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.

Pensioners may not pay NIC but I'd rather we focussed getting the millions who are not working (I'm not talking about those genuinely unable to) back to work and paying tax and NI. By the time I retire at 67, in 8 years time, I'll have paid over 50 years of NI contributions and I'll continue to be a taxpayer. I think over 50 years of contributions is enough.

We need people to stop acting like the nhs is some special thing to protect at all costs. We need to m or to a European system and stop the waste.

Many doctors working for the NHS are on visas and are brought in by hospital trusts, but unfortunately, they're often treated poorly. It's not a career many would choose willingly; it feels like committing slow suicide. The hours are long, the responsibilities endless, and patients sometimes use up precious admin time with trivial complaints. It's a relentless cycle of non-stop clinics without breaks for lunch, coffee, or even a visit to the restroom.

And we must move away from reactive to preventative care

Which means tackling obesity and lack of exercise

Sugar taxes , UPF taxes, car parking costs increased

Which is hugely unpopular

Which is why no politician will promote it

I agree with everything except car parking costs. It just drives even more people to online shopping and out of town retail parks and is ruining town centres.

But a massive yes to healthier lifestyles, healthier eating/drinking habits, etc. But the answer to that is as much education and opportunity rather than the lazy option of higher taxes which barely ever works.

More carrot and less stick in all areas really, whether it's to encourage people to walk instead of using buses/cars, or to encourage people to make healthy eating choices.

Just look at the "sugar tax" on soft drinks. People are still drinking the unhealthy stuff and shops (Co Op, I'm looking at you) have reverted to charge the same for full strength coke as for diet/lite coke. Same with lots of restaurant chains who charge the same for low sugar/diet soft drinks as they do for full sugar equivalents.

If prohibitions and taxes (to make expensive) worked, we'd not have problems with drugs, underage alcohol, smoking (proper) cigarettes, etc. There's a limit to how much you can change behaviour by price alone (tax). It has to go and in hand with reasonable changes to opportunity and also much improved education right from the earliest years (i.e. scientific and logic based education not just all the "preachy" stuff we seem to suffer today).

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.

Chatting to my oncology consultant friend, she was saying that it's not the norm (and considered a bit disloyal) to move trusts once you're at a certain level. Surely this can't help fostering a transfer of best practice which comes with working in a variety of hospitals?

Inheritance tax isn't the answer. Bluntly I've paid income tax when I earned it, income/capital gains tax on most of my investments and 40% of what's left after tax relief in IHT. I also pay for private healthcare as the NHS scares me at times. If IHT was raised to fund the NHS, I suspect net receipts would fall as people squirrel their money away in trusts and limited companies.

Vote for a part pay model from me too. It's not just about injecting money, it's reducing waste as people would be less likely to miss appointments and undergo unnecessary treatment. Plus it encourages the underperforming hospitals to shape up or patients will choose to go elsewhere (which I gather happens in some European countries).

I agree. Trusts were set up to foster "competition" but it's failed miserably as in lots of areas, there simply isn't any competition. Same happened with the railways when the govt still control which operators can use which routes and stations!!

I can't change GP surgery even though it's absolutely crap because there is only one in our town - it's a group who've expanded to take over all the other surgeries, so now it's the same group, just different branches, and you've no choice of branch, you're allocated what's available at their choice!

Same with hospitals, we're in a rural region, so there is only one hospital within a realistic travelling time. Hence no competition!

Even when there is competition, it's artificial, as it's still the NHS funding it, controlling who gets what treatment by centrally determined criteria, etc., access still controlled by GPs, etc.

Part pay - an approach favoured by someone with clearly a lot more money than average !

So @midgetastic , those with the broadest shoulders should pay more... like income tax. If you can, I think you should.

How has 'part pay' worked out for dentistry?

It could work, either through % of income and/ or say a quarterly fee to acess a GP. So you'll pay say £50.- in a quarter and can see your GP as many times as necessary within 3 months.

Similar for consultants referral.

Long term illness once diagnosed, like cancer, should be treated as disability and exempt. So you'd only pay once.

We already pay for prescriptions and have bands for dental work.

Obviously certain groups will be exempt, same as now.
Emergency care should always be free at point of access. But if further treatment is necessary, eg broken leg needs physio, then a one off small free could be paid.

Something like this can be partially funded by government through general taxation and insurance contributions (% of income).
This wouldn't be cheap, but might be more in line with real costs of healthcare.
I would also hope that people would be more aware about making healthy choices- I'd think insurance companies would focus on this as avoidable expensive treatments eat into their profits.

The less well off you at the worse your health tends to be

So even if it's in proportion to your income ( say 1%) that will still hit the less well off the most

If it's not , then the squeezed middle get squeezed more

And if it's proportional to income why. It just increase income taxes ?

@midgetastic what's your solution?

As it stands, the current system isn't working. Healthcare with all the research, development and gadgets is very expensive.

Paying a % of your wages towards your health care in form of insurance & slightly higher taxes is an appropriate solution.
Obviously, nobody wants to pay, so hit me with something that doesn't involve paying more!

I'm on a low income (actually just outside qualifying for benefits) yet my health is important to me.
Having a healthy lifestyle isn't expensive, as long as you have the ability to do what's necessary... and that's the real sticking point, not the income. Insurance companies could be there for help and advice in preventing certain illnesses and conditions.

I am quite happy for proportionate method of paying more

That has to hit rich people much harder than those at the lower end because there isn't much slack for the majority ; which is problematic and why I think inheritance tax is the easier way to raise taxes - hitting rich and wealth - not hitting your ordinary week by week living

Along with a rethink about preventative medicine not just reactive - which means a change in the relationship between NHS and pharmaceutical development

And I'm open to charges for no shows, and full charges for violence against staff etc

That has to hit rich people much harder than those at the lower end because there isn't much slack for the majority ; which is problematic and why I think inheritance tax is the easier way to raise taxes - hitting rich and wealth - not hitting your ordinary week by week living

I agree, the majority of people: you've said everything necessary. The majority of us should be coaxed into a mindset where paying a fairly modest contribution for the care they need or want, THAT ISN'T AN EMERGENCY OR CRISIS, whether it is simply paying for a more convenient appointment time so it doesn't eat a whole day's work is normal and routine.

Inheritance tax is fine with me too. It will hit my DC harder than me, but given my DM89's house is a 2 up 2 down terrace in a Midlands town valued at roughly £200k after her equity release, and that's her total estate, it won't even trigger the £325,000 threshold. But when you look across most of the UK, there are far more 2 or 3 bed terraced houses valued below £300K than anything else in the housing stock. So I think the hammer the inheritants is also a hiding to nowhere. There are not that many estates (less than 5%?) that generate inheritance tax.

Charge for appointments not attended... can go with that too. Children always free to 18. I would be cautious about illness and disability exemptions. The ramp up in mental health conditions and claims currently being reported is concerning.

Just adding that I live in an area where life expectancy is not great, wages are very low compared to national averages. Recently recorded my blood pressure score with a nurse who practically cheered when it was "normal/healthy"; I find that level of acceptance of poor health as normal (I'm 67) a little bit problematic.

You cannot get more taxes from
people in more expensive areas. They have had to pay more and have higher costs too. London snd SE people already pay more tax than everyone else put together. Who exactly is rich now? Dwindling numbers of you have a mortgage snd dc. The better off are many pensioners. They might have paid for 40 years (few people pay NI for 50 years) but they continue to use the NHS. At a higher rate.

I do agree those not working need to work and pay tax but we have a part time work culture. Some people just prefer to live on less money.

If beds blocked are the problem that has to be solved first.

I would ban all the rainbow schemes. That wasted huge amounts.

If we gave visas to 1.3m people last year we need loads of extra doctors and dentists to meet their needs and that's assuming we have enough doctors and dentists to meet the current requirements. Which we don't.

We need to train more staff. We need better systems and a plan for dealing with an aging and unfit population.

That plan is probably not kind. And there's the difficulty. We either fail everyone or attempt to do better in difficult ways.

Bed blocking is mainly caused by not enough elderly care places or people to care for the elderly at home. That's what needs to be looked at, but no one wants to face it. Probably because it will probably mean telling people to sell their homes. The ' dementia tax' was probably the closest anyone got and it scuppered Teresa Mays government.

@DramaLlamaBangBang My mum has had to sell her house to fund a care home. There is no option unless you can get sufficient care at home. When mum was 98 we managed to secure 2 hours a week private care. At 99 the council offered 4 visits a day which would be around 15 minutes per visit. Totally ludicrous and no conversation with anyone until her 4th stay in hospital. There are no staff and homes are closing. Home is £5500 a month. Very few were much cheaper.

a plan for dealing with an aging and unfit population
Unless we can find effective ways to incentivize people to take responsibility for their own health we are fu(ked.

Allowing a charge to be put against people's homes for in-home care could (not necessarily would, I grant you) allow for funding of a reasonable intermediate level of in-home care beyond the crazy 15 minutes 4 times a day which is currently all that can be afforded by the councils.

@DianaTaverner No one wants the work. Staffing is a huge issue. Most care providers had no spare capacity. So it doesn’t matter where the money comes from, there’s no staff.

There are no staff and homes are closing. Home is £5500 a month. Very few were much cheaper.

so it’s absolutely impossible to get carers -2at £30,000 a year - to come to the house daily or maybe 5days a week with family doing weekend?

Care Homes wrap people in cotton wool so that they live for years longer than if they were at home and mixing with other people

@LittleWeed2 ? You are somewhat out of touch with the needs of the very elderly. They need some care in the night. They need to mix with others. That’s actually very beneficial. People really don’t want this work. The staff we had were £30 an hour, but they don’t want to be caring for just one person and they not on call 24 hours a day like care home staff are. Plus I’m not employing anyone! What family at weekends? There’s me. It’s not a job I can do. There’s no option but to use a home. It’s way better than being at home and boredom. DM now has activities, lots of people to talk to and no worries about property upkeep. Also who pays for care at home when you need to sell your house to get the money?

Teresa May come il with insurance. It’s the only way.