The NHS is a service not a shrine,” Mr Streeting said. “It is judged by how well it serves the public.”

nanna8

Australia pays better wages to doctors and nurses but the customer has to pay every time they go to the doctor and also for scripts. Public hospitals are free and ok for real emergencies but not so good for ‘elective’ surgery. Most of us pay for private cover because you have to unless you want to wait forever. A dear friend was told their pancreatic cancer treatment was non urgent and had to wait 6 months!

So the grass isn't greener!

I'd prefer to stick with what we've got. Some pathways and priorities need thorough evaluation and changes and the bottom line is that the NHS needs money for equipment and staff (recruitment and retention), but I'm happy with the underlying system.

The ‘re-thinks’ can also be extremely expensive.

knspol

I think the only way to sort out the NHS properly requires cross party action coupled with some of the best business managers/entrepreneurs in the country plus the goodwill of the population in general to be prepared for any resulting cost - imo very unlikely.

I'm afraid different parties have different priorities - I doubt if cross-party intervention would get anywhere.

Germanshepherdsmum

The ‘re-thinks’ can also be extremely expensive.

They can indeed!

We need the NHS and it needs government support. I have elderly relatives who’ve had amazing treatment from our local hospital and GPs. I’ve had friends and relatives who’ve had cancer and the doctors, nurses, ancillary staff, everyone within the hospital have tried their best to treat the person as well as the ailment. No it’s not perfect, yes things can be improved but we all need to know if we’re sick or hurt help is there whether we have insurance or not, money in the bank or not. No one in this country goes bankrupt from medical bills, unlike other countries.

The NHS needs a complete review. We need another Dr Hilary Cass, prepared to take on vested interests and obstructive and threatening behaviour and shine a light on how badly it is run and suggest how it can be changed to be fit for purpose.

Who do you suggest is up to dealing with this poison chalice?

growstuff

Top management in the NHS does what the government tells it to do.

me too and me too....I remember the NHS under Blair

That's twiddling with it. It needs a complete rethink.

kittylester

That's twiddling with it. It needs a complete rethink.

OK! So what needs rethinking?

This - for starters!

Why since lockdown do we have to book same day appointments?

It’s crazy.
Some people would be perfectly happy seeing a doctor later that week. It’s just forcing everyone on the phone to contact the surgery at the same time. Totally illogical.

Dental practices manage!
Doctors used to.

Remember the days when you could ring up (not 8am) and say to the receptionist ‘I’d like to see the doctor next Tuesday please’?

Why have they stopped allowing this? It makes No Sense.

M0nica

The NHS needs a complete review. We need another Dr Hilary Cass, prepared to take on vested interests and obstructive and threatening behaviour and shine a light on how badly it is run and suggest how it can be changed to be fit for purpose.

Who do you suggest is up to dealing with this poison chalice?

It’s not going to happen. I worked in the NHS for forty years, and every time there was a new government there was a big review, restructuring of, and in the NHS is a constant. In reality it’s a huge distraction from the core work, wastes millions of hours of time for key clinical staff, and achieves very little.
The government have recently capitulated to the consultants pay demands again. All the brave words and posturing came to nought.
Excuse me for being a cynic, but what needs to change is not the structure, it’s the focus. Innovation is stifled because there are too many targets, and not enough staff to do anything but firefight, which is ineffective and inefficient. Improved operational systems management would make a huge difference.

greenlady102

growstuff

Top management in the NHS does what the government tells it to do.

me too and me too....I remember the NHS under Blair

I'm not sure whether people understand how NHS management works.

The government and the Department of Health and Social Care are responsible for policy-making. Unfortunately, it seems sometimes that policies are influenced by the media and votes, so if the government thinks that promising people quicker access to GPs or cancer drugs (for example) will win votes, they'll make some kind of promise and announcement.

The DHSC then has to cost the promises and consider any other implications. More often or not, money is involved, so the government says it will put X amount extra into the system. Often this means reducing the budget in another area and/or the promised amount is totally inadequate.

The NHS itself (in England anyway) is then tasked with trying to make any new policies work. It can make a case that more resources will be necessary, but it's not responsible for the overall budget nor the policies themselves. It's all complicated by the fact that the NHS is so fragmented. For some reason, governments have thought that "competition" between providers would increase efficiency - least said about that the better. Being able to outsource to private providers does, of course, mean that there are loads of opportunities for private individuals to make a profit.

The only really big re-thinks necessary are to turn the clock back about 20 years on management structures and to invest more, so that the NHS has the same number of scanners (and people to operate them) as other first world countries have. However, the main priority should be to talk to NHS staff and understand why they're leaving in droves - and do something about it!

In my experience the NHS is not all bad, just desperately unpredictable, patchy and inconsistent.
Spin that roulette wheel.

The NHS must be governed by cross party consensus otherwise it will just continue to be a political football, and the consequences will be catastrophic.

Since the NHS was introduced, there have been huge leaps in the treatments available - all much more costly than the cost of treatments in the 40s.

Each time something changes, more managers are brought in to run the new initiatives. There are far too many managers and not enough people who know what they are doing.

As someone said upthread, it needs to be cross party - it definitely does, not politicians with an eye to the next election.

Rather than doing twiddly bits - we need a complete rethink to make it fit for today.

I speak as someone whose husband worked for the NHS from the age of 23 to 71.

Quite, GG!!

DH, left the NHS because he was subject to too much management. That might be a clue.

The NHS cannot be governed by cross party consensus, that’s an absolute non starter, because there isn’t any. The Tories want to move towards a privatised, American system. Apart from Reform, no other party else does, and that can’t be reconciled.

Casdon

The NHS cannot be governed by cross party consensus, that’s an absolute non starter, because there isn’t any. The Tories want to move towards a privatised, American system. Apart from Reform, no other party else does, and that can’t be reconciled.

So what do you suggest?

If we keep to the same old modus operandi veering from one cohort to the next then it’s pretty much guaranteed that the NHS as it was at its conception will cease to exist.

Why are people so frightened of reform and bringing the NHS into the 21st century?

This problem goes back years.. The NHS union I am still in reported and sent out a statement in about 2008 that there would be a significant shortage of quilified staff across the board due to pension changes and the demographic numbers involved from 2012 onwards.
I fitted into that bracket as I took my final salary NHS pension. I went back doing just x2 days a week. I know so many who did the same. I just work the NHS bank now.
The Government at the time totally ignored it, and so did other governments.

Every single Health Care professional regardless of profession has to get their own place at a University and pay like every other student for their education. Once you have your degree you have to find a job where the preceptorship takes place and then the NHS pays for most of the post grad training (well ours do). All this take at least 4-5 years minimum.

No magic wand or future government can wizz that away.

As for on site Managers, I have said before you need them, there are not too many, it hasn't been like that for years.
No easy fix, like others "it's here we go again".

Would it be better if GP’s worked as NHS employees rather than running their own business models?

Or how about paying them for actually seeing patients rather than the total number on the books?

Why are people so frightened of reform and bringing the NHS into the 21st century?

GG13, would you like to explain what you mean by 'reform' and 'bringing the NHS into the 21stC'? The statement is delightfully vague and could mean anything at all.

I have just registered that NHS waiting lists have dropped for the fifth time in a row. How amazing is this? So from 7.7 million to 7.5 million. No mention of whether the death rate increased and accounted for the change in waiting times.
Seems to me that the NHS needs to be removed from politics and moves to become a fully independent health service and not a political football.

Nothing is ever fully independent of politics, ronib because people are political. The only way that could be achieved would be to have it run by robots.

Any changes to any of our institutions - if they are to work will require long term planning and cross party consensus and be “written” into law to ensure the commitments last longer than the length of one partys’ tenure.
Have any of the current crop of politicians got what it takes?
At this moment in time I have little confidence that even a Labour government will wake up to the reality of our crumbling services and act before it is too late.
Imo this applies to education, water, transport, homelessness and policing. Root and branch😌