Let's turn the clock back to 1948

We started off with hospitals and hospital management committees answerable to Regional Boards. Then in 73 it was replaced by Regional Health Authorities, Area Health Authorities and District Health Authorities. A whole extra administrative tier with an extra layer of replica staff. Then further reorganisation demolishes what’s been set up. It’s all crazy. We were better off with the original model. In addition committee members used to be volunteers. Now they get paid albeit a limited amount. So yes I think it has been rebuilt but not for the best.

25Avalon

We started off with hospitals and hospital management committees answerable to Regional Boards. Then in 73 it was replaced by Regional Health Authorities, Area Health Authorities and District Health Authorities. A whole extra administrative tier with an extra layer of replica staff. Then further reorganisation demolishes what’s been set up. It’s all crazy. We were better off with the original model. In addition committee members used to be volunteers. Now they get paid albeit a limited amount. So yes I think it has been rebuilt but not for the best.

All the changes to NHS organisational structures were driven by successive governments 25Avalon. That is the fundamental problem.

If the NHS hadn't been founded in 1948 we would probably today have a much better system of health care in this country.
It has been a travesty since it was founded based as it was on our importing foreign trained doctors and nurses to keep it running, thus depriving the countries doing the training of much needed skills.
The NHS is a money pit that will never be sated. People demand more and more of it and fail to realise that "free at the point of use" does not mean free.
It is about time that people in this country realised that the NHS is broken and cannot be fixed no matter how much money is thrown at it.
We need a totally new system of healthcare in this country and we need it NOW, not after more reports that get us nowhere.

Redrobin, the alternative to the NHS does not necessarily involve paying fees. Many countries effectively have health systems that are effectivel free at the point of use.they just do it differently to the way we do. There ar more countries in the world other than the British and the USA and many of them have better systems with better outcomes than we have for illnesses like cancer and deaths in childbirth of mothers and/or babies.

There must have been some kind of free health treatment available before 1948.

Does anyone know what it was and how it worked please?

GrannyRose15

If the NHS hadn't been founded in 1948 we would probably today have a much better system of health care in this country.
It has been a travesty since it was founded based as it was on our importing foreign trained doctors and nurses to keep it running, thus depriving the countries doing the training of much needed skills.
The NHS is a money pit that will never be sated. People demand more and more of it and fail to realise that "free at the point of use" does not mean free.
It is about time that people in this country realised that the NHS is broken and cannot be fixed no matter how much money is thrown at it.
We need a totally new system of healthcare in this country and we need it NOW, not after more reports that get us nowhere.

Well, that’s one perspective from an extreme. The last sentence worries me, it’s the sort of thing Liz Truss would say. Perhaps we should ask her to get her magic wand out immediately.

Pre NHS if you couldn't afford to pay there were some doctors and hospitals that gave their services as charities. It was very hit and miss.

Yes the reorganisation of the NHS in the past is down to the government in power at the time. There is, however consultation in the form of green papers which then become consolidated as a white paper.
I never did quite work out how it was all put together as a white paper which was then what had to be done.

Here’s a good explanation of the Tredegar medical aid society and how it worked Callistemon21.
www.walesonline.co.uk/news/health/going-tredegar-ise-you-bevan-told-2187499

M0nica

*Redrobin*, the alternative to the NHS does not necessarily involve paying fees. Many countries effectively have health systems that are effectivel free at the point of use.they just do it differently to the way we do. There ar more countries in the world other than the British and the USA and many of them have better systems with better outcomes than we have for illnesses like cancer and deaths in childbirth of mothers and/or babies.

And they pay more!!

The system I know most about is the German one. All Germans, including pensioners, have to have health insurance, which for most is 14.6 - 15.6% of income, which is considerably more than in the UK. There is also a social care insurance. These are run by the state. In addition, some people have top-up private health insurance. It's no wonder the outcomes are generally better.

Germany is much better at preventative medicine. A friend of mine moved to Germany a couple of years ago and went for his first check-up before signing up for health insurance. The doctor wasn't subtle. He told my friend that he was too fat - no beating about the bush! My friend was quite shocked by the directness, but lost 15 kilos over the next year and goes (serious) hiking nearly every weekend. He looks much healthier.

On the other hand, Germany isn't without its problems. Waiting lists are increasing in some areas, particularly cities, and my friend's mother was messed about when they were looking for a nursing/care home for her. Although her insurance would have paid for a state home, it was some distance from where they all lived and they opted for a private home.

The bottom line is, however, that German citizens, including pensioners, pay more.

MOnica Maybe we need to draw a line under who is actually treated and using which expensive treatments. You probably know that "Quality-adjusted life years" (QALYs) are already used to judge whether it's worth treating people. You probably also know that, on average, more money is spent during a person't last couple of years of life. Do we really want accountants deciding that some people aren't worth treating? Do we want accountants to decide whether very premature babies aren't worth saving? The special care they receive is expensive and there's a higher than average risk that they will be disabled in some way. Do we want to ban all the expensive cancer drugs which are now available? These are the kind of questions which need to be asked, if people are serious about saving NHS money, but I doubt if people would like the outcomes. All the talk about charging people a couple of pounds for GP appointments etc is tinkering about the edges.

it could be that we need to cut down the obsessive statistic gathering

So how would we judge whether any changes are working, if there no statistics?

M0nica

I am sorry but my recent experience of the NHS, does not encourage me to think it very wonderful and a system similar to the French system, where we pay more and can expect more sounds far more attractive, providing provision is made for those on limited incomes.

Apart from initial misdiagnosis by a GP who didn't believe me when I said I had a painful lump in my breast, my NHS treatment over the last year has been exemplary. I've lost track of the number of tests and scans I've had and I can't even imagine how much it all cost. A second cancer was found by MRI, but it measured 3mm, which is tiny and easily treatable. It wouldn't have been found a few years ago.

Even my diabetes has been better monitored and I was prescribed more effective (and more expensive) medication. I'm going for an NHS physio appointment tomorrow, which I couldn't have afforded if I'd had to pay. I was fast-tracked because my DEXA scan showed that I have a real risk of developing osteoporosis and the aim is to build up my muscles in my hip and lower back, to try and avoid falls.

I've had a bumpy ride with my GP surgery, but had an appointment with the Practice Manager two weeks ago and a couple of things have been sorted. I feel as well looked-after as I could be.

If we were designing a health system now it wouldn’t look like the NHS. When it was set up it was trying to combat infectious disease like measles, diphtheria, polio, TB etc These are not the major killers any longer. What we do have is a hotch potch of provision which is understaffed and failing in many areas. Private pharmaceutical and other companies make a fortune out of the taxpayer via the NHS, so much of the huge funds spent go straight into private pockets. My DiL was taken ill in Paris with what turned out to be an ectopic pregnancy. The taxi driver took her straight to the Women’s hospital where she was operated on and stayed for 2 days. Her local NHS hospital in London had just given her some medication. They also refused to see her for a post op check up, saying they’d only see her if there was a problem. She returned to Paris for the check up . She payed a very small amount for her treatment which she could have claimed back, but didn’t. The whole system needs a serious overhaul but not by a Tory government thank you.

growstuff I cannot see the relevance of what you have written to what I have written. I am saying that the NHS is an inefficient Behemoth that is failing its patients and delivering worse outcomes than in many other countries with different systems. I am talking organisation, not money.

After 75 years I think the NHS is no longer fit for purpose and many more people could be treated much better if the whole service had a forensic examination and multiple inefficiencies were removed.

I recently had a scan. After the scan I was told I would be given an appointment to see the specialist. I asked if I could make the appointment then and there. I had my diary with me. The answer was 'No' I would get a letter telling me when my appointment was.

I then got a phone call a few weeks later from a nurse who gave me all the details of this appointment. I asked her to conffirm the date and she told me not to worry as I would be getting a letter confirming everything. Sure enough, a week later two letters arrived, one giving the date and time, the other telling me I needed blood and urine tests before the event.

This is ridiculous, time wasting and money wasting. I should have been able to make my appointment while at the hospital and been given a sheet with the labels etc needed for the blood and urine tests. Money was wasted on nurses time, postage and admin time sending the letters out. Still more time and effort would have been wasted if the appointment was for a day and time when I either could not get to the hospital or I had other commitments and had to be re-arranged.

vegansrock in a post above mine gives a classic example of poor treatment of a patient compared with other countries service at what must have been a traumatic and tragic time in her daughter's life.

As for the follow up treatment to DH's heart bypass op, do not even start me on that.

gives a classic example of poor treatment of a patient compared with other countries service and also compared with the private system in this country.
How it works is you see the consultant and he gives you a wad of papers to book blood tests, x rays, ultra sound, mri, endoscopy or whatever. You go straight to the desk and they book you in for the procedures and give you date and time, usually the next day or at the weekend. You are even given your follow up appointment time there and then too because they KNOW all the results will have been relayed to the consultant by that date.

MOnica Rather than repeating the kind of stuff the Daily Mail or Taxpayers' Alliance churns out, maybe you could give some specific examples. In what ways is the NHS an "inefficient Behemoth"? How do you judge efficiency anyway?

So you're talking about organisation? How would you organise it differently?

The NHS isn't failing all its patients. For many, it does a very good job, especially considering the budgetary constraints under which it operates and the fact that the NHS spends much less than some comparable countries.

What are these multiple inefficiencies?

It does sound as though your hospital needs a good shake-up, but that's because hospitals now operate as independent trusts.

I'm a patient at Addenbrooke's in Cambridge and have an online system called "My Chart". In the past, I've been on the phone to a nurse, who has discussed an appointment time with me and the appointment has appeared instantaneously on the "My Chart" dashboard.

I've had dozens of appointments over the last year and each one is written up and there's an "action" box at the end. Whatever further test or procedure is needed is then actioned, again nearly instantaneously.

So the NHS is fit for purpose in some instances.

Incidentally, one of my sisters (a former nurse) is currently having cardiac investigations and is full of praise.

Maybe some positive suggestions rather than constant carping would be more productive.

PS. I think there should be a reversal of the decisions over the last few years to defund community services and I've written as much. I've also explained why I think it would be beneficial and how it could work. I didn't know at the time, but the government has already decided to increase funding and I spotted ads for a new community team in the press.

Joseanne

^gives a classic example of poor treatment of a patient compared with other countries service^ and also compared with the private system in this country.
How it works is you see the consultant and he gives you a wad of papers to book blood tests, x rays, ultra sound, mri, endoscopy or whatever. You go straight to the desk and they book you in for the procedures and give you date and time, usually the next day or at the weekend. You are even given your follow up appointment time there and then too because they KNOW all the results will have been relayed to the consultant by that date.

I get all my results the same day they're available via the online system.

Further tests are booked automatically and I have the option to re-arrange.

That's swift growstuff. Is that true for everyone nationwide in the NHS for scans, ultrasounds etc which usually need checking by at least two doctors?

Joseanne

That's swift growstuff. Is that true for everyone nationwide in the NHS for scans, ultrasounds etc which usually need checking by at least two doctors?

Possibly not. But if Addenbrooke's can do it, so can other hospitals.

Sorry, and another question, do you get instant feedback from the actual person doing say the heart test that all looks good (or worrying) from their angle?

But if Addenbrooke's can do it, so can other hospitals.
Yes, top place, I know from a friend whose son is in charge of ICU.

For private investigations and treatment maybe it comes down to a better coordinated approach?

I can't remember how many ultrasounds I had - five or six. I know I had three MRIs, an echocardiogram and a DEXA scan. They told me the results of the ultrasounds as I was having them. I was told I could wait up to three weeks for the results of the MRIs, echo and DEXA, but they were available later the same day. In the case of the DEXA, I was also sent a two page analysis of what the results showed. I was also sent (online) loads of pages showing the results of the echo and a cardiologist had written explanatory notes.

The only time I had to wait for anything was because my case had to go to a multi-disciplinary team meeting to decide what the best course of action was. I was then sent minutes of the meeting, explaining the decisions. I had the scans on a Thursday, the meeting was on Monday morning and I was sent the decision on Monday afternoon. A breast cancer nurse rang me as well, to make sure I understood and to check how I was feeling about everything.

Joseanne

Sorry, and another question, do you get instant feedback from the actual person doing say the heart test that all looks good (or worrying) from their angle?

The person doing the echo was a technician. I received the results from a cardiologist, who had communicated with the cancer care team that there no problems with my heart. There was some concern because I've had a previous heart attack, so they checked.