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.

Maybe, then again I don't resent paying for private dental work and I am far from well off. The reason I pay privately is that I get better treatment than I do if I was limited to NHS dentistry.
Presumably the same would happen with healthcare?

In all fairness I also pay for private dental care. It is better than my old NHS dentist and it is closer to where I live now. I pay a set sum each month for a set number of visits to the dentist and hygienist each year. I could see something similar happening with healthcare. Personally I would not be opposed to that.

Wouldn't we then end up with a parallel 2 tier system, if you have a bad tooth and you go to an NHS dentist they will probably say it has to come out (unless it's anything other than a basic filling)
So with health care it'll be a case of, problem with your leg unless it's anything basic we'll have to cut your leg off, well perhaps not that bad but you will get a better and more sophisticated form of healthcare if you pay for it compared to those who only have the free option?

Yep

Thats how it would work, yes.

Accept that staff move abroad because they get paid more, don’t have to work overtime unpaid and can book annual leave.

The NHS is shit because secretaries don’t answer phones or let you know stuff that would take 2 secs to sort. That an outpatient clinic I go to has the same amount of staff nurses stood around doing fuck all as clinic rooms which aren’t used. They are very rarely used as chaperones. All they do is walk the notes 2m from the desk to outside the door which the secretary can do. It’s been the Same for the last 5 years. My DH gets so annoyed.

Because people believe that people should work in the nhs for free or as some kind of voluntary service. That they should work for less money than they can get one day a week private and be expected to take less money because claps help.

The NHS frustrates everyone IMO. It's too big and unwieldy to operate as a national service so the local trusts were invented, but each one needs a board and directors etc, and they all want to set policies over procurement, purchasing and priorities piecemeal.

If any political party seriously proposed shifting to a cross-party coalition approach on healthcare, it would win my vote regardless of any other manifesto pledges and commitments.

@GoldenDoor They move abroad for all those things but not a single one is moving to a NHS! Not one. They take the money from insurance systems. The people left here might “support” the NHS but they all want more money. The only way to get money into the system is to use an insurance scheme. Then sort out waste and dreadful productivity.

As an aside. You wouldn’t think it but the best return in terms of earnings on ANY degree is medicine. All grads get jobs. All grads get promotion and all have a very generous pension scheme. Other degree. Have a few who earn well but it very much depends where and what you study. Medicine doesn’t have such issues. IFS research on grad salaries firmly places it as the top earner and way more apply than unis have places for.

My experience at work has made me firmly of this view, however the practicalities and ethics are so complicated. Not that that is a reason not to do something, just to acknowledge how grey it all is.

I think some form of payment system would be good. A lot of time is wasted with people not attending appointments and the like.
Also prescribing certain medications- paracetamol, iron, basic stuff that costs very little to buy but a lot more on prescription.

However I am hesitant about insurance having seen MANY young people dying and their life insurance not paying out. I worry that companies will do their best to wriggle out of paying for stuff.

I'm extremely skeptical of the notion that AI and technology is going to save the NHS time and money- my experience of using it at work is that it doesn't work most of the time and slows things down.

I honestly think paying staff properly and funding training would improve retention. The value we seem to place as a society on the roles of public sector (not just healthcare) is so skewed.

I just want someone to spell out ways to save money for the NHS and actually have a plan.

Absolutely THIS.

@letyouberight I also work in the NHS in a non clinical role.

I think the NHS will cease to exist in the near future. There are too many problems that require billions to be fixed. Money that no government has.

They have already started to brainwash us into this by reducing national insurance contributions (I know they are not to pay for the NHS, but it's a popular myth that they are.)
I would love an insurance system like the one in Germany, but fear with Brexit and leaning closer to the USA, we'll gett their system - maybe slightly watered down for people with pre existing conditions or of a certain age.

The problem for my area/ trust is an ever increasing population.

Think 3 towns with a 55- 70k population each, plus new developments popping up everywhere. Our hospital has a bed capacity of 520, we have 2 out patients clinics and one urgent care unit to provide health care away from the main hospital.

The hospital is old, parts of it are closed off due to being unsafe. We have plans for a new one, but not enough funds - may reasons incl. miss management and the main building is riddled with asbestos, that wasn't calculated into the original costing.

Then there is the obvious under staffing and luck of consultants, probably due to being in a deprived area.

I'm sure our hospital isn't unique, there must be 100's with similar issues.

I blame successive governments who failed to invest and reform the NHS when it was still salvageable.

I know the staff at my hospital do their best under the circumstances, but in the end, you can't polish a rotting turd.

Invest in re-opening community hospitals, maternity units, carehomes, psych units. Extend gp surgery hours and walk in centres. Acute Hospital only for surgery, emergency care, a&e. Pay staff better, stop ridiculous wastage, claim back oversees patient bills, employ either nhs or private doctors,not a mixture of where they work.

Oh I agree it’s the funding. Doctors are striking to get fair pay to keep it free at the point of contact. If the elite get their way and it goes full private then doctirs will get a fair pay and better hours and be treated fairly. But they are fighting for everyone and people don’t see that

Actually I don’t want them to fight for me. It’s piecemeal and not a solution. They do earn well and I would rather we had an honest conversation about being unable to afford the nhs. We need to accept doctors want more money and are prepared to accept money from insurance scheme health services abroad. It’s that simple. We need to evaluate how to introduce it here. It’s going to take 25 years to reform this behemoth but we must make a start.

Insurance companies can make profits but we could have not for profit organisations. We do have millions of people investing in insurance companies - via pensions. It’s far too easy for people to say profits are bad but millions of people invest in them, as they do other companies.

Claiming back overseas patient bills is interesting. I was recently in Spain and met an ex pat who came back to the UK last year for a hip replacement. She's been living in Spain for over years and hasn't paid tax in the UK in all that time! She told me that all you need is an NI number and to give them a UK address (she used the address of a family member) and they don't charge. She told me that a lot of people regularly travel back to the UK for treatment as they never get charged and although the hospital treatment is good in Spain the language can be an issue.

I'm sure this is true as when my aunt was visiting from overseas a few years ago she needed some hospital treatment and offered to pay as she hasn't lived here for years she was told not to worry!

Health tourism is a big problem.

The European 'same per capita funding' is not all from the government as far as I can see. It includes the insurance based contributions. Surely there can be some state guaranteed not for profit insurance based system. I agree the wastage needs to be cut. Charge for missed appointments, fewer free prescriptions for things that cost pennies at the pharmacy, stop the triplicate of work andcthe clunky systems. I work in the public sector. ( not NHS). We waste huge amounts ofvtime on admin because instead of spending money on proper systems, we have several cheapo systems that don't work together properly, which is incredibly frustrating. I can imagine it's 10x worse in the NHS.

Save money? This is the problem. Healthcare, good healthcare, is expensive. It’s more expensive than we are currently paying. We know this because the health systems in other comparable countries cost more. And we have a massive backlog both in throughput and infrastructure to work through.

If we want it, we will have to pay for it. The discussion needs all to be around how much of it we want and the best way to pay for it. The fairest, and the most efficient.

But we’re not having the conversation because political parties are either scared (Labour, currently) or pro-US model (Tories).

This of course should be off set by the number of people from overseas (mainly EU) living in the UK who go 'home' for medical and dental treatment. I have got to know a lot of Ukrainians, they mostly go back to Ukraine for medical/dental treatment because provision in the UK is so poor.

Spot on!

In this case, it's not even about the money, it's just plain cruelty extending horrible, painful, lives like this with endless medical treatment. We do it because we're to cowardly not too.

In some cases, it IS about money. Hospitals/trusts get paid for treatments, so they have an incentive to do work if they get the extra funding to do it.

My OH was sent to a different hospital (same trust) to see a highly specialist consultant for a stem cell transplant. He (and his stem cell transplant co-ordinator) were all over us at first, showing us the state of the art equipment, re-assuring him, giving a tour of the department. It really was like some smart sales presentation. When OH started showing uncertainty after the tour about the serious and length of the treatment, there was a distinct reduction in interest from the consultant, and they both seemed disappointed and were pretty quick to show us the door. It really was like going into a car showroom, getting offered the coffee and cake, and then being ignored when they realise they've not got a car you want to buy and lose interest.

We mentioned it to his own oncologist and she confirmed that they get funding (huge amount in the case of a stem cell transplant) so the more transplants they do, the more funding they get! OK, not going into his pocket (hopefully) but it does show that some things in the NHS are financially motivated, and that any "gaps" in the number of patients going through the stem cell transplant process means they get less money, so it's in their interests to keep their beds and equipment fully utilised!

Always a good place to see costs/benefits etc. Contrary to popular belief there are now way more doctors and nurses than ever. Admin/managerial staff has stayed constant. 45% of budget on salaries though, next biggest drugs.

https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/key-facts-figures-nhs

I don’t think it’s a bad thing to keep expensive equipment fully used though. I’m also aware of the Kings Fund research. Lots of evidence flies in the face of popular rhetoric. What must be addressed though is why there is low productivity. Our admin costs are lower than other countries apparently (so an expert said on radio 5 this morning) but we don’t seem to get the through out of patients we should.

I agree with @Kendodd . If you see some of the wards with elderly people in them, you do pray with all your might that you never end up like that. I’m also tired of hearing how others think we should stay alive when we don’t want to. I want to make my own decisions.