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.

Because the major cause is unpalatable. Too many people living too long with multiple co-morbidities, very poor quality of life costing absolute millions.
The 'charge for missed appointments' theory for example, wouldn't work, because the young and the old would be exempt, penalising the poor sods in the middle yet again.
Nurse of over 30 years.

People are living "too long" everywhere in the world that you'd want to live. They're not waiting on trolleys in A&E corridors for twelve hours everywhere else.

Yes improving the general fitness of our elderly population, along with a revolution in social care to reduce blocked beds and falls, would help NHS resources go further, but other health services are doing better (aided by substantial additional cash from higher earners and employers).

How do you improve the fitness of a 98 year old? You cannot. It’s just waiting to die in the best way you can. In hospital
is the absolute worst. It’s actually better to have loads of things wrong as GPs actually see you. If you just decline into old age you are just a statistic. Then hospital looms and you don’t even get anyone talking to you.
@Sunnnybunny72 I do not see why older people with money should be exempt. They have the best pensions, money through buying houses at the right time and pretty big nest eggs if they sell up and downsize . Why do we keep thinking they cannot pay but working families can?

https://capx.co/broken-britain-is-driving-everyone-out-even-our-immigrants/?utm_medium=email&_hsmi=85099509&utm_content=85099509&utm_source=hs_email

Not good news for the future of UK healthcare.

@TizerorFizz I do agree with you. We have been fortunate. We were born at the right time into a buoyant economy. We had (or I did) an effectively free university education, and parlayed that plus/via overseas experience into 20 years of decently paid self-employment. Via a work project, I explored the pension landscape and all the options. And made decisions (25 years ago) that now look clever. They could have been bad decisions. I/We could have lost everything and been on SP with nothing more. My pension was tiny; DH had none (no auto-enrolment then). I have both parents still (89 and 90) and am unlikely to inherit much from either.

But the two most important words in the paragraph above are self employment.

And before everyone jumps to the conclusion that it has all been sunshine and butterflies, I lived through the three day week in the 1970s, then spent 1980-85 in NYC (when it was bankrupt and DANGEROUS). Now that I am ageing, I don't want to go back to it, but I acknowledge that I need to contribute personally to the cost of my health care.

Unless society decides that having earned more than £000, I should be taxed at a higher rate. I don't resent paying tax on my basic state pension. BUt it seems daft to pay one partner c£13k and then tax it back.

@Papyrophile I was working during the 3 day week. My employer gave us candles! During the 70s it felt like the UK really was failing. Much worse than now for lots of people.

@TizerorFizz Life was objectively much harsher in the 1970s, but a large percentage of MNetters will never believe it.

I actually think we need to stop gp’s being gatekeepers to private insurance. Where I live you just turn up at a private hospital with your insurance card, pay your excess and off you go. In the UK it’s ridiculous that you need your GP to sign it off.

I believe it. I remember huddling round a camping stove as a child and living on sandwiches as we had no means of cooking. No heat or light or power. Just the camping stove and candles.

I think we also need to think about healthy life span rather than just longevity.

We already do. And systems exist like that in the U.K.

I was in last week to have a troublesome ovary removed. 20 ladies between 50& 75 arrived at 7am checked in by one nurse, got themselves into surgical gowns slippers and walked to anaesthesia. Hopped on a trolley, keyhole surgery, woke up, proved I could pee, eat & walk and was collected by driver (dsis). Home by 4pm. It was all very efficient.

What I always find strange but fascinating at the same time is that, when you look at the leadership structure, the C suite and main decision makers in the hospitals/trusts, is that I often see they are not medical professionals. They are executives form big firms who found themselves working for the NHS. And these non medically trained people are making decisions on how hospitals should function, they probably also decide how the money are spend (budget) but please correct me if I’m wrong….

In the country that in from this would be unthinkable. The decision makers, leadership teams in hospitals are actual doctors and/or medically trained professionals who moved up to be in the leadership.
Dont get me wrong, the care is not perfect and waiting lists are also long for some specialists but I often wonder if some of the NHS problems could be fixed by placing into leadership teams people who are day in day out at the frontlines… they understand like no one the challenges, problems, they see firsthand what need to be done and so on.

Funding, incompetence, ageing population, people surviving that would have died and needing ongoing care, people not caring for themselves. Around 10% of the NHS budget is used for type 2 diabetes. My family are genetically predisposed to type 2 diabetes, my Mother managed by being careful to not go down that road and she lived in to her 90’s. Of my siblings three made no effort, one died from kidney failure because of diabetic complications and the other two are on meds. The other three of us have made an effort to not be fat, not drink, not smoke. We all had the same knowledge and warnings.

When I was at my GP very recently they had a sign up. It’s a six Dr large practice it said last month 290 people missed their appointments, please remember to cancel. Of those I’m sure there may have been a few genuine emergencies, terrible though.

@Spendonsend
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.

German here, and would disagree it's a good model to emulate. Yes, patients get excellent healthcare with at-will specialist access but it's also exceptionally expensive at system level, as well as ridden with extreme social inequities. The vast majority of the population pay income-based insurance contributions enabling run-of-the-mill care while the richest ten percent get to opt out into private insurance at often lower cost (because of cherry-picking healthy/young patients) and with better benefits (shorter wait times, private hospital rooms, nearly infinite physio appointments.)

Much better models would be Sweden (tax-funded), the Netherlands (reformed insurance system) or France.

@MissFortune1 Why would we train doctors at £1/4 millions go and more to work in management? Of course others should be doing this role but it should be collaborative. Medics really should stay as medics and not reduce the workforce even more.

Yes of course, if you put it that way it makes no sense to train doctors for them to move onto the management. Although, the doctor that have been trained are either leaving or going private 🤷🏼‍♀️ Without going into nitty gritty, like I said below, I do wonder if many problems could be fixed if they are looked at/managed by people who are in the heart of it 🤷🏼‍♀️

A lot of the managers and administrators won't have ever worked anywhere else, so will be blind/blinkered to how things are done elsewhere. But the same will be said of doctors too.

It really needs a more diverse workforce, and I'm not talking about race, sex, etc., I'm talking about attracting far more staff from outside the NHS who can bring different skills and experience into it, and more importantly, the NHS actually being willing to listen, learn and change.

Someone with, say, 10 years experience of working in 3 different organisations has a lot more experience than someone who's spent 20 years working in the same one!

@GrumpyPanda Thats very interesting. Yes of course there will be much better models i dont know about.

I think my love of the german system was just cos i got good treatment there compared to in the uk.

@taxguru I think there does need to be a mix of skills in the NHS. It’s a massive employer but I think lots of savings could be found. Plus working more efficiently and improving life/work balance for employees. Bringing in top managers from elsewhere could bring a fresh perspective. Changing anything is very difficult though as there are entrenched views.

I am well aware many work for nhs and private clinics at the same time. They are not necessarily full time private. Many use nhs facilities when nhs isn’t using them. For me it was an eye operation and my consultant had nhs patients and private ones. Nhs operating room was used by him for private patients on a Saturday. This was in addition to his nhs workload.

No system is perfect but we have gone from 75% thinking the nhs is good to 25% in 5 years. So clearly post covid there’s a lot wrong.

You don't any more. You just call your insurance provider, have a chat, and they issue you with a treatment code. Alternatively you can just book a same day appointment with a private GP, via the insurer, and they refer you. It's pretty much a direct system.

Sweden does not have a nhs though. It has huge taxation for individuals. We are never going to be able to introduce that to a nation that has been used to something for nothing. We have too few people paying tax now. We have part time working. Millions not working at all and engaging population. We have higher mortgage rates and child care costs than people are used to. Maybe Swedish old people continue to pay a full tax rate - they don’t here. They don’t pay NI. Maybe that should change but I don’t know what the revenue would be.

I assure you that pensioners in the UK pay income tax once their income goes over £12,570 -- at the same rates as the rest of the population.

The point is they don't pay NIC. Only "workers" pay that which is why it's so unfair to burden the people who are actually productive. Landlords, pensioners, etc., don't pay as much tax on the same level of income because they don't pay NIC!

Instead of focussing on taxing income look at inheritance taxes

Inherited wealth isn't earnt by the person benefitting but does screw the housing market

If instead of 3% of estates paying inheritance knock it down so the 20% biggest estates need to pay the tax

I mean people will still get hundred of thousand of pounds