To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

[NaiceBlueSquid]

People often blame NHS management for its ongoing crises but isn’t the real issue much deeper? An ageing population, increasing patient expectations that can’t realistically be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.

AIBU to think that while NHS management could probably be improved, it’s nowhere near the biggest problem the system faces?

YES! I hear you I live in a sweatbox one bedroom flat and food goes off so quickly. You cant store everything in the fridge. Which brings me to my next point Flat gets so hot in summer that my fridge freezer stops working. And before anyone says anything its FINE in the WINTER. Very small kitchen with small workspace. Even having the hob on is unbearable at the moment. The UKs shit housing has a lot to answer for. 31 years ive been in this flat

GP services are seeing more patients than ever with less funding (due to inflation). How’s that failing? Did you mean, underfunded?

In my experience, NHS care is fantastic once you get through all the red tape and failed management. Administration is shocking. I don't understand why people such as Type 2 diabetics get medication for free when they should be paying towards it themselves. It is a lifestyle choice at the end of the day.

I think that ageing population is one aspect of the NHS issues but the main issue is overpopulation.
The NHS cannot possibly keep up with the demands on it with the population growth we've had in the last 25 years.

Other PP have said that we have become a more demanding society but I believe that's because we are waiting much longer for appointments and treatment when compared to a few years ago. When you're in pain that feels like an even longer wait. 😒
Also the wait for GP appointments has become ridiculous. Where I live it's not unusual to have to wait 3 to 4 weeks for an appointment which isn't acceptable but no one in power seems to have a solution for this 🤔.
I realise that this government has a mountain to climb with the NHS but I worry about much worse things are going to get before they begin to get better.

Well said.

Well said

This is one of those "how long is a piece of string" posts. There's no one "correct" answer - it's going to be a mixture of many things, and a good number of them are subjective because they depend on how people view and interact with the NHS, and the opinions that guide those interactions.

I do think it would be helpful if people were given information on the actual costs of their treatment every time they are given treatment. Even if it's just comparison figures. Some of this stuff is easy: Pharmacies could easily print the ACTUAL cost of the drugs that are prescribed on the carton of meds (this happens regularly in places like, for example, the USA, where the prescription co-pay is listed, along with the actual cost of the drugs that was billed to the insurance company etc etc. Some of those are incredibly eye opening: for example when I had spine surgery in the US the cost of the numbing/soothing patches for the skin next to my surgery site was over $1,000 for a pack of 10 patches. The pain meds I received were relatively expensive EXCEPT for an IV administered (i.e. injected - not tablets) version of paracetamol which cost a fortune compared to, for example, IV morphine (which is cheap these days given the age of the drug).

This would be easy enough for the NHS to do - the drugs costings are all in the med books that each GP has in their office (you can ask yourself next time you see them how much the drugs actually cost - they can tell you direct from the book).

Other costings - like how much it costs to see a GP, or a consultant, or basic procedures etc are more subjective/difficult - but they could put basic comparison costings next to them. For example, an out of pocket GP appointment in the US would cost somewhere in excess of $600. Or, if you use the "private medicine" comparison in the UK: a private consultation with a spine specialist in the UK at a private hospital would set you back somewhere around £250 (.increasing to over £450 for some of them at my local private hospital).

Here's a stark example for you: I had a microdiscectomy surgery done in the USA. The cost, before insurance, was over $130,000 - for the surgery and two nights in hospital. The NHS wouldn't have charged a penny out of pocket. You can get a private microdiscectomy surgery un the UK starting at around £20,000 (depending on days spent in hospital, scans required, meds required etc etc - note that no private hospitals can do emergency discectomy surgery).

The UK Is also dealing, as are many other countries, with the perils of a population that is increasingly obese and diabetic. Over a quarter of the population is obese. Two thirds of the population are overweight generally (that figure includes people who are overweight, obese, morbidly obese). That is a staggeringly awful figure in terms of national health.

Diabetes Type 2 (the diabetes variant that is typically caused by an unhealthy lifestyle) treatment alone (dialysis and insulin together with the various equipment and tests required) costs the NHS an absolute fortune every year. meaning that the British population's increasing desire to eat and drink junk is costing all of us a fortune and causing horrific pressures on the NHS. Our local village hospital, where people use to go to recuperate after an operation (i.e. elderly having a hip operation who needed a bit of building up between hospital and going home) has now been taken over by a giant dialysis unit! Meaning that people are no longer able to recuperate in their own village, close to home and their support systems. The concept of local village hospitals has been utterly devastated, which again has cost all of us a fortune and impacted community healthcare in more ways than just £££.

Add smoking, booze, alcohol, and a lack of exercise to the problems and you've got a recipe for future disaster unless something is done to drastically change the way people eat/drink and the fact that so many have a sedentary lifestyle. It's not just an age issue, it's a population lifestyle issue. Indeed, many elderly people have a far better diet than young people these days. Spend a few days at a school or college and you'll get an idea of the problem: the kids eat junk and drink monster/redbull and a variety of other horrific synthetic/artificial/overcaffeinated crap. The NHS is dealing with the impact of that already, but the future costs are going to be astronomical.

Exactly right. And people who have low incomes such that they are truly very poor usually qualify for free prescriptions anyway - meaning that they can get the prescription strength vitamins/iron tablets etc etc etc free.

For those who don't know about this already I would suggest that if you have more than one prescription a month and pay the prescription charges you look into signing up for the monthly prescription pre-payment certificate. It can save you an absolute fortune if you pay for your prescriptions and have more than one a month. I had no idea about it until the lovely pharmacy techs told me about it a number of years ago. It's since saved me a fortune. It's the certificate that allows you to tick the "F" box on the back of a prescription form.

Saying "no" to the other post is incorrect. Objectively there are big time societal issues that are as, if not more, crushing to the NHS than inefficiency/management issues. More than a quarter of the population being obese (a massive change in a relatively short period of time) being a good example. Look at the vast increases in costs the NHS has had to spend on providing type 2 diabetes care. Nine out of ten people with diabetes in the UK have Type 2, not Type 1 (Type 1 is the one that cannot be prevented). The dialysis costs are crippling and have nothing to do with NHS inefficiency or mismanagement: The NHS could be a bastion of efficiency and great management and it would still be having to fork out millions upon millions of pounds every month just for dialysis costs for a preventable illness. It's one of the reasons that the NHS is actually spending money on ozempic/mounjaro: to reduce dialysis and insulin spending - it's not so people feel more attractive!!!

Ruling out causes isn't helpful - that's a "head in the sand" approach. You may be very upset about mismanagement and inefficiency, but saying there are NO issues with the NHS having to support a population that not only has a significant population who are elderly and have untreatable illness that requires long term management (dementia for example), and NO issues relating to the NHS having to expend vast amounts of money treating people who have preventable illnesses (Type 2 diabetes, heart disease, lung disease etc etc) is an odd stance to take.

Here are some figures for you to consider: The NHS spends some £10 billion every year on Type 2 diabetes-related treatments alone! That's 10% of the entire NHS budget being spent on PREVENTABLE illness treatment! For you to ignore that and say it's not an issue that is contributing to the NHS being under pressure is extraordinary. In 2024 Labour claimed that the NHS was wasting some £10 billion per year on inefficiency/waste (disputed figures). So: according to you the NHS is being crippled by waste, but isn't being crippled by the exact same amount being spent to treat a preventable illness - and those are proven figures.

In addition, more than 2 million people in the UK have pre-diabetes - which itself causes a raft of health care problems and predisposes people to a range of costly care. In 2023 alone the NHS had to spend around £1 billion on dialysis treatment for type 2 diabetes. Dialysis requires people to go to and be in hospital - which takes up space, care, staff, equipment etc etc etc. Type 2 diabetes is as, if not more, crippling to the NHS as any claimed inefficiency/waste.

[Figures quoted are taken from the NHS's Diabetes Prevention Website.]

treating people who have preventable illnesses (Type 2 diabetes, heart disease, lung disease etc etc) is an odd stance to take.

How does one prevent all lung or heart disease?

I think the question of the 'worthy' and 'unworthy' ill is a perennial one. I wonder how many tax payers in reality want money diverted into such areas such as breast cancer which has a high genetic component rather than lung and head and neck cancers which have more of a environment component (e.g. smoking)?

I do think for a lot of the middle classes they do see the NHS as a branch of state that supports low income families and they do not see the quid pro quo of people choosing healthier lifestyles so they do take it badly when they are on a long waiting list and therefore would support an insurance based syatem.

Look how seriously the government is aiming at PIP in the commons and we can see it would be easy for government at some .point to review the whole syatem.

I'm still upset that someone I know who used to live here then retired abroad used to fly back for check ups and medicine for cancer after finding out medicine alone would cost £150k+ per annum privately, where he lived. The problem is that the NHS isn't set up to deal with any level of health tourism, much less this where the person already has an NHS number.

Plus over-complicated systems that waste time. First time I got a coil fitted, about 8 years ago, I had a brief appointment with my GP, who had my records in front of them, booked me in and then fitted it a couple of weeks later. The last time, it took a few phonecalls to be given the details of the separate clinic who now fits them, then days trying to contact said clinic, then two phone calls from them, one from an administrator taking personal details and then an hour-long phonecall with a nurse asking about my entire medical history, as they didn’t have my records. Then I saw someone different at the clinic, which was also a longer appointment as they also wanted to ask questions about my medical history. I’ve been waiting a year to see a specialist about something else, because their systems wouldn’t let one consultant refer me to another in the same hospital department, it had to go back to the GP who I had to have another appointment with and then they had to write a new referral and start at the bottom of the waiting list again etc etc. There’s a heck of a lot of inefficiency.

I know many examples just from my own acquaintances and friendship group.

I agree with a PP about the impact of housing and related amenities on health and wellbeing. I work in a food bank that runs a supermarket model, so people choose for themselves what they’d like. We hear a lot of “I’m sorry, I don’t have a cooker / my cooker is broken”, “I don’t have a fridge” and so on. Apples are sometimes a no-go because of poor dental health. We used to receive really lovely bread from a local baker but had to ask them if they minded giving us softer loaves instead, which more people can chew. And frankly when life is difficult and your nerves are frayed you are very likely to reach for your vice or treat of choice, whether chocolate, alcohol or whatever.

I have a (touch wood) secure job, an equipped kitchen, a car, a high level of education - when I needed to feed my family with just a kettle for prep we were fine and ate well. Doesn’t mean my medal is on its way.

I do think that our retired population have too high expectations of our NHS. I don’t know why or how that happened.

Take my dad for example. He goes to the doctor for everything. He needs blood thinners but he is the fittest, healthiest 80+ I know. He has 2 hospitals on the go for a knee operation. They are both doing tests and physio, and he is waiting to see who offers first. Except they have offered, and he’s put it off and put it off and it miraculously gets better every time they try to book in the op. So, he’s had 3 years of appointments. Then he went as he felt low (due to knee pain) and they offered him counselling and meds to lift his mood but he refused to take the meds. He’ll also call them up for appointments for a headache, sore shoulder ( after lifting something too heavy) and anything else.

My in-laws are the same. In fact my MIL’s GP has told her she should find another doctor’s surgery to go to.

If I want an urgent doctor’s appointment for me or my DC I have to pay for it.

The problem with the NHS is lack of funding and that they've managed to convince people that it is inefficient when it is not. I'm not sure what the European model is as every country does it differently, I'd go for the European models that have everything free for everyone and WAY more funding, beds and doctors. I'd also make medical training free.

Absolute and complete utter rubbish. It’s nigh on impossible to get autism and adhd diagnoses on the NHS, ditto any mental health treatments under CAMHS or adult. The lack of care in CAMHs then causes a bottle neck in adult services with treatable MH conditions turning into chronic MH conditions. We’re talking young people who SH, try to take their own life several times, suffer from severe trauma etc. Transition between the two is dire. Patients are held by inexperienced and low qualified staff and access to expertise is very hard to get. Inpatient beds are often non existent with young people being sent across the country, young people lurch from one Crisis to the next getting worse……

As a parent who has witnessed this and frustrated NHS staff who feel like shit because they can’t provide what’s needed I can most definitely say a lot is down to poor management and severe short sighted underfunding.

My previous post was in reply to this truly ignorant post.

Wes Streeting has acknowledged that there are too many people who just aren't getting the support they need and has highlighted the government's pledge to recruit 8,500 more mental health staff to cut waiting lists.

Untreated MH does not go away it causes worse more chronic conditions. You reap what you sow.
Undiagnosed ND does not get people into work and well. The right treatment, medication and support does.

I spent 35 years attending hospital appointments with my parents after my mum had a life changing stroke, and as they both aged. My dad was a doctor and my granddad was one of the first NHS GPs

1. Medicine is now a career not a vocation
2. Medicine is very disease focused rather than patient focused. This isn’t helped by specialisation to the extent that has happened
3. wholly degree led nursing has changed the make-up of nursing and also reduced the vocational element
4. no-one is willing to have difficult conversations with patients about their treatment options
5. quantity of life over quality of life is very problematic and linked to 2
6. growing isolation of elderly people leads to a sort of healthcare as a hobby approach which is not always conscious
7. there is very little effective mental healthcare for elderly people
8. just because something is medically possible doesn’t mean it’s the right thing to do
9. we need to all have adult conversations about our healthcare choices and what we would want to happen in certain circumstances
10. social care is utterly fucked at all levels and causing massive issues

Lack of preventative medicine and health issues not being caught early enough. Also the postcode lottery, my advanced cancer would have been caught last year if I'd lived in a neighbouring county, now I'm costing the NHS a fortune for the sake of a cheap test (which if I'd known about it, I'd have bought the test myself!).
The amount of people I talk to in the oncology waiting room, who have visited their GPs countless times, yet have been fobbed off. So many people aren't diagnosed until things are serious and then they need expensive and extensive treatment.

nope no it isn't ALWAYS a lifestyle choice. Plenty of people with T2 have led healthy active lives.

Same! My dad will make a GP's appointment because he's not sleeping well (somehow always manages to get seen the same day!). The GP tells him to stop drinking strong coffee late at night 🤦‍♀️ which he'll do for a few months. Then he sleeps better so starts drinking coffee before bed again and then goes back to the GP because he's not sleeping well. But apparently the NHS is really inefficient and we were all sitting on our arses in ICU during covid.

Quite. Covid infections also increase risk of getting diabetes for both children and adults.