NHS in crisis

Discussion in 'General Discussion' started by backontrack, 6 Jan 2017.

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  1. Bletchleyite

    Bletchleyite Veteran Member

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    There are a couple of models. In Germany it's provided by the State in the form of the regional Allgemeine Ortskrankenkassen ("general local health insurance fund"), but you can opt out and go fully private if you wish. In Switzerland it's provided by commercial companies who compete on price - but for the basic "social" package of services the law states they can only price based on ability to pay, not on risk etc, and they are prohibited from refusing insurance to anyone regardless of risk. What happens there is that companies compete not just on price and how exactly the basic service is delivered[1], but also on top-ups like cover for single rooms when in hospital, provision of non-essential out of hours care etc.

    [1] Some cheaper policies in CH require you to call a call centre similar to NHS Direct before visiting a GP or pharmacist, for example. This approach saves costs as it weeds out unnecessary visits - and in some cases they can move on from a nurse to a telephone doctor who can even make a prescription on some things where a visit really isn't necessary, or in some cases even refer straight to specialists where the problem is very clear-cut. I'd personally be happy to take such a policy even if it cost more - if it was cheaper, as it likely would be, that's a win-win.

    I think there is strong merit in both of them or indeed a hybrid of them in some form - e.g. most of the people who need out of hours non-essential care e.g. late evening or very early morning GP appointments are people like London commuters who tend to be earning a bit more yet need those services relatively occasionally due to being younger - so why not let them pay a higher insurance contribution or a fee for them? It's in a way like easyJet speedy boarding used to be - a perfect price differentiator - people either value it and pay for it, or think it's pointless and don't.

    It may well not be - it's one exception. But it depends whether you think that having children is a right or a privilege. I'd tend towards the latter (possibly the best privilege the world has ever known, and one that also comes with massive responsibilities that some parents sadly shirk), I think you perhaps tend towards the former - both are valid views and I don't seek to drag the discussion that way, rather I was just proposing an example.
    --- old post above --- --- new post below ---
    Mentioning "top-up" care...could an example of a top-up to the basic contract be thus:

    Basic, legally entitled NHS contract: you register with a GP within X distance of your home, and may see that GP between 8am and 5pm, Monday to Friday, except in the case of emergency care which would be available by some means 24/7 as at present.

    Enhanced options at a fee: the ability to visit any GP for non-emergency matters (e.g. one nearer work), visits between 6am-8am and 5pm-8pm or on Saturdays/Sundays where offered, etc etc etc.

    There are people willing to pay for this kind of service - so why not let them, and allow the NHS that extra money that they would voluntarily give to it?
     
    Last edited: 11 Jan 2017
  2. DarloRich

    DarloRich Veteran Member

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    The problem I have is that I simply do not trust either Conservatives or insurance companies with health care provision. I think they will rip you off and welch on the deal the moment they can.

    I would rather the government built a progressive taxation system that provided sensible funds for health and social care and built a sensible system (and gave it time to work) to deliver that care.

    For instance many people attend A&E or a GP when they don't need to. I would like the NHS to build hospitals with a GP service, minor injuries unit and A&E on the same site and direct patients to the most suitable venue on arrival via an early assessment. That means they get the appropriate treatment and critical resources for urgent care are not tied up with minor problems.

    If the government could fund some social care to help stop people needing to visit the health centre that would be superb!

    Agreed - I was being facetious.
     
    Last edited: 11 Jan 2017
  3. WelshBluebird

    WelshBluebird Established Member

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    In terms of translating that to the UK, the problem you have is that a lot of private healthcare essentially relies on the NHS (for 999 calls, for emergency care, and for when things go wrong). So it wouldn't be at all fair for someone to opt out because they would still potentially need NHS services. Also it wouldn't be fair because as I said before, the whole point of the NHS is that those who can pay do so and those who can't pay get covered because of that, if you start letting people opt out then you essentially deprive the NHS of even more money.
     
  4. Senex

    Senex Established Member

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    I agree wholeheartedly with this, and particularly with the point about selection by queuing even if not by purse. But then the NHS has from its very inception relied on queuing to manage demand. I do think it's also very important to remember the point made in the posteing following DynamicSpirit by Ainsworth74, that only some things relating to needs are free at the point of access, whilst others, like prescriptions, opticians' services, and dentistry are not, not to mention the whole social care question. Why should someone with the misfortune to be born with lousy teeth be treated worse financially than someone with a more "normal" medical condition?
    --- old post above --- --- new post below ---
    Equally, I simply do not trust a socialist state and a socialist system to deliver a high-quality service (of any sort) without waste. Resorting to the blank cheque can never work as there will come some point where the money runs out and people just aren't willing to put up more without a much greater sense of control over what they're paying for. And surely totally free at the point of delivery encourages abuse -- people don't value what they get for nothing. (Wasn't there one of the former East European democratic states that tried free local transport, but backed off very quickly because (a) they couldn't deal with the demand and (b) people weren't valuing what they were getting because they weren't consciously making a contribution?)

    Is there any common ground between those of us who think that the money is not unlimited and there have to be limits on what can be offered and almost certainly rather more charges at the point of delivery than there are now and those who take your more idealistic position that everyone should get everything they need free at the point of delivery regardless of cost because you see that as the way to run a civilised society? How do we achieve a balance between pragmatism and idealism, if such a balance is possible?
     
  5. paulweaver

    paulweaver Established Member

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    Some problems cost a fortune to treat -- cancer for example. The whole point of the NHS is that we are grateful that we put more in than we get out. We have a system in this country that the richer you are, the more you pay. At least in theory (in practice those who are richest don't pay as much)

    Yes there are wastes -- hospitals being forced to rent an MRI machine at £1m a year rather than buying one with a 5 year lifespan for £2m plus £100k a year maintenence, having to pay contract rates for doctors because you can't hire permanently for whatever reason, but don't forget that the medical expenditure in many other countries is far higher per head than in the UK.

    Happy to have a situation where these signs (matching symptom to treatment) are given more prominence
    [​IMG]

    That if you go to A&E there's facilities to do what you should have done in the first place (A phone to link through to NHS direct for example, a pharmacist to talk to and get you on your way), and perhaps even that A&E walkins are de-prioritised unless they've been referred to from nhs direct/walkin or a gp or pharmacy. Likewise with GP surgeries. On the other hand it seems from sitting and eavesdropping in waiting rooms on occasion that a large number of people there are retired, all know each other, and are regular visitors to the doctor for one reason or another.
     
    Last edited: 11 Jan 2017
  6. DarloRich

    DarloRich Veteran Member

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    The point you miss is that you don't need a GP appointment for reassurance. Making that appointment is one of the reasons the system is so jammed. Go to the minor injuries unit or the pharmacy or call NHS direct.

    If we had a better sign posted and funded system delays could be reduced by helping you find the right venue for your care. You would be treated much more quickly and resources used in the right places.

    Instead people pitch up at A&E having fallen off their bike and twisted their ankle or go to the Drs demanding antibiotics for a cold.
     
  7. Bletchleyite

    Bletchleyite Veteran Member

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    Indeed. That's where that Swiss concept comes in - you don't go to *anywhere* until the telephone call has referred you, unless it's really clear cut A&E/ambulance material.

    So instead of NHS Direct being optional, it would be a mandatory first-line point of contact that could do something like arrange a GP or minor injuries[1] appointment as well.

    [1] What's the point of having people sit and queue when the queue could be more virtual?
    --- old post above --- --- new post below ---
    Yes, that is one issue with it. I think my inclination would be *not* to allow opting out, but instead to allow private insurance to be much more of a top-up. (Or if opting out was used, the private insurers would be required to pay a sum to the NHS insurer).
    --- old post above --- --- new post below ---
    Agreed. And a pharmacy. I went to the MK Urgent Care Centre[1] a year or so ago with suspected (and indeed diagnosed in the end) DVT, but they thought it could also be a skin infection (turns out it wasn't, or it was both) and decided to treat both.

    For DVT I was given 5 injections to use for the first 5 days, while longer-term treatment (which was successful) was arranged.

    For the possible infection, I had to drive 5 miles across town to the duty pharmacy to obtain the prescription.

    Why? It makes no sense - extra pollution, extra cost - possibly unaffordable cost of a taxi to a non-driver. There should be a pharmacy on site capable of issuing regular prescriptions.

    [1] The system over here, as you may have experienced (but hopefully not), is that one centre handles both emergency/out of hours GP type work *and* minor injuries. It works quite well - I had previously gone to Edinburgh walk-in centre a day earlier and they did an X-ray and confirmed the cause of the pain wasn't a break, but they were somewhat at a loss as to what else it could be - as they were just a minor injuries centre and didn't have any doctors on site, just nurses.
     
    Last edited: 11 Jan 2017
  8. DarloRich

    DarloRich Veteran Member

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    I am sure there will be. I would prefer to only pay for treatment when all central government taxation options have been exhausted. I don't think they have been when so many people, especially rich Conservatives, seem to be able ( and at times encouraged) to dodge their taxation responsibilities. Bluntly we all need to pay more tax to support the NHS. Of course that needs to go hand in hand with reform and rooting out waste but we don't need to hand the whole thing over to private enterprise to rinse profits from our sickness.

    I simply don't understand why Conservtives are so fearful of the NHS.

    I forgot the pharmacy!
     
    Last edited: 11 Jan 2017
  9. Bletchleyite

    Bletchleyite Veteran Member

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    I would agree with an increase in Income Tax (a small increase, maybe 1-2p on the basic rate and a larger one, maybe around 5p, on the higher rate) to fund significant NHS improvements and other things.

    I do however think the NHS is in need of significant procedural (bureaucratic, I mean, there's nowt wrong with the *actual* healthcare) improvement - and I fear it's just a bit too big a supertanker to turn.
     
  10. DarloRich

    DarloRich Veteran Member

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    Agreed - However I would rather we try to turn the tanker away from the rocks rather than torpedo it and take to the lifeboats!
     
  11. Trog

    Trog Established Member

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    If they did that I bet the NHS would be back claiming poverty and begging for more in less than two years.
     
  12. OneOffDave

    OneOffDave Member

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    It wold have been a good idea if the extra layers of bureaucracy that the Health and Social Care Act 2012 added were undone. this of course after we were promised "no top-down reorganisation of the NHS"
     
  13. LateThanNever

    LateThanNever Established Member

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    The NHS it is unique in the world - when you have a cure you have a queue. That is why the deliberations of NICE are so heavily influential worldwide.

    Quite why you should be concerned with Socialist waste when inherent in the current system is privatised units who all want to take out 10% as profit - thus making their services valuable to their shareholders but 10% less valuable to the British taxpayer.
    That is a complete waste. And it requires a wasteful bureaucracy to administer!

    Charging at the point of delivery will add yet another level of wasteful administration and is unlikely to raise any money unless set at Etonian levels.
    Some things are better not charged for - when as property owners we paid for individual fire brigades that didn't work out too well.
    And money is a lot less limited than we are told. We have a sovereign currency so if we can find people willing to accept payment for goods or services in sterling we can afford it - just as we did for the banks. We have to recognise where money comes from. The government's whole purpose is to look after its citizens and improve their lives. (Quite what the current government thinks its purpose is I'm less sure)
    Exactly. Another gross waste of time and resources.
     
  14. PHILIPE

    PHILIPE Established Member

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    In Prime Ministers Question Time in the House today, Theresa May linked the quality of the NHS service to a strong economy. A person waiting on a trolley what have I got to do with the economy.
    The Welsh Health Minister was interviewed on local TV News tonight and, despite the evidence put in front of him, was still in denial.
     
  15. Senex

    Senex Established Member

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    People will have to feel they can trust it first, and I'm note sure that's the case at the moment -- especially when one sees reports such as that on the service in the South West.

    As for the alternative services in general, I think confidence in them does need to be built up. People trust medics, and especially their GPs. There isn't that trust in pharmacists yet -- and certainly not much desire spell out your problems in the shop or in the pretence for privacy you see in some places.

    That seems to make a lot of sense to me, but the NHS has always been against allowing any sort of top-up rather than insisting on either/or provision.

    The transport cost is a very interesting point. Over several decades now there has been a consistent move of hospitals out from accessible city-centre sites to more remote locations, often with wholly inadequate public transport services, so that expensive taxi-travel or use of a private car coupled with very high parking payments to the hospital has become normal. This cost is an unavoidable part of the visit to the hospital, and yet we still talk about free at the point of delivery (and object to any small charge for seeing a GP).

    And also to comment on a point you made a little lower down. Before we consider raising taxes to find extra money for health and social care, should we not look again at the total national budget and ask if we still want to spend so much on playing the Great Power on the world stage, giving so much in aid, and so on, when we are really quite a minor power these days? But if we do have to raise taxes, then the money should be hypothecated, and it should be a simple rise across the board, without the penalty so so-called higher earners that you suggest. (I don't regard senior teachers, police inspectors, or trains drivers as high earners, but rather part of what is now the middle-income group.)
     
  16. paulweaver

    paulweaver Established Member

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    The cost of healthcare is increasing as population ages. Unless we decide to cut off old people's funding (which would make economic sense as they cost the most and contribute the least to today's society), this problem isn't going away. When we're near the top of the "money spent per capita" tables I'll listen to arguments about waste.

    The main reason not to change the NHS in any way is time and again successive governments have shown that they simply make it worse.
     
  17. Arctic Troll

    Arctic Troll Established Member

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    The main issue is the Conservative budget cutting, and not always in the NHS either. Repeated council funding cuts mean that there isn't the social care budget available. This means the vulnerable people don't get the care they need which, in turn, means they can't be discharged from hospital.

    There is no slack anywhere in the system, none whatsoever, and it is purely thanks to the ability and dedication of NHS staff that the whole thing hasn't already blown over.

    We can blame both Labour and the Conservatives, but the simple fact is that the NHS improved between 1997 and 2007, from an extremely dilapidated low in the early 90s. We're back there now already, and it is getting worse.

    I see Theresa May has promised "more mental health funding". This is rich given her government has presided over massive cuts in the last seven years, to the extent that many trusts are not taking on permanent members of staff because they cannot guarantee the funding. In both my wife's current trust and her previous two, the majority of new clinical posts are 12-month temporary contracts and many other roles, such as CPNs, are simply not replaced when they leave, purely because of massive budget cuts and volatility caused by the competitive tendering of the 2012 Health and Social Care Act.

    The NHS is failing, simply because of this government stretching things ever further. All the slack has gone in "efficiency saving". They've cut the fat right down to the bone. It makes me so angry.
     
  18. Howardh

    Howardh Established Member

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    I've never really looked at private cover; is the following right?
    You could insure yourself with (any name) but if you are at home, break a leg, your ambulence is NHS and you are taken to A+E and treated there?
    If so, when does the private part kick in?
     
  19. DynamicSpirit

    DynamicSpirit Established Member

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    Generally speaking, if your (NHS) GP refers you to a specialist/hospital for further treatment or testing, then you can take that referral to your insurer, and so get all treatment and testing for that condition from that point on done privately.
     
  20. ainsworth74

    ainsworth74 Moderator Staff Member Moderator

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    I also believe, further to the above example, if after your broken leg you needed physiotherapy then your private insurance would kick in and get you private treatment rather than NHS treatment (with NHS waiting times).
     
  21. WelshBluebird

    WelshBluebird Established Member

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    Essentially as above. Generally in this country private healthcare is more for longer term treatments etc rather than A&E cases. Probably because of the fact that it is simply not viable to have different private A&E's around the place all competing with each other.
     
  22. PHILIPE

    PHILIPE Established Member

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    The NHS is top-heavy with Managers, many highly paid, but nobody in power seems to or wants to grasp that fact although it is obvious to people on the outside. Staffing levels should be determined at ground level, i.e. doctors, nurses etc. and then determine how many staff are required for the administration side of it.
     
  23. furnessvale

    furnessvale Established Member

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    Another feature of private medicine is you can go into a private hospital for a routine operation. If it goes wrong and there are complications, they pack you into an ambulance and rush you round to the nearest NHS hospital to be sorted out.

    IMO in such cases, yes, use the NHS for its specialities and quality, but the costs should be covered by the private insurance.
     
  24. DynamicSpirit

    DynamicSpirit Established Member

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    What evidence do you have for the bolded assertion? Several people here have said something similar, always without presenting any evidence.

    It seems obvious to me that most people outside the NHS are going to have no detailed knowledge of the internal structure of the NHS, and therefore no way to judge whether or not the management structure is unnecessarily bureaucratic. Maybe it is, maybe it isn't, but without some hard evidence, making assertions either way doesn't seem a very clever thing to do.
     
  25. furnessvale

    furnessvale Established Member

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    If you do not have private insurance, you can also pay out of your own pocket for a specialist consultation, thus jumping the queue.

    Having then discovered you have a treatable condition, you can then slot back into the NHS queue for treatment, but at a much higher level thus avoiding delay.
     
  26. PHILIPE

    PHILIPE Established Member

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    Just compare with the situation in the past
     
  27. DynamicSpirit

    DynamicSpirit Established Member

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    Sorry, but you'd need to elaborate a lot more on that. By itself that sentence doesn't - so far as I can see - tell me anything of significance.
     
  28. Greenback

    Greenback Moderator Staff Member Moderator

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    From my own experiences of working in the NHS in Wales, there are too many roles that are involved with managing the administration side of things. I think that this is at least partly due to the increased bureaucracy that exists in every aspect of modern life. There have to be policies on privacy, freedom of information, data protection, disabilities and all sort of other things.

    Life is certainly not as simple as it was when the NHS was founded, but I don't think the majority of people would say that the things I've listed above are bad things. They do have to be organised and paid for, though, so I can't see how the increase in managers and other admin could have been avoided.

    Similarly, on the medical side there are a lot more clerical based processes now that doctors, nurses and health care assistants must follow. All of this has massively complicated the provision of medical care, and I've no doubt that this has been compounded by additional, and probably unnecessary internal processes.

    Certainly, where I worked there was a real fear of litigation with meant that a lot of processes were introduced in order to try and safeguard against legal action. I'm not convinced that they were all good decisions, as some of the stuff that was brought in would have cost more than the sum total of what it was trying o prevent.
     
  29. PHILIPE

    PHILIPE Established Member

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    I agree with what Greenback has said and now understand further regarding the increased bureaucracy and the reasons behind it. Unfortunately, bureaucracy can increase more bureaucracy.
     
  30. DarloRich

    DarloRich Veteran Member

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    correct - emergency care, including if your elective surgery goes wrong - You will be collected by an NHS ambulance and taken to an NHS hosipital where NHS staff will patch you up

    Outpatient services
    --- old post above --- --- new post below ---
    but the frustrating thing for coal face staff ( at least those i know ) is that the cuts in back room staff have come to those who actually support clinical delivery.

    This means clinical staff are tied up on what are essentially admin tasks for increasing parts of their day. That means less time "on the tools" making people better.
     
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