcare system,

How and who would decide what "essential care" is?
Would that be the same as "getting what's available"?
How and who would decide whether people can "pay a bit" or "absolutely can't"?

Aide memoire:
GreatReader · Today 19:59
In your vision for UK healthcare,

How and who would decide what "essential care" is?
Would that be the same as "getting what's available"?
How and who would decide whether people can "pay a bit" or "absolutely can't"?

OptimismvsRealism · Today 19:53
I think that the entire funding system should be changed so that people pay a bit, unless they absolutely can't and if they absolutely can't they get what's available (which is probably better than what's currently available for anyone). I don't know if transgender care is essential any more than I know if prostatitis is liveable with.

GreatReader · Today 19:51
My question was about funding for transgender support, medications and support.

What are your views on that?

** "what are your views on NHS funding for transgender support, medications and surgery?"

OptimismvsRealism · Today 19:49
Funnily enough while looking at a really agonising crack in my perineum I started thinking about how sore it must be to mess with this area for that purpose. Personally I'd counsel against it.

The NHS is demotivated. Its an organisation in crisis.

its been strangled of proper funding for 13 years. The Tories would love to kill it off becayse it wasnt theur idea, labour brought it in.

They are now

• monitored and measured so much that if they're like every other company/ each trust will be green washing the data
• the choice is to go to a private service that the nhs funds - it's morally wrong, no wonder there's no money - and noone holds those services to account.
• forced to make a profit so trusts don't buy from the nhs
• poor salaries and lack of funding for key items
• poorly trained people plus others too focussed on how much the Corp team is earning to pay attention to their own jobs

The last goes on.

The Tories have nearly killed it off. But we need to get behind the new government and get it back to what it was like when Tony Blair/Gordon Brown were leading this country. It worked then, it worked well and it can again.

@OptimismvsRealism you should not be asking for it to be killed off fgs. Have you seen healthcare in the USA? That def let's people down. People due because they can't afford insurance!

Yes I have family in Germany. I don’t know much about any of the alternative models people are mentioning here, but one thing I do know is that my family member had to pay a significant amount for health insurance even when not earning loads.

I think people like to imagine there is some special model where everyone can pay less and get more. The truth is we just need to pay more, one way or another. So why not do it through the current system rather than instituting a new model, which would in itself cost billions upon billions?

The problem is that being a GP is shit

You slog your guts out getting into uni, study for a medical degree, train to be a doctor, fighting to get your rotations in, bouncing up and down the country chasing placements in the different disciplines, accruing debt the entire time

There aren't enough consultants to train and mentor all the trainees that are needed, so you are constantly aware of how 'lucky' you are

After getting all your rotations in, to be a GP, you have to step off the hospital merry-go-round, foregoing all the perks of working in a hospital and ending up in a GP practice

Meetings, mentoring, safeguarding, social services, practice management, hiring, firing, continuing personal development and all at your own personal cost - exams, courses, registrations, insurance and all associated costs are on you

Who'd be a GP?

With my private health insurance in Germany, I have to pay 50€ every visit to the GP and dentist appointment for myself or my DC. I then have an excess to pay on medication. It is almost impossible to find an Obgyn even in a major city and I had to put my name down literally the day I got a positive line. I can't imagine what it is like out in the countryside where there are even fewer. If I want a GP, you don't make an appointment. You take a morning/day off work and you sit in a waiting room and wait until it's your turn to be seen. I am lucky as the GP works on the ground floor of my apartment building so I just go downstairs but there have been times when I get there at opening times and am waiting 2 hours to be seen. I also find the care here favours homeopathic treatments and I've been misdiagnosed numerous times. I went with fatigue and cluster headaches to be told I needed homeopathic oils. They did no tests. I started waiting till I was back in the uk and was diagnosed quicker here for anaemia.

NHS England agrees GP access is currently a crisis in the UK. And there have multiple initiatives to try and address it. GPs are currently working to rule to force the government to provide more funding so they can provide better care.

This does not mean some individuals are not able to access a GP but most aren't.

https://www.england.nhs.uk/gp/case-studies/600-gp-hours-released-a-year-after-reducing-inappropriate-appointments-chiswick-health-practice-london/

No thank you. My experience of the nhs had always been amazing. Stop comparing and realise how lucky you are to have the nhs. Can't stand people that complain about it.

Yes my treatment is world leading and was very swift from the point of diagnosis onwards. And I have a specialist nurse who responds within 24 hours if I message or call.

Meanwhile in the US people are desperate because their insurers make them fight battles for months and months to get the same treatment

Quite, let's stop idealising other systems.
All systems have their flaws.

But that's just as silly as saying you've been to Brazil, seen the same, and that's what socialised medicine gets you.

There are plenty of other models besides the UK and US ones.

If the UK voting public isn't prepared to fund the NHS at the rate that demographics demand (they aren't), then there's no virtue in them proclaiming loyalty to the NHS. It's just delusion. Pick a system that can scale to the needs of the country and that won't be permanently underfunded. Many advanced European and Asian countries have good mixed systems that work.

I agree if we all paid more it should work better. But this is the UK, with any further privatisation the additional costs will just be profit for private companies.

I work in the ambulance service and they've privatised a lot of the transport services/PTS. So private companies undercut the NHS ambulance services to get the contract - then they provide little to no cover so when they don't arrive the ambulance service picks up the slack, or the patient is ever so slightly unwell (shock horror they've been booked to be taken to hospital by a Dr) so they also refuse to take them and the ambulance service again steps in. It's effectively a few old minibuses with a glorified taxi driver and a first aid certificate. Or the care alarms they put in old people's homes, privatised - all those households paying £25 a week for a pendant that goes through to the office where they'll have 1 staff member working - who just passes the info onto the ambulance service. These companies make millions for nothing and the NHS does the actual work. All privatising does is take more and more money away from healthcare.

When I compare the NHS (however challenged) to dentistry, I really fear for the future if the NHS follows the same track.

I can pay for my dental care, so I do. I do it for convenience, to see my preferred dentists and dental technicians, to find people I trust. But I can do that because my dental requirements are relatively simple and not beyond what I can afford.

By comparison I know of many who can't access an NHS dentist easily. And when they do their choices of treatment option are severely limited - either in what can be offered or the timescale.

But healthcare is a whole other ball game. I can't afford private treatment, and at an older age with a couple of minor age-related problems I cannot find any affordable health insurance.

The NHS funding does need a rethink but to claim it's one of the worst in the world is total nonsense, and low productivity is nothing to do with health. The NHS's main problem is that social care has been terrible for a long time and has now pretty much crashed. People get admitted for social reasons (need care at home and fall/ can't eat & drink or take their meds without it) then get stuck in hospital because they need care at home or a residential placement. None of this is under NHS control.
Plus the public have totally unreasonable expectations. A large chunk of GP consultations are either total nonsense or for social reasons. A European co-pay model with compulsory insurance is needed. EU countries with better outcomes spend more as a percentage of GDP than the UK does. You want better healthcare - pay for it!

Sadly, the wait in our GP surgery is longer than 2 hours and that is with an appointment. You can only get an appointment if you call bang on 8am and by about 8:15 all appointments are gone and you have to try again the next day.

Being able to go into a GP surgery and just wait and know you will be seen is a luxury. This is partly why A&E in the UK now routinely over 8 hour waits - people who should see GPs go there because they know they will be seen. Even though inappropriate for A&E

That still requires insurance companies who will set their own terms and conditions.

@MereDintofPandiculation

Social care is far more than dementia care and dementia care is far more than social care.

Those suffering from dementia do not always need outside social care - many are cared for by families and partners who provide support for their activities of daily living.

Others require residential care that involves provision of many services - housing services, hotel services (food/laundry) and social care services (washing/dressing toileting assistance). They may also have some health care services provided linked to the disease process of dementia.

Why would people with assets not pay for their housing, food and help with what they can no longer do?

The healthcare parts will still be paid for, just not the rest.

And this is different from your current system how? I didn’t think you could just go to any GP with an opening?

I just searched my insurance company by my plan. I have 227 PCP/GP’s to choose from and I picked 2 at random from the first page. First one, first appointment Oct 17th second one- August 27th.

If I need a specialist I just schedule an appointment with them. I do not need a referral. Honestly as an outsider that’s half the problem nobody can get a GP appointment because people are funneled through them for referrals. If people could see GPs sooner a lot of conditions might be treated early enough that specialist care isn’t needed. Yes specialists may end up seeing people who don’t need them but that’s still less resources overall for one visit to be told ‘no you don’t need my treatment’ vs 5 GP appointments to try random things that ultimately lead to specialist care anyway with a bigger issue.

Statutory pension insurance is 19 % of gross/pre-tax income (again, the employer pays half if you have one. Some self-employed occupations are compulsorily enrolled, others aren't - unlike health insurance, which is mandatory for all). This doesn't eliminate old-age poverty, sadly, although i suspect it's less of a problem than the UK. Workers' rights generally better, especially wrt sickness and sick pay (the UK attitude to sickness as a disciplinary matter shocks me profoundly) - statutory redundancy only a bit better than the UK. Wealthy country but won't disclose.

Nigel Edwards wrote a very helpful comment series for the Nuffield Trust that discusses common myths such as the superiority of some insurance models (Europe included) relative to the NHS: Through the looking glass: myths and magical thinking about the NHS
A series of short articles looking at common critiques of the NHS and why they're mistaken.

https://www.nuffieldtrust.org.uk/comment-series/through-the-looking-glass-myths-and-magical-thinking-about-the-nhs