Junior doctors strike

Well MaizieD okay great! Let’s do it!

I wish…… do we march on Downing Street? How do we get beneficial change pushed through apart from twittering on GNet respectfully of course?

P.S. Every pound invested in the NHS, of course. Other things, like Defence actually have a negative multiplier... That seems to be the one that is quoted by people trying to prove that state investment is a waste of money...

growstuff

I think you already know the answer to your last rhetorical question.

What, me?

In addition to pointing out how money flows work, we shouldn't forget that while it is flowing through the economy every £1 invested creates £4 worth of economic activity...

I think you already know the answer to your last rhetorical question.

ronib

Growstuff does the German insurance system also end up with siphoning money? How does it work? Did not the Nhs have record amounts siphoned off during the pandemic without an insurance based system?

The money 'siphoned off' during the pandemic wasn't money that had been allocated to the NHS. It was the extra money for purchasing PPF and for the Test, Track and Trace. Of course, there was funding for the vaccination programme, too, but there was no extra money put into the NHS itself. And we know that the money was siphoned off into the pockets of tory friends and donors.

If the government could fund all those extras, at a cost of £billions there is no reason for it not to be able to properly fund the NHS at all. The model is only 'failing' because the government refuses to fund it properly.

You have to understand that it is a more efficient use of money to directly fund the NHS and get it returned to the Treasury via taxation, than it is to add an extra layer of privatisation where a significant part of the money goes into the pockets of 'investors' via dividends and doesn't return to the Treasury in such a large amount (because they don't spend it, they speculate with it... or send it to a tax haven and use tax avoidance schemes. Why should public money be used an inefficient way?

foxie48

Apart from the tax, NI, VAT etc that would be paid out of any increase, 9% would go towards paying off the considerable student debt that most junior doctors have, so a fair bit would go straight back to the treasury.

Nearly all of it would go back to the Treasury. That's how money flow works.

ronib

Growstuff does the German insurance system also end up with siphoning money? How does it work? Did not the Nhs have record amounts siphoned off during the pandemic without an insurance based system?

What the heck does that have to do with the normal operation of the NHS? The "extra" money for Test and Trace and the vaccinations was "created" money.

Apart from the tax, NI, VAT etc that would be paid out of any increase, 9% would go towards paying off the considerable student debt that most junior doctors have, so a fair bit would go straight back to the treasury.

Growstuff does the German insurance system also end up with siphoning money? How does it work? Did not the Nhs have record amounts siphoned off during the pandemic without an insurance based system?

PS. There is the money in the economy to fund the NHS better. Where do you imagine the money ends up? It doesn't get incinerated. Much of it is paid to staff, who then pay taxes and it's returned to the Treasury.

What an insurance-based model would do is siphon off money spent on healthcare and end up in a few hands.

ronib

Daisy Anne we don’t have to stick with a failing model of health care funding. One mother of a trainee surgeon suggested that we need to double at least the funding given to the Nhs. She was open to the need for individuals to pay much more than at present. I don’t think there’s the money in the economy to do this currently although some will disagree. Germans pay 15 percent of income for healthcare with additional insurance for some.

No, we don't have to stick with a failing model. We could fund the NHS better! Simples!

ronib

Just to be clear it’s completely false to suggest that I wish to in anyway undermine the Nhs as we currently use its services but with variable outcomes, probably like the rest of the Uk. The old saying ‘nothing is perfect’ applies but of course, individual life and/or death experiences will always colour outlook.

I think it’s important to keep an open mind as to how the health service is likely to evolve and it does no harm to examine successful health models elsewhere to see how we could potentially adapt to improve outcomes for both patients and medical staff. It’s just with 7 million patients apparently awaiting treatment, I don’t think we can afford to be too self congratulatory!

I have some experience of the German healthcare system. It's true that waiting times are generally less and I prefer some aspects to the NHS. However, Germans pay more for healthcare than we do in the UK and it's not always better.

A friend's German mother died at the beginning of the pandemic from care home-acquired Covid, so somebody wasn't taking all the precautions they should have done. Just a couple of weeks ago, another friend's German mother died in a German hospital and the staff seem reluctant to give full details. There's no doubt she was elderly and frail and I suspect didn't have a high life expectancy. However, in the last few months of her life, she was pushed around from one hospital to another. Communications were poor and, at one stage, was sent to a convalescent unit 75 km from her home or any family. She had paid German health insurance all her life (including as a pensioner), so had always contributed. My friend, who lives in Germany and speaks fluent German, found the whole process extremely frustrating because it was difficult to get information and he was forever filling out forms on his mothers' behalf. Not so different from some people's experience of the NHS!

I still fail to understand how an insurance-based model would deliver better outcomes for everybody (not just those who could afford the premiums for top ups).

Daisy Anne we don’t have to stick with a failing model of health care funding. One mother of a trainee surgeon suggested that we need to double at least the funding given to the Nhs. She was open to the need for individuals to pay much more than at present. I don’t think there’s the money in the economy to do this currently although some will disagree. Germans pay 15 percent of income for healthcare with additional insurance for some.

maddyone a friend's DD went to NZ years ago to work as a GP but disliked the system over there and returned to the UK.
Another friend's DD and SIL went as Hospital Consultants and like it there, so far have stayed.

I do know medical staff who have done the reverse - come from Australia and NZ and live and work here.

Who is being self-congratulatory ronib. I would say this conversation has been far from it.

I agree we have to be open minded - that's why I and others have added knowledge and facts about how services are wrong. I may have misread what you have written but you actually only seem to have one aim, so where is your "open mindedness?

Just to be clear it’s completely false to suggest that I wish to in anyway undermine the Nhs as we currently use its services but with variable outcomes, probably like the rest of the Uk. The old saying ‘nothing is perfect’ applies but of course, individual life and/or death experiences will always colour outlook.

I think it’s important to keep an open mind as to how the health service is likely to evolve and it does no harm to examine successful health models elsewhere to see how we could potentially adapt to improve outcomes for both patients and medical staff. It’s just with 7 million patients apparently awaiting treatment, I don’t think we can afford to be too self congratulatory!

Thanks Daisy.

You didn't offend maddy. I just thought it worth saying that you can come from other areas than medicine to add information to the hive brain. Understanding that these countries are not the UK or even a reflection of the UK is important too.

I know my niece (the doctor) is happy with America but she knew it well before she left, as her family were there. Culture differs so much and will be reflected in the politics of health.

Oh I’m sorry Daisy, I didn’t know your family members had emigrated too. I didn’t mean to offend. I was actually referring to this thread only as I know there are a lot of others on Gransnet generally whose children have emigrated, and I was of course, only meaning to refer to the parents of medics on this particular thread. And I certainly didn’t mean, or say I didn’t think, that people lose their intelligence or perception by not being a doctor. Did I say that they had? I apologise if I did, but didn’t think I did.

I found our self drive tour of the Deep South (pre Covid) very illuminating and quite disturbing, but I won’t derail the thread by discussing that now.

My daughter only went to NZ during Covid and would like to come back now but there are circumstances which prevent her from doing that at the moment. But her comparison of the two health systems is interesting.

maddyone

I think I’m the only mother whose child has left to work on another country. I did point out that New Zealand, where she’s gone, are having problems in their own health care system as well. It’s partly funded by the patients, partly by government. A visit to a GP costs about £25 to £100, with most being somewhere in the middle. Only children up to age 14 get a free consultation. Many drugs are unavailable to the doctor to prescribe unless the patient can afford to pay for them. My daughter dislikes this as she feels unable to prescribe the best drug for her patients unless they can pay. She said she usually has a choice of two possible drugs available to her, but sometimes these drugs don’t suit the patient (side effects etc) but is unable to prescribe a better drug because the patient can’t afford it. She also cannot always put a patient on a waiting list for a necessary treatment or surgery because the list is closed. The New Zealand government close waiting lists when they reach a certain size.
I’m not convinced that the British people want this kind of healthcare service.

No Maddy, my child left to work in Australia some 17 years ago. I think there are others on here too. He isn't a doctor, but he still has an insight into how the country works and its politics. With two children, he keeps up with its education and medical system. He didn't lose his intelligence and perception by not being a doctor.

My brother, now retired but not a doctor, went to America and has lived there for over 30 years. I think that's also enough time to understand how his country works. Both nieces are with him. One is a doctor, the other not. The one who is a doctor only went - leaving the NHS - about five years ago. The second has been there as long as my brother has. She has lived in the deep South for most of this time and has insight into how poverty works and who it affects, in a way I doubt any of us have.

It is not just, or even at all that the health systems attract workers to these countries. They are young countries (although America is not as much as it used to be). The opportunities are there. The lack of history has its plusses as well as its minuses. Sadly, our view of our history can mislead us, and we often don't seem to see that opportunity for others is a good thing for the whole country.

Looking at the problems in the New Zealand healthcare system, I think that growstuff is right. Introducing this type of model doesn’t appear to make people any happier (we spoke to a number of people about this whilst we were there, not just our daughter) and would need the introduction of a further layer of management to deal with costs. Plus people get left behind because they can’t afford or access the care they need. It does suit doctors and other medics as they don’t work such long hours, but they’re still not happy by having their hands tied in so many ways. We need to achieve better working conditions for our medics and achieve better outcomes for our population. We don’t have either at the moment.

MaizieD

ronib

Growstuff the way the Nhs is funded seems very dependent on the government of the day and economic circumstances. The Nhs is presumably costed with inflation to be halved by the end of the year? This is central control. From what I understand, countries with an insurance element as well as State funds seem to be more relaxed in their medical systems.

Sorry, I don't think you have a clue what you are talking about, ronib. Your 'explanation' (if that's what this post is meant to be) is incomprehensible.

I agree. There is no explanation about how the whole system would be more efficient and/or enhance patient care. The bottom line is that the NHS needs more funding to deliver the service people want/need. All an insurance model would do is introduce an additional middleman, shareholders and extra admin. It would also mean that those who couldn't afford the insurance for whatever reason would need to be subsidised by the state (unless we're happy for people to suffer and possibly die unnecessarily) or be provided with the most basic of services.

The current internal market system in the NHS has done nothing to improve communications and patient care. It would be even worse with an additional player.

I'd love to read a sensible and coherent argument.

I think I’m the only mother whose child has left to work on another country. I did point out that New Zealand, where she’s gone, are having problems in their own health care system as well. It’s partly funded by the patients, partly by government. A visit to a GP costs about £25 to £100, with most being somewhere in the middle. Only children up to age 14 get a free consultation. Many drugs are unavailable to the doctor to prescribe unless the patient can afford to pay for them. My daughter dislikes this as she feels unable to prescribe the best drug for her patients unless they can pay. She said she usually has a choice of two possible drugs available to her, but sometimes these drugs don’t suit the patient (side effects etc) but is unable to prescribe a better drug because the patient can’t afford it. She also cannot always put a patient on a waiting list for a necessary treatment or surgery because the list is closed. The New Zealand government close waiting lists when they reach a certain size.
I’m not convinced that the British people want this kind of healthcare service.

ronib

Germany and France fund their healthcare partly through State provision and partly insurance based. I think Australia also. Probably loads more countries. Just because we have a fully underfunded on the bone State system in England doesn’t mean that we have to stay with this. Other countries do it better it would seem from the comments of mothers whose children have left.

That is not just an argument for studying the German, French or Australian system and taking what is appropriate from them. It is also an argument for properly funding our National system.

You seem prepared to do one but not the other. Why not do both? Other countries have one system for those who can afford it and another for those who can't. Our dental system has already moved to this. Do you shout your praises and say all is going well with that. Perhaps you are rich enough to think so.

I have family in Australia and the USA. If you are well enough off or working and have your insurance paid, the system works well. Otherwise, you go without or go bankrupt. Is that really what you want us to move towards?

The "better" that the mothers whose children have left see is that they are going to countries that have acceptable conditions or work and pay the going international rate. What makes you believe we can't do that? Obviously, 13 years of mismanagement under the Tories has not helped. However, that does not mean we have to or even should throw those on lower incomes under the oncoming bus of little or no healthcare. It can be sorted, but certainly not by those who have spent 13 years trying and failing - mainly because, like you, they do not want to succeed.

ronib

Germany and France fund their healthcare partly through State provision and partly insurance based. I think Australia also. Probably loads more countries. Just because we have a fully underfunded on the bone State system in England doesn’t mean that we have to stay with this. Other countries do it better it would seem from the comments of mothers whose children have left.

Underfunding is a political choice, not a financial necessity.

You haven't explained how using another model would improve junior doctors' pay and conditions.