[Closed] It appears I have misunderstood Jeremy Hunt all along....

do you think the NHS needs more money

I'm not saying Jeremy Hunt is doing a good job, far from it, but I doubt anyone could do a good job (according to the majority) given the circumstances.

evil tory ****

If the cap fits.

Because its basically a tax on either being sick or having sick family members. And unless you live in a city, a car may be the only practical way to get there. Bit harsh to ask parents for £3 a time to visit a sick child twice a day.
But I agree, I'd rather spend the money on actual care than free car parking.

Impressive doublethink! But that's probably for another thread, and I do empathise - society constantly tells you to have a car, then penalises you at every opportunity...

Tax the citizens a vast amount more/try communism

We live in a low tax - low spend economy in the UK. We could easily raise more tax to pay for the NHS. It's just politically unpalatable.

Alternatively, scrap Trident, or try communism (the latter hasn't been tried properly IMHO yet!).

We live in a low tax - low spend economy in the UK.

We look to be well towards the top end however you calculate it:

https://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_to_GDP_ratio

Alternatively, scrap Trident

Wouldn't really scratch the surface.
Did a bit of googling on that the other day.
We are currently spending ~7.5%GDP on NHS.
The estimated lifetime cost of Trident renewal varies depending on which source you look at, but looks to be an annual cost of ~0.2%GDP.
Even the fairly modest LD pledge for 1% Income tax rise for NHS would raise more than scrapping Trident.

Hunt's a remainer.

I doubt it, particularly. He votes with the party line. When the party line was Remain, that's what he went go for. When the party position shifted, he fell into line. I've had a few bland pro-forma letters from him (South West Surrey - he's my MP. Country-ish. Certainly not inner city) about The Will Of The People in response to my concerns about Brexit.

fifeandy and ninfan have a point, we do need to have a sit down and a think about what we fund and how we fund it. But defunding the existing system to point of collapse is only polarising the parties involved and making that debate impossible. (compare your response to ninfan's arguments vs fifeandy's - you need to take people with you)

The thing that I find most repugnant is how the current course is set to line his pockets and those of his family and friends. Makes it very, very hard to argue that the current direction is motivated by very much else than self interest.

http://hat4uk.wordpress.com/2012/10/10/revealed-at-last-the-hunt-bottomley-link/

Edit: That story is blatently written from a certain point of view. Tone down the turn of phrase as much as you feel like, but the facts remain.

I don't think anyone actually wants standards to go down,

A government that sees the standard drop and doesn't do enough to stop that happening while giving money away to the rich doesn't give the impression they don't want them to go down does it?

We look to be well towards the top end however you calculate it:

https://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_to_GDP_ratio
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34.4%, the lowest* out of western Europe?

*just scanning the list, I may have missed something.

Free boob jobs and sex changes for all!

You really are a classy piece of work, aren't you.

You do realise - you [i]surely[/i] must realise, even over on Planet Ninfan where you appear to be doggedly in favour of us going back to the halcyon days of 1940 - that there is a fundamental difference between "want" and "need."

People don't get these operations on the NHS simply because they "want" them. Someone who is transgender doesn't wake up one day, think "yeah, life's great but think I quite fancy a penis" and sign themselves up for a free slapadicktomy. Similarly, I doubt Katie Price's bresticles were an NHS job. Conversely a friend of mine had breast reduction surgery a little while ago because walking round with Right Said Fred up her jumper for twenty years was causing severe back issues.

I can only conclude that you're either massively ignorant of the world around you outside of your own little bubble, or you have an underactive empathy gland and really don't give a tuppeny shite about anyone but yourself. You might want to give that some thought, though I suspect you simply won't care.

34.4%, the lowest* out of western Europe? *just scanning the list, I may have missed something.

Indeed, you've missed the countries that aren't in Western Europe.

The difficulty being those who have empathy (which seems a bit of nature and nurture) should be showing empathy to those that don't (the tory) but we struggle with that for some reason....

that there is a fundamental difference between "want" and "need."

Agreed

You seem to have kicked off with a knee jerk reaction to what you [u]think[/u] I said, rather than what I [u]actually[/u] said - in fact it seems to be a bit of a repeated pattern with you Cougar

As I said on the previous page:

[i]Did I suggest no boob Jobs? No, of course I didn't - that would be just as much of a ridiculous extreme as boob jobs for anyone who wanted them.
But where does the line lie between those two extremes in order to produce this mystical "properly funded NHS" that people are speaking of?
Same goes for expensive cancer therapy that might buy an 80 year old a few extra months, versus the same in someone younger - where does the line lie that allows us to signify the NHS being properly funded?[/i]

What you appear to have done is failed to differentiate the very principle of [u]want[/u] and [u]need[/u] that you slapped around yourself. Where would you draw the line between the two? At what point, precisely, does want become need?

Now, theres lots of massively emotive issues within the NHS where the same principles apply, see IVF/Fertility treatment as an example.

are kids a want or a need?

Where do you draw the line?

as someone who works in the nhs its always interesting to read views from other people.

There is a lot of interesting chat amongst people I work with about where the line is and that the NHS works with a lot of companies who are in it for the money/profit and so if the nhs had more money would that mean they wanted more money to?
There is certainly a lot of interesting chat about the procedures that some don't deem worthy of nhs money.

Even given my own not insignificant experience of the nhs I would stuggle to say how much is enough funding.
I guess it would be the point where I know treatments are based on clinical need alone.

coming back to one of the points earlier about the A&E nurse at 1am, dealing with the drunk... from my experience of having those chats, the normal conversation is it would maybe better to be working at aldi or lidl overnight where the money is prob not that different but you don't get people endangering your life and showing you no respect.

I think the biggest threat to the nhs is the talent that is leaving, I know of many outstanding doctors and nurses who are walking due to the lack of being valued - and that is a mixture of financial and holistically.

We look to be well towards the top end however you calculate it

True, it's a shame how little humanity values society.

Wouldn't really scratch the surface.

Shame, would've killed two birds with one stone.

The difficulty being those who have empathy (which seems a bit of nature and nurture) should be showing empathy to those that don't (the tory) but we struggle with that for some reason....

You know what, you're right! I don't really understand why either. I think it may have something to do with them having the same or greater intelligence, education and opportunities than me, but still not recognising that. Frustration is the natural enemy of empathy I reckon.

The problem ninfan is you've made a whole load of assumptions to get to the point where the line needs redrawing in order to properly fund the NHS.

Many of which I would refute.

Then the other opposite point is that if you accept this drift into private healthcare, where is the line drawn then? It will be based on what you think you might need in the future - i.e. people will gamble, or people will simply be mistaken and it will undoubtedly cost more than they were paying in tax for the vast majority of people.

Sammysquid, great post, very interesting

There is certainly a lot of interesting chat about the procedures that some don't deem worthy of nhs money.

I hope you will take my point that its not necessarily an issue of 'deem worthy' its more a case of, as I keep saying, where do you draw that very difficult line, as the 'controversial' procedures are just a more visible/easier example of the underlying issue - e.g. the same applies to cancer treatment in kids, old people, all sorts of situations.

Even given my own not insignificant experience of the nhs I would stuggle to say how much is enough funding.
I guess it would be the point where I know treatments are based on clinical need alone.

That seems like a very good measure, but as mentioned, where does that sit with things like infertility (especially where tied in to obesity etc)

@Alexsimon

You've made a whole load of assumptions to get to the point where the line needs redrawing in order to properly fund the NHS.

What assumptions have I made? its other people that are saying that the the NHS needs to be 'properly funded' - I'm just trying to ask what the hell they mean by that, what is their measure of 'properly funded' because 'need' is almost endless - the NHS looks after and treats far more conditions now, in a far more extensive and impressive fashion than it did in the 1950's and 60's - but where does it stop growing? particularly with the endless medicalisation of issues, as many argue things like Female sexual dysfunction are.

I met mr hunt once, he was nice, he shook my hand and told me that I was doing "vital, essential, important work". That's why I quit the CQC, if Hunt thinks you're doing a good job, you've clearly become something quite monstrous, and that monster goes against the values and ideals that I thought were my core. I do miss getting paid loads and doing nothing though.

You seem to have kicked off with a knee jerk reaction to what you think I said, rather than what I actually said

I know what you said, really my objection was to you lumping in gender reassignment in with your list of people who want cosmetic surgery. They're not even remotely the same thing and that fact that you appear to think they are is offensive.

Did I suggest no boob Jobs? No, of course I didn't - that would be just as much of a ridiculous extreme as boob jobs for anyone who wanted them.

So... given that neither of these things are the current state of affairs, what exactly is your point?

People wanting / needing this sort of surgery will go through countless processes to ascertain their suitability and decide whether an operation is the appropriate next course of action. I've never been through either operation as I'm quite happy with both my breasts and my penis, but every assessment I've ever seen for anything in the NHS is a series of criteria with a score. At the end of the list a total is calculated and that result recommends a course of action. So in answer to your question of how / where we draw the line, that's exactly what we already do.

I do agree with you on your other point though, I expect that like many public organisations the NHS does need to spend money more effectively. Blindly throwing money at the problem isn't necessarily the answer (though throwing less certainly isn't). But it's easy to say "do more with less" and rather more tricksy to put into practice (or we'd all be doing it). Is the government providing any resources to teach them how to do that or is it just another empty soundbite? Perhaps in the short term we need to give them consultants who can look at their processes and try and streamline everything.

Yet, we're still (apparently) spending less on the NHS than in comparison to other western developed countries.

This is true, but the US invests more than anyone per capita in health care and they're 100% private insurance based system which nobody wants, so this is not a measure to look at in isolation or the answer would be a private insurance based system. Looking closer to home with systems like the French NHS and into Europe, they have significantly more private involvement than we do in our NHS. If you involve private companies and if you properly govern them and incentivise them they they will provide additional investment.

Its not just about more money, its about how its spent and all the other health systems in the world have a completely different approach than the NHS to patient care. The NHS is simply not fit for purpose. It rolls on from one crisis to the other - it has for all my life as far as I can remember - it has never been in a 'good' place.

Why is it that as a nation we seem to be completely incapable of having an open and honest discussion about the NHS and how we might better run it in a sustainable manner for the benefit for all. We don't have to re-invent the wheel here, we can just take a survey of how other nations who do it better than us do it. It's not rocket science. It would be an irresponsible government who would just keep plugging more and more money blindly into a system that doesn't work in a sustainable way.

You seem to have kicked off with a knee jerk reaction to what you think I said, rather than what I actually said - in fact it seems to be a bit of a repeated pattern with you Cougar

Might be a reaction to how you present your arguments/statements, ninfan.

If the style of your communication continually provokes misunderstanding, maybe change your approach?

But comments like "free boob jobs for all" suggest you're quite happy to provoke unnecessary friction, when you're very aware that a more nuanced approach would lead to productive exchange of ideas.

People wanting / needing this sort of surgery will go through countless processes to ascertain their suitability and decide whether an operation is the appropriate next course of action. I've never been through either operation as I'm quite happy with both my breasts and my penis, but every assessment I've ever seen for anything in the NHS is a series of criteria with a score. At the end of the list a total is calculated and that result recommends a course of action. So in answer to your question of how / where we draw the line, that's exactly what we already do.

You've just restated the problem though. Currently we draw a line. If you're one side of the line, you get the thing; if you're the other side, you don't. Is the line in the right place?

There is actually a grain of truth to a single aspect of the usual Ninfan rant.

We have seen again & again that previous generations really did cherish the NHS and would rather almost die at home rather than "trouble the nice Doctor" or god forbid ring an ambulance.

NHS is a pretty much taken for granted by generation snowflake innit..

Then the other opposite point is that if you accept this drift into private healthcare, where is the line drawn then? It will be based on what you think you might need in the future - i.e. people will gamble, or people will simply be mistaken.

Someone is already gambling on our behalf. Private healthcare allows people to make their own gamble.

Personally, so far, I've pretty happy with the gamble the NHS makes on my behalf but you can't escape from the large numbers of people in threads like these who are not remotely happy with it.

Is the line in the right place?

I've no idea. I'd assume (hopefully?) that the systems have been designed by people who know far more about healthcare than you or I do. Maybe it needs reviewing? But then we're back to having the funds and resources to to that review.

Maybe it needs reviewing?

That's what he said. Except he was an arse about it.

But then we're back to having the funds and resources to to that review.

Worth spending a little to work out whether you're spending it in the right place, though? Just budget control.

You've just restated the problem though. Currently we draw a line. If you're one side of the line, you get the thing; if you're the other side, you don't. Is the line in the right place?

Or you could use the current line - are we funding/handling in correct way to meet the current line?

As sammysquid said

"I guess it would be the point where I know treatments are based on clinical need alone."

again it continues to make you think and it makes you reflect on your own views.

ninfan - Member

I hope you will take my point that its not necessarily an issue of 'deem worthy' its more a case of, as I keep saying, where do you draw that very difficult line, as the 'controversial' procedures are just a more visible/easier example of the underlying issue - e.g. the same applies to cancer treatment in kids, old people, all sorts of situations.

Well for some this has already been decided - there is a lot of input that goes into the idea of a Qaly, and if a procedure is worth it and this is true of where there is a lot of money in the pot and where there it little. This is the grand scale and then people decide where on this list things fit, and sensibly there is room for some discretion.
"boob jobs" are on the whole not allowed but specific cases can be made and are made and I think people cleverer than me try and come up with sensible approaches.

ninfan - Member

That seems like a very good measure, but as mentioned, where does that sit with things like infertility (especially where tied in to obesity etc).

I'm sure the introduction of extra criteria which leads to a longer time before operation has been assessed and some people are aware it might affect the total spend on such operations.....

"I guess it would be the point where I know treatments are based on clinical need alone."

clinical need, “the input needed to reduce risk and achieve predicted outcomes, ”

Pretty subjective, which is why it needs to be reduced to a points scoring system.

but sammysquid is claiming there's a point at which he will "know" (KNOW!) that all treatments delivered in the UK conform to his (or whose?) idea of clinical need.

Edit: sorry sammy, only saw your comment out of context - I think we're on the same page.

I suppose some examples to encourage some more thoughts?
the nhs initially turned down the drugs to help breast cancer in terminally ill patients - this has been changed due to a deal between the nhs and the drug company - if they wouldn't have turned it down initially they would have paid more...
and yes comparing tens of thousands to give a patient an extra 3 months of life with tens of thousands to recruit another mental health team is really fascinating.

I think you can argue either way.

The one thing I think we have to be careful of is that I truly do think the nhs is not destined to be with us for much longer - especially in its current form. And then it will be private insurance companies who make these decisions....

nedrapier - Member

Pretty subjective, which is why it needs to be reduced to a points scoring system.

but sammysquid is claiming there's a point at which he will "know" (KNOW!) that all treatments delivered in the UK conform to his (or whose?) idea of clinical need.

Edit: sorry sammy, only saw your comment out of context - I think we're on the same page.

so like I say I work within the health service. An example would be- there has been previous history of post codes lotteries, and I am saying I would want to be able to treat my patient based on their clinical need not on their post code. 🙂

sorry one last point...

"Pretty subjective, which is why it needs to be reduced to a points scoring system."

if you were really jolly unwell, would you prefer someone to be looking at you as a set of numbers? or would you prefer them to be looking at you as a person? would you get points for family? or kids? for pets? for the job you do? for the amount you earn? point systems guide yes, but imagine being told that you can't have a treatment as you don't have enough points - if only you were 1 year younger or that you had got married instead of just living together....

Free boob jobs and sex changes for all!

Free at the point of delivery!

It's as it should be, the longer you live the more you'll have paid in and just when you get to the age where you need breast reduction surgery - bingo! there it will be on the NHS. Vote ninfan. I certainly will.

Personally, so far, I've pretty happy with the gamble the NHS makes on my behalf but you can't escape from the large numbers of people in threads like these who are not remotely happy with it.

Quite. Those whose only concern is money.

sammy, agreed on all your points, it is fascinating, and an impossible task trying to decide who's worth spending money on, and what problems are worth treating.

now I see your point about clinical need. Wife and I moved house nearly 3 years ago and ended up on an IVF path, some if it funded by the NHS trust. If we'd bought the other house we were looking at, less than half a mile away, we'd have got nothing.

Ned, I think its great to talk about, I am not always right and I know that! its always good to talk about things. The system isn't perfect and I have certainly seen it abused.

Like I say I think this nhs is not going to be something we pass down to our children.

personally I think there is a lot of stuff the NHS funds that it shouldn't. IVF being one. Some hugely expensive and not very useful cancer drugs is another - but when you are dying and somone says this pill could help you its natural people fight for it and the right wing press will pick up on the fight to further its aims of kiulling the NHS. £50 000 for drugs to give you another couple of months to die in or a full time MH professional for a year. the other thing is futile treatment.

IVF being one

Not going to say you're wrong. Current NICE guidelines recommend that 3 cycles are funded, with a justified rationale. No problem with anyone disagreeing with it, it's on the list of things to discuss cost/benefit analysis, along with everything else.

Some trusts follow current recommendations, some don't.

Unfortunately for ninfan and his, erm, laser-like analyses, he has doomed himself from here to the end of the world to being known as...

The guy with a tiny dick.

Well, its hardly news, but, see, you fell into the same trap as Cougar - you reacted to what you think I said rather than what I actually said.

I just said I'd like a larger one

N+1 and all that

I still don't think the NHS would regard it as a [u]need[/u] rather than a [u]want[/u] though

you reacted to what you think I said rather than what I actually said.

There's that problem again. Did Humpty Dumpty have a tiny dick as well?

if you were really jolly unwell, would you prefer someone to be looking at you as a set of numbers? or would you prefer them to be looking at you as a person? would you get points for family? or kids? for pets? for the job you do? for the amount you earn? point systems guide yes, but imagine being told that you can't have a treatment as you don't have enough points - if only you were 1 year younger or that you had got married instead of just living together....

its that difficult thing though isn't it, everyone is a worthy case in their own special way - and placing the responsibility of rationing on a doctor without objective/numbers criteria puts them in the almost impossible position of being the person who has to say 'no'.

ninfan - Member
Unfortunately for ninfan and his, erm, laser-like analyses, he has doomed himself from here to the end of the world to being known as...
The guy with a tiny dick.

Well, its hardly news, but, see, you fell into the same trap as Cougar - you reacted to what you think I said rather than what I actually said.

I just said I'd like a larger one

Yes. I know. But isn't it fun...

Jeremy Hunt.

That man has no shame.

[url= https://inews.co.uk/opinion/comment/jeremy-hunt-health-secretary-blood-on-his-hands-raymond-tallis-essay-nhs/ ]https://inews.co.uk/opinion/comment/jeremy-hunt-health-secretary-blood-on-his-hands-raymond-tallis-essay-nhs/[/url]

ninfan - Member
its that difficult thing though isn't it, everyone is a worthy case in their own special way - and placing the responsibility of rationing on a doctor without objective/numbers criteria puts them in the almost impossible position of being the person who has to say 'no'.

I think you will find a lot of doctors (senior ones) are in that position often.
I think the problem is there is no objective global measure.
For example pain - you ask about back pain, very common, most people have it, some peoples pain is 1/10 some people 10/10 and can't do anything. its all pain and is it some people's is worse? or is it people have different pain thresholds? is it that some people just "get on with it". I've seen people telling doctors their pain is 10/10 and hell and then kicking off as they can't go for a fag. but these people would put their pain on this "objective measure" as 10/10 and above those who maybe have scored it differently...
the same is true on impact on life. I know people who have their appendix out and want to go back to work that day and others who need "a few weeks off".

sorry I realise I've changed the direction of this thread.
back to Mr Hunt... he has too much vested interest in selling off the NHS to care about its future. He is very clever and knows what he is doing, its just a shame its dismantling the health service

From last week,

https://www.independent.co.uk/news/health/nhs-cost-cutting-plans-conservatives-leaked-campaigners-election-2017-a7775571.html