Why doesn't anyone have a proper plan for the NHS?

[letyouberight]

I say this as someone who works within the NHS as a registered professional. At work, it's total shit. We are so overwhelmed and stretched all the time, morale is in its boots, quality of service is naff and it's all just inefficient.

As a patient, I have recently been having an absolute nightmare trying to have a fairly minor procedure done which would actually relieve me of significant pain, reduce my time off work due to the issue and is literally a day-case procedure if that. I have seen 2 GPs who haven't listened so I have had to go back 3/4 times for the same problem. Then been told to see a specialist service whose waiting list is long.
I priced up going private and was told £2600, money I do not have.

I get it from the individual professionals' POV, as I also am medically trained and while I can see some aspects of care are individuals' faults, most of the problem is systemic.

Seriously, what are any of them proposing to do about it?! Reform, reform, reform- YES but HOW?!

Apologies if this is a bit ranty but I am honestly at breaking point with my work stress and health issues- both of which stem from the NHS.

[TizerorFizz]

It’s obvious. We need to move to a partial insurance model. All these doctors that clear off to Australia are not joining a NHS. Nor will they anywhere else in the world! So that’s what we must do. Learn from others. Also become lot more efficient. We need to stop treating the NHS as untouchable and accept we are asking it to do too much. We are asking younger workers to pay higher and higher taxes to cope with an aging population whilst those young people have fewer and fewer options for buying homes etc.

We do need to think about who gets what. My mum has a nhs dentist. We sat next to a lady chatting on her phone about all her holidays. She could have gone private. She took up a much needed place a poor person needed. I know loads of elderly people with very generous pensions who insist on nhs dental care. They manage to buy expensive glasses! They manage expensive holidays but won’t pay 1p towards their health. This has to change.

[TuesdayWhistler]

Reform and repairing public services costs.money.

To get that money, taxes need to go up.

Ant party that suggests people pay more tax ias committing political suicide.

Everyone wants everything, everyone wants to pay nothing for it.

[Tinybigtanya]

Agree with all of the above. We need to give up the myth of the NHS being "free".

[Spendonsend]

I think the issue is people are scared of the reform being the version of healthcare offered in the states. And realistically if reform happens under the conservatives, it will be. The system in the states seems to bankrupt ordinary people. Everyone has pre existing conditions too so who would insure all these unhealthy people if we did the states model..

I always liked the german system which is insurance based but doesnt seem to have that no pre-existing conditions or bankruptcy element the states has - but i imagine it would be a hard sell for labour.

[Twiglets1]

I think the NHS has got too big & expensive to control so there is no plan. Ultimately it probably needs to move to a partial insurance model but few politicians dare to publicly say that as it would cause an outcry.

[LittleWeed2]

I had treatment in the US privately. What surprised me was not seeing lots of decrepit old unable to manage themselves people (I'll be like that soon btw). I don't know what they did with them but everyone was a walking well (ish) and the colonoscopy suite was like a factory - only one nurse about getting everyone ready - well they got themselves ready (stripped and on to trolley, then medication to relax) and in and out one after the other. It was a clinic with that speciality - they rattled through them. No ambulances, wheelchairs, everyone looking after themselves with someone arriving to take them home by car.
Everyone has cars nowadays or uber or taxis are available. We should get ourselves to hospital unless heartattack or broken bones.

[DianaTaverner]

Pledging it pre election would be political suicide because the other side would portray it as destroying the NHS. Remember the "Death Tax", which was a perfectly sensible policy brought down by negative spin?

And the problem is that it might take more than five years to implement and bed down so even if Starmer came in day one and said "right, we're doing X" the plan would still be vulnerable to attack and misrepresentation before the next election. I think realistically the way to go is a big cross party consultation during the next parliament to come up with a really detailed plan using the best elements of the German/Australian/Belgian etc systems, to put to the electorate in the 2029 election, and with the big European and UK insurers primed and ready to step in.

But realistically it's going to cost a lot. All the costs of the NHS plus the costs of a billing system and insurer profit margins at an absolute minimum. The question is how to spread those costs around.

I do think something's going to happen though. Wes Streeting is a man with a plan, itching to get stuck in.

[JoanOgden]

Obviously we have an ageing population which expects ever more sophisticated medical care. But that doesn't explain why NHS productivity has actually reduced recently despite more funding and extra personnel.

So what is going on? We can all see the NHS is collapsing but why has it got so much worse in the last couple of years? I know the Covid backlog is an issue but there is clearly some other stuff going on too.

[DramaLlamaBangBang]

@TizerorFizz

It’s obvious. We need to move to a partial insurance model. All these doctors that clear off to Australia are not joining a NHS. Nor will they anywhere else in the world! So that’s what we must do. Learn from others. Also become lot more efficient. We need to stop treating the NHS as untouchable and accept we are asking it to do too much. We are asking younger workers to pay higher and higher taxes to cope with an aging population whilst those young people have fewer and fewer options for buying homes etc.

We do need to think about who gets what. My mum has a nhs dentist. We sat next to a lady chatting on her phone about all her holidays. She could have gone private. She took up a much needed place a poor person needed. I know loads of elderly people with very generous pensions who insist on nhs dental care. They manage to buy expensive glasses! They manage expensive holidays but won’t pay 1p towards their health. This has to change.

I agree. I think the current model is just unsustainable and it sadly has had its day. It's far better to have a decently funded insurance based model from the start than piecemeal services that arent available and force people to fork out money when they need treatment which they would have got if they had insurance. It doesn't need to be anything like a US model, but all European countries have a partial insurance model and all of them are far more efficient than the NHS. The problem is no one wants to say it.

[HermioneWeasley]

Because nobody wants to hear that the NHS in its current form is unsustainable

[DramaLlamaBangBang]

@LittleWeed2

I had treatment in the US privately. What surprised me was not seeing lots of decrepit old unable to manage themselves people (I'll be like that soon btw). I don't know what they did with them but everyone was a walking well (ish) and the colonoscopy suite was like a factory - only one nurse about getting everyone ready - well they got themselves ready (stripped and on to trolley, then medication to relax) and in and out one after the other. It was a clinic with that speciality - they rattled through them. No ambulances, wheelchairs, everyone looking after themselves with someone arriving to take them home by car.
Everyone has cars nowadays or uber or taxis are available. We should get ourselves to hospital unless heartattack or broken bones.

The reason the US system is so expensive is partly because the 'worried well' get treatment all the time, sometimes when they dont need it, because there is money to be made by doctors, and the pharma industry. The decrepit are too expensive to treat, so often dont get treatment at all.

[DramaLlamaBangBang]

@DianaTaverner

Pledging it pre election would be political suicide because the other side would portray it as destroying the NHS. Remember the "Death Tax", which was a perfectly sensible policy brought down by negative spin?

And the problem is that it might take more than five years to implement and bed down so even if Starmer came in day one and said "right, we're doing X" the plan would still be vulnerable to attack and misrepresentation before the next election. I think realistically the way to go is a big cross party consultation during the next parliament to come up with a really detailed plan using the best elements of the German/Australian/Belgian etc systems, to put to the electorate in the 2029 election, and with the big European and UK insurers primed and ready to step in.

But realistically it's going to cost a lot. All the costs of the NHS plus the costs of a billing system and insurer profit margins at an absolute minimum. The question is how to spread those costs around.

I do think something's going to happen though. Wes Streeting is a man with a plan, itching to get stuck in.

Edited

This would be ideal, and would be more likely to happen if we were more used to coalitions, instead of the adversarial electoral system we have now. It all stems from that.
On the insurance element, would there be a way we could have a not for profit insurance system? Maybe run along the lines of NS and I? It may also encourage more preventative medicine. I do like Wes Streeting. I hope he can do something without being hamstrung by his own party members, which I think is what will happen unfortunately.

[hillaryjg]

@TizerorFizz

It’s obvious. We need to move to a partial insurance model. All these doctors that clear off to Australia are not joining a NHS. Nor will they anywhere else in the world! So that’s what we must do. Learn from others. Also become lot more efficient. We need to stop treating the NHS as untouchable and accept we are asking it to do too much. We are asking younger workers to pay higher and higher taxes to cope with an aging population whilst those young people have fewer and fewer options for buying homes etc.

We do need to think about who gets what. My mum has a nhs dentist. We sat next to a lady chatting on her phone about all her holidays. She could have gone private. She took up a much needed place a poor person needed. I know loads of elderly people with very generous pensions who insist on nhs dental care. They manage to buy expensive glasses! They manage expensive holidays but won’t pay 1p towards their health. This has to change.

But why should she go private? She is paying the same tax and NI as everyone else and is entitled to treatment. If we are going to say that people who have saved hard for their retirement have to go private then we need to move to a properly resourced insurance based service which gives people options on what healthcare they choose throughout their lifetimes.

[User3456]

We have an insurance system now. it's called National Insurance. We absolutely must keep the NHS free at the point of use.

[Meadowbird]

User - why? Yours is an emotional rather than a practical / logical response. Plenty of people can afford to pay eg £20 to see a gp. The system simply doesn’t work - there are too many elderly people with complicated needs, to mean people in poor health due to lifestyle (obesity) and new technologies/ medicines are very expensive. The NHS was designed for relatively cheap treatments and people to die quickly a few years after retirement, not to linger on for decades in poor health, or give themselves diabetes through obesity.

[Kendodd]

I think we need to stop preserving life at all costs. The mum of a friend was in a care home for her last five years with increasing dementia and multiple other painful conditions. She spent the last three years of her life screaming in terror because she didn't know where she was or who anyone was. She was also top of the queue for every vaccination going and only had to sniff for the doctor to show up with antibiotics for her. This was because she was deemed vulnerable and small illnesses could kill her. I have no idea why, keeping a very elderly women alive for as long as possible in terror and pain is seen as the moral action. It was absolutely awful for everyone involved.

[DianaTaverner]

@User3456

We have an insurance system now. it's called National Insurance. We absolutely must keep the NHS free at the point of use.

We have an additional tax on workers that's labelled "National insurance". It's no more insurance than a fish has fingers.

[GCAcademic]

Plenty of people can afford to pay eg £20 to see a gp.

True. But I suspect that telling people that they need to pay tax and NI for other people to get a service for free that they themselves have to pay for is not going to win any political party votes at the ballot box.

[Earwiggoearwiggoearwiggo]

A general perception that America is the world and so an insurance based system means something like America where you can end up in tens of thousands of debt if you get hit by a bus.

A general unwillingness to acknowledge that Europe exists and that lots of European countries have insurance based systems that are very good, and protect people who are not in work.

The elevation of the NHS to God like status, bearing the whole weight of national identity.

An unwillingness by those in power to risk the public wrath (due to the above) caused by pointing out Britain's current huge, fat, ailing, aging population doesn't really resemble the public of the 1940s the system was designed to serve.

[olympicsrock]

NHS dentistry should change. Make it free for kids and retired people . Everyone else should pay partial insurance .
I pay private dentistry because there are not enough spaces but there should not be such un fairness

[CrotchetyQuaver]

@User3456

We have an insurance system now. it's called National Insurance. We absolutely must keep the NHS free at the point of use.

Why? The NHS is on its knees with staff leaving in droves for various reasons. Keeping it free at the point of use is unusual compared to other European countries who do charge to see a GP I understand.
It certainly can't carry on as it is, there won't be enough staff left soon.
They have to find a way to retain their staff and keep them happy. Money is a part of that, but work culture and management attitudes are big factors too and of course the service users attitude. Many of us will have observed the way some people behave and made our own judgements on that.

[Octavia64]

For at least the last 30 years it has been the case that for some treatments/illnesses people could choose to go private.

30 years ago I was told I wasn't ill enough to be put on the waiting list for a laparoscopy to be diagnosed with endo and a grandparent paid for me to have the operation privately. I then got treatment.

Now with much longer waiting lists for everything, private organisations are really expanding. Private GPs are available through private medical insurance, lots more companies are offering private GP services - my school joined a scheme where you paid 20 pounds a month and got access to a private GP.

So many people can't see a GP for minor stuff (chest infections, ear infections, etc etc) that they are happy to pay a bit for an appointment. I couldn't get in to see my GP recently with a bad ear infection, and they sent me to my pharmacy but my pharmacy isn't funded to see adults with ear infections so they wouldn't see me. I ended up at the walk in, but if I'd had a private GP closer than 20 miles away I'd have gone to him.

The government has plans to let pharmacists diagnose and prescribe for these sorts of things which I think is a positive step the problem is you don't know who to go to. Is your pharmacy funded for your problem for you?

In the meantime, as more people are in the situation where if they pay for the private operation/appointment etc they will be back at work/back at school quicker then more of them will pay.

So the private sector will expand.

Realistically the NHS will become an emergency service - if you have an RTA or similar then you are going to A and E, and the planned side will have fewer and fewer resources and longer and longer waits so people choose private if they can.

If my state school is offering a private GP service as a benefit then other organisations will as well. So I'd guess that more and more companies offer private GP/private medical as a benefit and slowly we move towards the American system.

[MartinaMorningstar]

@JoanOgden

Obviously we have an ageing population which expects ever more sophisticated medical care. But that doesn't explain why NHS productivity has actually reduced recently despite more funding and extra personnel.

So what is going on? We can all see the NHS is collapsing but why has it got so much worse in the last couple of years? I know the Covid backlog is an issue but there is clearly some other stuff going on too.

Its deliberate to get people calling for privatisation.

There is money to save it, it just needs to stop being spent funding the worlds wars and god knows what else and be spent on the NHS. They managed to find billions to send to Ukraine.

They also need to cut out a lot of the unnecessary bureaucracy and 'managers' and go back to some of the older ways of doing things.

As well as only treating people that are entitled to it. In some places in Europe you have to show a card that they scan that is directly linked to your social security. If you haven't paid in enough, or are not currently paying in, or are not a citizen, then you don't get free care. They also have the same system for benefits, if you haven't paid in enough, then you aren't entitled, simple as. That would save fortunes.

How can we propose bringing in a paid for service for everyone while still dishing out care to those not entitled to it? Other countries have no issue protecting their services, I don't know why the UK can't.

They also need to stop companies raping the arse out of the budget and get the procurement under control. I've seen a company charging £20 for a box of biros, because its the NHS. And that was a LONG time ago so its probably all even more exepnsive now.

[concernedchild]

@Octavia64

For at least the last 30 years it has been the case that for some treatments/illnesses people could choose to go private.

30 years ago I was told I wasn't ill enough to be put on the waiting list for a laparoscopy to be diagnosed with endo and a grandparent paid for me to have the operation privately. I then got treatment.

Now with much longer waiting lists for everything, private organisations are really expanding. Private GPs are available through private medical insurance, lots more companies are offering private GP services - my school joined a scheme where you paid 20 pounds a month and got access to a private GP.

So many people can't see a GP for minor stuff (chest infections, ear infections, etc etc) that they are happy to pay a bit for an appointment. I couldn't get in to see my GP recently with a bad ear infection, and they sent me to my pharmacy but my pharmacy isn't funded to see adults with ear infections so they wouldn't see me. I ended up at the walk in, but if I'd had a private GP closer than 20 miles away I'd have gone to him.

The government has plans to let pharmacists diagnose and prescribe for these sorts of things which I think is a positive step the problem is you don't know who to go to. Is your pharmacy funded for your problem for you?

In the meantime, as more people are in the situation where if they pay for the private operation/appointment etc they will be back at work/back at school quicker then more of them will pay.

So the private sector will expand.

Realistically the NHS will become an emergency service - if you have an RTA or similar then you are going to A and E, and the planned side will have fewer and fewer resources and longer and longer waits so people choose private if they can.

If my state school is offering a private GP service as a benefit then other organisations will as well. So I'd guess that more and more companies offer private GP/private medical as a benefit and slowly we move towards the American system.

To be honest I'll only use a private GP now. My NHS surgery has failed three members of my family in three years, one died and two nearly died because of their incompetence

[TizerorFizz]

@Earwiggoearwiggoearwiggo Exactly. We cling to an outdated system. The idea that the elderly have paid all their lives into an insurance scheme and then deserve nhs mcare because they have paid up is ludicrous. My DM barely worked as married didn't in those days. All taxes, and NI is a tax and not ring fenced, are paying for services at the time the services are delivered. There is no insurance pot of money. Post retirement, people don’t pay NI. Even if they work. Yet we all know they use services more. We need to stop calling this tax “insurance”. It isn’t.

I don’t agree with piecemeal privatization: I also don’t like the USA system. European systems are better and we need to see how they can be applied to us. Where resources are scarce, (nhs dentists) there needs to be fair rationing. Wealthy pensioners should pay and not cling on to services at the expense of others. There’s insufficient dental places for the poor so we need to regulate who gets the resources.

We must move away from people thinking they have already paid for everything - they haven’t.