Imagine life without the NHS?

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?

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.

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.

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.

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!

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.

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

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.

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.

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

I agree with a lot of what Foxie8 says, as well as with Growstuff. The NHS does need a cross party, non -political 'sort out', and there is no doubt that huge amounts need to be spent on the actual structure, the buildings. We, the public, also need to face the truth that if we want an all encompassing cradle to grave health system, including social care, mental health provision (desperately in need) then we will have to pay more for it. Not individually, not through jumping the queue and paying to have our knees replaced, but through taxation. This is a huge, potentially unthinkable step for the leadership of any political party, to go into an election telling people they will have to pay a bit more.

HousePlantQueen - I’m beginning to believe that any party that says how much extra tax will be taken to better fund the nhs could be electable.

Many of us have direct experience of getting better, quicker care from GP’s in other European countries. Many would be prepared to pay £20-25 to see their GP. We shouldn’t have to wait 4 weeks for a ‘routine’ appointment.

We aren’t training or retaining doctors, nurses and there’s a crisis in social care.

The idea of a cross party approach to finding the best way forward sounds like a plan. Won’t happen though will it

Well said Foxie. The NHS isn't working now . I think it needs a complete rethink as what worked previously just isnt satisfactory . It should be taken out of politics as all successive governments seem to do is throw more money
that way and think it's enough. There are no restructuring plans.Surely it wouldn't hurt to look at how our European neighbours mange theirs. They don't have the waiting lists and comparison tables have long showed that we are well down the bottom end when it comes to survival rates.It worked well at the time , was quite a brave step in the dark I'm sure to move away from the panel system. Surely that bravery is needed now.

No it probably won't happen. I have spent £95 this month on private physio. I would far rather spend £15 or £20 per month additional "NHS tax" and have access through it, and enable others to do so too. I realise not everyone can pull out £95 before anyone jumps in but I was bent in half most of the day with spinal spasms.

westendgirl

Well said Foxie. The NHS isn't working now . I think it needs a complete rethink as what worked previously just isnt satisfactory . It should be taken out of politics as all successive governments seem to do is throw more money
that way and think it's enough. There are no restructuring plans.Surely it wouldn't hurt to look at how our European neighbours mange theirs. They don't have the waiting lists and comparison tables have long showed that we are well down the bottom end when it comes to survival rates.It worked well at the time , was quite a brave step in the dark I'm sure to move away from the panel system. Surely that bravery is needed now.

The NHS has been restructured twice since 2010. What have restructurings achieved? And how would you restructure now? Sorry, but all I ever read is that the NHS must change, but nobody ever seems to come up with concrete ideas. Most of our European neighbours pay considerably more for healthcare. Change for its own sake because something isn't working isn't good change.

How can the NHS be "taken out of politics", when one of the main responsibilities of a government is to distribute resources?

westendgirl

Well said Foxie. The NHS isn't working now . I think it needs a complete rethink as what worked previously just isnt satisfactory . It should be taken out of politics as all successive governments seem to do is throw more money
that way and think it's enough. There are no restructuring plans.Surely it wouldn't hurt to look at how our European neighbours mange theirs. They don't have the waiting lists and comparison tables have long showed that we are well down the bottom end when it comes to survival rates.It worked well at the time , was quite a brave step in the dark I'm sure to move away from the panel system. Surely that bravery is needed now.

Have you ever thought that the system is not working because it is set up to fail? The theory of privatisation is very clear and follows exactly the same pattern.

growstuff I’m sorry but I don’t agree to not treating people over 80.
When does it stop .. those that are mentally handicapped or mis fortuned at birth or through life?

I think a way should be found if people want to use an end of life program.

I was among a group of UK medical people talking. The conversation was about an 96 year old. She had a skin cancer and although she couldn’t look after herself, lived in a nursing home, didn’t know her carer, where she lived etc. the doctor still operated on her. Was that wrong? Was that a step too far?

growstuff

How can the NHS be "taken out of politics", when one of the main responsibilities of a government is to distribute resources?

I could see that 'taken out of politics' could be another way of saying 'stop trying to privatise it'.

On the other hand, I take issue, again, with the assertion that it has had money thrown at it; because it hasn't. For the last 12 years it has been subjected to very serious 'real terms' cuts in funding. There is absolutely no reason why the state couldn't invest more in the NHS. It is full of desperately overworked staff struggling to provide a service. If it were full of staff sitting around doing nothing there would be grounds for 'savings' and reduced funding. But that just isn't the case.

Mokryna I don't think Growstuff or anyone else has suggested not treating people over the age of 80, quite the reverse.
With regard to treating a 96 year old with skin cancer, IMO it's an ethical question, ie Could the patient give informed consent? Did she understand what was wrong with her and why she was being operated on? What would have been the consequence of leaving the cancer? Often relatives want everything possible to be done to keep a loved one alive when sometimes it is not in their best interests. I have already made my wishes known and that is, should I become mentally impaired and unable to give informed consent, I would not wish for any treatment that would prolong my life.

''Privatisation technique: defund, make sure things don’t work, people get angry, you hand it over to private capital. — Noam Chomsky''

I'd add another step in the middle- give people glimpses of a 'better' private system to create need and envy, and being part of the 'elite' somehow.

mokryna

growstuff I’m sorry but I don’t agree to not treating people over 80.
When does it stop .. those that are mentally handicapped or mis fortuned at birth or through life?

I think a way should be found if people want to use an end of life program.

I was among a group of UK medical people talking. The conversation was about an 96 year old. She had a skin cancer and although she couldn’t look after herself, lived in a nursing home, didn’t know her carer, where she lived etc. the doctor still operated on her. Was that wrong? Was that a step too far?

I don't agree with not treating people over 80 - certainly not - I gave it as an example of saving the NHS loads of money, far more than all the tinkering with charging people for missed appointments, etc.

My point was (and is) that if we want expensive care, which is what treating elderly people and chronic conditions is, we need to pay for it as a society. The alternative doesn't bear thinking about (which you've just demonstrated).

MaizieD

growstuff

How can the NHS be "taken out of politics", when one of the main responsibilities of a government is to distribute resources?

I could see that 'taken out of politics' could be another way of saying 'stop trying to privatise it'.

On the other hand, I take issue, again, with the assertion that it has had money thrown at it; because it hasn't. For the last 12 years it has been subjected to very serious 'real terms' cuts in funding. There is absolutely no reason why the state couldn't invest more in the NHS. It is full of desperately overworked staff struggling to provide a service. If it were full of staff sitting around doing nothing there would be grounds for 'savings' and reduced funding. But that just isn't the case.

I agree with you. I see it as a question of values. Does the government want a national health service, which treats everybody according to need? It will always be political because there are some people who don't believe they should pay for other people's care, when they can afford what they need personally.

I don't know if you are aware but if you have a disability or illness and you need an expensive operation it does go to a panel meeting anyway, a bit like it does within social services and they discuss whether the operation is viable and ethical and whether they should fund it. Sometimes further meetings are had to discuss the matter further.

I have read some of the discussion and it has been really interesting btw. Someone I know is American, middle class and she said even if you have insurance loss adjusters can make decisions on your life, rather than medics. I think I'd live constantly in fear

I belong to a breast cancer Facebook group and there are many American members. It's horrifying to read what some of their insurance companies won't fund. It's no surprise that there is a significant difference between survival rates of wealthier Americans and poorer ones, especially ethnic minorities.

When I was being prepped for an MRI scan, I overheard a telephone conversation between the radiologist and administrators. A private patent wanted an MRI, but her insurance company refused to fund it, unless she had an ultrasound first. MRIs are more effective, but many times more expensive than ultrasounds.