Imagine life without the NHS?

sorry OPD

It is a bottomless pit where money is concerned.

It isn't.

Funding reached a high point in the last years of the last Labour government. Since then, over the past 12 years, it has been cut back heavily in real terms by successive tory governments. If were to be properly funded, with some investment into updating its IT, it would work far better.

Chatting to a hotel manager in USA, he was disbelieving that it only cost £1.80 per day (Car parking for partner) This was for open heart surgery including medication etc. He had had to pay $1,500 even with insurance when his daughter broke her leg
I will fight to keep the NHS within the public domain

Some very subjective stories here which is understandable but for every bad experience I am sure there are many more good.
You get bad doctors in the private sector too
My DiL left her job in a NHS hospital (she's a senior nurse) to work nearer to her home, in a new private hospital.
She found the bad practices so distressing - patients did not come first - that after a few months she begged for her old job back which luckily, although it had been filled, a new job was created for her.
God help us if we follow the US down the private route.

When you're poor and middle-aged, you don't go to Medicare in the US, unless you are on disability; if you're not disabled, you go to Medicaid. When my husband received a very serious cancer diagnosis, the chemotherapy would have been $144,000 a year. The doctor gave me the name of a company which gives grants for very expensive health treatments and my husband wound up getting a grant which has taken care of all of his chemo needs. There are very many scary situations out there, but there are also very many solutions out there for ill people. Since people don't share as many of these stories as they do the shocking ones, I thought I would add something hopeful.

RichmondPark1

I adore Bill Bryson. He said he wished Britain would stop focusing on economic growth and just concentrate on making life wonderful for everyone. I agree.

This morning I called into my GP surgery as I have a changing mole on my arm. The receptionist said there had been a cancellation and I could see the clinical practitioner immediately. He was kindness itself, examined me, took photos, mailed my details to the local dermatology unit and said I would hear back within a week. Just amazing, especially on the busy morning after a bank holiday weekend. The NHS is phenomenal. I can't imagine life without it.

I adore him too. In fact I was only thinking about him today and wondering what he was thinking about the state the countries in at the moment. Someone whose books used to make me look at my own country and think how lucky I was to live here.

Elizabeth27 Your post is a while ago. But you are correct, people’s idea of the heath system in the USA is much misguided.

Health

happycatholicwife1

When you're poor and middle-aged, you don't go to Medicare in the US, unless you are on disability; if you're not disabled, you go to Medicaid. When my husband received a very serious cancer diagnosis, the chemotherapy would have been $144,000 a year. The doctor gave me the name of a company which gives grants for very expensive health treatments and my husband wound up getting a grant which has taken care of all of his chemo needs. There are very many scary situations out there, but there are also very many solutions out there for ill people. Since people don't share as many of these stories as they do the shocking ones, I thought I would add something hopeful.

I’m pleased your husband received a grant, but there is nothing hopeful (or equitable) about a system in which healthcare depends on charity.

No NHS. The death rate and quality of life for very sick and disabled will be unbearable. For too many years the NHS has been abused by many people from abroad coming here for treatment, people not turning up for appointments it all has to be paid for. There has been too many managers and not enough ground staff. The benefit system will go as more will apply and it becomes unworkable, so the only people ok will be the wealthy and people with private health care. It's the most valuable thing thus country has and it's going, already doctors choose where they practise, not in run down areas but where their children will be educated properly and they have the amenities they desire. It's already fast becoming the haves and have nots, the gaps widening.

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.

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

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).

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.

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/

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.

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.

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.

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

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.

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.

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?

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

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?

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.