Imagine life without the NHS?

Thank you. Everyone has been brilliant. Lots of contact and help and offers of help off our friends. Really helps to lift us.

So sorry to hear that Socksandsocks01 hope everything goes well. The RVI is a fantastic hospital so he's in really good hands. Hope you are managing and have some support.

Socksandsocks I hope your partner has a good outcome, thankfully the NHS is still brilliant at critical care. I was so shocked when I found out that in America the main cause of bankruptcy was health related. Thank goodness we don't have a system like that and hopefully never! Sending my good wishes for a quick recovery.

I've been worried about my partner who is now in ICU transfer by ambulance to the RVI Newcastle. They have all been marvellous at Sunderland Royal and RVI. imagine the bills racking up and being worried about the cost on top of having your loved one critically ill. Thank God for our NHS

I think you've nailed it. People in their last years of life cost the NHS far more than they do at any other time. Of course they have more co-morbidities, but unless the NHS refuses to treat everybody over 80 (for example), I don't see how it's not going to cost more. I think there would be a general outcry if there were to be such a limit. I agree that the money needs to be spent wisely, but I honestly think that we need to face up to the fact that more money is needed. I'm not disputing that there could be efficiency savings, but they're tinkering around the edges. I also think that the country needs to start NOW in planning for more training places, even though the results won't be seen for years.

Mmm.I think we might be saying the same but in different ways. the reason we are surviving into old age is because we have better treatment, hence the increase in life expectancy but we are surviving with co-morbidities that would have killed us in the past and that is a huge expense to the NHS ie all of us. BTW I'm not saying we shouldn't do that but it does have to be paid for. Yup, countries with better health outcomes get a bigger share of the GDP, I've no problem in paying more for a better service. I think the reason no-one comes up with solutions is a) it is always seen as "political" b) no political party wants to upset the voters c) some of the most obvious solutions to increase output would not be popular with doctors and d) no-one seems to actually want to pay more for a better service or accept that change is required. That is why I'd like a cross party initiative to try to unpick the many tangled threads but if I had a magic wand I'd try to improve the mental health services. Our GP, A&E waiting rooms and prisons are full of people who need help with their mental health and I'd also want to look at Social care provision!

By the way, I don't agree that general health has got worse. Certainly, obesity and longevity have meant there are more people with chronic illnesses, but life expectancy has increased and people are surviving illnesses in a way they didn't before the NHS was set up. I know it's anecdotal, but I've survived bacterial meningitis, a heart attack, cancer and I've been diabetic for over 30 years. I think it's likely I would be dead by now, if I'd had to rely on pre-NHS treatments. I actually think that being alive is healthier than being dead. With careful monitoring of my lifestyle, I live a "normal", healthy life.

Thanks foxie for responding.

I'm very familiar with the German system of healthcare and the bottom line is that Germans, including pensioners, pay more.

I'm always interested when people criticise the NHS for non-attending patients, health tourism, top heavy management, waste or even suggest wholesale reorganisation because very few people ever come up with concrete solutions and I'd genuinely be interested to hear about them.

Growstuff I would like to see a cross party initiative that examines the NHS and makes recommendations that are not seen as belonging to one party. I agree the NHS is too important to keep changing but I honestly don't think it's working ATM and hasn't been for quite a long time, it does need more money but that money needs to be spent wisely. Daughter says the through put of operations in one hospital is much more than in previous hospitals where she often felt frustrated that operating theatres were not being used efficiently, also said there is a lot of unnecessary wastage of expensive equipment. I don't want to give any more info as I don't want to identify hospitals. There's also abuse when patients fail to turn up for appointments which is also very frustrating and expensive. If you compare the NHS to that provided by countries such as Sweden, Germany, France and Denmark, they all have different systems but they do have patient charges despite spending a higher % of GDP than the UK and they also seem to have improving health services whereas the NHS does not. There is also an element of personal insurance, do have a look on the internet, it's really quite interesting to see how these countries fund health care. Germany for eg has a private insurance top up with a compulsory minimum payment but people can pay extra for a higher level of cover. They all seem to use private services but all slightly different and some of the providers are not for profit, some are not. France also has charges with emergency care and long term illnesses being covered 100%. I would just like us to be more open minded. When the NHS was set up it was thought that people's health would improve and the the costs would decrease. No-one could have imagined how treatments would improve, general health would actually get worse for some sectors of the population and that many of us would struggle along into our 80's and 90's with major problems and the need for lots of care. I've done my best to answer your q's but honestly don't know the answer, just know it's not just a case of more money.

foxie48

My American visitor had an unexpected trip to our local A&E dept with a British friend who had a suspected broken ankle. Despite having a considerable wait, she was astounded that everything was free and thought the treatment was brilliant. My sister lives in Spain and is a Spanish citizen but is sometimes told by her doctor that he can prescribe x free but y would be better and she'd have to pay for it. The NHS is far from perfect and I think it needs a complete overhaul, it's not just a case of putting in more money. I think we need to accept that with our ageing population, many of whom have very complicated co-morbidities we need to make changes to what we can provide free, how we provide care and how we fund social care properly. However, the NHS is a bit of a "sacred cow" and people want it to remain within the spirit of what was set up in 1948, which tbh I think is unrealistic. I'm not sure any country is able to provide a free at point of entry service for any citizen regardless of their medical needs unless they are sitting on an oil well but happy to be corrected

The NHS has had two major overhauls since 2010. How do you suggest it should be overhauled yet again?

I don't have a problem asking people who can afford more to pay through their tax system, not by allowing them to jump queues and take staff and resources away from the NHS to private medicine.

By the way, the countries in the UK, particularly England, already have a hybrid system. What kind of changes do you suggest could be made?

foxie Would it be possible to give concrete examples of wastefulness/ Has your daughter ever brought them up at meetings?

Glorianny

growstuff

Fleurpepper

A very large number of 'health tourists' are expats living permanently abroad, and who come back for treatment and operations using a relative's address, totally fraudulently (unless they have S1 acquired pre-Brexit, if they were of UK pensionable age with no income or pension from elsewhere).

I know, so how much does it cost the NHS? Some people seem to think it's a significant part of the budget, so I'd be interested in seeing it quantified.

I think the problem is that some of the actions of the NHS to reclaim money come some considerable time after the treatment. The wheels grind exceedingly slow. I had an accident whilst abroad, and claimed on my insurance. Quite a long time afterwards I got a letter from the NHS asking if I had had treatment that was a result of the accident after I returned home, because if I had that treatment should be paid for out of my insurance money. I hadn't so it didn't apply, but I would imagine many claims for payment take a long time.

OK! I get that, but do those people who claim that health tourism is significantly affecting the NHS budget actually know how much it costs?

Grantanow I know that we pay for the NHS, I think my American visitor is used to being asked for evidence of her insurance or her credit card is she needs any medical service. I am also not suggesting a profit led insurance scheme, however, I believe other countries do have what I would describe as "hybrid" systems which seem to work better than the NHS. We can't go back to change anything done badly in the past but perhaps we could look forward to see what sort of NHS we want and need. My daughter is a hospital doctor working in the NHS and having worked for a number of different health authorities/hospitals she's seen how inefficient and wasteful the NHS can be and that doesn't change by throwing more money in the pot. We are going to have a real shortage of consultants in some specialisms and already have them in many areas. www.hospitaldr.co.uk/blogs/our-news/nhs-facing-shortage-of-medical-consultants-as-unfilled-posts-hit-ten-year-high-data-shows
Training doctors isn't just a case of putting students through a 5 year course, it's on-going for years and there needs to be enough consultants to provide that training pathway. I actually feel quite uncomfortable importing lots of doctors and nurses from less wealthy countries as we haven't paid to train or educate them, perhaps we should have a system where countries pay a levy back to the country where the doctor has trained so that at least we are putting something back rather than just benefiting.
I think it's a shame that any mention of change makes people assume it's a Tory plot to enrich friends. I don't vote tory but I do want an effective NHS that treats people swiftly, effectively and with dignity and social care provision that is a lot better than we currently have and affordable for everyone who needs it. What I don't have a problem with is asking people, who can afford it, to pay for some services so that other people who can't afford to pay can have theirs too. That actually sounds rather socialist to me.

It's nonsense to say we don't pay for the NHS. It's mainly paid for out of general taxation and if the government has to borrow to fund it then we pay back the loan over time. So it is providing a service we pay for. We should expect it to deliver effectively though I doubt it can ever be perfectly efficient. But it is a whole lot better than profit-led insurance schemes and I don't begrudge paying for it. Governments of both Parties have underfunded it and I worry the Tories would privatise it if they could for the benefit of their rich friends. The lack of forward planning has left us very short of doctors and nurses, not to mention the Brexit disaster and ridiculous claims about immigration, which has led to problems which I think the Tories would claim could be solved by a commercial approach. Rubbish, of course.

My American visitor had an unexpected trip to our local A&E dept with a British friend who had a suspected broken ankle. Despite having a considerable wait, she was astounded that everything was free and thought the treatment was brilliant. My sister lives in Spain and is a Spanish citizen but is sometimes told by her doctor that he can prescribe x free but y would be better and she'd have to pay for it. The NHS is far from perfect and I think it needs a complete overhaul, it's not just a case of putting in more money. I think we need to accept that with our ageing population, many of whom have very complicated co-morbidities we need to make changes to what we can provide free, how we provide care and how we fund social care properly. However, the NHS is a bit of a "sacred cow" and people want it to remain within the spirit of what was set up in 1948, which tbh I think is unrealistic. I'm not sure any country is able to provide a free at point of entry service for any citizen regardless of their medical needs unless they are sitting on an oil well but happy to be corrected

growstuff

Fleurpepper

A very large number of 'health tourists' are expats living permanently abroad, and who come back for treatment and operations using a relative's address, totally fraudulently (unless they have S1 acquired pre-Brexit, if they were of UK pensionable age with no income or pension from elsewhere).

I know, so how much does it cost the NHS? Some people seem to think it's a significant part of the budget, so I'd be interested in seeing it quantified.

I think the problem is that some of the actions of the NHS to reclaim money come some considerable time after the treatment. The wheels grind exceedingly slow. I had an accident whilst abroad, and claimed on my insurance. Quite a long time afterwards I got a letter from the NHS asking if I had had treatment that was a result of the accident after I returned home, because if I had that treatment should be paid for out of my insurance money. I hadn't so it didn't apply, but I would imagine many claims for payment take a long time.

Fleurpepper

A very large number of 'health tourists' are expats living permanently abroad, and who come back for treatment and operations using a relative's address, totally fraudulently (unless they have S1 acquired pre-Brexit, if they were of UK pensionable age with no income or pension from elsewhere).

I know, so how much does it cost the NHS? Some people seem to think it's a significant part of the budget, so I'd be interested in seeing it quantified.

Zonne

... but there is nothing hopeful (or equitable) about a system in which healthcare depends on charity.

Charity - well meaning though it is - is a whim. When people are seriously ill needing treatment which they cannot afford, the very last thing they need is to have to cast around to find a charity or organisation that might be able to help them, or a crowd that might fund them.

There are good people out there who give not only their money but also their time to help others, but they can never replace a structured, co-ordinated, universal health-care service. Unfortunately, our own NHS is unravelling in these areas because of the introduction of the internal market where hospitals whilst superficially co-operating with each other are in fact forced to compete.

There will always be problems in an integrated socialised health service providing for millions of people, but where there is the 'will' to solve them, then there is a way. Personally, I don't believe our current government has any 'will', intention or desire to grapple with such problems other than through 'the market' because healthcare is viewed as a commodity on which they can speculate and accumulate. As can the general public of course - assuming they have some disposable income.

I found an article by the Office of Budget Responsibility which says:

In 2021-22 we forecast National Insurance contributions (NICs) to raise £157 billion. That represented 18.2 per cent of all receipts and is equivalent to £5,600 per household and 6.8 per cent of national income.

It goes on to add:

The main reason that NICs are the second-biggest source of revenue (after income tax) is that personal income makes up the majority of total national income. NICs are only levied on the labour income (the wages and salaries of employees and earnings of the self-employed) element of personal income. Different types of NICs are paid by employees, employers and the self-employed. In all cases, earnings are no longer subject to NICs when a person reaches the State Pension age.

I'm sure some will say "we know that". However, it doesn't hurt to come back to basics, occasionally.

This is an interesting reminder:

NIC receipts are, unlike most taxes, paid into the National Insurance Fund and are notionally used to pay for state pension and other contributory benefits, where an individual’s past payment record has some influence on the size of payments they receive. A small amount is notionally directed to the National Health Service (NHS), although this only makes up a small proportion of NHS funding. As such, in some presentations of receipts, NICs are counted as ‘social contributions’ rather than taxes.

Also the use of the word "notionally" is a worry. Either our contribution should not affect such things as our pensions which we should receive on an ability to live on basis having paid what amounts to a subscription. Or they should and they need to be accurate. This half-way house just clouds the issue.

"A small amount is directed" Who runs anything in this way.
More importantly to this thread, if we are not properly funding the NHS then why not? This article is saying it is paid from general taxation. Shouldn't we know what it should cost each of us to run it for our needs?


obr.uk/forecasts-in-depth/tax-by-tax-spend-by-spend/national-insurance-contributions-nics/

Govt statistics show so called health tourism costs only 0.3% of the nhs annual budget.

We should focus on expecting our government to work effectively with nhs managers and clinicians. We lost medical staff due to Brexit, newly qualified doctors no longer see general practice as the best way to practice their skills. Established GP’s are demoralised and exhausted by long hours and increasing management duties that take them away from front line care.
We need a government that actually sorts out the chaos between health and social care. When I started work in a generic social work team 40 years ago, ‘bed blocking’ was a significant concern. Endless reports on how best to improve the system have been prepared. Nothing changes.

A very large number of 'health tourists' are expats living permanently abroad, and who come back for treatment and operations using a relative's address, totally fraudulently (unless they have S1 acquired pre-Brexit, if they were of UK pensionable age with no income or pension from elsewhere).

A few people have mentioned "health tourism"? Do they have any idea how much it costs the NHS?

Regarding health tourism, I heard an American on the radio some years go who had been taken ill on business here and subsequently had what he called world class surgery and treatment for an unsuspected heart condition. On leaving hospital he produced his payment cards only to be told that there was 'no mechanism' for taking his money. He made a large donation to the hospital, but he is probably one of a few who have.