How would you fix the NHS?

[PinkFruitbat]

The Government is asking for ideas on how to fix the NHS.

https://change.nhs.uk/en-GB/

What would you do to fix it?

DH's parents were in both born before WW2. They're in their 80s and are the so-called "Silent Generation".

There's several million over 80s in the UK.

And like I said in my post yesterday, for the next generation - the so-called "boomers", life experiences and circumstances are very varied - as I quoted from the published studies, inequality within older generations is more extreme than for younger generations.

And in fact, although it's supremely unhelpful to generalise by age because of the wide variation within every age group, the age group with the highest poverty rate is aged 60-64. And older people in poverty have often been in poverty for a long time. So not a blessed life at all.

That's the problem with generalising by age - lumping a large group of people with almost nothing in common but age. It ignores the wide variations within any age grouping.

You're so right.

It's not only extra layer of bureaucracy and so more expensive. It's also led to a postcode lottery re access to decent healthcare.

Same goes for all essential public services. Postcode lottery, which shouldn't be the case.

There was a good rationale for localising healthcare though. The needs and requirements of patients in Bolton, are very different from the needs of those in Weybridge. You have to have a flexible, local, management addressing the needs of the local population. Just like you have regional, local and parish councils, would you want those to be nationalised too?? One size fits all??

I would focus more on wellness rather than illness. That would be a good start.

After that, I would change the funding system, so that patients pay into a 'pot' that's theirs, to use on NHS care when they need it. The idea that I pay monthly into a system which, in turn, hasn't remotely been there when I've needed it, is utterly preposterous!

Agree with the first bit, but what about if you get cancer or have a rta in your 20s?

Are child-rearing women entitled to less care than men who worked during those years?

Do poor people get lesser care than the wealthy?

I don't like the current NHS system anyway. I want a European social insurance model

GPs themselves are also the largest obstacle to change. They can say no to everythign and then threaten to leave the service if change is imposed. I say fuck em frankly

Do explain how that would be materially different

When I used to have yearly diabetic checks, they were more concerned with asking questions and ticking boxes on their screen than actually listening to my answers and answering questions etc. Every sodding year, I was asked if I was depressed - apparently they got extra funding based on the number of "depressed" patients. They were deliberately only interested in asking questions that led to higher funding, and showed no interest at all in anything I mentioned that didn't trigger more funding.

What different needs?

Wherever someone is in the UK, they all have the need for easy access to timely and good healthcare (and other essential public services).

If you mean, there's a higher proportion of wealthier people in Weybridge than in Bolton, a) Wealth doesn't prevent ill health. It helps yes but wealthy people still get sick or have circumstances (eg. DV) that require healthcare or other support.

Also in generally wealthy areas, poverty still exists. Just often more ignored because people generalise about areas. So sometimes less help available precisely because of those stereotypes.
A good example actually of how one size fits all being applied to local areas failing people.

And there's the social cleansing issue. Vulnerable older people are more likely to be isolated (a health risk factor) because their children - family support network - have been socially cleansed away from them.

Re local councils. I don't think they should be scrapped (they represent the local areas) but I do tink all essential public services should be provided on a national level - with equally good access and quality - across the UK.

Personally I'd scrap council tax, and increase income tax instead. Possibly though keep some form of local income tax - to be used for local nice-to-have but not essential services or facilities.

Thanks for accusing me of lying...

https://www.lancasterguardian.co.uk/news/nurses-save-trust-more-than-ps150k-2487648

Feel free to apologise!

This. At my last surgery I had constant evening reminder calls/ letters to attend my cervical smear, and it was pushed at every appointment regardless of what I was attending for. I was going through some serious health stuff at the time which was left untreated, yet all they were interested in was my smear! I'm not saying it's not important but when you go in to talk about a serious health problem and half of the appointment is spent with the gp pushing the smear, there's a big problem. My new surgery couldn't be more different thankfully.

You have choice.

You originally implied the staff bought their own consumables.... they did not, they identified cheaper suppliers, saving the trust 150k.

It was a team of 15 staff working with the trust to id savings.

However, i didn't mean to suggest you were lying, just that i doubted very much nurses were queueing in Staples to buy boxes of pens etc etc, which they were not.

Apologies.

3.2m people are over 80 which is 3 times as many in 1994

I did no such thing at all. I've just re read my comment and implied nothing of the kind. You're making out I suggested they trotted off to Aldi to buy cheap stuff when on offer in their lunch hour - I said nor implied anything of the kind!

A trivial point but it's caused me stress many times...

At our local hospital, paying for parking is really complicated and often the machines aren't working - which of course doesn't get you off the hook necessarily. I allow lots of time for this, but still end up in the relevant department very hot and bothered about it, especially when I haven't managed to pay for some reason.

Had to take my daughter to Poole hospital where they have a brilliant system. You have your appointment first, then go to a kiosk to pay for parking. So much less stressful. I wish this was the norm. It's not rocket science either.

Also more council housing across the UK asap, including 1 and 2 bedroom homes, and homes suitable for elderly (and younger disabled). More council homes (that are well-maintained) would save the NHS loads.

I agree
Poor housing/homelessness is the root cause of so many problems in the UK. Problem is though, as soon as a planning application is put in for housing, the locals (all nicely housed themselves) object. Council housing is particularly hated by the local community.

I think that nhs physio needs to improve.

The health needs are considerably different due to demographics and population. To say they have the same health needs is simply not true. Obesity and Diabetes is a good example. There's little point in having weight and diabetes services in an area where they don't exist. You'd want those services focused in Bolton, not Weybridge. Different areas of the country have different health needs, and at different stages of life.

These are all extenuating circumstances/emergencies, which NHS should absolutely be there for. But because the NHS wastes so much money, it isn't. I don't believe the NHS is underfunded, I just think the money it gets needs to be spent more wisely.

Should poor people get lesser care than the wealthy? In an ideal world, no. But what we currently have is largely a system where the 'wealthy' are paying in money that seems to be readily available to those who aren't.

The only TWO times myself and DH have ever needed hospital care we've had to go private. This can't be right?

The survey does mention a focus on prevention which is encouraging.

Main thing is a shift to tests and support in the community. Which sort of feels like going round in a circle - we used to have this then funding got cut. So where will the funding come from.
I hope lots of people have filled in the survey.

DM is 76 and had all her teeth removed after getting an access, and has dentures. Seems a bit barbaric now. They said that's what they had to do.

So you think no one in Weybridge has diabetes then? You do realise that T1 isn't linked to lifestyle don't you? It can happen to anyone, anywhere.

What you do in different areas is change the scale of the treatments. So in an area with a lot of diabetes, you put on more diabetes clinics. A GP surgery with few diabetes patients may only need one clinic per week. A surgery with lots may need several clinics per week. But the clinics should all operate the same, do the same tests, offer the same advice, it's just a matter of scale.

Same applies with most other things. You'd need "more" contraception and sexual health clinics in an area where there are more patients using those services, again, larger/small departments, more/less clinics, etc., depending upon the numbers. But again, there won't be any areas where no one needs contraception nor sexual health services!

I don;t want or need a stupid choice - I need the right medical care, at the right time. Choice is for idiots who need the impression of control. I don't want control. I want the best treatment and give I am not a doctor, I am not best placed to decide anything.