The Tories are in sight of their goal aren’t they?

Seasonal Marsh family video on the strikes.
www.youtube.com/watch?v=pOHEF5CjS1E

Everyone coming into this country gets free health care, without paying a penny in.

No, they don't.

Outsourcing to private companies means that somebody is making a profit and money is not being spent on frontline services.

Don't forget that France pays considerably more for healthcare than the UK.

I do not agree that the current system entirely fails to provide safe and efficient care. I've just been the recipient of care which cost the NHS thousands of pounds. I do realise that there are huge problems, but I do not accept that the system is "per se" broken.

The NHS is an overweight behemoth, that is too big to be run efficiently by anyone, state or private. It needs to be broken up into independent regional companies, much as the public utilities were before privatisation.

I was the regional market research manager for a British Gas region, and apart from taking part in occasional national research projects, I was free to make all the decisions about how the market research dept was run and what work we did, in consultation with the managers who would be using it. The variation in how market research was conducted varied hugely from region to region, according to each regions needs and agreement about what they wanted.

If the NHS was broken up, leaving each region to decide what ervices they needed and how to provide them, with very light touch oversight from a small national HQ, I think we would have a much better more efficient NHS.

As it is broken and inefficient, World rankings of health systems, the Uk is rated at 10th at best worldpopulationreview.com/country-rankings/best-healthcare-in-the-world and some years and some rankings do not put us even that high up.

We are sinking in the ratings and will continue to do so unless something major is done to our system.

Outsourcing the provision of health services does not mean the privatisation of the service, nor does it inexorably lead to paying indivdiduals paying for health care. Lots of the countries in the top 10 health systems provide medical care that is effectively free to the patient, but is paid for in all kinds of ways.

As long as health care is free to the patient on need, I really do not care that much whether the system is entirely state paid for or paid, as in France, which has one of the best health systems in the world, by a mix of free and insurance paid by those who can afford it.

What I want from a health sytem is one that works safely and efficiently to serve its patients and give them the best possible outcomes and is freely available to all that need it.

The current system fails entirely to do any of the above.

That wasn't my issue Joesanne more your comments about choosing to pay for your private health care; your choice of course.

Ha ha? Which bit about my discussing the pastoral role of GPs is troubling you?

Joseanne

So you haven't answered my questions, just got personal?

Just getting personal is more polite than I would be if I replied to you

Can I also just say, GP phone appointments are inadequate. I had to have one for a personal problem and they rang me whilst I was at work and I imagine this is happening to a lot of people. How can you discuss things ad hoc over the phone. I feel it's unfair

Casdon

DaisyAnne

I would guess many people would agree with this *Casdon" and accept a big move on it. That's the start of a plan. If we can focus on a plan we don't panic quite as much or build the fear of catastrophe; even if it is still a possibility.

Now imagine you are a year or eighteen months (don't worry about the time factor) down the line. The Care Service has become an attractive option. It's integrated into the NHS career structure. It's working well. Discharges are happening. People are often not having to go to the hospital as they can get better preventative care at home. Areas new to the Service are running within their remit. It is finding new and different ways to run, giving them maximum productivity with minimum wasted effort or expense. They are still heavily funded, but people can see the improvements and that it is improving the medical services.

What would your next choice be to build on this?

I’d increase vocational training, and resource universities and clinical teams so that the workforce could be grown. The route to become a registered nurse needs to be funded better and more places made available, as do places for professions allied to medicine, and medicine itself.

Thank you so much for this Casdon. Again I think this would probably be agreed upon by many as a next step.

I don't think this is directly just about money. That is something governments will choose to do or not. We will, no doubt, vote according to what we want from them.

What the NHS needs are managers who can deal with complexity, plan and manage a many-stranded improvement strategy, and prioritise and reprioritise on an ongoing basis. And we need them not to be micromanaged by the government.

So are we saying that it is the more pastoral role of the GP that has disappeared with bad consequences and that this is the area that needs addressing first? The family doctor that Iam64 mentions doesn't seem to exist much which is a shame if it leads to better outcomes. I'm guessing this is what leaves patients and their families feeling worried, angry and insecure, because no one is really taking charge of their problems at ground level.

In the early 1980s I remember a good and satisfactory health service from my local gp who went the extra mile. The population of the Uk was around 56 million. Today we have experienced a population increase of about 12 million which is more than the total population of Greece for example.
Clearly health provision in particular has not expanded sufficiently to cope with the increased population. Population expansion has been supported by the main political parties without sufficient investment in health services.

Joseanne, there’s plenty of research confirming continuity of GP care, trust between family doctor and patients = better outcomes, longer lives

When I started nursing 40 yrs ago there was pretty good continuity of care, over the years that has been dropped, if you need to see a doctor you get whoever is on duty, of you can get an appointment at all.

I really don’t see any return to being able to see “your” doctor, it will be an achievement if it does not get worse.

Why would any young person want to do a unsociable hours job like care work or nursing there are plenty of jobs available that pay well working normal hours. It was different when there were plenty of migrants willing to work unsociable hours, they have gone home.

Either wages rise or a lower level of service will have to be accepted.

Oreo

Allsorts

Everyone coming into this country gets free health care, without paying a penny in. The advancement in medicine means that so many more illness can be treated, there's too little going in the kitty which is badly used by top heavy management rolls. Labour will do no more than Tories, it's too late to put right all the mistakes in the NHS. The figures don't add up. Too little going in, too much going out. I would not be having children knowing this in this day and age.. The hospitals have been wonderful, their doctors working flat out, not so if you want to see your GP. They are like an endangered species now. Hospices are dealing with end of life care and they depend on fund raising and donations from a public hardly able to manage their food bills. It will be a two tier system, those that can afford private treatment will be fine, the rest of us it will be chance.

👏🏻👏🏻👏🏻

There was an interesting comment made by the GP in Call the Midwife yesterday evening, that visiting his patients at home and getting to know them made it five times easier for him to establish their needs and plan their care. Of course, things were different then in 1960s, and yes I know it's a drama, but it still holds true that continuity of care is probably what patients value above all else.
With private medical insurance there is very little aftercare provided, so even if patients get their treatment paid they are still putting a drain on the services and this falls back onto NHS GPs. As does end of life care etc. etc.

Allsorts

Everyone coming into this country gets free health care, without paying a penny in. The advancement in medicine means that so many more illness can be treated, there's too little going in the kitty which is badly used by top heavy management rolls. Labour will do no more than Tories, it's too late to put right all the mistakes in the NHS. The figures don't add up. Too little going in, too much going out. I would not be having children knowing this in this day and age.. The hospitals have been wonderful, their doctors working flat out, not so if you want to see your GP. They are like an endangered species now. Hospices are dealing with end of life care and they depend on fund raising and donations from a public hardly able to manage their food bills. It will be a two tier system, those that can afford private treatment will be fine, the rest of us it will be chance.

👏🏻👏🏻👏🏻

DaisyAnne

I would guess many people would agree with this *Casdon" and accept a big move on it. That's the start of a plan. If we can focus on a plan we don't panic quite as much or build the fear of catastrophe; even if it is still a possibility.

Now imagine you are a year or eighteen months (don't worry about the time factor) down the line. The Care Service has become an attractive option. It's integrated into the NHS career structure. It's working well. Discharges are happening. People are often not having to go to the hospital as they can get better preventative care at home. Areas new to the Service are running within their remit. It is finding new and different ways to run, giving them maximum productivity with minimum wasted effort or expense. They are still heavily funded, but people can see the improvements and that it is improving the medical services.

What would your next choice be to build on this?

I’d increase vocational training, and resource universities and clinical teams so that the workforce could be grown. The route to become a registered nurse needs to be funded better and more places made available, as do places for professions allied to medicine, and medicine itself.

Iam64

Katie59

I wish I was optimistic that the NHS was going to reinvent its self and attract enough doctors, nurses and carers, it can only do that by offering better wages AND reasonable working hours and conditions. They are a million miles from that at present, it’s all about low wages, stress and unsociable hours, that is what you expect if you don’t have choices, forced Labour.

I wish I was optimistic the social care problems will be resolved. It was a big problem when I started in social work in 1980. Every l.a. Had good staff working on the best way to fund a combined service. My fear is funds will go to the nhs for social care but be swallowed up in the gaps in other parts of the health service.

I agree Iam64, increasing social care funding is the first piece in the jigsaw of sorting the NHS. I’m in favour of integrated community services, with one pooled budget for health and social care (including continuing healthcare, and district nursing) - ring-fenced so the funding can’t be sucked into acute services.

Everyone coming into this country gets free health care, without paying a penny in. The advancement in medicine means that so many more illness can be treated, there's too little going in the kitty which is badly used by top heavy management rolls. Labour will do no more than Tories, it's too late to put right all the mistakes in the NHS. The figures don't add up. Too little going in, too much going out. I would not be having children knowing this in this day and age.. The hospitals have been wonderful, their doctors working flat out, not so if you want to see your GP. They are like an endangered species now. Hospices are dealing with end of life care and they depend on fund raising and donations from a public hardly able to manage their food bills. It will be a two tier system, those that can afford private treatment will be fine, the rest of us it will be chance.

Katie59

I wish I was optimistic that the NHS was going to reinvent its self and attract enough doctors, nurses and carers, it can only do that by offering better wages AND reasonable working hours and conditions. They are a million miles from that at present, it’s all about low wages, stress and unsociable hours, that is what you expect if you don’t have choices, forced Labour.

I wish I was optimistic the social care problems will be resolved. It was a big problem when I started in social work in 1980. Every l.a. Had good staff working on the best way to fund a combined service. My fear is funds will go to the nhs for social care but be swallowed up in the gaps in other parts of the health service.

I wish I was optimistic that the NHS was going to reinvent its self and attract enough doctors, nurses and carers, it can only do that by offering better wages AND reasonable working hours and conditions. They are a million miles from that at present, it’s all about low wages, stress and unsociable hours, that is what you expect if you don’t have choices, forced Labour.

I thought National Insurance was supposed to help with cost. I am retired and pay no National Insurance now. I would be prepared to pay some NI now.

I would guess many people would agree with this *Casdon" and accept a big move on it. That's the start of a plan. If we can focus on a plan we don't panic quite as much or build the fear of catastrophe; even if it is still a possibility.

Now imagine you are a year or eighteen months (don't worry about the time factor) down the line. The Care Service has become an attractive option. It's integrated into the NHS career structure. It's working well. Discharges are happening. People are often not having to go to the hospital as they can get better preventative care at home. Areas new to the Service are running within their remit. It is finding new and different ways to run, giving them maximum productivity with minimum wasted effort or expense. They are still heavily funded, but people can see the improvements and that it is improving the medical services.

What would your next choice be to build on this?

The priority would be the resourcing of the care sector DaisyAnne, because until there is provision for people to be discharged safely, nothing in the NHS will function, the tide of admissions will keep growing.

I didn't make my question clear Casdon. If you could have all the money you need to work through one issue what would it be? You have no choice to do more than one in this exercise.

DaisyAnne

Casdon

I’m au fait with the setting up of the NHS, I worked in it for over 40 years, and live about 20 miles away from Tredegar, where it all started so it was imbued in me from an early age. I don’t disagree with what you’re saying, the NHS and the rest of the welfare state were very ambitious and took a huge leap of faith. Having worked in the NHS since the 1970s though, I can promise you that the services delivered have radically changed since the NHS was set up. Vaccination programmes and childhood and employment health checks were necessary, and still are - but there wasn’t the same ‘cure all’ approach then. If you had cancer for example, surgery was the only option. If you had dementia, you were either looked after by your family or placed in a ward in a psychiatric hospital with thirty or so other sufferers -and so on, for virtually every condition. The world has moved on.

If you were told you had a bottomless purse, Casdon, what one thing would you do in the NHS?

I think there is now such a massive uphill task to get it back on track that any one thing would make no major difference DaisyAnne. Amongst the first practical things I would do with a limitless budget are:
Make care an attractive career option by removing the market, ideally bringing it back under public services control, and paying carers the same as healthcare support workers in the NHS
Single budget and integrated care provision for all community care services rather than some under Health and some under Local Authorities
Correct the tax disincentive that is resulting in so many senior doctors retiring early because it is not financially worthwhile for them to continue working, particularly GPs
Increase manpower -resource training adequately, both at university level and for clinical placements
Attract staff who have left back into the NHS by increasing flexibility, more pay, more incentives
Retain existing staff by reducing the stress - as above, plus increasing the number of beds to reduce the bed management chaos. This would be possible if staff could be attracted to return.
That’s just off the top of my head, there are loads more things that could be, and need to be done, of course.