NHS winter crisis looms

The Daily Mail are running a headline that says something along the lines of "Put our old people first - not the foreign aid budget"
So let's blame the refugees instead of Attilla the Hunt.

Why can't the NHS be run like the system we have here in France? My DH and I pay roughly €2000 a year and for that we get a superb service which includes doctor's visits, prescriptions and hospital care. Maternity is also covered; a friend of ours recently had a baby and during her pregnancy she had home visits from 2 midwives, plus after birth visits. In the UK my DD paid around £8000 for this kind of care from a private agency. This system also involves hundreds of jobs processing payments. 70% of healthcare is state funded and the rest is covered by 'top up' payments that we pay to a medical insurance company. We would happily pay this in the UK if it meant that we were assured of an excellent service. Is this too much to ask in the UK or would introducing such a system be political suicide?

No couple here (unless well off) would contemplate spending £4000 per year, although if somebody were to want to see a consultant quickly, they may fork out £200 or so.

Sorry, Rosesarered, I wasn't very clear. The €2000 a year covers both of us.

Antonio Sounds ok until you realise that some people are scraping by (jams) and definitely couldn't afford equivalent of €2,000 to top up health care. Some don't even know where their next meal is coming from. What is more, including private contributions, France spends more per GDP on health care, around 10%, whereas in UK it is about 9% including private contributions.

No Antonia, Your kind of thinking is just what the government want us all to do. We already pay for our health care through NIC and the more people spend their own money on operations/queue jumping then the more it will get pushed through as a way forward. We need to bite the bullet and raise the additional funds through taxation and not piddling about with invoicing so called health tourists either. And someone tell the Daily Mail that the problems with the NHS are down to lack of investment, not the fault of refugees/immigrants/fat people/smokers/benefit cheats.

You forgot baby boomers Gill

I think that very poor people get their health care costs covered by the state here in France.
Nursing home costs here are much the same as UK and once a person has used their resources - having sold their homes etc - the children have to pay the bill.

indeed anya all those selfish old people cluttering up the surgeries.

Then why not have sliding scale, means tested top up contributions, with those who can't afford it paying nothing? I think everyone agrees that something has to be done with the NHS, and why would most people object to contributing if the result was an excellent health service?

We do have a means tested sliding scale. It's called tax.

Anya it would not be "blaming" baby boomers - but it would be true to say that the increase in birth rate in the post war is starting to hit the health service - along with the greatly increased longevity of those who were born before and during the war.
And yes "Antonia" the extra 1000EU each sounds like piddling around to me. We get a very similar service here (the things you list - including free prescriptions for older people, kids, Welsh people etc) without messing about with extra payments. We've done it through the taxation system for over 60 years and it has worked fine thanks.
Means tested contributions etc sounds like a massive paper chase - we already get taxed according to our income. Why complicate it? I think you are making the French system sound like a job creation scheme for civil servants.
The problem is that politicians in power are against tax rises to pay for increased need. They prefer to give tax cuts in the hopes of getting voted in again.

Not sure whether this will work... shows some of the problems with the French system?
pbs.twimg.com/media/Czk_A1-XcAAA6vn.jpg:large

We also pay means tested contributions called National Insurance, although there's a cap so the wealthiest pay a lower percentage. Pensioners don't pay anything and I wouldn't mind betting that at some stage reduced NI for pensioners will be brought in, although it will be politically difficult - maybe when/if the Conservatives have a huge majority.

The description of a job creation scheme is just about right Jess the French do love their bits of paper and everyone having. 'Dossier'. However the system does seem to work well enough. It is only in the last few years - about ten or so - that the Health service has given everyone a card (a credit card type) and you do need to have it with you all the time in case of medical emergency.

This thread seems to have drifted somewhat. The problem with winter is that too many people are admitted to acute hospitals, who would be better off staying at home or in a community setting, but the resources aren't there. These services aren't funded by the NHS but local councils, who are themselves facing savage cuts.

Isn't it more that they are admitted because they are acutely ill but then can't get discharged because the "care package" is not in place, or is not adequate, or there is no suitable non-acute-hospital facility for them to go to? I dont think they admit many people to hospital these days who are not acutely ill?

It's both.

One of my sisters was a team manager for a large team of district nurses (NHS). The whole service was transferred to social services (council run), who then outsourced it to private companies. My sister and about a hundred qualified staff were made redundant. Some of them were re-employed (on lower rates of pay and insecure contracts), but much of the work is now being done by carers without medical qualifications.

The clients now get a couple of short visits a day (if they're lucky) and are often admitted to hospital to be on the safe side. When the service was run by the NHS, district nurses could assess patients and deliver treatment if necessary. Carers can't do that and there is virtually no district nursing team left.

Therefore, people are admitted to hospital, sometimes just for observation, and hospitals won't discharge them if there isn't 24/7 care available at home.

In addition, community hospitals with low dependency beds have been shut down, so there is no 'half way house', so people end up blocking beds in acute wards. Admittedly, some of the geriatric and medical wards were a bit grim and people wanted to get home as soon as possible, but the option isn't there now, so people are either discharged too early (often requiring readmitting) or they stay in an acute hospital, sometimes miles away from relatives and friends.

District nurses were a national treasure. I used to lecture on a course where experienced nurses used to do the Diploma.
When MIL was alive I used to fret because the carers obviously were not medically trained to spot any worrying symptoms. Like the time her legs swelled like sausages and she kept this fact to herself for a couple of days. However carers used to help her wash every morning... It was caused by a worsening of heart failure and required a week or so in hospital to get meds adjusted...
There were several occasions when her dear and wonderful friend, a practice nurse, spotted something and called the doctor.

Exactly! These days a community nurse might be used by a council to assess a patient's needs for care, but is much less likely to be involved in actually doing the caring or managing the team doing the caring.

There's also the extra whammy of Osborne blithely increasing the minimum wage without accounting for the fact that this would put up the cost of care - without making any more money available to pay for the increased salaries. Shocking that carers are on minimum wage, but that is often the reality. Consequence is care homes closing. Leading to knock on effect...

I agree, but I'm really talking about people not in care homes. The situation used to be that vulnerable and elderly people stayed in their own homes and were looked after by the district nursing team, the GP and input from the council (eg meals on wheels) and the voluntary sector.

If a person needed a higher level of care, they could be admitted to a medical ward (which weren't that great), a care home or an acute hospital, if necessary. District/community nurses had the expertise to know which would be most appropriate. People with money have always had the option to go to a better quality care/nursing home.

The problem is that the options are no longer there. It's now either 'no care' or 'acute care'. That's a bit simplistic, but not far off the reality. For example, lots of elderly people have leg ulcers due to poor circulation. A community nurse could treat ulcers at home, but often ulcers are neglected and the patients end up in hospital. In extreme cases, this leads to sepsis and/or amputation. Good community care could avoid the problem in the first place.

There are various estimates of how much avoidable hospital admissions cost the NHS. I don't know what the exact figure is, but it's almost certainly in the billions. Whatever the figure is, the claims of health tourism and people 'wasting' A&E time pale into insignificance.

It's all about saving money in the short term and costing in the long term - not forgetting the experience of people in the last few years of their lives.

When my husband was dying of cancer, we had hospice at home carers coming to see him four times a day. They used to tell me they were there for me as well as him, so if there was anything they could help me with, they would. They used to make 30 minute calls instead of fifteen minute ones.
They still had to phone up and say when they were leaving to go on to the next home.
I can't imagine that happening now. It's all about finance, isn't it?

Round here, hospice at home is a charity. Similar to Macmillan. Was that NHS?

Macmillan is a charity, as are most (all?) hospices.