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

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.

Casdon @ Sat 31-Dec-22 17:39:23

No government of any persuasion will ever allocate a limitless pot to health though, I’m sure you can see that, and see why?

I agree that any government with the same ideology as our current one wouldn't allocate a limitless pot to the NHS.

This is not because they think they can't do it. They very clearly can allocate any amount of money that they care to to anything they want to allocate it to. Most conspicuous modern example is the allocation of £37billion to the Test, Track and Trace initiative in 2020. There was also funding for vaccine development and for the vaccine roll out, £billions for PPE contracts, particularly through the illegal VIP lane, and the furlough payments and support for businesses. None of which has, in actual fact, come out of any budget allocation, or cost 'the taxpayer' a penny. Nor should it cost 'the taxpayer' anything, though the government will make it a convenient excuse for increasing taxation and cutting services.

Governments have done this at other times, too. Silently committed to limitless spending when they felt the need to do it.

I have said continually that the amount which could be spent would only be limited by the resources available to spend it on. Growstuff quite rightly illustrated this by pointing out that the NHS is short of a vital resource which cannot be rapidly replaced, i.e people to fill the 100,000s of vacancies.

Resource availability should influence spending, not ideology or myths about the country having a finite amount of money.

“I have said continually that the amount which could be spent would only be limited by the resources available to spend it on. Growstuff quite rightly illustrated this by pointing out that the NHS is short of a vital resource which cannot be rapidly replaced, i.e people to fill the 100,000s of vacancies. “

Is this the way they plan to limit the cost of the NHS - no staff no treatment!.

Witzend

Either taxes have to rise, or at some point both people and political parties will have to accept that ‘free at the point of use’ is no longer viable.

Other European countries, whose healthcare systems are so often praised as being so much better than ours, do make small charges at point of use. Except that it’s such a sacred cow here, I really don’t see why we can’t.
Better, surely, than privatisation?

Because the amount it would raise would be peanuts and there's no guarantee it would cover the costs of administration, especially as some people would have to be exempt, as they are from prescription charges.

If you had cancer for example, surgery was the only option.
That's simply untrue. Radiotherapy was used in the late 19th century and chemotherapy began in the 1960s

The hospitals which accommodated dementia and mentally ill patients were self supporting communities with their own farms and market gardens. Patients were in wards but there were also huge grounds with sports facilities. Most wards were not locked and patients could use the facilities. Not saying it was ideal but homes with single rooms aren't all that much better with people confined to overheated communal rooms.

Glorianny

^If you had cancer for example, surgery was the only option.^
That's simply untrue. Radiotherapy was used in the late 19th century and chemotherapy began in the 1960s

The hospitals which accommodated dementia and mentally ill patients were self supporting communities with their own farms and market gardens. Patients were in wards but there were also huge grounds with sports facilities. Most wards were not locked and patients could use the facilities. Not saying it was ideal but homes with single rooms aren't all that much better with people confined to overheated communal rooms.

Radiotherapy was not widely available in the 1940s. It was only in 1937 that doctors and scientists at St Bartholomew's Hospital began using the first system that could deliver high-energy X-rays, providing improved treatment of deep-seated tumours.

I worked in a psychiatric hospital as a trainee in the 1970s, and patients with severe dementia were kept together on (usually locked) wards, the hospital itself was a self contained community (asylum), but unfortunately people with dementia weren’t part of the wider hospital community, the hairdresser for example went to their wards, and they didn’t wander freely as other patients did. This was typical, I’m not criticising the staff, it was an impossible task, but it was largely a babysitting service. I was an innocent, and it really upset me at the time.

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?

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.

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.

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 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 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 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.

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.

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.

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.

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.

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.

👏🏻👏🏻👏🏻

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.

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.

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

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.

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.

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.

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