Junior doctors strike

Doodledog

This is nothing to do with the doctors' strikes. A plumber's charges are not his 'pay'. He will be charging for offtakes, NI, tax, wear and tear of equipment, transport, maybe premises, an accountant, insurance and goodness knows what else before he or she gets anything for him or herself. Doctors, in common with most other employees, are paid after their employers have factored all of that in.

The 'who is more valuable?' debate is massively complicated, and like pretty much everything is political. IMO (as a believer in a large but liberal state) we, collectively, should pay for all training and education for anyone who can benefit from it, and in the case of those whose careers are (or can be) in the public sector this should be in return for a pro-rata contract with the trainee that they will work for a pre-arranged period of time in the role for which they've been trained at a pre-agreed and index linked rate which is clear to both parties at the time of starting the training.

Those going into private sector careers could have additional taxes until their training is paid for. I would have no differential between expensive and cheaper courses - training would be at a flat rate to the trainee, so an engineer who needs expensive equipment to learn on would be paying back no more than someone whose course is book-based and cheaper to teach. I would make it prohibitively expensive, or even impossible for someone trained on a 'public sector' free course to switch to a private sector role before their payback time has elapsed.

That way, if we need more doctors/teachers/town planners, we can pay for them in the knowledge that they will be there for x years, and nobody need be put off going into any profession, trade or whatever because of the cost of training. That would restrict the field to the most talented, not those most able to absorb prohibitive costs. A sensible government (I know, but this is never going to happen anyway ) could plan for things like surges in the birthrate, an ageing population, or whatever, and ensure that there are enough relevant people to fill the roles that are needed.

I wouldn't exclude poets, musicians and artists from any of this. They would still get free education in the Arts, and would pay taxes on their work washing dishes and waiting tables which is how most make their living, but would stop us from becoming a nation of barbarians. I see them as worthy too. As are hairdressers and other groups who earn little but work hard and improve our lives in different ways.

Differentials in pay are, IMO, necessary, but there shouldn't be as much of a gap as there is now. We all need one another - yes, we can't do without some things (eg ambulance drivers, doctors, care workers), but life would be pretty inconvenient without sewage workers, plumbers and shop assistants and miserable without TV producers, actors, artists and authors.

It's a long quote but worth repeating in case anyone missed it.

I do like the fact that you put in a description of your political stance as a believer in a large but liberal state. The differences in parties and political beliefs are both economic and cultural and it helps to know where people's opinions are based.

I may not be coming from exactly your political stance but knowing what it is makes it much easier to agree.

Siope

growstuff

Maybe those patients who consistently miss appointments and/or cancel without adequate notice could be fined or "struck off", but why should everybody else pay for them?

Because universal healthcare has to be universal. Excluding one behaviour that costs the NHS money for no ‘good’ reason is the wedge to excluding all sorts of behaviour that someone could deem unnecessary or inappropriate.

I know hospitals do remove no-show, no-explanation patients from treatment plans and/or bump them back down waiting lists where clinically feasible, but doing so can cause bigger, more expensive to treat problems.

I agree. I wasn't being entirely serious. If a patient does consistently miss appointments, maybe he/she could be contacted and asked why and maybe given a bit of a telling off if there wasn't a good reason. I wonder what percent of total NHS expenditure is accounted for by DNAs.

Reminder that, 10 years ago, the NHS was independently ranked the No 1 healthcare system in the world. Political ideology is what has changed this, not affordability. Siope Fri 14-Apr-23 11:28:36

I don't think we can say this too often.

ronib

Callistemon21

^There is enough money in the economy to pay for a decently run NHS^

This
I have said that several times.

There is no will to do so.

King’s Fund points out that we spend more than the EU average on health apart from Germany, France, The Netherlands and one other country. Bit puzzling.

Amanda Pritchard insists that the Nhs delivers value for money spent - Nhs is wonderful talk to conference members for ‘we are the Nhs’ available on YouTube.

Something like 3.8 per cent uplift each year in spending? Or thereabouts…up from 1.5 per cent.

It’s beginning to feel that the Nhs needs double the amount spent on it ? Time to rethink the whole concept?

These are also from the Kings Fund report.

Our analysis of health care spending in 21 countries shows that the UK has fewer doctors and nurses per head of population than almost all the other countries we looked at. Only Poland has fewer of both.

Of the countries we looked at, only Denmark and Sweden have fewer hospital beds per head of population than the UK, while the UK also has fewer beds in residential care settings than comparator countries. While lower numbers of hospital beds can be a sign of efficiency, the growing shortage of beds in UK hospitals indicates that bed reductions in the NHS may have gone too far.

Although costs are rising, the UK spends less on medicines than most of the countries we analysed. A key reason for this is the success of initiatives to improve the value of expenditure on medicines, such as encouraging the use of generic drugs.

Under the Organisation for Economic Co-operation and Development (OECD)’s new definition of health spending, the UK spends 9.7 per cent of gross domestic product (GDP) on health care. This in line with the average among the countries we looked at but is significantly less than countries such as Germany, France and Sweden, which spend at least 11 per cent of their GDP on health care.

Your "fact" drawn from the King Fund report is simply not what they are saying. Quotes would be more acceptable then we can make up our own minds rather than being fed very biased comment.

growstuff

Maybe those patients who consistently miss appointments and/or cancel without adequate notice could be fined or "struck off", but why should everybody else pay for them?

Because universal healthcare has to be universal. Excluding one behaviour that costs the NHS money for no ‘good’ reason is the wedge to excluding all sorts of behaviour that someone could deem unnecessary or inappropriate.

I know hospitals do remove no-show, no-explanation patients from treatment plans and/or bump them back down waiting lists where clinically feasible, but doing so can cause bigger, more expensive to treat problems.

The Greek healthcare system (about which I could bore for England, but won’t) means that, provided someone is registered with the state healthcare system, EOPYY, they can see an EOPYY doctor for free or at a reduced cost and with a referral can get free hospital care. And health insurance is regulated and managed to support, not undermine, state healthcare.

Reminder that, 10 years ago, the NHS was independently ranked the No 1 healthcare system in the world. Political ideology is what has changed this, not affordability.

Maybe those patients who consistently miss appointments and/or cancel without adequate notice could be fined or "struck off", but why should everybody else pay for them?

Yep! The NHS needs reform - more funding would be a start!

How exactly would a fee to see a GP make the nation healthier?

Greece is infamous for not being very efficient about collecting taxes.

The Nhs has costed out missed appointments and appointments cancelled without sufficient notice. It’s a significant figure. A payment system might stop this?

I know that an impoverished country like Greece has a fee to see a gp in place. Also the Greeks I know seem very well informed on basic health care, nutrition, exercise etc plus use of pharmacy as first port of call. My feeling is that somehow the Nhs continues to struggle and some reform will become necessary in the future. It feels as if the two options here are very expensive private health insurance or an increasingly stretched public health sector.

Some research on the feasibility and effects of charging a ‘nominal’ fee for primary care and other NHS services www.ncbi.nlm.nih.gov/pmc/articles/PMC6532806/

Also worth noting -since the article references it - that Ireland, which has a mixed private-public system has a shortage of GPs and hospital beds, and non-consultant (junior) doctors are leaving in unprecedented numbers to work elsewhere.

BTW My partner's father (in his 90s) has been in hospital over the last couple of days. No complaints about the care he's received. It would appear that emergencies have indeed been covered.

Glorianny

ronib

The idea of £25 to see a gp is not mine but suggested to me by the mother of an impoverished 30 year old junior doctor.

Well who would this hit most? The sick, the elderly and those with young children. My mother had a number of illnesses that needed regular GP monitoring, at £25 a go she would just never have gone. I suppose she would have saved the NHS money by dying earlier.
This is so contrary to what good healthcare involves one part of which is monitoring the health of people to prevent serious conditions developing and deterioration. So it isn't just unaffordable for many it's a stupid idea as well.
Imagine the choice for a parent not just "heat or eat"but "heat or eat ,or take my sick child to the doctor"

Are these people likely to vote Tory?

Glorianny

ronib

The idea of £25 to see a gp is not mine but suggested to me by the mother of an impoverished 30 year old junior doctor.

Well who would this hit most? The sick, the elderly and those with young children. My mother had a number of illnesses that needed regular GP monitoring, at £25 a go she would just never have gone. I suppose she would have saved the NHS money by dying earlier.
This is so contrary to what good healthcare involves one part of which is monitoring the health of people to prevent serious conditions developing and deterioration. So it isn't just unaffordable for many it's a stupid idea as well.
Imagine the choice for a parent not just "heat or eat"but "heat or eat ,or take my sick child to the doctor"

... and expectant mothers. If you look at a graph showing who uses the NHS most, there's a big bump for women in their late 20s and 30s - mainly for maternity care.

Casdon

The people who get prescription exemptions would get a payment exemption under the type of system you propose ronib. So nearly 90% of people wouldn’t pay. The cost of administering the system for 10% of people would not be worth the hassle due to the administrative costs, just as it isn’t for prescriptions. Meanwhile, those in the 10% who can’t afford to pay would get sicker, resulting in higher costs to the remainder of the NHS. It doesn’t stack up.

It's a inane idea.

ronib

Volver3 her mother is a health care professional who has watched the decline of the Nhs and she thought the Nhs model is not working and needs a rethink. From her day to day working experience!

It's this woman who needs re-educating.

How would a £25 fee to see a GP help improve the health of the nation?

The people who get prescription exemptions would get a payment exemption under the type of system you propose ronib. So nearly 90% of people wouldn’t pay. The cost of administering the system for 10% of people would not be worth the hassle due to the administrative costs, just as it isn’t for prescriptions. Meanwhile, those in the 10% who can’t afford to pay would get sicker, resulting in higher costs to the remainder of the NHS. It doesn’t stack up.

ronib

Maybe with exemptions for children?

So old people like my mother can just die earlier?

ronib

Maybe with exemptions for children?

And how much will the exemption system cost the NHS to run?

Maybe with exemptions for children?

ronib

The idea of £25 to see a gp is not mine but suggested to me by the mother of an impoverished 30 year old junior doctor.

Well who would this hit most? The sick, the elderly and those with young children. My mother had a number of illnesses that needed regular GP monitoring, at £25 a go she would just never have gone. I suppose she would have saved the NHS money by dying earlier.
This is so contrary to what good healthcare involves one part of which is monitoring the health of people to prevent serious conditions developing and deterioration. So it isn't just unaffordable for many it's a stupid idea as well.
Imagine the choice for a parent not just "heat or eat"but "heat or eat ,or take my sick child to the doctor"

Volver 3 is anyone?

So. Not an expert in funding large organisations then.

Volver3 her mother is a health care professional who has watched the decline of the Nhs and she thought the Nhs model is not working and needs a rethink. From her day to day working experience!

Well I'm sure s/he's a very good doctor but his mum is no economist.

The idea of £25 to see a gp is not mine but suggested to me by the mother of an impoverished 30 year old junior doctor.