It has taken a little over 10 years and Tory cuts to push the NHS from the top to second from the bottom of risk nation health care.

She777

I think you need to take into account the number of migrants to the country that come in and need medical attention straight away.
I worked in the NHS for many years and they call it NHS tourism. The amount of people who arrive in this country on “holidays” and end up having very costly surgeries and agree to pay and then disappear int the ether is unbelievable.

I used to plan theatre ops and the number of people who get sent home on the day of their surgery is massive, this is usually due to an emergency case pushing the ORs to run over.

I’m not just talking about Asian or African migrants, they literally come from all over the world to get access to free surgeries. I think the last time I checked it was costing £4billion.

Another factor is the money spent on training people only for those staff to then be poached by Aus, NZ, USA. Those countries can afford to pay better wages because they are not investing as much in training as we do. Years ago you couldn’t leave within so many years of your training but now they get their qualifications and leave the country and don’t pay back student loans/NHS grants.

It is not a Tory problem it is a national problem regardless of who is in power.

It is confusing to call it Health Tourism. Many people are using "Health Tourism" from the UK to other countries.

Top 10 Medical Tourism Destinations in the World

Canada. ...
Singapore. ...
Japan. ...
Spain. ...
United Kingdom. ...
Dubai. ...
Costa Rica. ...
Israel.

These are people from all over the world travelling all over the world and paying for their health care.

I live in France (as some of you may know) and have done so for the last 14 years. The French govt pays around 70% of our health costs (can't remember the exact figure). For the balance we pay into a "mutuelle" . We are now both 76 so the top up is quite expensive - around 250 euros for us both.

The mutuelles are non profit making and cannot get rid of us, unlike private health insurance companies in the UK. They do have limits as to the amounts that they will pay/. For example if you want a private room there may be an additional charge that you have to fund yourself. There is a limit on the contribution to specs and dental treatment so you cannot get cosmetic work done on your teeth.

There are public hospitals and private clinics and you can use whichever you prefer. It can be difficult because you can chose which specialist you see and where. I think the food may be better in the private clinics.

If you have what is known as a life threatening disease (in my case asthma) the total cost is met by the state. Some medication can only be prescribed by clinicians, not your GP.

Since we've been here we have used the French system more often that we ever used the UK system (apart from GPs) and we joke about being health tourists.

Some years ago my DH had sever pains in his upper left arm. About 10.30pm I called the emergency service and a doctor came within 15 minutes. She had an ecg machine and couldn't find anything wrong so she called the Samu (paramedics) They turned up with a much larger machine but couldn't find anything wrong but it was obvious that he was in pain. The pompiers then turned up and he was rushed to hospital. I think all this took around 30 minutes.
The hospital doctors were mystified and then one suddenly thought of pericarditis, which it was and prescribed massive doses of aspirin. He (and his heart) recovered fully.

The large public hospitals each have a helicopter - do they in the UK? One landed in a field next to us recently. It was called out to a man in his early fifties who had suffered an heart attack. Sadly he died but they were there for about an hour.

As you can tell I am impressed by the health system in France.

RosesandLilac

Indeed She777
Nothing new, this was happening when I first qualified in the mid 70’s, it’s escalated enormously since then.

I'll ask you the same question as I (and growstuff) asked She77. Which part of the country did you work in?

I’m sure you know what I mean by ‘management’ growstuff.

It’s not for me to make suggestions as to how efficiency and cost-effectiveness might be improved beyond what I have already said about the multi-headed behemoth and ‘public sector mentality’ which would not be tolerated in the private sector.

Germanshepherdsmum

I’m afraid whatever any of us says based on personal experience is dismissed as ‘anecdotal’. Pointing out that the Kings Fund report refers to bureaucracy is ‘rubbishing’ it.

It suits the most vociferous left-wing posters to claim that all the problems of the NHS result from the actions of the current government.

A number of reports from eminent bodies have been cited as evidence of deteriorating standards and performance targets on this thread Germanshapherdsmum, and the impact of sustained reduced funding, coupled with increased government interference is part of that picture.
. It is not left wing to point out that, and if you’d read the reports you’d know that the systemic issues and external factors are also taken into account. Personal experience is always anecdotal, but when there are many people with similar experiences there are certainly issues which need addressing. A failure to acknowledge part of the picture renders you equally as culpable as those who you claim are totally blaming the government.

Amalegra

I read somewhere that when the NHS was founded 75 years ago it was expected that someone, say, who broke a leg would get it fixed on the NHS. Now, not only is it expected to be fixed, but physio, rehab, any aids etc are expected as well. We have a very different and much larger population than in 1948. Medical advancements are too numerous to mention. 44% of all public spending is on the NHS (ONS figures). How can we AFFORD more unless a different funding model is considered? And NOT USA here but European ones and I believe Singapore is an interesting example. The NHS is touted as a national religion and I doubt there is a political party who is brave enough to tackle that! So what to do? More efficiencies, higher NI/taxes? I honestly don’t know and nor does anyone in power by the sound of it.

I found the stats. That figure includes spending on coronavirus, non-NHS social care and private care.

My OH has recently had an emergency op and we couldn't praise the NHS enough from GP to nurses and surgeons for their prompt action.
The only complaint is that he was told by the surgeon at 10.30am that he could be discharged . He did not arrive home till 12.30 the following night. He spent all that time -bed blocking. waiting for his meds to be dispensed. A relative waited from 10.30 till 5pm waiting for her meds.
Another friend was discharged by his surgeon on Friday but the physio said he couldn't go home till he had assessed his home suitability and that would not be till the middle of the next week. Entirely unnecessary in his case.
Who is managing who?

Germanshepherdsmum

I’m afraid whatever any of us says based on personal experience is dismissed as ‘anecdotal’. Pointing out that the Kings Fund report refers to bureaucracy is ‘rubbishing’ it.

It suits the most vociferous left-wing posters to claim that all the problems of the NHS result from the actions of the current government.

It might help if you could define what you mean by "management". I'm not even sure you know how the NHS is managed.

It would also be helpful if you could make suggestions for improvement, given that the NHS has been reorganised a number of times in recent years and the focus was on efficiency especially in the first years of the coalition government.

I’m afraid whatever any of us says based on personal experience is dismissed as ‘anecdotal’. Pointing out that the Kings Fund report refers to bureaucracy is ‘rubbishing’ it.

It suits the most vociferous left-wing posters to claim that all the problems of the NHS result from the actions of the current government.

Indeed She777
Nothing new, this was happening when I first qualified in the mid 70’s, it’s escalated enormously since then.

Germanshepherdsmum

The NHS has had various reorganisations over far more than the life of the current government. Each time it has become more fragmented and more complicated. With fragmentation and increased complexity come increased bureaucracy and costs with no apparent benefit to the consumer and a tremendous lessening of purchasing power. It’s a multi-headed behemoth out of control and in need of root and branch reorganisation to take it back to something approaching a manageable entity.

I completely agree; I worked for the NHS for 28 years and during that time there were more than 12 restructuring or reorganisations nationally or locally. The costs were eye-watering with rebranding, new uniforms, everything changed. Most of these ended up with more layers of bureaucracy, more management and less productivity.
The NHS locally is a complete shambles, no one seems to be accountable and no one seems to care quite frankly.

maddyone

I’m a supporterof having an NHS fit for purpose that is not subject to political dogma and constant change, unless that results in real improvement……..

This.
The NHS has saved my life on at least three occasions. I support the NHS wholly and unreservedly. I think that we all do.
I am concerned about the cost of health tourism as She777 points out.

My MP, Kemi Badenoch, was born as a result of health tourism. Her mother flew to London to give birth. At the time, it also gave Kemi automatic British nationality (although she doesn't talk about that now).

Amalegra Do you have a link to the NHS figure because I don't recognise the 44% figure.

The King's Fund report says that other models cost more in admin, so what are you suggesting?

She777 Do you think that's the same in areas?

Do you have a source to back up the claim that it costs the NHS £4 billion?

How do they escape student loans? My daughter went travelling after she graduated and the Student Loan Company tracked her down to South America. If she hadn't paid up, I would have been liable as her sponsor.

I read somewhere that when the NHS was founded 75 years ago it was expected that someone, say, who broke a leg would get it fixed on the NHS. Now, not only is it expected to be fixed, but physio, rehab, any aids etc are expected as well. We have a very different and much larger population than in 1948. Medical advancements are too numerous to mention. 44% of all public spending is on the NHS (ONS figures). How can we AFFORD more unless a different funding model is considered? And NOT USA here but European ones and I believe Singapore is an interesting example. The NHS is touted as a national religion and I doubt there is a political party who is brave enough to tackle that! So what to do? More efficiencies, higher NI/taxes? I honestly don’t know and nor does anyone in power by the sound of it.

I’m a supporterof having an NHS fit for purpose that is not subject to political dogma and constant change, unless that results in real improvement……..

This.
The NHS has saved my life on at least three occasions. I support the NHS wholly and unreservedly. I think that we all do.
I am concerned about the cost of health tourism as She777 points out.

What area of the country did you work in, She777?

Here's an interesting chart showing what percentage of health spending administration costs in a number of countries. OECD figures.

Note that the UK is way down the list

I think you need to take into account the number of migrants to the country that come in and need medical attention straight away.
I worked in the NHS for many years and they call it NHS tourism. The amount of people who arrive in this country on “holidays” and end up having very costly surgeries and agree to pay and then disappear int the ether is unbelievable.

I used to plan theatre ops and the number of people who get sent home on the day of their surgery is massive, this is usually due to an emergency case pushing the ORs to run over.

I’m not just talking about Asian or African migrants, they literally come from all over the world to get access to free surgeries. I think the last time I checked it was costing £4billion.

Another factor is the money spent on training people only for those staff to then be poached by Aus, NZ, USA. Those countries can afford to pay better wages because they are not investing as much in training as we do. Years ago you couldn’t leave within so many years of your training but now they get their qualifications and leave the country and don’t pay back student loans/NHS grants.

It is not a Tory problem it is a national problem regardless of who is in power.

This another long read, but it describes some of the major factors which affected the NHS over 20 years:

The Rise and Decline of the NHS in England 2000-2020

www.kingsfund.org.uk/sites/default/files/2023-04/Rise_and_Decline_of_the_NHS_April_2023.pdf

Grantanow

The Kings Fund report is a thorough piece of research and attempts to rubbish it using anecdotal stories don't cut the mustard. It's obvious the Tories want to rubbish it because it exposes the very serious damage their underfunding of the NHS has done. Sunak's interview on Sunday was bizarre - he gave the same answer to four different questions: obviously a poor defensive ploy. Many EU countries were able to respond better than the UK to Covid because they had built surplus capacity into their health services as a matter of policy. Comments about NHS managers being incompetent and unnecessary are usually anecdotal. Private sector management in my experience is far simpler than public sector management: public sector managers often have to meet a wide range of complex (and sometimes conflicting) targets set by public expectation and political ideology whereas private sector managers can focus usually on simpler targets like profit, individual client satisfaction, recruitment and retention. And there are management disasters in the private sector, for example in mining (where companies failed to deal with foreseeable environmental problems), ignoring harassment issues leading to public opprobrium, dubious balance sheets that should have been corrected by adequate audit and computer-related errors which led to the dubious prosecutions for fraud of many subpostmasters by a long-privatised mail handler. Most of the adverse comments are based on a political belief 'private sector good, public sector bad' which fails the test of the real world rather than a Tory parallel universe.

Thank you Grantanow. I couldn't agree more.

Thanks Casdon

Callistemon21

Whitewavemark2

The problem with the Tory supporters on this thread who are desperate to rubbish the Kings Fund report is that everything that they are saying is anecdotal.

No one has produced actual evidence to show that it isn’t lack of funding leading to staff shortages, investment in infrastructure etc, but in fact entirely down to bad management.

Their arguments do not stand up, because they are not based on anything but here- say.

I'm not rubbishing the report just asking for comparisons in research criteria between two reports.
Do we have evidence that 10 years ago we were top and so proud of our NHS
Were we?

We were told the NHS was "the envy of the world" just a few years ago - but was it really? There have been reports of disastrous outcomes and crises for a lot longer than just ten years.

I do have friends whose DC worked as doctors, nurses in the NHS but left to go overseas as they were desperately overworked and disillusioned and this was more than 10 years ago.
Perhaps people were not informed, social media was not so active then. Perhaps people were more inclined to believe what they were told unless they had personal experience, such as in the Stafford Hospital crisis?

It's been going downhill for much longer than ten years but yes, I agree more rapidly recently.

There is evidence related to performance against the key targets that demonstrates significant deterioration Callistemon21.
This is a long read, but informative.
www.health.org.uk/publications/long-reads/nhs-performance-and-waiting-times
It’s pre-Covid, so probably a fairer indication of where the NHS was heading before the curveball.

Ps I'm not a Tory supporter either - but a supporter of having an NHS fit for purpose that is not subjected to political dogma and constant change, unless that results in real improvement, and an NHS that is not used as a"political football" as the saying goes.

Whitewavemark2

The problem with the Tory supporters on this thread who are desperate to rubbish the Kings Fund report is that everything that they are saying is anecdotal.

No one has produced actual evidence to show that it isn’t lack of funding leading to staff shortages, investment in infrastructure etc, but in fact entirely down to bad management.

Their arguments do not stand up, because they are not based on anything but here- say.

I'm not rubbishing the report just asking for comparisons in research criteria between two reports.
Do we have evidence that 10 years ago we were top and so proud of our NHS
Were we?

We were told the NHS was "the envy of the world" just a few years ago - but was it really? There have been reports of disastrous outcomes and crises for a lot longer than just ten years.

I do have friends whose DC worked as doctors, nurses in the NHS but left to go overseas as they were desperately overworked and disillusioned and this was more than 10 years ago.
Perhaps people were not informed, social media was not so active then. Perhaps people were more inclined to believe what they were told unless they had personal experience, such as in the Stafford Hospital crisis?

It's been going downhill for much longer than ten years but yes, I agree more rapidly recently.