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NHS in crisis

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ralphchadkirk

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Just this weekend I've been part of teams delivering high quality critical care to very seriously ill and injured people. They received probably the best care in the world from the NHS, certainly far better than the US provides and higher than most European countries (save for perhaps Norway and Sweden). The cost probably ran into the tens of thousands. But they got all that for free, and I'm rather proud of that.
 
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LateThanNever

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At present the NHS is a universal, free at the point of use service that provides support for all of us regardless of means or social standing. Why is that seen as a bad thing? Why the rush to change to a system that will exclude people from health care provision?

Quite.
And private provision wouldn't save money anyway as the accompanying invoicing and administrative paperwork would increase complexity and swallow up extra resources. The amount of paperwork produced by a French hospital visit for example is quite remarkable (and most is difficult to fathom even for the French!)
The NHS isn't broken it just needs the government to stop poking its nose in to privatise it (and as a result increase NHS costs) and to fund it properly. The government has the resources but is trying to con us for reasons best known to itself that it doesn't. It could create the money out of thin air if it wished.
Indeed that is why we have a government, though I wonder if the current incompetent lot can properly be referred to as a government.
--- old post above --- --- new post below ---
Just this weekend I've been part of teams delivering high quality critical care to very seriously ill and injured people. They received probably the best care in the world from the NHS, certainly far better than the US provides and higher than most European countries (save for perhaps Norway and Sweden). The cost probably ran into the tens of thousands. But they got all that for free, and I'm rather proud of that.

And so you ought to be!
 

DynamicSpirit

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At present the NHS is a universal, free at the point of use service that provides support for all of us regardless of means or social standing. Why is that seen as a bad thing? Why the rush to change to a system that will exclude people from health care provision?

Is anyone suggesting that we exclude people from healthcare? (Some have suggested charging some people smallish amounts where those people are perceived to have directly caused the condition that requires medical attention, but doesn't seem to be exactly the same thing as excluding people). Do the healthcare systems in the countries Ainsworth74 mentioned (France, Germany, Sweden, Australia) exclude people from healthcare provision?
 
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DarloRich

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Is anyone suggesting that we exclude people from healthcare? (Some have suggested charging some people smallish amounts where those people are perceived to have directly caused the condition that requires medical attention, but doesn't seem to be exactly the same thing as excluding people). Do the healthcare systems in the countries Ainsworth74 mentioned (France, Germany, Sweden, Australia) exclude people from healthcare provision?

but any direct financial contribution (whether by insurance or cash payment) will exclude people either through choice or through ability to pay. Our current system excludes no one and provides a bloody good level of care to all without graduation.
 

Johnuk123

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It is - where do you think the money for Quantitative Easing for the banks came from?

Richard Werner the German who invented the term has said that it's failed in this country.
It's had little if any effect and is not a long term solution.
It's similar to offering a glass of water to a drowning man because he's thirsty, it's better than nothing but not a solution to his problem.
 
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PHILIPE

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Why doesn't the NHS just go back to the way it was operated in the 60s but embracing updates in technology ? We would then be rid of all the excess of management layers. bureaucracy and Quangos together with Chief Executives who award themselves massive salaries.
Programme on BBC2 re state in hospitals but I presume Ministers will still keep their heads in the sand just deflecting any criticism as though it's nothing to do with them.
 

DynamicSpirit

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but any direct financial contribution (whether by insurance or cash payment) will exclude people either through choice or through ability to pay. Our current system excludes no one and provides a bloody good level of care to all without graduation.

The current system does exclude people. It mostly doesn't do it by fees, it does it by queuing. Example: In my part of London, depending on the time of year, an appointment with the GP can take between 2-3 weeks. There have been several occasions when I've wanted to see the GP to get some issue checked out/get reassurance that it's not serious/etc., but have given up because 3 weeks was long enough for the symptons to go away (you could argue that if they go away in 3 weeks then it probably wasn't serious, but that's still 2 weeks or so of the worry of not knowing). Another example is the huge waiting lists for operations (although I don't have figures, I'd be astonished if there aren't some people who die while waiting months and months for an operation).

Similarly, the stories we are hearing - some posted on this thread - of the situation in many A&E departments is appalling - and it would again be astonishing if at least some people who ideally ought to get A&E treatment, or ought to be checked out after a minor accident, get put off from going to the local hospital because they know of the pressure A&E departments are under/can't wait the 4 hours or so. (Obviously this wouldn't be the case for people who are very seriously hurt, I'm talking people who have been mildly hurt - enough that getting a doctor to check them out would be a good idea. It's also more likely to happen with people in the kind of low-paid jobs or zero-hours contract where waiting hours on end in an A&E department will mean you'll be late for work with a risk that your employer will just not to give you any more shifts if you are late).

Ultimately, whether you like it or not, resources for treating people are finite, and it's simply not possible to treat everyone for everything for free. There has to be some limit. You can push that limit back by pumping more money into the NHS, getting more doctors and nurses, etc. You could do a lot by funding social care properly - and I do think the current Government's record on that is truly appalling. But you can't change the fact that that limit is ultimately going to be there at some point. There is no way to avoid the problem that, no matter how well you fund the health service, sooner or later you'll hit a financial boundary at which you'll need to prioritize what treatments are available, or whether some treatments that are perhaps non-essential can be funded by other means. And I don't think there's anything wrong with acknowledging that, and having a discussion about where that boundary should be or what the priorities should be.

In that context, it's clear that the NHS is now being required to spend huge amounts of money treating conditions that would have been entirely preventable with - for example - better lifestyle choices. I think there is a legitimate argument about cases where people require treatment for things that are arguably largely self-inflicted, or where the person shows no sign that they are prepared to modify their lifestyle to prevent the problem recurring - although I realize that the boundary there is very fuzzy and it's very hard to see where you can draw the line in a way that doesn't look unfair to some people. I also wouldn't go along with the judgemental manner in which some posters here have been presenting that argument.
 
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ainsworth74

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As well as the above, very good post, in terms of exclusion lets not forget that there are fees for prescriptions, opticians and dentists as well in our own system! Only those in very specific circumstances get those for free and there's no reason that couldn't continue of course if we adopted a different model to the one we haven now.

Why shouldn't I pay £20 to see a GP? I can certainly afford it! Whilst someone on income based-Jobseekers Allowance or on a very low wage might not be able to afford £20 they would get it for free just as they currently get their dental treatment for instance.
 

DarloRich

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The current system does exclude people. It mostly doesn't do it by fees, it does it by queuing. Example: In my part of London, depending on the time of year, an appointment with the GP can take between 2-3 weeks. There have been several occasions when I've wanted to see the GP to get some issue checked out/get reassurance that it's not serious/etc., but have given up because 3 weeks was long enough for the symptons to go away (you could argue that if they go away in 3 weeks then it probably wasn't serious, but that's still 2 weeks or so of the worry of not knowing).

Go to the walk in/minor injuries unit/local care centre/pharmacy and wait or ring NHS direct . That is what they are for. By trying to see your GP for minor/trivial issues you add to the problem


Another example is the huge waiting lists for operations (although I don't have figures, I'd be astonished if there aren't some people who die while waiting months and months for an operation).

In no way caused by the lack of funding or resource? I seem to recall similar issues under the last Conservative government which got better under the last Labour one.

Similarly, the stories we are hearing - some posted on this thread - of the situation in many A&E departments is appalling - and it would again be astonishing if at least some people who ideally ought to get A&E treatment, or ought to be checked out after a minor accident, get put off from going to the local hospital because they know of the pressure A&E departments are under/can't wait the 4 hours or so. (Obviously this wouldn't be the case for people who are very seriously hurt, I'm talking people who have been mildly hurt - enough that getting a doctor to check them out would be a good idea. It's also more likely to happen with people in the kind of low-paid jobs or zero-hours contract where waiting hours on end in an A&E department will mean you'll be late for work with a risk that your employer will just not to give you any more shifts if you are late).

This is EXACTLY what the minor injuries units are for. They should be at the hospital and staffed up to allow for proper triage and direction to the most appropriate hospital service. A&E is for serious/life threatening emergency care not for a sprained wrist.



Ultimately, whether you like it or not, resources for treating people are finite, and it's simply not possible to treat everyone for everything for free. There has to be some limit. You can push that limit back by pumping more money into the NHS, getting more doctors and nurses, etc. You could do a lot by funding social care properly - and I do think the current Government's record on that is truly appalling. But you can't change the fact that that limit is ultimately going to be there at some point. There is no way to avoid the problem that, no matter how well you fund the health service, sooner or later you'll hit a financial boundary at which you'll need to prioritize what treatments are available, or whether some treatments that are perhaps non-essential can be funded by other means. And I don't think there's anything wrong with acknowledging that, and having a discussion about where that boundary should be or what the priorities should be.

So your answer to that issue is that you can afford health care and sod the poor burgers who cant?

You might not have been in a position where you have to make choices about heat or light. I have. Health insurance would very quickly have been dumped to keep food on the table.

In that context, it's clear that the NHS is now being required to spend huge amounts of money treating conditions that would have been entirely preventable with - for example - better lifestyle choices. I think there is a legitimate argument about cases where people require treatment for things that are arguably largely self-inflicted, or where the person shows no sign that they are prepared to modify their lifestyle to prevent the problem recurring - although I realize that the boundary there is very fuzzy and it's very hard to see where you can draw the line in a way that doesn't look unfair to some people. I also wouldn't go along with the judgemental manner in which some posters here have been presenting that argument.

But that is exactly what you are doing. Judging. You are saying that if you are fat, or smoke, or drink or play sport or ride a bike or whatever you should be denied health care so that those who live the hair shirting life of a monk should have care.

it is wrong -we can afford decent NHS care in this country but we have to pay for it. Part of that payment is putting in place proper social care to help people make the changes that mean they become the good and virtuous citizens you want to see and thus reduce the burden on the NHS. We don't invest enough in the services before Drs or Hospital and then wonder why the medical services are in trouble!


As well as the above, very good post, in terms of exclusion lets not forget that there are fees for prescriptions, opticians and dentists as well in our own system! Only those in very specific circumstances get those for free and there's no reason that couldn't continue of course if we adopted a different model to the one we haven now.

Why shouldn't I pay £20 to see a GP? I can certainly afford it! Whilst someone on income based-Jobseekers Allowance or on a very low wage might not be able to afford £20 they would get it for free just as they currently get their dental treatment for instance.

I'm all right Jack eh? It wouldn't be £20 for long and nor would the exemptions remain in place for long. You must know that any change to the system undertaken by a Conservative will result in a slide, quickly, to an American model of insurance and tiers of care based on your financial worth.
 
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AlterEgo

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The current system does exclude people. It mostly doesn't do it by fees, it does it by queuing. Example: In my part of London, depending on the time of year, an appointment with the GP can take between 2-3 weeks. There have been several occasions when I've wanted to see the GP to get some issue checked out/get reassurance that it's not serious/etc., but have given up because 3 weeks was long enough for the symptons to go away (you could argue that if they go away in 3 weeks then it probably wasn't serious, but that's still 2 weeks or so of the worry of not knowing). Another example is the huge waiting lists for operations (although I don't have figures, I'd be astonished if there aren't some people who die while waiting months and months for an operation).

Similarly, the stories we are hearing - some posted on this thread - of the situation in many A&E departments is appalling - and it would again be astonishing if at least some people who ideally ought to get A&E treatment, or ought to be checked out after a minor accident, get put off from going to the local hospital because they know of the pressure A&E departments are under/can't wait the 4 hours or so. (Obviously this wouldn't be the case for people who are very seriously hurt, I'm talking people who have been mildly hurt - enough that getting a doctor to check them out would be a good idea. It's also more likely to happen with people in the kind of low-paid jobs or zero-hours contract where waiting hours on end in an A&E department will mean you'll be late for work with a risk that your employer will just not to give you any more shifts if you are late).

Ultimately, whether you like it or not, resources for treating people are finite, and it's simply not possible to treat everyone for everything for free. There has to be some limit. You can push that limit back by pumping more money into the NHS, getting more doctors and nurses, etc. You could do a lot by funding social care properly - and I do think the current Government's record on that is truly appalling. But you can't change the fact that that limit is ultimately going to be there at some point. There is no way to avoid the problem that, no matter how well you fund the health service, sooner or later you'll hit a financial boundary at which you'll need to prioritize what treatments are available, or whether some treatments that are perhaps non-essential can be funded by other means. And I don't think there's anything wrong with acknowledging that, and having a discussion about where that boundary should be or what the priorities should be.

In that context, it's clear that the NHS is now being required to spend huge amounts of money treating conditions that would have been entirely preventable with - for example - better lifestyle choices. I think there is a legitimate argument about cases where people require treatment for things that are arguably largely self-inflicted, or where the person shows no sign that they are prepared to modify their lifestyle to prevent the problem recurring - although I realize that the boundary there is very fuzzy and it's very hard to see where you can draw the line in a way that doesn't look unfair to some people. I also wouldn't go along with the judgemental manner in which some posters here have been presenting that argument.

Excellent post and captures my thoughts perfectly too.
 

DarloRich

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Excellent post and captures my thoughts perfectly too.

so your view is that you live a good life and can afford care so should benefit while those less fortunate than you should suffer?

EDIT: I am not trying to be rude i just believe, strongly, that we should not willingly give up the concept of the NHS and replace it with one based on care decided by your financial worth.

The first steps on that road are proposed here, no doubt for the most worthy of reasons and with a desire to improve things for everyone, but the Conservatives will quickly push us forward towards an American style system and once those first steps are taken there will be no going back.

You may be more trusting and perhaps I am cynical but I simply do not trust Tories with the NHS.
 
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Howardh

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If I were the government I's spend a fair bit on an educational campaign. Would this strike a chord?
MINOR AILMENTS (Burns, grazes, bruises, sprains, sores, headaches, upsets etc)
Choice -
Go to A+E and wait five hours
Go to your pharmacy and be seen in five minutes.
And if it's urgent the pharmacist will fast-track you to a GP or A+E.
 

AlterEgo

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so your view is that you live a good life and can afford care so should benefit while those less fortunate than you should suffer?

EDIT: I am not trying to be rude i just believe, strongly, that we should not willingly give up the concept of the NHS and replace it with one based on care decided by your financial worth.

The first steps on that road are proposed here, no doubt for the most worthy of reasons and with a desire to improve things for everyone, but the Conservatives will quickly push us forward towards an American style system and once those first steps are taken there will be no going back.

You may be more trusting and perhaps I am cynical but I simply do not trust Tories with the NHS.

My view is that, as an economically and socially active man of 30, I actually get much less benefit from the NHS despite paying an above average proportion towards its upkeep.

It is actually people in our society with the most time (and often, the least money or resources) who will be seen most quickly, most often, and will therefore receive a slightly better service.
 

DarloRich

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My view is that, as an economically and socially active man of 30, I actually get much less benefit from the NHS despite paying an above average proportion towards its upkeep.

It is actually people in our society with the most time (and often, the least money or resources) who will be seen most quickly, most often, and will therefore receive a slightly better service.

but when you become a much less active, isolated and unwell man of 60's or 70's or older you will get your monies worth - That is the whole point.
 
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WelshBluebird

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but when you become a much less active, isolated and unwell man of 60's or 70's or older you will get your monies worth - That is the whole point.

Or if you are involved in an accident or get an illness that mean you can no longer contribute. As you say, that is exactly the point of the system. Those who need it the most are usually the least able to pay, so it makes perfect sense that the burden of the cost is shared out across society.
 

AlterEgo

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but when you become a much less active, isolated and unwell man of 60's or 70's or older you will get your monies worth - That is the whole point.

I don't plan on being isolated or less active in my 60s or 70s, because I have a proactive approach to managing my own health and wellbeing.

I may be less well, for a myriad of reasons, but I am not suggesting I - or anyone else - should be left without healthcare. In fact, if I was privately insured, the same argument would apply; it's expensive when you're 30, but you get the benefit when you're 70.
--- old post above --- --- new post below ---
Or if you are involved in an accident or get an illness that mean you can no longer contribute. As you say, that is exactly the point of the system. Those who need it the most are usually the least able to pay, so it makes perfect sense that the burden of the cost is shared out across society.

I don't begrudge paying taxes for the NHS - but what I do think needs review is the prioritisation of care, so the system we have is more efficient. I have had significant benefit from the NHS, as I have a hidden disability. But in all of the interactions I have had with the NHS I have seen waste and questionable use of resources.
 

DarloRich

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I don't plan on being isolated or less active in my 60s or 70s, because I have a proactive approach to managing my own health and wellbeing.

I may be less well, for a myriad of reasons, but I am not suggesting I - or anyone else - should be left without healthcare. In fact, if I was privately insured, the same argument would apply; it's expensive when you're 30, but you get the benefit when you're 70.

I am sure no one plans on being old or isolated or ill. It happens though. it might happen to you quite easily via divorce or death or injury or illness or business failure or financial failure. Your proactive plans will be for nothing then when you are left with very little.

but I am sure it wont happen to you............
 
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ainsworth74

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I'm all right Jack eh? It wouldn't be £20 for long and nor would the exemptions remain in place for long.

What like exemptions for dentists and opticians and prescriptions?


As for the tired 'I'm all right Jack' argument for rather a long period of time I wasn't 'all right' and was able to take advantage of the free healthcare afforded by the existing exemptions. But, now that I am 'all right', I'd be quite willing to contribute something towards the cost of any healthcare I need.
 

furnessvale

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I don't plan on being isolated or less active in my 60s or 70s, because I have a proactive approach to managing my own health and wellbeing.

I may be less well, for a myriad of reasons, but I am not suggesting I - or anyone else - should be left without healthcare. In fact, if I was privately insured, the same argument would apply; it's expensive when you're 30, but you get the benefit when you're 70.

If you think t is expensive when you are 30, try paying the premiums as a 70 year old.
 

AlterEgo

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I am sure no one plans on being old or isolated or ill. It happens though. it might happen to you quite easily via divorce or death or injury or illness or business failure or financial failure. Your proactive plans will be for nothing then when you are left with very little.

but I am sure it wont happen to you............

Perhaps not.

Do you think that, for example, the Swedish modes excludes people from healthcare? If so, why? And what effect does that have on society?
 

LateThanNever

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Richard Werner the German who invented the term has said that it's failed in this country.
It's had little if any effect and is not a long term solution.
It's similar to offering a glass of water to a drowning man because he's thirsty, it's better than nothing but not a solution to his problem.
What Richard Werner invented has never actually been used in this country. The government nicked the name, without doing what he recommended.
But leaving aside the name, where did the money come from?
--- old post above --- --- new post below ---
What like exemptions for dentists and opticians and prescriptions?


As for the tired 'I'm all right Jack' argument for rather a long period of time I wasn't 'all right' and was able to take advantage of the free healthcare afforded by the existing exemptions. But, now that I am 'all right', I'd be quite willing to contribute something towards the cost of any healthcare I need.
In a way you already are if you pay tax.
 

DarloRich

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Perhaps not.

Do you think that, for example, the Swedish modes excludes people from healthcare? If so, why? And what effect does that have on society?

but Sweden have a more liberal tax and spend regime and a lower population. I also wonder if they have the same levels of deprivation as we see in the UK and the same level of low/no wage families
--- old post above --- --- new post below ---
What like exemptions for dentists and opticians and prescriptions?


As for the tired 'I'm all right Jack' argument for rather a long period of time I wasn't 'all right' and was able to take advantage of the free healthcare afforded by the existing exemptions. But, now that I am 'all right', I'd be quite willing to contribute something towards the cost of any healthcare I need.

but you are already doing that - my point is that £20 should be taken via taxation
 

AlterEgo

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but Sweden have a more liberal tax and spend regime and a lower population. I also wonder if they have the same levels of deprivation as we see in the UK and the same level of low/no wage families

So can I take it that the Swedish system doesn't "leave people behind" then?

I would much rather retain the NHS - which is broadly good - but with stricter management of waste.

We need to have a proper debate, as a country, about what exactly we are prepared to fund, and what we are not prepared to fund.
 

Bletchleyite

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We need to have a proper debate, as a country, about what exactly we are prepared to fund, and what we are not prepared to fund.

I agree on this - I would see a useful output being a "national insurance contract" of some kind that defines precisely the NHS's remit, almost like an insurance policy.

Indeed, a "social insurance" scheme with hospitals being charitable trusts on their own paid by said insurance, like the German system, could solve some of the issues with the NHS being just too big to manage - and would be better than the postcode lottery of CCGs. GPs of course are already private, as are dentists, so it wouldn't be as big a change as some think in terms of the services they use most frequently.
--- old post above --- --- new post below ---
I think that also includes things you would take *out* of the NHS's remit. I can think of one example I certainly would - IVF and other related fertility treatments. It's costly, and there are significant numbers of kids out there who need a loving family to bring them up and are instead bouncing around foster families[1]. Adoption should be encouraged to a far greater extent instead.

[1] Not to do foster families down - they do excellent work - it just isn't the optimal way to bring up a child.
 
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DarloRich

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So can I take it that the Swedish system doesn't "leave people behind" then?

i might suggest Swedes are, generally, better paid, more affluent, healthier people than those found in many parts of the UK!

I would much rather retain the NHS - which is broadly good - but with stricter management of waste.

We need to have a proper debate, as a country, about what exactly we are prepared to fund, and what we are not prepared to fund.

Agreed - but the problem is that such a debate simply allows the whisky priests to flaunt their holier than thou social judgments.
--- old post above --- --- new post below ---
I think that also includes things you would take *out* of the NHS's remit. I can think of one example I certainly would - IVF and other related fertility treatments. It's costly, and there are significant numbers of kids out there who need a loving family to bring them up and are instead bouncing around foster families[1]. Adoption should be encouraged to a far greater extent instead.

[1] Not to do foster families down - they do excellent work - it just isn't the optimal way to bring up a child.


There speaks a man...................
 

DarloRich

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I agree on this - I would see a useful output being a "national insurance contract" of some kind that defines precisely the NHS's remit, almost like an insurance policy.

Indeed, a "social insurance" scheme with hospitals being charitable trusts on their own paid by said insurance, like the German system, could solve some of the issues with the NHS being just too big to manage - and would be better than the postcode lottery of CCGs. GPs of course are already private, as are dentists, so it wouldn't be as big a change as some think in terms of the services they use most frequently.

Would that social insurance be provided via taxation or by a private insurance company?
--- old post above --- --- new post below ---
I'm not just thinking female fertility treatments - male ones too.

Point still stands! Sorry you are firing blanks. No, we cant help but here is a book of orphans. Help yourself to a nice one on your way out ;) You cant force the emotional bond of being a parent . Some people wouldn't be able to adopt as that bond wouldn't be there. Would it be wise to direct childless couples who no doubt have a great deal of emotional upset to take on an orphan? Would they be the right candidates in those circumstances?

You get three chances with IVF on the NHS if you are a woman under 40 and you meet the current fertility guidelines. You get one shot if between 40 & 42. I doubt it is the most wasteful treatment offered.
 
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