[Closed] If the NHS is the envy of the world...

because the Tories long since defunded and privatised most dental provision.

You get what you pay for, and that includes the NHS.

Contact your CCG (google it) ask them to find you a dentist who's accepting new NHS patients.

It was sort of, in all but name, privatised / removed from the NHS 10 years ago.

I've got an NHS Dentist, a very good NHS dentist, but they don't take on many NHS patients, I snuck on when my Wife was with them when she was a student.

If you're in pain there's usually an emergency NHS treatment centre available near to you who'll patch you up, if you're not then like a lot of things you just have to wait, or pay a lot for private care.

It is not. The concept is marvellous, free at the point of delivery for everyone. The delivery is second rate and much more money into the same system won"t work. There is a very good reason no one else does universal health care like the UK.

In Surrey Dentistry was effectively privatised 15 years ago, it was virtually impossible to find and nhs dentist who you could register with. GPs now have a 2 week wait for an appointment. My mum suffered in agony for 6 months being unable to walk more than 10m before she paid for a private MRI and the cortizone injection we knew was required (she refused to accept private treatment for that long as she "believed in" the nhs). Took my Dad as long to get his medication changed as the better one with no side effects is 4x the price.

Health care spending needs to rise 30% that's £40bn per anum !

because the Tories long since defunded and privatised most dental provision.

You get what you pay for, and that includes the NHS.

Nope, long before the coalition in 2010

Second yes agreed but its the system which needs changing too

In Surrey Dentistry was effectively privatised 15 years ago

High street dentistry has ALWAYS been private. there has never been a time when all dentists were NHS.

The delivery is second rate

Give us examples of the First Rate that we should aspire to

My better half Mrs Scud, works as a Senior Radiotherapist in a cancer department, she has just about had enough and is doing her Masters in the hope of getting in to lecturing or training, she has gone from working monday-friday with one late shift a week, to multiple late shifts and on call at weekends, and has had no raise in pay for 4 years, this is mostly so that they can meet the targets set by Government.

The trouble, not all sorts of cancer are aggressive as others, but often they find themselves treating non-urgent cases because they have waited a while over cases that are desperately urgent but are higher up the list in timescales. They then have to break themselves keeping their machines and department running 8-8 most days to actually treat those most in need of treatment in and around the ones the Government targets dictates should be treated next.

NHS dentistry is shit tbh, I'm not sure most people think of it as really being part of the NHS in the same way as medical care these days, I certainly don't.

We need to reanimate Anneurin Bevan, there aren't any capable politicians around to sort it out.

Some of the Northern mainland European healthcare systems French, Dutch, German, Swiss - are probably the envy of the world but not the NHS

Guess it depends on who you are. People who can't afford healthcare, probably think "wow, this is amazing".

TBH we just don't spend enough as a country, we don't intervene/educate enough, and social and health aren't joined up enough.

All sortable though

GPs now have a 2 week wait for an appointment. My mum suffered in agony for 6 months being unable to walk more than 10m before she paid for a private MRI and the cortizone injection we knew was required (she refused to accept private treatment for that long as she "believed in" the nhs). Took my Dad as long to get his medication changed as the better one with no side effects is 4x the price.

Find yourself another GP. They're not all that bad, even in Surrey.
I could see mine today if need be. I could speak to him on the phone in ten minutes...

There is a very good reason no one else does universal health care like the UK

There are a few reasons, among them vested interests, venality of politicians, significant private healthcare provider spending on lobbyists and widespread misrepresentation of both the costs and societal benefits of universal healthcare.

Luckily we're working on defunding, demoralising and demonising the NHS so the government can hand work to entities like Virgin Care, who are so selfless that they continue to bid for contracts even though they've been reporting losses in the UK for the past 5 years and therefore paying no UK tax. I can only hope the new £750 million contract they were awarded this month helps turn things round for them and pulls them out of loss.

I always thought there should be a specific NHS tax, I think we have all been thankful when the NHS have been there, but would all like it to improve and it requires more funding, and less Government trying to drive it into the ground for it to improve.

We don't get a breakdown really of our taxes our spent, but i think most would happily see that 0.5% of my income go direct to NHS funding.

Canny say I've ever had a problem getting a dental appointment. Or a doctor's appointment.

Indeed - we don't have that wait at all at the GP surgery I lead...

BUT, yes NHS dentistry is really withering and disappearing in many places. Contact your CCG though.

The NHS was at its best about 5 years ago. It is heading downhill rapidly. Lots of factors, older patients, more expectations, poor quality out-of-hours services, real-terms decreases in funding for NHS and for Social Care ( which is hit by living wage and pensions implications and is preventing discharges from hospitals) etc etc...

Lots of evidence that it really [i]was [/i]pretty good. Espescially for the Money. But what we really need is 30,000 civil servants to deliver Brexit.

Facepalm.

In Surrey Dentistry was effectively privatised 15 years ago,

GPs now have a 2 week wait for an appointment. My mum suffered in agony for 6 month

Anyone know about NHS outsourcing to private hospitals? I've had an appointment cancelled twice with no reason given. Is it a case of private patients taking priority over pre-booked NHS appointments?

We don't get a breakdown really of our taxes our spent, but i think most would happily see that 0.5% of my income go direct to NHS funding

Try 10% and you will be closer (based on cost to each person of £2069 against average salary of £24K - numbers from 2014)

Anyone know about NHS outsourcing to private hospitals? I've had an appointment cancelled twice with no reason given. Is it a case of private patients taking priority over pre-booked NHS appointments

Back to the op. I had a root canal in the NHS a few years ago. The practice said they weren't taking on NHS patients and quoted me four figures (a crown as well). My wife and kids had been taken on as NHS patients though so I managed to get them to take me as NHS patient as well. Whole lot done for about £250 I think.
The whole time I was being treated the dentist was doing his best to upswell me the private treatment- it will look nicer, I'll be able to use more powerful magnifiers to see to the bottom of the root etc.
I soon got moved off his list to another NHS dentist in the practice after that. I didn't ask why.

I've had an appointment cancelled twice with no reason given

you could ask?

I get the impression now that dentistry is about unnecessary cleaning, minor remedial work and referring anything complex onto a specialist. Sounds like you are trying to jump the first stage which is where the money is so no one will be keen.

I'm still convinced I would get a better service from an App than a GP surgery, hook it up to my Garmin account perhaps annual blood tests with the occasional question answered by specialists in their own time.

why can't I find a dentist closer than 40 miles away who can offer less than a 3 week wait to START a root canal treatment?

Because you waited until you needed major treatment before registering with a dentist?

After years of doing exactly this, I registered with a dentist when I didn't have toothache and kept going for regular checkups every six months.

Instead of "repair" I moved to a "maintenance" model.

If I broke a tooth today, I know that, because of that relationship, I could phone my dentist and get treated today or tomorrow.

A Dentist is for life, not just for toothache.

ring 111 nhd irect as it used to be called they will then tell you of a local nhs dentist, worked for me

No this does not happen.
It's because it's winter and the hospitals are full of ill people so no room for planned cases. It happens every year.

Thanks docrobster. I hate to tell you but it's Autumn down South with temperatures well into double figures. 😀

Have just phoned them, consultant cancelled the clinic but they are very busy anyway.

you could ask?

I did nick, see above.

Most of the time when I have to cancel clinics it's because

1. something's broken down. (Had to cancel minor surgery the other day as the heating wouldn't work, and the surgeon could see his breath...)
2. Someone is ill and I haven't got enough staff to replace them
3. Consultant has crashed his car (happens more often than you would have thought...)
4. the room's been double booked.

bumping NHS pts to see private pts? I couldn't spare the time/energy/resource to look through the list, phone the NHS pts, cackle down the phone at them, plus the NHS pay me faster, and I have a contract, and the numbers are always solid. I'd have to be really dumb to piss off the CCG's I work with.

nick - I honestly don't know how it works hence my cynical question. It feels as though I've been passed from pillar to post despite it being a straight-forward need for surgery. They've not been able to give me another date but when they cancelled previously I had to wait a month for a new appointment.

Of course I understand from your examples that things happen, no problem with that but guess I'm just a bit anxious that the op could be cancelled/postponed once I reach that stage. 🙂

Edit: I've no problem with private patients, in fact I was intending to be one but now that I have another health condition to finance it's out of the question.

Nope, long before the coalition in 2010

Second yes agreed but its the system which needs changing too

yes long before 2010, so long before that it was a previous Tory administration!

Ar you advocating the US model which costs more for less and leaves a huge proportion of the population without healthcare?

Or are you proposing a co-pay model, which will cost more to administer as per most of Europe?

Either way NHS funding is low by western standards, and the huge issue is preventative not reactive healthcare. But i guess that is the EU's fault and post brexit everything will be fine?

Give us examples of the First Rate that we should aspire to

My experience in France, Switzerland has been they are far better. Ditto treatment I have had in Singapore and US although there the system is effectively 80% Private (with much lower taxes).

As above we get what we pay for in UK, we don't pay much relative to France and Germany for example and we get second rate service. In France VAT on food is 5% in Germany it's 10%. French and Germans also pay many times higher rates of tax on Gas and Electricity.

[quote=kerley ]We don't get a breakdown really of our taxes our spent, but i think most would happily see that 0.5% of my income go direct to NHS funding
Try 10% and you will be closer (based on cost to each person of £2069 against average salary of £24K - numbers from 2014)

Thank goodness we are no on the German system where it is approximately 15% of your gross income goes direct to your health insurance with a further 7% contribution from your employer.

CG, like I said I couldn't afford to piss off the NHS, it's 99.9% of all the patients I see, plus private work is a ball ache to be honest.

it's going to be one of those things I've listed up there, I've had to cancel some cataract pts. 3 times recently because of admin cock ups mostly. Doesn't help the poor patient, and I understand it can be frustrating, but there's no great conspiracy to make your life harder, it's just the system's stretched to breaking point, and it doesn't take much to throw a spanner in the works I'm afraid.

Hope you get sorted soon.

Thanks docrobster. I hate to tell you but it's Autumn down South with temperatures well into double figures.

Because in the last 10 years the population has increased by at least 6 million. It's bound not to cope it's not like we ever had over capacity in the nhs is it?

nick - thanks for explaining. 8)

scaredy - really? What will it be like come January when the weather invariably changes?

Forgot to mention. NHS winter starts August the first and runs till July 31st. Going by bed occupancy rates anyhow.
Going back to kerley's figures of the average spend per person, that's backed up by similar stats [url= http://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/expenditureonhealthcareintheuk/2015-03-26#total-healthcare-expenditure-in-the-uk ]Here[/url] which also show how when the financial crash happened in 2008, the proportion of healthcare spend in the private sector dropped (as people no longer can afford/have company schemes) thus putting more strain on the NHS. So it really is all the bankers fault. Eh Jamba? 😉

A few numbers.

NHS exec recently service needs 4% extra pa to stand still, so over a Parliamentary term of 5yrs thats 20% or £26bn pa extra by 2020
Previously NHS said they needed £8bn extra pa
Labour promised £2bn, Tories £8bn and now say they will do £10bn

Now my estimation is the service neeeds £40bn now to meet spending of France and Germany

Where will that come from ?

Total VAT raise is £100bn
Total income tax, nat ins, iht is £300bn
Corporation tax £60bn

My view is you need a mix of tax rises across the board and proper integration with private insurance (as per France) so for example pre-existing conditions must be covered. Private companies are kept in check by state insurers (ie a state owned insurer selling "private" cover)

The issue is that politically we do not seem capable of having a sensibke discussion its all scare tactics of "privitsing" the nhs and so ehow Labour are going to "save" the service spending £2bn extra pa whilst Tories are going to destroy it spending £8bn extra

See what @welshfarmer says - we don't spend nearly enough. It would be naive to suggest our service is as good as the Germans when we spend a fraction. Its also ridiculous to suggest our service delivers because it's efficient (have seen that posted here before). We can critise Germany for a few things but efficiency they are good at.

We raise £533bn and NHS spending is £130bn or 24%

UK Taxes raised data below

its all scare tactics of "privitsing" the nhs

i was going to write a long winded reply to the op but as someone mentioned earlier, if you wait until you have a major emergency problem to try and find a dentist, then it's hardly surprising you are going to find it difficult.

Honestly 99% of dentists would love to be able to treat patients under the NHS if the system allowed them to offer the kind of service/ treatments/ high quality materials that are available but guess what. The system is underfunded, chronically so. It prioritises quantity of patients seen rather than quality of treatment provided and having a practice that provides completely nhs treatment (regardless of what you the punter actually perceive is the case) often involves more compromises than the highly intelligent and qualified, caring dentist cares to make.

My view is you need a mix of tax rises across the board

What about uk citizens that live abroad? There's quite a few of them.

Do they use the NHS? Have we got overseas branches now? Cool, I never knew that.

yes effectively they do mitsui - in that under EU rules we have resciprocal arrangements so that UK nationals get free local healthcare in the EU same as EU nationals get free healthcare in the UK

Non eu nationals in the uk have to pay for all except emergency treatment

The issue of health tourism is a non issue made up by "newspapers" - don't believe it.

Still don't let the truth get in the way of good old fashioned xenophobia

Onzadog - where are you?

Surely one of the STW dentists can sort you out sooner? (I reckon same going rate as LBS workshop - choc hobnobs as payment...)

Although there seem to be quite a few 'internet' dentists on here who'd prob have a go in their shed....

Are you calling me xenophobic TJ??

https://fullfact.org/health/health-tourists-how-much-do-they-cost-and-who-pays/

I had a patient living in Italy try to get prescriptions for expensive bowel maintenance stuff (paraplegic) and another who lived and worked in Dubai "willing to take travel back to the uk for appointments " so yes. Rarely, people do.
Because the one you thing the NHS does that no other system does, is cover everyone.
Entitlement to NHS treatment is based on residency, not citizenship. Seems fair. You live here, you get to use it.

Edit

ceepers +1

There is a very strong case for introducing an insurance mix into the healthcare of the UK, in a similar fashion to France, as unfortunately, one of the unforeseen side affects of free at the point of delivery means that no value is placed on the service.

The example of 'I'd pay 0.5% of my salary to help fund it' as above, illustrates my point. Its also why we have a lot of regulars, visiting the GP for minor irritations and fat people.

If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.

If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.

Don't Americans pay for their healthcare and manage to be one of the unhealthiest countries in the world?

Hardly a convincing argument for introducing insurance into the UK health system

Where will that come from ?

Maybe the answer is on the side of a bus.

I took my Dad into hospital on Sunday night as his pacemaker had stopped working, within an hour he'd been triaged, bloods taken, seen by a Dr, Xrayed on this way to the ward. Tuesday morning he had it replaced and then home in the afternoon.

How is that second rate service?

If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.

That's great if you can afford to pay for it but still missing the rather large point that not all health issues are down to personal responsibility.

If you were on minimum wage and you suddenly became ill with something you couldn't have done anything to avoid you may, just may, change your opinion on this one.

slackalice - Member

If we had to pay for our healthcare, we might, just might, start to take some personal responsibility for our health.

Yup, I'm a perfect example- being a type 1 diabetic is potentially financially crushing if you live somewhere without free healthcare or you don't have insurance, or full insurance. Even leaving aside doctor's time my consumables would be something around $7000 per annum in the US. If I lived there, I'd surely have taken greater responsibility and avoided developing this autoimmune disease at 7 years old.

(meanwhile type 2 diabetes is mostly due to lifestyle choices, and is far more common in the USA than it is here)

whilst some of that is true, slackalice makes a good point.

In my experience more of those who receive their treatment free value it less than those who pay for it. They are also more likely to miss appointments wasting valuable clinical time which impacts the cost and availability of service for all and those who get treatment free are frequently more unreasonably demanding in their expectations than those that pay.

Obviously broad strokes and just one area of healthcare but I have seen a lot of patients in the last 20 years!

It depends what the healthcare system is trying to achieve surely?
Maximum benefit for all and minimal variation in health between the haves and have-nots or maximum benefit for those who are deemed deserving and can contribute the most, sod the rest.
I'd suggest reading the health gap by Michael Marmot to understand why systems that provide the most universal coverage produce the best results for the population. We should be looking at Sweden not the US for inspiration. A 15 year old man in the US has less chance of reaching 60 than those of 49 other countries despite the US spending around three times as much on health care as most of its peers.

Anecdotally, sometimes you have good experiences sometimes bad.

My perception was changed when I moved to a different Doctor's Practice. Went from thinking it was all rubbish to all good.

Overall perception is that it is good I guess. And there are lots of worse examples.

I think theres an element of trying to square the circle here.

I'm sure everyone agrees that a universal healthcare system for all that is free at the point of service is an ideal that we would all want. The difficulty is how to pay for it.

The reality is that providing the standard of universal healthcare that everyone expects costs more than the amount of money going in to the system right now (& I agree theres probably a nlot of waste and unnecessary tiers of management at present)

Something has to give, either the funding must go up (significantly) which involves people paying more either through tax or in individual contribution.

Or the level/ breadth of service provided must be cut to match the level of funding available.

Fundamentally (in my view) that's the decision. You pay your money and take your choice as they say.....

Certainly at the moment things aren't working universally because the breadth of what is provided and the standard of the provision that's expected actually costs more than the available money and something has to give. Dentistry is a good small example of this

...meanwhile type 2 diabetes is mostly due to lifestyle choices, and is far more common in the USA than it is here.

While it's pretty well proven that being overweight and lazy increases your risk it's not necessarily true the other way round that having Type 2 means you are overweight and lazy.

I was even asked by my GP why I'd gone for a test as I didn't look like the typical shape, as soon as I explained family history I got the test.

Personally I don't give a sh!t about Type, if I can convince someone to avoid developing it then all the better as it's a sh!t condition regardless of Type.

Type also doesn't dictate how well you look after yourself, plenty of Type 1 people can be a drain on the NHS. Poorly controlled diabetes is just as bad if you're Type 1 or Type 2.

It's bad enough that the media want to blame us for everything without other diabetic people being dicks about it.

yes effectively they do mitsui - in that under EU rules we have resciprocal arrangements so that UK nationals get free local healthcare in the EU same as EU nationals get free healthcare in the UK

Non eu nationals in the uk have to pay for all except emergency treatment

Which is why Spain is getting pissed off with all the elderly Brits retiring to the Costas, they cost far more than the younger (and generally healthy) workers moving to London to work as waiters...

I pay my taxes in Spain and I'd be quite happy to see this reciprocal deal get axed - it won't do the NHS any good but it might help out the Spanish health system.

Fixing healthcare provision in the UK is actually quite easy.

Scrap Trident 2, then invest the money in health education, prevention and outdoor activities for kids, so the next generation grow up stronger, fitter, healthier and better able to look after themselves.
It's not difficult.
Oh, wait, some idiots down south still living in the last century think we NEED Trident.....

The entire cradle to grave cost of Trident over the 40 year or so lifespan is not much more than one year of the NHS budget - which isn't enough as it is.

We could shut down everything, military, police, benefits, pensions, education etc. and it wouldn't be enough to sustainably fund the NHS. That's the problem.

Oh, wait, some idiots down south still living in the last century think we NEED Trident.....

Is that the S of Scotland?

That's the problem with defense. You never know what you are going to NEED. It's only in the last few years we've purged our armed forces from their cold war focussed equipment 20 years after the end of the cold war.

The problem with Nukes is that once you've got rid of them you're not getting them back. They're not like a crate of hand grenades. You need a whole industry maintaining them and once you've lost that you've lost your capability. Trident is cheap. Very cheap compared to other government departments or even other weapon systems. It's a stupid notion to suggest getting rid of it will save you enough funds to make a difference to anything. There is nothing to gain from getting rid of Trident and potentially everything to lose.

We need to save the NHS but in order to do this we need to move the debate on from the current stalemate its been at for as long as I can remember. Constantly blaming Maggie for anything is not doing that.

The problem with Nukes is that once you've got rid of them you're not getting them back.

Good.

Constantly blaming Maggie for [s]anything[/s] everything is not doing that.

Yes but TBF she did privatise the NHS, so it is all her fault and her's alone

Didn't Maggie say there's no such thing as society?
You can't improve health without paying attention to society. So yeah, Maggie and her descendants have a lot to answer for. The Tory party's pursuit of austerity is harmful to health as it is widening health inequity in our society.
Priorities all wrong.

She did but not in the way her detractors suggest

Bloody good advice in the end - those who chose to misunderstand it/misrepresent it ended up the losers. More fool them.

Didn't Maggie say there's no such thing as society?

"I think we've been through a period where too many people have been given to understand that if they have a problem, it's the government's job to cope with it. 'I have a problem, I'll get a grant.' 'I'm homeless, the government must house me.' They're casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It's our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There's no such thing as entitlement, unless someone has first met an obligation."

That statement just shows how someone at the advantaged end of the social gradient views the behaviour of others, without wanting to understand the causes of the causes of the behaviour that they are viewing as irresponsible. Walk a mile in their shoes etc.
It's one thing to talk about rights and responsibilities when you're a successful person in a society that treats you well, it's another thing altogether when you've come from the other end of the spectrum.

I prefer this one from Bobbie Kennedy:

"Too much and for too long, we seemed to have surrendered personal excellence and community values in the mere accumulation of material things. Our Gross National Product, now, is over $800 billion dollars a year, but that Gross National Product - if we judge the United States of America by that - that Gross National Product counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and the jails for the people who break them. It counts the destruction of the redwood and the loss of our natural wonder in chaotic sprawl. It counts napalm and counts nuclear warheads and armored cars for the police to fight the riots in our cities. It counts Whitman's rifle and Speck's knife, and the television programs which glorify violence in order to sell toys to our children. Yet the gross national product does not allow for the health of our children, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country, it measures everything in short, except that which makes life worthwhile. And it can tell us everything about America except why we are proud that we are Americans."

Docrobster, are you saying that any of the points that she made in that paragraph are actually incorrect?

Of course morally it's "correct" to state that there are obligations on individuals. I just think it's missing the bigger picture. As I said, the causes of the causes. "I don't care if you grew up in care because your dad went to prison for killing your mum when she tried to stop him raping your sister, you can Bally well fill out this form whether you learned to read or not..." I, Daniel Blake is not far from the truth.
As a GP trainer one of the tutorials I give to trainees is how to deal with people suffering from what we refer to as "shit life syndrome". When you've seen it a few thousand times you tend to want more from the politicians.
There is plenty of evidence out there that providing good universal social support structures- education, health, policing, and yes even benefits leads to a society with less inequality. But as the Kennedy speech points out, if you are only interested in GDP you will not reap these benefits. E.g. Reliance on the financial sector might be good for the old GDP but it's not good for society.

Which is why Spain is getting pissed off with all the elderly Brits retiring to the Costas, they cost far more than the younger (and generally healthy) workers moving to London to work as waiters...

They are entitled to charge the UK and do, likewise we can charge Spain for the treatment of Spaniard but don't to the same degree.

[url= http://news.sky.com/story/nhs-scandal-as-uk-pays-millions-to-eu-10189381 ]Article here[/url]

No further comment ninfan?

I took my Dad into hospital on Sunday night as his pacemaker had stopped working, within an hour he'd been triaged, bloods taken, seen by a Dr, Xrayed on this way to the ward. Tuesday morning he had it replaced and then home in the afternoon.

How is that second rate service?

Drac the NHS is pretty good at stuff that may kill you. We should expect it to be so. What is very poor at are so many of the other genuine health needs with which it can't cope as imo it has the wrong organisation and a spend which is 30% too low.

TJ health tourism is somewhere between £110m-£280m as per the fullfact link, you may argue in a budget of £130bn that's a small amount but it's not a "non-issue". A French system of a health id card (Carte Vital) or you pay in full would sort most of that pretty quickly.

And how much would it cost to set up and administer a card vital scheme?

I work for the NHS and was sent this today in an email. It's by Roy Lilley, the NHS commentator. Apologies for the long post!

[i]We are where we are.
It matters not how we got here.
What matters is; what happens next.

We can't change the past; the banking crisis, quantitive easing, panicky politicians, austerity economics. We are where we are.

We can't turn back the clock. We are in the NHS, not a Tardis.

How we got here doesn't matter any more. It might matter at the next election... get your own back. But, now, we are where we are.

What matters is; what happens next.

We could be like the King's Fund and make wholly unjustified imputations that the NHS is working on the future in secret.

We could rubbish STPs. We could run around like the Captain Mainwarings at NHS Providers, crying 'doom'.

We could hammer the MPs who voted for austerity politics and we should, at every opportunity.

More productively, we have to focus on what happens next. What could happen next?

The NHS has the mother-of-all-winters and collapses under its own weight. The system could silt-up with yer granny, two-to-a-bed, marooned in hosptial because social care is bankrupt.

The renegade rump of the BMA malcontents could go back on strike, the RCN could ballot for industrial action over nursing assistants, bursaries, no proper pay increment since Florence was a lad in short trousers and GPs could follow through on their threat to resign on-mass.

Or, we could realise; what matters is what we make happen, next.

One thing we do know is; planning for next year and the year after has been moved forward. How we come at this cycle will define us.

We could say there's not enough money. What shall we cut? Or, we could say; how do we look at funding in the round to try and make what we've got, go around.

I see no role for commissioning. I see every point in coalitions of providers, syndicating resources, pooling the cash-in-flow around long-term conditions. I see redesigning patient flows which might sweat the health-pound and take some heat out of the system.

Vertical integration; recognising patient journeys that are seamless might just be better for them and cheaper for us. Social care, primary care, community care, secondary care, out of hours care. Who cares? Patients don't but protective professions do.

We are where we are... but this is not the first time the NHS has been in a tight spot.

In post war, austerity Britain it took political courage to nationalise the health infrastructure, fight the doctor's union and deliver the NHS; taking from the shoulders of working people, the worry and anxiety of accident, illness, maternity and disease.

It defined our nation; became recognised as the best health system in the world, formed the centre piece of global attention for our-Olympics and because of its significance in our national life, became the focus of lies from the chisellers and shysters of Brexit.

In the years since the NHS was born it has been used and manipulated by malevolent MPs, messed about by politicians, kept short of cash, complained about and complimented. It has made a mess, created innovations; achieved some notable firsts and played its part in helping us to live longer and better lives.

None of that happened on its own. It happened because men and women just like you, working in and around the NHS made it happen.

Now it is our turn. We have a crisis to deal with; just as those who went before us recognised they had to solve their problems if there was to be an NHS to hand on.

We have to solve our problems and hand over the NHS, safely, to the next generation.

Sharing solutions. Turning sterile meetings into melting pots of ideas into action, finding out what good looks like and doing it. Being open to better and best practice and demonstrating the NHS isn't just a bottomless pit for the Treasury to throw money into.

We will come through this tough time. We will get better at doing better.

We are where we are; together we can deal with it.[/i]

I agree with much of it but in particular this....

[i]I see no role for commissioning. I see every point in coalitions of providers, syndicating resources, pooling the cash-in-flow around long-term conditions. I see redesigning patient flows which might sweat the health-pound and take some heat out of the system.

Vertical integration; recognising patient journeys that are seamless might just be better for them and cheaper for us. Social care, primary care, community care, secondary care, out of hours care. Who cares? Patients don't but protective professions do.[/i]

The attempt to introduce internal competition and local GP commissioning has been a disaster IMO. Services are so fragmented and I think the only way for the NHS to improve is for these organisational and political barriers to be broken down completely. In my area of Pharmacy the problems are clear. We have pharmacy teams at the acute trust where I used to work, the community trust where I now work, and with the CCGs supporting primary care. None of these teams are fully staffed and people just move between them. It's largely the same pool of staff. We all know each other but we work almost completely separately. There's duplication of roles. The acute get aggrieved becuase they do the bulk of the training and then lose staff to the community or CCGs. The acute and community get aggrieved becuase the CCGs should only commission but in some cases provide services from direct employees and blur the lines. It's a mess and the organisational divisions are the biggest barrier to better outcomes without doubt. We need to be one pan-organisational team, with one central commissioner. We need to co-ordinate, remove duplication, remove the barriers, so we can follow the patients care throughout their treatment pathway. More can can be delivered out of hospitals. Virtual wards in the community. It can all be done and done much better but not without co-ordination of provision and commissioning the way it is now, will simply not allow it. That is what has to change.