Yes.
Literally today my wife has been refused a consultation due to "capacity issues". She'll now attempt the morning internet trial that is a Dr's appointment. She has a Thyroid issue, and on the last two occasions the GP was in shock and manipulated an appointment on the basis my wife is "...at serious risk of a heart attack..." The reason she is calling is her resting HR is up to 90bpm and other symptoms put her levels at risk. A 12hr wait in A&E won't help.
Gov.UK doesn't give a shit about the proles dying as long as they make their money.
<br />I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better. <br /><br />
I agree. You only need to look at how Circle health ran Hinchingbrooke hospital to see how much better things would be.
Or Serco’s butchery of Suffolk Community Services. They under-bid the NHS providers by £22m and then lost £22m trying and failing to run it. And that was a fairly straightforward set of services. They ****ed it so badly that they haven’t bid for a clinical service since. <br /><br />
The answer is not privatisation, it’s acknowledging that in a civilised but aging society we’ve all got to pay a bit more tax.
Really? When people can’t afford to eat or heat their homes, you want to charge them to see a doctor?
Plus adding in a load of admin to charge/collect fees along with shipping out debt-recovery from those who's cheques bounced etc or weren't actually allowed not to pay.
Any healthcare system that 'decides' who will be treated and to what level has a far larger admin overhead than one that doesn't. Most of the NHS admin is related to staffing, buildings, logistics & procurement plus managing the constant Govt changes (waiting lists and the like) - not payables, invoicing, recovery etc etc.
One of the reasons the USA has a healthcare problem is folk don't go until it's really serious, even those with good insurance - check out "healthcare deductible".
The NHS needs root and branch reform before more money is chucked at it. Should still be free at the point of use for those who cannot afford to pay, but surely some sort of health insurance based type system, like in most of Europe (where healthcare outcomes are generally better) would be far preferable to the shitshow we currently have which seems to serve no-one very well?
The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories. I am not excusing the Tories as they are utterly shit too, but just saying that the problems clearly run much deeper than whichever political party is in power.
However, if you believe the young adults of today are as tolerant and robust of aches and pains than our grandparents are then I would suggest you are very much mistaken.
I have no idea but I do know that their grandparents were likely to have asked their GP for a home visit if they were feeling poorly and had a bit of a temperature.
I also know that back in the day their grandparents could pop down to see their GP on a whim, they didn't even need an appointment - they could just turn up any weekday and expect to be seen!
I also remember a time when a GP would sometimes ask you to come back after completing a course of treatment to see how you were. Imagine that, a GP having the time to see someone with a cured medical complaint!
The NHS needs root and branch reform before more money is chucked at it.
Yay, more reform.
some sort of health insurance based type system, like in most of Europe (where healthcare outcomes are generally better)
Where they also spend more of their GDP on healthcare you mean?
Yay, more reform.
It is one thing the various governments have been competent at with regards to the NHS.
Shouting loudly about "sacred cows" and "cant criticise the NHS" and "needs reform" to cover up all of them have been buggering around with it since about the year dot never allowing anything to settle in before they dive into their own personal dream of how to "improve" it.
I kind of think that @Kramer (et al) has summed things up and made much of this thread superfluous… including the stuff I have written below.
As users of the system each of us who expresses an opinion here is doing so on the basis of anecdotal evidence; gained from our experiences and those of people we know. The people we should listen to are those that understand and work in the system.
I can cite examples of things where I think the system didn’t work as it should… but in many cases the outcome would have been the same if things had been done differently.
In the end I feel we need to pay more to the system as a whole and invest in primary care and prevention. At the moment too many NHS users let themselves get unhealthy, moan about tax and then moan about how long an ambulance takes to turn up. On top of that they moan about immigration whilst relying on an immigrant for their healthcare and so on… all the time they are subject to the drip drip gaslighting of the billionaire press and think tanks so they vote for parties who perpetuate the situation we have.
note sure this'll work
https://twitter.com/gloshospitals/status/1742584102694350864
When you have the NHS telling people to stay away you aren't in a good place.
Just don't go stuffing yourself into trees or on rocks for the next week.
I was well looked after as an in patient for 6 weeks after breaking my spine, express delivery through A&E straight into resus.
That was a while ago.
The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.
I wonder why a Tory government might act in a way to make a labour government look worse?
Charge to be seen? I can't even get seen.
My local practice regularly has people calling over 100 times to get through. They don't allow walk in appointments and have a couple of phone operators if you're lucky.
They used to run e-consult which was great, fling in symptoms, bish bash bosh, wait to get triaged and they would contact you for an appointment. Then they made it run during opening hours only. Then they scrapped it entirely.
So if you have an urgent medical issue how do you get seen? Or an issue that's not that urgent but you don't want to take half a day off work to sit on the phone hoping you get through. ****ed if I or anyone else knows, it's an utter shit show.
@kramer I doubt you mean it but you are coming across as quite dismissive and arrogant regarding other countries medical services. If there's one thing I've learned it's that we always have something to learn from our peers and there is always room for improvement.
I had cause to pop into minor injuries last week.
Angle grinder spark in my eye.
Walk in , 4 people waiting. Booked in within a minute.
Fab .
Triage within 5 mins , usual " are you an athlete?" HR around 60 , BP 105/67.
Back out to waiting room for 10mins, then called to see eye specialist.
Just a burn and no debris so ointment for a week and don't be a dickhead with an angle grinder chat.
Out the door within 30 mins. So , in this instance on a sample of 1 , amazing service from the NHS .
Queue was more or less the same when I left ,
The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.
How do you know it’s worse? If it is, how do you know if the reason is due to the Welsh Govt and not other variables? Are any differences significant when corrected for population and other regional variables?
Don’t forget how desperate the current UK govt is to show Labour in Wales as failing. I’m not saying WG or its institutions are perfect and beyond reproach but the current UK govt works hard to shaft the WG whilst making it look like they are trying oh so hard to do the opposite.
Then they made it run during opening hours only. Then they scrapped it entirely.
I know its frustrating, but I know why GPs do this. Web based triage systems are like building an extra lane on the motorway, for a bit they divert people from walk in or the phone, like the extra lane makes traffic move faster for a bit... But soon patients overwhelm them as they think they'll get seen quicker, and they still rely on GPs to triage them, if I divert a GP to look at those, that's a GP who's not seeing patients. If I left our web-system on 24/7 we'd never get through it ever, and we'd be back to square one. It might be boring and a bit beyond scope of the thread, but GPs pay contracts are based around seeing a number of patients each year "at the expense" of other patients on the register who never really come in. I don't know of many GP practices who're are within hat contract ratio anymore, and we haven't been for a while now.
edited to make more sense and typos.
@kramerI doubt you mean it but you are coming across as quite dismissive and arrogant regarding other countries medical services. If there’s one thing I’ve learned it’s that we always have something to learn from our peers and there is always room for improvement.
I refer you back to my point about "something was done" therefore people judging it as being good when in fact it isn't.
Overtreatment and over diagnosis is a massive issue in health care systems, especially insurance based ones.
The NHS isn't brilliant, but most other countries that we're comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.
Something to consider, when the system is short of frontline staff, and we're not talking one or two, but 10's thousands there will be an impact. To train a nurse is going to take 5+ years, a doctor a decade. Throw in an aging population, decades of underfunding, not exactly great conditions, staffing is going to be an ongoing issue.
Privatisation isn't going to fix anything when the staff don't exist. Remember the farce of the nightingale photo ops. no staff to populate the buildings.
Spending money on consolations and reorganisations is easy, getting staff when you tell all the foreigners to f*** off less so.
To see how well privatisation works, take a look at dentistry.
I work for the NHS (Mental Health, and I'm a MSc Student Dietitian, so partly funded via the NHS) what I see from a work point of view and from the other side of the coin is completely different, mental health, bloated mess, no discharges, bed blocking, huge buildings and wards for 45 patients, managers for managers, 90% of discharges into private residential, at huge cost
however, on a couple of occasions in the last month I've been on the other side of the coin
1st, had a kid, waters went a month early, 5 day stay for baby mama, discharged with a plan, went back in, augmented, baby safe, flawless, couldn't ask for more (ok maybe a bit quicker from you're getting discharged, to you can go, but it is what it is), baby readmitted 8 days later, phone call at 8pm after blood results were back for 24 hours due to jaundice and feeding issues, bit of a staffing issues and access to a machine but it was 9pm new years day, they were understaffed, he wasn't a priority
2nd, friends partner hung himself, arse end of nowhere in Lincolnshire, took me 40 minutes to get there, by the time we had, there was already 2x police, and an ambulance, he'd been resused and worked on for a good couple of hours before the ambulance left for the hospital, unfortunately he died a couple of days later having never regained consciousness however, you literally couldn't have asked for more
lots of other stuff like missed appointments, and other stuff, but when you need it sometimes, it's still good
How do you know it’s worse? If it is, how do you know if the reason is due to the Welsh Govt and not other variables? Are any differences significant when corrected for population and other regional variables?
I'm not sure of the politics, but my brother has been waiting 2.5 years to see a dermatologist in Wales for a fairly unpleasant and progressive skin disorder. Still no joy to see anyone despite his GP trying to expedite his referral - twice. His next door neighbour has just had both knees done as she was getting to the stage where she was unable to go to work with it. She paid and went private in the end as the wait for her operations on the Welsh NHS was 5 years. 5 years - just let that sink in for someone of working age who is struggling to stay mobile.
So pretty ****ing sh*t I would say.
Yeah Scotland and Northern Ireland aren’t great either.
@mrmo dentistry, well that’s a whole separate thread but the death of nhs dentistry is already a foregone conclusion & broadly speaking it’s the result of massive under investment going back to the last labour government and includes both parties ignoring the profession telling them what was going to happen about 20 years ago.
The dentists themselves would tell you that privatisation has not massively increased incomes compared to the heyday of the nhs but it has eased workloads to under burnout levels and has allowed clinicians to practice the dentistry they were taught to do not some speeded up bargain basement version that doesn’t really help the patient or the dentist in the long run. So it has worked just not on a whole population level.
ever wonder why dentists were in the top three of professions that committed suicide?
anyway carry on.
@ceepers I think it started even longer than 20 years ago. I remember my father stopping being an NHS dentist ~35 years ago because they brought in a new contract that made it (in his eyes) unviable to continue as a dentist.
@kramer yep that was the first nail for sure and it’s only got worse.
Back then it became unviable to practice really high standard dentistry. Now it’s pretty much unviable no matter how many corners you are prepared to cut & nhs dentistry only really exists wheee a business has a private side to subsidise it!
as a business owner I am increasingly wondering why my personal finances are subsidising a health service provision that the government won’t fund properly and yet we and many others continue do So as far as we can because it’s “the right thing to do” as healthcare professionals
I’m not sure of the politics, but my brother has been waiting 2.5 years to see a dermatologist in Wales for a fairly unpleasant and progressive skin disorder. Still no joy to see anyone despite his GP trying to expedite his referral – twice. His next door neighbour has just had both knees done as she was getting to the stage where she was unable to go to work with it. She paid and went private in the end as the wait for her operations on the Welsh NHS was 5 years. 5 years – just let that sink in for someone of working age who is struggling to stay mobile.
So pretty ****ing sh*t I would say.<br /><br /><br />
That sounds crap and indefensible… but you can find similar counter claims the other way. A friend who went private in England for an op that another friend had done on the NHS in no time in Wales. Other people I know who have all kinds of issues in Cumbria with geriatric care that I haven’t had here with my folks. My brother was an audiologist in England and his service got privatised… he came home. Wales does have some significant problems I know. But my point is
1. Our observations are anecdotal and not the whole picture. <br />2. If Wales is worse then it isn’t an order of magnitude worse; it’s in the same ballpark.<br />3. That Wales is screwed over by the current government; they have the magic money tree but WG doesn’t. It simply hasn’t got a tree to shake. <br />4. Wales lacks the economy of scale in all kinds of public sector services that England relies on. <br /><br />But again this is kind of by the by. The issues stem from a Govt and its support systems/influencers (press, think tanks, the USA corporate lobbyists, the Brexit lobby) that have not looked after us and our public services.
The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.<br /><br />
Exactly… yet the Govt(s) and wannabe govt as well as the likes of Kelvin MacKenzie will have you believe the opposite. The comments you hear from them on issues such as NHS pay are reprehensible to put it politely.
@nickc but now nobody can be seen at all unless they have the spare time to phone 100odd times before they get through.
I appreciate your explanation, I just think there's a sensible middle ground somewhere. Have the e-consult for those that can use it and leave the phones free for those who can't or urgently need an appointment.
The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.
@kramer That makes more sense, cheers.
Or you could just have the right number of gps for the population they are expected to see.
But there’s a crisis in recruiting GP’s and more leaving the country / taking early retirement than are being replaced.
which is back to pay & conditions and lack of investment in primary care instead of secondary services as mentioned above...
they have the magic money tree
Don't they just. Apparently even though we are now the 6th biggest economy in the world, we can't afford to fund a decent level of healthcare for our population, or decent social care for those who need it most. Or train sufficient numbers of doctors or nurses or ambulance drivers.
But there is always plenty enough money to bail out the bankers, fight or fund wars in foreign countries, give it to our mates for dodgy PPE, fritter it away on a useless HS2 vanity project, or in Wales case, change all the 30mph road signs to 20mph at a cost of £32 million.
Did you know our response to Covid cost somewhere between £310 and £410 billion pounds. That is nearly three times the entire annual budget of the NHS!
Public spending during the Covid-19 pandemic
And what exactly did we get for that money and where has it all gone? Ask yourself are we healthier now as a nation after all of that spending? Have our NHS waiting lists gone down? Did we save loads of lives and was it all worth it? Or have peoples lives got worse?
It is our hard earned money that the Tories have pissed up the wall (and given to their mates). Money that we will all be paying back for years and at the expense of the vital services we rely on. During the last financial year, the government spent £111 billion on debt interest alone. That's more than the entire annual spend on education! Practically criminal levels of mis-management from our government.
And what have Labour done to oppose any of the above? What have they done to hold the Tories feet to the fire?
**** all, that's what!
Meanwhile, just another £1.1 billion of taxpayers money down the drain by June.
No biggie though, eh?
Yeah but
Lifting the lifetime cap on pension payments so alot of GPs who were effectively working for free due to punitive tax regulations might be return or not leave reducing natural wastage over time
@singletrackmind that’s definitely going to help a small amount with hospital consultants but it’s not a big factor for GP’s using medics I know as a guide.
seems to be more about volume of workload / stress and General practice (especially in rural areas ) seeming less glamorous to the type of person now qualifying.
others can perhaps comment more learnedly
EDIT: As i understand it, the pension thing is about making it more attractive to do "extra" hours - not everyone is going to be willing or able to do "overtime" longterm
fwiw, i know quite a few GP's. They all work very hard, have lots of work stress. One just moved himself and his Dr wife to New Zwealand for a better work / life balance. Another has been telling me about the looming recruitment crisis for the whole time i've known him ( 10 years).
The fundamental problem with NHS is the lack of understanding or acceptance of just how expensive running a comprehensive health system is.
Small real terms increases doesn't come close to meeting the growth in demand, or the rate of growth in cost of drug/treatment/technology advances.
The same for all public services. The fundamental problem is not starting with the question about how much does it cost to have a service at the level we really want (staff, drugs, equipment, estate) and then deciding how to shape society to afford it. Honesty about the trade off between tax and public services.
The £1.5billion that Labour have promised above whatever's the Tories have said - to address waiting times - I reckon is maybe 10% of what is needed as a starter - and I do have a lot of experience in this area at a national level.
It's depressing really, and the NHS is in a better position than most public services. Many local Authorities are on the verge of collapse, justice/prison service is dysfunctional, care services problems are so difficult nobody even talks about it etc etc
Meanwhile, just another £1.1 billion of taxpayers money down the drain by June.
"Paxlovid – an antiviral developed by Pfizer and designed to be used shortly after people test positive for Covid-19 – was approved across Britain in 2021 after trial results found it reduced the risk of severe illness by almost 90 per cent."
Presumably there are at risk people with access to this, who are also testing to catch things early enough to then be given the drug if needed? Is this a success (those people aren't testing positive, so don't need the drug) or a failure (not enough people who could benefit have been given access to testing and the drug)?
The same for all public services. The fundamental problem is not starting with the question about how much does it cost to have a service at the level we really want (staff, drugs, equipment, estate) and then deciding how to shape society to afford it. Honesty about the trade off between tax and public services.
The problem currently is that you can't fix the NHS without fixing the care system and council budgets. Everything along the pathway, from pre-hospital prevention/education, through to primary care, diagnostics, acute treatment and post-discharge care is dysfunctional, creaking, or virtually non-existent.
Labour in the late 90s was the last government to attempt the semblance of a plan on how to start improving things, starting with stuff like SureStart to help set a foundation of better health in infancy, and then investing to reduce waiting times for diagnosis and treatment, and moves towards a National Care Service. But the scale of the problem was vast, and even the substantial funding provided then was not able to achieve all these aims. And obviously, the government which followed ended up reversing much of this or just starved it of resources.
I have not seen anything from the current Labour Party with the same level of ambition, but then economically we are hamstrung.
And what exactly did we get for that money and where has it all gone? Ask yourself are we healthier now as a nation after all of that spending? Have our NHS waiting lists gone down? Did we save loads of lives and was it all worth it? Or have peoples lives got worse?
It is our hard earned money that the Tories have pissed up the wall (and given to their mates). Money that we will all be paying back for years and at the expense of the vital services we rely on. During the last financial year, the government spent £111 billion on debt interest alone. That’s more than the entire annual spend on education! Practically criminal levels of mis-management from our government.
I'm a bit confused. Are you complaining because labour are not challenging the tory's narrative that there is not enough money for public services, or are you complaining because our govt borrows too much? You're right that the current govt gives public money to their mates for very little return. That's what the tories always do, it's their raison d'etre. You're wrong though that borrowing or the national debt is a problem. We should be 'borrowing'* and spending much, much more than we currently are to fund public services. Where labour are getting it wrong is accepting the tory narrative that the country doesn't have the money to fund public services. It does many times over, but it needs politicians willing to speak the truth and challenge the myth of austerity.
*It doesn't need borrowing or taxes, the govt can just spend what it wants.
but then economically we are hamstrung.
Are we? Please explain.
It's all linked (as has been said)..NHS health care...social care..schooling etc etc
In our area (West-ish Sussex) there's been reviews done (by teams that sort of transcend social/health care) on the impact that stopping food economics in school will have.
Not today, not tomorrow, but in a generation's time. Yes, money will be saved today, but the impact on the health of a nation will be huge. Mainly from poorer diet education leading to worse health leading to needing more health input.
The main issues really are managing the frail and ageing population properly (I'm sure i've raised this before..).
We've more 85+ years olds than ever. And the average age will continue to grow. And we simply can't treat them the same as the 'average 55 year old' - not because of the desire to discriminate, or save money by "not treating old people", but because they don't respond the same.
Peopls simply don't live forever, and EVERYONE dies. Unfortunately, death is still seen as a failure..as if something has gone wrong.
The mindset of the natin needs to be changed, so that accepting that a 96 year old, bed bound patient needing 100% of their care to be met by carers, SHOULD be allowed to die in their nursning home.. and NOT ring 999 when they "become a bit more drowsy"..
because 999 will take them to hospital, and hospital will "think they need to do something"... when really they jsut need care and family around them.
I feel massively that we (i'll say it) mistreat our frail and elderly, by forcing them to endure medical treatments and such, purely because we're (family, doctors, nursing homes) too stubborn to let people die nicely..
DrP
too stubborn to let people die nicely..
Oh absolutely. It is human nature to 'fight against the dying of the light', but we need to embrace the concept of a 'good death' - and devote our efforts to improving the quality of those last weeks or months, rather than just desperately trying to add a couple more to the tally.
But again, this is partly due to failures across the NHS and care systems. I have a relative who may be approaching this shortly, and the absence of any communication between the various clinical and care teams, when they should be moving to set a decent palliative plan in place, is very frustrating.
A member of our family recently popped off at 96. He'd had a week in a care home for respite but in doing so he lost his ability to walk around the house. He had a 'good death' though and aged disgracefully, regular trips to the pub and surprising stuff on his computer, the old dog.
The mindset of the natin needs to be changed,
And not just with attitudes to dying, but with their attitudes to taking responsibility about their own health. Generation X is getting on to being wildly unhealthy. They may not smoke as much as their parents did, but their diets and lifestyles are way poorer, and their children are now leaving school obese. Its GPs who're shouldering the burden of that.
Now I get that its a wider societal issue and as a nation we have to have a proper conversation about the "food" that we have surrounded ourselves with, but we have a major political party who think that any sort of intervention is "The Nanny State" and a current health minister (Victoria Atkins) who's married to a CEO of one of the worlds largest sugar manufacturer [apparently that's not a conflict of interest] , and her solution is diet advice, which we know doesn't work.
Quite agree about intervention when someone is at end of life. Really should have stopped intervention at least twice on MIL - final time this ended up with her 'hanging on' for another week because a relative and staff decided to intervene as she arrived in hospital, rather than accepting the inevitable (which family decided 24 hours later).
Prior to that was probably a year before - again at death's door, too much intervention and she was 'around' another year. She didn't want to be.
The system is broken with the bed blocking - we do need more care units for elderly, rather than them filling A&E and high intensity wards, just because we can't get them out without a decent care package'.
I literally heard someone in the office mention an elderly relative wouldn't take paracetamol to manage a high temperature, because this person preferred to be in hospital being looked after !
