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

Eloethan and Grannytwice excellent, well informed posts.

I'd just like to add a point about taking an overview and prioritising competing demands.

It seems to me that we all agree the NHS is groaning under the weight of demand. That demand is to a large extent, caused not by 'dramatic' illness, but by the consequences of national policies which favour short termism and the benefits to large corporations. For example, obesity causes a vast amount of illness and suffering, but there are few policies which effectively promote and / or subsidise heathy food. Transport policies favour ever more road building to the detriment of local communities including walkers and cyclists. A culture of blame instead of openness encourages rank closing and defensiveness. I could go on, but the point is that the health of the nation has to be seen in its widest terms and not confined to dealing with illness once it has happened as a consequence of poor policies.

1. Bringing in the private sector and outsourcing some services leads to fragmentation.

2. Fragmentation leads to poor services as teamwork (the backbone of the service) is undermined.

3. Fragmentation leads to each fragment having its own costly bureaucracy.

4. Each fragment needs its own profit.

5. The positive psychology of teamwork and job satisfaction are undermined and the patient gets a poorer service; the workers get stressed and miserable.

For me the last factor is the most important one and is also the one that is always overlooked in these grand plans. They look great on paper and computer models, but the service runs on PEOPLE and for PEOPLE and that gets forgotten.

"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."
I think you are talking about the NHA party, GrannyTwice.
There would be enough money if we made rich people pay their taxes properly. A mansion tax would be a start in getting more money into the system.

" They look great on paper and computer models, but the service runs on PEOPLE and for PEOPLE and that gets forgotten."
Mishap, that appears to be the brief for the health tzar, but as the government realises it will cost more money to have more staff, he appears to have been sidelined. Hunt was quoting him everywhere last year, but has given up now. His brief was to listen to patients and carers and see what could be improved.

I still maintain there could be fewer managers and more central buying just for a start! That would allow more front line staff to be employed!

I agree, kitty.
This is a brilliant speech by Khailash Chand, a GP.
This is what I want for the NHS.

classonline.org.uk/blog/item/health-care-isnt-a-privilegeit-is-a-fundamental-human-right

The NHS was created by far-sighted idealists who after the war and at a very difficult time, forced through against strong Tory and medical opposition the creation of our present health service, which has been the model for most of the civilised world. The problem is that the NHS has been too successful for its own good and now needs reappraisal, re-focusing and restructuring, but in principle must continue to provide cradle to grave medical facilities at the point of need, regardless of the ability to pay. I simply do not trust our present politicians, especially the Tories, to do all this. They are more concerned at lining their own pockets.

Agreed, papaoscar. The list of MPs and Lords who are gaining from their links to private healthcare companies grows longer every time I look.

Thinking about a health tzar, isn't one of the problems that there are too many people who are at the top of the NHS?

The coalition said it would get rid of quangos, but there are too many parts now all vying against each other to be considered the most important. The only one who is no onger responsible for the NHS is Hunt. That is why the Efford bill has been put before Parliament, so that there is someone at the top who can be held to account. The Health and Social Care Bill took that responsibility away from the minister and shared it out between NHS England, the CQC, and other quangos.
Who is really responsible for our NHS?

I am learning a lot from the very informative posts on this thread - always good to hear from those who really know what is going on. Thank you.

A really interesting discussion & I agree with Micelf, some excellent posts from people who really know the NHS. I hope you've got what you wanted Whitewave. I remember the Ch4 TV series where Gerry Robinson tried to help NHS Managers improve their effectiveness &I agree with GrannyTwice that it can't all be blamed on Managers as such a big & complex organisation cannot be run without them - & quite a few I believe are ex-medics. One of our best GPs at my surgery now spends most of his time managing the practice rather than doing medicine which seems such a waste. One of the biggest problems which GR's programme brought out was the power of some of the old school consultants which was a throw back to the promises made to bring round the medical opponents to the idea of the NHS referred to by Papaoscar. They spent a lot of time working in the private sector & wanted to maintain their supremacy by sabotaging any improvements 'lesser' staff at the coal-face suggested. The Manager had become quite scared of them. The thought of having the NHS run by the likes of G4S horrifies me after the debacles their management has caused in the Prison system & at the Olympics.

What an excellent speech by Dr Chang, DJ. As far as I am concerned the NHS is my Alamo: perhaps the greatest achievement of the UK in my lifetime after the Battle of Britain, so I would stop at nothing to save it from the predations of our grasping, conniving, devious and frankly traitorous politicians. Since Margaret Thatcher's time I've seen virtually the entire public framework of the UK deliberately wrecked by politicians and sold off piece-meal to avaricious scrap-dealers, while witnessing the spivs who did it drape themselves in ermine and titles, and further benefit from dodgy expenses.

Now the NHS, the biggest prize of all, is secretly being lined up for the wrecking-ball and privatisation. I have only utter contempt for David Cameron, Nick Clegg and their cronies for masterminding and overseeing this disaster. History will judge and condemn them, but in the meantime we must all do our best to fight for the NHS by complaining again and again about what is happening to it. I sense that the public are beginning to realise what is going on and will take massive electoral revenge on the guilty parties for their despicable conduct. The NHS must be saved. I hope you're up for all this, David Milliband, your party is our last hope.

Freudian slip, papaoscar?

Agree completely, papa. I do hope that Miliband comes out from behind his focus groups who are doing him no good.
If he puts the NHS at the top of his list, I might even vote Labour again, which I haven't done since Blair came into power. I like geeks.
Slightly ingenuous of me because I have lived in Labour constituencies since moving back up North from Hampshire in 1987. However my husband and sons always voted Labour, which cancelled out my vote anyway.
If he does not, I will vote Green or NHA, whichever is available, to stop the NHS from privatisation, I hope, and save it from the TTIP.
Sorry, the rest of you, but it is impossible to keep politics out of the NHS, as it is the coalition who want to destroy it and hand it over to their privatising cronies.

Divine inspiration, perhaps, Ana!

Or wishful thinking!

You never know, Ana, the much put-upon British public are capable of awesome power if you push them hard enough, as Messrs Churchill, Thatcher and Brown found out, much to their surprise.

Not sure David would be up for it now, though. He seems to have found his niche elsewhere...

Near the beginning of this thread, I asked whether people were only talking about medicine or other parts of the NHS too.

Does anyone think it would be good to jettison other parts eg dentistry, optics etc etc to save the NHS?

I think the practice of "big pay offs and then being re-employed" is rife throughout the public sector as a whole janeainsworth

A recent example is Sunderland chief Karen Straughair and her husband Chris Reed (North Tyneside) receiving over a £million pounds in payoffs and were then both re-employed (by the NHS of course) earning £50,000 and £70,000 each for 4 months work. Not forgetting their handsome pension entitlements too of course.

It stinks.

Rotten teeth can cause major health problems and dentists can also spot some symptoms of serious underlying illnesses, ditto ophthalmologists.

Apart from all the sharp practice by politicians and private health providers, I think one of the biggest problems the NHS has had to cope with since it started is the medical profession and its controlling bodies, many of whom seem to exist only to feather their own nests. Unless the back of that can be well and truly broken nothing much will change. As regards the layers of quasi- and non-medical management imposed on the NHS over the years, I'd sack the lot of 'em without compensation and start again with decent and competent people in charge who have the true interests of the NHS at heart. No snake-oil purveyor of private medical nonsense would cross my threshold!

Just been reading the posts and quite impressed with the nuanced and sophisticated contributions you have been making. Much more knowledge out there than I could contribute.

So far folks and you will correct me if I am wrong;-

Everyone seems to agree that there are enormous pressures being put on the NHS for a very wide variety of reasons but at the same time recognizing that it is a world leader.

Looking at a some of the pressures they include
constant restructuring, costing time and money.
Mismanagement in employment and redundancy policies
Much comment about top-heavy management although you recognised the need for some management.
The constant development of new technology and the resultant cost
I was interested to note that no-one suggested that an aging population might be an added pressure! (who us?)

Some GN's were concerned at the pressures and employment conditions being endured by the staff, and felt that this lead to a demoralized and depressed staff.

Looking at what you wanted they could be summarised;-

We should all be responsible for our own health, by living a healthy lifestyle and as far as possible, when having to use the health system being informed so as to be able to be actively involved in decisions in relation to our treatment.

A consistent level of provision throughout the UK, with an overall National form of management. No-one was keen on the postcode lottery. From reading some of the posts this was as a result of lack of National management which leads to inconsistency of provision. Individual contracts with GP's and dentists allow the individual provider to make decisions that may lead to lack of particular skills e.g physio.

Some were reasonably happy for the NHS to contract out some of the provision, but most seem worried that this would lead to fragmentation, and a costly tendering process.

A couple of GN's said that there should be no use of NHS facilities by private health care
There was a suggestion that any major restructuring should be banned for a number of years
Tzar was also talked about but the opinion is a bit mixed on that largely it seems because of a tzar appointed by the current government not appearing to be at all effective.
There should be national terms and conditions for the staff

How we pay for it ;-

There seems to be no appetite for any form of American Insurance system. So no to privatization of the NHS. Indeed GN's are on the whole extremely suspicious of government of any colour, and their apparent desire to introduce private contracts etc.

Some suggested a payment by use/visit but others thought that this would be too costly, although a charge is made for some provision e.g dentistry, optician etc.

Most seemed to recognize that there may be a need to pay more, but no-one really explored that area.
I am sure that I have missed stuff but hopefully have given a reasonable summary.

Good isn't it!!?? I have enjoyed this, thanks to everyone who has helped me understand a bit more. Now who to vote for!!??

nhap.org/its-here-our-policy-framework/

I thought you lived on the Isle of Man. Do you have a vote? Isn't your parliament different? Or am I getting you mixed up with someone else?

Anyway, you can still read the NHA policy framework and see what you think. Does it fit in with your summary?

Well summarised Whitewave.

I think no-one mentioned an aging population because older people are one of the reasons the NHS exists? Surely, it is to look after the vulnerable particularly, that is why prescriptions, dentistry, eye tests etc are free to certain categories.

So, should there be more charges for those that can pay either at the point of use or in taxes? The NHS can't be all things to all people in a time of such huge advances and, it has to be said, the huge challenges that it faces today. Think of the huge drain on the NHS if ebola was to appear here. We have bed blocking, patient eviction notices, ambulances queueing to discharge patients, cancelled ops and so on already.

Successive governments have made a mess of things but I would be loath to vote for a party that bases itself of supporting the NHS.

I have just been listening to Radio 4's File on Four on the subject of Continuing Health Care Funding, which is the process by which the NHS is obliged in law to pay the care costs of those in the community (their own homes or residential/nursing homes) with primary health care needs.

It is a system I got to know very well when my father was in need of care - and I did get his care costs paid by the NHS in fact.

But I do question what this is all about - it pits health against social services as they both fight not to pick up the bill. Huge amounts of money are wasted in these assessments/appeals/reviews/training/legal costs as they slog it out. Both systems are short of cash and their attempts to avoid paying could be seen as proper budgetary management. But it is perfectly ridiculous that this situation should have arisen. The whole system needs overhauling.

The reason that patients fight to get the CHC funding is because it cannot by law be means tested (any more than any other aspect of the NHS can) whereas care via the SSD is means-tested and patients usually have to make a contribution.

It is a hugely costly system for the NHS. Is this what we expect them to be spending our money on? - or do we feel that direct medical treatment should be the limit of their remit? Should the law in this area be re-assessed?

nhap.org/our-policies/national-health-action-party-policy-framework/section-3-economy

Policy on the economy of the NHA, kitty. They have policies for everything, just like other parties. Do you always just go on a name? If that were true, the Conservatives should not have semi-privatised the NHS. They should have left it as it was, instead of calling it a 60 year mistake.

Just because they want to stop the NHS from being privatised does not mean that's all they think about.