What do we want from our NHS and how should we pay for it.

I think it does PRINTMISS - I vaguely remember reading statistics that said just that.

I don't think it should be a political issue on this thread durhamjen, although it obviously is in the real world.

It seems to me that the NHS should be rethought totally. It was a brilliant concept and could be again but it can't be all things to all people. Things have moved on too much. Maybe, because the NHS has been such a success.

No politician is brave enough to come out and say that. Apart from that, JaneA's idea of a compulsory none intervention policy for a sustained period seems like the best idea.

I reckon that the NHS is such a multi faceted organisation that is growing and developing all the time to accommodate new discoveries and also increasing demand that coming up with one all encompassing solution to how its run would be impossible. I do agree that we, the public/potential patients, need to take more responsibility for ourselves. eg we all know the health risks of smoking, drinking to excess, overeating etc etc we could do something about this ourselves. Its also clear that some people have daft expectations of NHS eg one GP of my acquaintance told me of people making appointments for seriously trivial matters - on one occasion for a nose that was "a bit red from blowing her nose while having a cold"!!

Personally I think it should have more money put into it [saw the how our money is spent form this week, and the health bill, although enormous, wasnt more than I was expecting]. But with a proviso that it has some sort of health tzar? Or health major type figure. But they have to be good, ie money efficient at what they do and achieve.
I know that all sounds like a bit of a dream, but there must be people able to do it.

My perfect NHS - First it would be preventative, bending over backwards to persuade and encourage all of us to lead more healthy lives. Diet and exercise should be a national priority, backed up my much, much stiffer regulation of the food and drink industry. Secondly, medical facilities from GP to clinic, specialist and/or hospital should continue to be available to all, possibly with some sort of an up-front payment and possibly even provided by a private or semi/private organisation reimbursed by the state. However, the use of NHS facilities for private purposes would be rigorously prohibited. Thirdly - the whole thing should be taken out of the everyday control of politicians. Fourth - money. Much better budgetary and financial controls should be implemented to achieve greater efficiency and reduce postcode variations in the quality of treatment and service. After all, it is a NATIONAL health service.

I would be happy to pay more for the NHS provide the service improves. Not that I any issue with the current service I get, but if more money means it could be better, I am for it.
However it does need to become more efficient, learn from the private sector. In our area, North Essex, most routine surgery, knees, hips, carpal tunnel etc. is contracted out to private hospitals. I suspect this is because it is cheaper than utilising main hospital beds that have all the intensive care etc. available. All my recent operations have been at a private hospital.
I know that UCH were utilising hotel rooms for patients that needed several days care, but did not need a hospital bed as it was cheaper.

I think that's a good idea soon, in theory, but in my experience anything that is done to 'improve' things just brings in more managers.

If someone could actually take time to REALLY look at waste, central purchasing, layers of management, whether privatisation would really work, is outsourcing really the best way to get clean hospitals, would a 'core' service with people paying more for 'add-ons', tax relief on private payments/insurance, etc, etc, that would be brilliant. Add to that a 'leave things alone' policy while they were doing it and we might get something that was fair and worked well.

Ah but the magic tsar would not bring in more managers!
Agree about the looking at waste, central purchasing stuff.

I cant decide whether I think that plastic surgery should be an add on. Probably yes, if it was for cosmetic reasons.
But some would say they are being bullied etc for their looks, so not sure where the line should or ought to be drawn there.

But yep. kittlylester for health tsar.

I worked in the private sector most of my life (manufacturing). I retired early and got a part time job with Age Concern as a carer in a day centre, I was horrified at the out of date, wasteful practices that were in place. Many of the AC management were ex NHS people and brought their practices with them. Our local Age Concern went broke, and it was no wonder. Couldn't organise a p---up in a brewery.

Lockheed Martin, an American arms company, G4S, and several other non-medical organisations are about to bid for the contract to provide support services to local GP-led clinical commissioning groups. Apart from the usual misgivings about the danger of involving profit-orientated companies in providing public services, it seems to me that having such a close association with clinical commissioning groups would give the successful bidder a "foot in the door" for a large number of other health-related contracts.

It's been reported that private health firms are about to win a further £9 billion's worth of contracts. Dr Mark Porter, Chair of the Council at the BMA, said that these privatisations have caused a fragmentation of services and have diverted funding away from front line services to costly and complicated tendering processes. The NHS does not have the enormous financial/legal resources of the private companies, and - because of this lack of a level playing field when bidding - is increasingly losing out to the might of huge multinational organisations.

Patients of these private healthcare providers may well be impressed with the service they receive. Private companies bid for the least complicated and thus more profitable areas of health care. The NHS is left with the "messier", expensive, chronic services.

Once a few large companies have a virtual monopoly over acute health care, the scene may look very different. Now that Royal Mail is in private hands, there are already murmurs that, because other companies are allowed to "cherry pick" profitable areas of operation, Royal Mail will be unable to maintain its obligation to provide an equal service to everyone. We have seen that privatising energy companies, water companies, etc, etc., has not resulted in competition bringing down prices or improving investment and services. How much more evidence do people need that, ultimately, privatisation of essential services does not work in favour of the consumer?

Thanks to our devious and grasping politicians there is not much left of the public sector for the government to sell-off or give away to powerful private interests, whether on-shore or off-shore. The formula for this has been well developed since Thatcher's time. Underfund the public sector, criticise and rubbish it, break it up into bits and pay your City friends to dress it all up and sell it off for a song. Then retire to the Lords with some ermine, nice directorships and so on, to keep your cupboard full. Before long it all goes belly-up but that's somebody else's problem.

Perhaps the saddest aspect of all this is that the vile process was picked up and carried forward with glee by the Socialists. So now across the board the public sector has mostly been rolled up and privatised. Standards have suffered and will get worse, yet another big, juicy apple is about to be plucked off the NHS tree and plopped into the basket of privatisation. But we, the poor souls who will have to pay for all this cannot be told the full facts because that would breach commercial confidentiality. Is there a 'why' in cynicism? Yes, indeed. Its all done to line the pockets of those who govern us.

Does the private sector also train doctors or is it just the NHS?

I like the idea of a health tzar.

I wonder if there are an GN's who would prefer a private health system?

Oh papa - the process wasn't carried forward by the socialists but by the New Labour government!!

Whitewave - just the NHS

Or whitewave, are there any who can see the merits of a mixed system but with the 'free' bit much better managed than currently.

Kitty - how would the free ' core' and the paid for 'add-ons' be defined?

I think I agree with Kittylester, assuming I have understood her post.

I have no issue with privatised services running in tandum with public NHS, surely that has been happening for years under governments of 'NO ONE COLOUR' to keep with the request in the OP to be unpolitical..

Who hasn't had, know somebody who has had,, waiting to have an operation or consultation at/in a private hospital but paid for by the NHS. It's common for knee/hip replacements for example to be carried out by privatised hospitals.

I know the age old argument is private hospitals 'cherry pick' but I don't neccessarily see it that way. I see it as getting minor ops done and providing larger NHS hospitals the ability to take on A&E facilities, Emergencies, Intensive Care etc. that makes common sense in lot's of ways, to me at least I know others totally disagree.

The wastage in the NHS, procurement, PFI, you name it the NHS probably fails to keep an eye on or accept the need for good housekeeping. Some of the new hospitals spend a small fortune on visitor areas and shops, why? Bed space and patient facilities should be the priority, who cares if communal spaces resemble a 4 star hotel.

We have had threads that speak of poor quality provision of food, yet some hospitals can provide good food at a lesser cost per head, management are rubbish.

We know the incredibly stupid PFI agreements that have put many Hospitals into a straight jacket for funding, repair costs putting them into debt.

Silly little costs mount up. Why shouldn't you have to put a deposit down for equipment you leave hospital with such as crutches, walking sticks. Mind you I've been told if they are returned they were chucked out not reused because it's not cost effective to 'clean' them.

Going back to privatisation am I correct that the NHS was 5% privatised and it is now 6%?

I also think it has to be accepted A&E departments are abused by the public and the whole ethos of A&E facilities needs establishing.

I also think the NHS is not free, we pay taxes to pay for the service. I think we should do the same as other countries and expect visitors to have pre paid health insurance policies, the same as we have to do when travelling outside the EU.

So who else wants a health tzar?
Don Berwick has obviously not been doing a very good job, as he has been Cameron's health tzar since 2013. He came from a private health company in the US.

Never heard of him.
I googled him.
He seems to head up some sort of patient safety panel.
Not really what I had in my mind when I suggested a health tsar.

That's what Cameron introduced him as, soontobe.
Has anyone else read or watched the debate about the privatisation of the NHS in parliament today. The Tories and Libdems did not turn up, they are that interested.

www.bbc.co.uk/news/health-30137368

This is what I want for the NHS now.

I just think the NHS has been so under-funded over the years, because each successive government has been loath to put up taxes -( I will cover my ears!) - We are struggling to use procedures which at the time the NHS was started were unthought of, without accepting that these things involve more cash. Having said that I also think that the cash which is available is probably not used in the best way, with too many hangers-on. If only the government would allow the doctors to heal, the nurses to nurse, and stop their meddling, then perhaps more could be achieved.

PRINTMISS - I agree about the under- funding in general. The NHS in terms of value for money is a world leader. It is also up there in terms of equity which is a vital aspect. As for nurses nursing and doctors healing - of course but in order to do that, there has to be an infrastructure to support that. The issues are different in primary and secondary care. A GP practice, for example has to have a practice manager, receptionists and administrators, access to IT support, cleaning and maintenance staff. Without all this being properly set up and managed, patient care would suffer. In hospitals, the issues are even more complex. I'm not saying that there isn't room for improvement but it isn't as simple as front line staff = good, all others = bad. i well remember an example from my days on a Trust board. Thee was very poor utilisation of theatre time at certain times. Doctors arranged it all themselves. Expensive theatres stood empty - especially on Friday afternoons- theatre staff had nothing to do, patients languished on waiting lists. We decided to appoint a theatre manager ( yes one of those dreadful manager people) answerable directly to the Chief Exec- ie if staff refused to cooperate, s/he could go straight to him. It revolutionised the use of theatres- some staff didn't like it at first but got used to working in a more collAborative way. Patients benefitted which was the end point of the exercise. I can't quite remember the figures now but I think it was something like the cost of the salary was recouped in the first 2 or 3 months.

Obviously,some managers are necessary but over management is wasteful! In my experience the practitioners are not trusted to be 'professional' and are treated as though they are stupid (at best) or swindlers! In reality most NHS staff just want to do the best for their patients.

I would just like to point out again that the Commonwealth Fund, a Washington-based foundation which is apparently highly respected for its research methods, found the NHS to be the world's best healthcare system - scoring highest on quality, access and efficiency.

Whether their findings would be the same now that this government has deliberately cut NHS funding, who knows. It is naive to think that it is possible to discuss this matter without politics being involved. The Conservative Party has a stated wish to substantially reduce the state and this, of course, affects public service provision.

Jeremy Hunt and Douglas Carswell co-authored a book called "Direct Democracy: an agenda for a new model party" which contains the comment:

"Our ambition should be to break down the barriers between private and public provision; in effect denationalising the provision of healthcare in Britain."

Michael Gove and several other Conservative gave their support to a book called "The plan: twelve months to renew Britain". The author, Daniel Hannan, appeared on US TV (Fox News) and said that the NHS was a "60 year-old mistake."

I would far rather we had our "60 year-old mistake" than the system they have in the US where, according to the Commonwealth Fund report, "America denies care to many patients in need .... and is also the poorest at saving the lives of people who fall ill."

There is also a suspicion that the enthusiasm for privatisation is not only ideologically motivated but also arises from the number of politicians who have a financial interest in the healthcare industry.

socialinvestigations.blogspot.co.uk/2014/03/compilation-of-parliamentary-financial.html

Brilliant post, Eloethan. Thanks.

The theatre example I gave resulted from some senior consultants putting their own interests before those of their patients and their other colleagues. However, what is more common and what needs overall management is very caring professionals fighting their corner and putting their patients first. However, there's is not, and there could not be, enough money for all demands to be met. Someone has to take an overview and listen to and decide between the competing priorities of the various departments within a hospital. Shouting loudest doesn't mean you have the best case. Hospital politics are very real and impact on the decisions made - and these are not always in the best interests of the patients.