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.

It needs to switch to a European insurance model. People see the word insurance and think of America but it’s nothing like that and works very well, ensuring everyone can have healthcare and patients can have genuine choice.

A huge centralised system like the NHS no longer works in a world where medical care have progressed so much. If we want to keep the NHS as it is, it will have to be for basics only.

The problem is the people who think they have paid for everything vote.

By and large they are the older generation who remember the earlier days of the NHS.

Any party suggesting major reform will be voted out. So no party dares.

So you get creeping privatisation because nobody dares change things because they'll get voted out.

The US system needs no reform to happen. It just needs constant neglect, forcing people into private healthcare, creating a two tier system.

We’ve already sleepwalked half way there.

Anyone saying “but we don’t have to have the US system” is delusional. Under the Tories we do.

I think there are a few elephants in the room that no politician will want to address.

The first, is that there is a proportion of the population that will require an incredible amount of money if we are to keep them healthy or even just alive. We simply can't afford this whilst offering a reasonable level of healthcare for the rest of the population. Look at Kate Garraway's husband's care bill and it quickly becomes obvious how it doesn't take many people requiring this level of funding before the whole system is bankrupted. It is obviously deeply controversial issue and linked to all sorts of sensitive areas such as disabilities, personal responsibility, increasing life expectancies and poverty, but the reality is that the costs are a huge burden on an already struggling system and we can't pretend this isn't a massive part of the problem.

There is also the issue of whether those who have money should be expected to not only fund a supposedly 'universal' system but then also have a moral obligation to pay privately where possible. A small minority of people in the UK are net contributors and they are realistically the ones funding everything for everyone else. Is it fair that they do this and then people also expect them not to use any of the services they pay for? I think there is an assumption that the rich must pay for the poor and that the poor should be entitled to the same level of healthcare as everyone else. This is an anomaly in a capitalist society where almost every other aspect of life is dictated by someone's wealth.

Fucking hell. I didn’t read OPs question as one about insurance/ privatisation vs NHS… I read it as a question about the operational plan of how to get the system working (eg different systems in different departments aligning, waiting lists cut)
Im a patient currently. A lot of the glitches in the system are logistical ( patients passed from clinic to imaging for example but different systems for booking and scheduling). The other central problem that I can see is just not enough equipment and not enough boots on the ground staff to operate it (hence delays).
But here we are, a raft of posts blithely telling us we can’t expect to keep ill people alive and hey, everyone has a car and can afford £20. Its really easy to write old or ill people off and think that because you have savings and the wherewithal to pay for private insurance everyone should but that’s not who we should be aspiring to as a country. Wtf happened to Fair Play? Compassion?
As another pp pointed out, we already pay insurance but I would increase NI with a ring fenced NHS tax to be spent on a)overhauling all the processes and systems and b)more equipment and frontline staff. I would increase wages and training for admin staff too, and make sure they are excellent at their jobs as they are central to the organisation of it all.

Kendodd · Today 09:10
I think we need to stop preserving life at all costs.

Definitely this. Most people can’t afford to go to Dignitas in Switzerland, but even if they can but need assistance to get there, then the assisters are questioned by the police when they return.
My mother had dementia for four years. She screamed and sobbed for much of the time. I dread this fate more than anything.

Can anyone explain how a partial insurance model will help healthcare and for whom?

It appears to me that there’s just not enough resource/man power, surely the private sector will start to slow if we move to insurance model and if not why can we not adopt the same expansion in the NHS.

How will partial insurance benefit ppl who cannot pay for the insurance?

Many NHS services are already expensively privatised anyway, look closely and you’ll see ‘proudly providing the NHS service’ everywhere.
The cost just hasn’t yet been passed on.

I think the main problem with many systems in this country are that they are political. Decisions are often made because of votes and keeping big businesses happy rather than what is the best plan.

I agree,

We need to have a serious conversation about what services the NHS provides for free. Difficult decisions need to be made, so no party wants to be the party to do that. Its not a case of a 'properly funded' NHS with more money, the NHS will consume as much money as we want to throw at it and still need reform.
The growth alone in diabetes since 1970 is projected to seriously test the NHS, if the rates carry on increasing at the same rate.
We are living longer, but not healthier. Very difficult decisions need to be made.

And that attitude is exactly why the NHS will ultimately fail and we'll be left with an expensive private medical system!

We need to be realistic and move to an insurance based model (akin to Germany maybe) with contributions, co-payments, options, etc. If we plan it over many years, we can transition over to something that is actually sustainable and affordable.

If we keep pretending that all the NHS needs is more money, then it WILL ultimately fail as it's a bottomless pit, a leaky bucket.

Nail on the head. Politicians are scared of saying what needs doing because they know the voters won't like it. So they just continue to kick the can down the road and hope to leave their successors to deal with it.

Not helped by the politicians of both major parties "weaponising" the NHS in elections over the past 20-30 years forcing the other party to commit to continue throwing ever more money at it without actually dealing with it's fundamental problems.

@GKD

Many NHS services are already expensively privatised anyway, look closely and you’ll see ‘proudly providing the NHS service’ everywhere.
The cost just hasn’t yet been passed on.

That's the exact problem of pretending the NHS is salvageable in it's current form. Using expensive private providers is a short term sticking plaster over a gaping wound. What we need is a long term plan where expensive short term fixes aren't needed.

Take hearing tests, Specsaver are, by and large, doing a good job of picking up the slack from NHS audiology departments via what I believe to be a national contract. They can still make money by being more efficient. But, what it needed was a long term contract so that Specsavers could change their premises to include hearing test rooms, equipment to do it, recruit and train staff to conduct hearing tests, discuss options, and fit aids, etc. If instead, a specific audiology department had a short term problem and called in a short term fix, it'd cost them shedloads more money, i.e. a mobile hearing test trailer with locum/contractor audiologists.

@TammyOne

As another pp pointed out, we already pay insurance but I would increase NI with a ring fenced NHS tax to be spent on a)overhauling all the processes and systems and b)more equipment and frontline staff.

Blair/Brown did the increase and ring fence thing and it didn't work. The money was immediately spent and then another increase in NI was needed.

And, on this topic, if it's to be NIC that pays for more NHS spending, then EVERY taxpayer needs to pay NIC, not just workers! It's grossly unfair to tax a worker more than, say a pensioner or a landlord with the same income!

NIC isn't an insurance scheme anymore it's just morphed into another tax, and because of that, it should be paid by everyone.

These threads make me despair. 😩

Posters: The NHS is broken. We need to learn from France, Germany, Switzerland, Australia etc.

Me: I agree. We should be investing as much money into healthcare per capita as they do.

Posters: No, we don’t mean that! We need to bring in more profit-making middlemen, AKA insurance companies! That’ll fix it.

For what it's worth I am in favour of an nhs that is free at the point of use.

But in practice what that means is that treatment is rationed via GPs.

30 years ago my GP would not even refer me to be put on the waiting list for endo surgery, my grandparents paid and I was treated.

It's no use it being free if you cannot access it.

In my view the best solution would be a European model as the nhs has always run by rationing treatment by time (waiting lists) and gatekeepers (GOs). I don't like the alternative of rationing treatment by whether you have money but that is what we seem to have at the moment.

If we're to keep the NHS at all, it needs to be free to charge "extras" so that it can actually start to raise funds for itself.

We already have it (or had it) with opticians, dentists etc. You could "choose" the NHS glasses or filling, or you could pay "private" for a better option.

Why can't that be extended to other NHS services. I.e. a basic hearing aid for people with hearing impairments (as currently), with an option to pay extra for an all singing, all dancing hearing aid (as would be provided by a private audiologist). The difference being that the NHS could actually charge more and make a profit, that profit staying in the NHS rather than lining the pockets of the private audiologist.

I just don't see why people have such a problem with that kind of thing. People seem to want the NHS to provide the top of the range hearing aid for free, and there's just no money in the pot to do that, and never will be, so everyone suffers the downgraded service.

Why can't we pay for the NHS on a means tested percentage basis, with rich people paying a higher percentage, down to some people paying nothing?

It would be complicated to instigate, and would need reviewing annually, as people's incomes can fluctuate.

It can't continue to be free, and we need to avoid going down the American route - health insurance there is extortionate, and I hate the idea of treating people on the basis of their ability to pay.

We need to get rid of middle managers and go back to the good old Hattie Jacques days of matrons.

@AnnaKristie

Why can't we pay for the NHS on a means tested percentage basis, with rich people paying a higher percentage, down to some people paying nothing?

How do you define "rich"? Is it income based or asset based? What about people with "hidden" income or assets, i.e. those engaged in the black economy, tax evasion, benefit fraud, selling stolen/duty free goods, not charging VAT, etc?

What about those who currently manipulate/hide their income to avoid paying child maintenance - they're already evading tax, so they'd also benefit from getting free NHS treatment that others who are honest and declare their income would have to pay for.

What happens when the rich don't want to pay, especially if they already make their own arrangements via private healthcare, they may just beggar off abroad instead.

It's a nice idea to say "rich people should pay", but it's just not going to work in the real world.

Perhaps a better option would be to actually encourage "rich" people to use private healthcare, so they wouldn't cost the NHS anything, maybe via tax relief on private healthcare costs, in the same way there's tax relief on private pension costs?? I.e. carrot rather than stick.

Its too politically sensitive.

The NHS tries its best to deliver far more than it can for far less than it gets.

It has a hugely increasing burden from increasing population - despite decreasing birth rates and old people burden it too.

It likely would need to cut back its "free" services and utilise an insurance system for all but the most essential, emergency services, which the media and left would brand as killing the poor or switching off nannas life support machine - so no party will touch it.
The only solution in reality is probably to let it collapse and then rebuild it as reform is too difficult.

How do you define "rich"? Is it income based or asset based? What about people with "hidden" income or assets, i.e. those engaged in the black economy, tax evasion, benefit fraud, selling stolen/duty free goods, not charging VAT, etc?

I would define 'rich' in terms of income plus assets.
There will always be people who evade payments, or who engage in fraud, but you can't base a whole system on the minority who try evasion.

What happens when the rich don't want to pay, especially if they already make their own arrangements via private healthcare, they may just beggar off abroad instead

They would have to pay - like income tax, non payment isn't an option. We all pay for state education through our taxes, even those who choose to go private - healthcare would work in the same way.

Going abroad isn't that easy to do for most people.

Perhaps a better option would be to actually encourage "rich" people to use private healthcare, so they wouldn't cost the NHS anything, maybe via tax relief on private healthcare costs, in the same way there's tax relief on private pension costs?? I.e. carrot rather than stick

Doesn't this already happen? Some posters have already said they went private when NHS treatment wasn't forthcoming or wasn't effective.

Everything will be privatised, the MP's mates and families and donators will all make fortunes, while the government, i.e. the rest of us, pay poorer peoples monthly insurance premiums. There will also be a two tier system with expensive premiums that cover everything, and the cheaper ones that are worse than useless.

Also, just wait for it to become mandatory to have insurance, like car insurance, once the MP's/elite/their cronies move into insurance companies.

Some people really should be careful what they wish for.

@taxguru It’s long overdue that the retired should pay NI. Haven’t the Cons said they went rid of NI? It should just be general taxation on income- for all. Many pensioners have far better incomes than young families. We actually got tax relief on our mortgage! We’ve had the best of the nhs. We’ve actually had the best of everything. Tax relief on medical insurance would be a good start. Looking at Australia would also be beneficial. After all they poach all these doctors who don’t like it here. So how come their system is so great? Or are they mostly fit and healthy without an aging population? Germany is surely a decent role model too. Definitely not USA but people always mention USA without ever looking at state insurance schemes . We are so poorly informed and killing off all decent healthcare.

So what treatments do people suggest the NHS stop providing if you say we can't provide everything.

DH was part of an NHS team along with cross party politicians and NHS folk who visited Netherlands. This is happening all the time. Recommendations are made. The NHS ten year plans, digital transformations, etc etc APPG's in longevity, mental health, etc etc, they run and put together reports continuously.

The issue is they never get implemented. It can be funds, it can be intransigence by local trusts, it can be because Tories will never be trusted with change because the NHS is sacrosanct, and staff, unions and a large section of the electorate, don't want to admit that anything new or different is actually better.

Maybe Labour can push something through. Watch the unions fight tooth and nail for status quo though, all they want is increased wages. Look at the railways...... Change and improvements are not readily accepted.