The NHS.

I have got to hope that there is a will to fight for it. The alternative fills me with horror.  I'm currently sat in A&E and have seen the best and worse of the NHS in the last fortnight.  The best being without exception, every single one of the dozens of caring, professional staff I've dealt with.  The worst being the chronic under resourcing, especially staffing.

I've said this before my current predicament, but I and everyone I know would happily have an income tax increase if it was hypothecated to the NHS.  Staff need to be properly remunerated to recruit and retain them.  We as citizens need to get used the idea of paying for that.

In my opinion the NHS is one of, if not the defining thing that makes the UK a world leader in social care.

The thing it is not a world leader in social care, just that people have been told it is for a long time.

I also fear for the A&E as it is the victim of "Death by a thousand cuts". It has been deliberately run down, both financially and in the press portrayal, to the point that you can make a coherent argument that it is 'not fit for purpose' which then allows the government to make radical changes 'to return it to glory'.

The stuff in quotes is the kind of phrases that make the headlines without really saying anything.

The fundamental question is "Should healthcare be free to the users?" The challenge then comes back with what Free actually means as clearly someone has to pay and also what healthcare should actually be included.

Free is either paid through government taxation, locally or nationally, or paid through private insurance. Neither of which is actually free but both mean that they don't check your credit card as the ambulance scrapes you off the floor. The trouble with private companies is that they exist to make money and so will want the right to refuse certain people, would you insure me for example? The other problem is that people will choose not to pay their insurance and spend the money elsewhere so it would have to be mandatory. The trouble with government tax is that it is damned expensive and always tempting to trim it a bit to spend on other stuff.

Question 2 is What is healthcare? Things like A&E seem obvious enough and also main stream illness and operations but what about cosmetic surgery (just one example)? After a car crash, should there be free plastic surgery to remove visible scarring where possible? What about breast remodelling after breast cancer surgery? What about nose reshaping after riding into a wall? What about a face lift, new nose and breast enhancements because someone feels a bit old and saggy? Where does healthcare stop? Also, what about extremely expensive treatments with limited success rates? Should you have the right to a treatment that costs £1,000,000 a month and should prolong your life by 6-18 months but cannot stop the disease?

Question 1 is (A) Tax or (B) Private Mandatory Insurance
Question 2 is (C) Unlimited Treatment or (D) Restricted list of available treatment

I think an adult discussion about the NHS is impossible in this country as we're all too bought into or brainwashed about the portrayed ideals of it all.

My (entirely uninformed) view is that it appears to be underfunded, staff underpaid and it's simply too big of a bureacracy to work efficiently. We as a public also expect too much of it and take it for granted.

Maybe the Brexit money for the NHS got lost in the post or something, who knows... it feels like something radical needs to be done, but which of our shallow, selfish political parties has the nuts to tackle it with a long term view?...

The thing it is not a world leader in social care, just that people have been told it is for a long time.

Whilst I think you are probably right, what the UK is a world leader in is establishing and maintaining (maybe a debatable term) the principle of a health system free at the point of delivery. I guess the issue is making that a viable thing as the great British public annoyingly started living longer and the list of prossible medication and procedures got longer and more expensive, the UK population got more sniffy about working for peanuts whilst all the time where never particularly keen to vote for a political party wanting to hike up taxes to pay for a service that could keep up with demand.

As with many things in life, we get the NHS we deserve.

There's a double whammy of underfunding and rising cost of new life changing/saving treatments. Plus a complete failure to sort out the social care end with an aging population, which backs up the system.

I absolutely agree that free at the point of delivery should be maintained. There needs to be a grown up debate about the cost/social benefit of some treatments, and as the Tories have sold off the national silver for the last 40 years, how we will fund that- and all public services - through taxation.

I'd sooner a sometimes inefficient NHS than profits to shareholders.

My (entirely uninformed) view is that it appears to be underfunded, staff underpaid and it’s simply too big of a bureacracy to work efficiently.

Is it? The NHS manages to deliver healthcare of a similar standard to the rest of the world at sometimes half the cost. Particularly vs USA but also compared with European neighbours it’s very efficient.

Underfunded? Sure. But ‘inefficient’ is not really a fair argument here.

To keep the principles of the NHS as we know them it needs massive reform, the problem is that it would grind to a standstill during that process. The only alternative is to throw money at it to plug leaks as they appear. This applies from ambulance/GP at one end to community care at the other
I've recently experienced day-case private healthcare (courtesy of the NHS) followed by the same process in the NHS (because not enough theatre time was booked I got as far as gowning-up but didn't have the private op).
The NHS pre-op was more comprehensive with C19 PCR rather than LFT (private) and MRSA tests (none in the private pre-op)
My conclusion from that snapshot is that the NHS system is gold-standard medically and private is a more pleasant experience with lower waiting times
I'm not medically qualified to answer this, but is the PCR and MRSA necessary for a day case? It's staff and lab time that the private system didn't think necessary
EDIT pay is not necessarily the issue. The system could be improved to make the working environment more pleasant and keep staff happier

So far as I know the NHS does not provide social care. It provides health care. Part of the reason there is so much trouble with bed blocking in the NHS is the woeful underfunding of the social care sector which prevents the NHS from discharging people and thereby freeing up beds. (social care worker)

The NHS has not recently become broken, it’s been happening for 20/30 years and stems all political persuasions.

In a nutshell, people are living longer with more complex health needs, there are massive resource issues, and the private sector likes to exploit the NHS. All a perfect storm

What’s different now though is that the staff are exhausted but being asked to do more, people who didn’t get healthcare during COVID are appearing causing more pressures, social care cannot cope.

Oh and if you thought private health was the answer, that is really struggling for capacity too at the moment.

There simply isn’t the capacity needed for healthcare/social care in the uk that we need/want

The NHS is incredibly efficient spending less on management and admin than other systems although compated to scotland england wastes more

What it needs is more money. We spend much less than other countries on healthcare

The issues with it is the result of deliberate tory policy so they can justify selling it off to insurance companies which would increase costs massively

Major gains could be made quickly and cheaply. Remove the false market nonsense as was done in Scotland 12 years ago and you immediately free up 10 % of the budget from admin to care and remove massive inefficiency.

And yes you do need those tests.

Under blair spending went up from 8% of gdp to almost 10%. Most countries spend 12% or more. US nearly 20%

This is a deliberately created crisis by the tories. Deliberate.

The waiting times are such that the free at the point of delivery is a bit of a myth. It is - if you can wait , otherwise all who can afford it are paying for private ops or treatment.
This is for routine treatments like knees, hips, hernias etc.
The waiting times are measured in years, not months

It’s not a uniquely British problem. I am sitting in a conference in Sydney listening to a Scot presenting on the topic as a global issue.

Is it the NHS that needs fixed, or is it the population?

I’d argue that the problems in the NHS are a symptom and not a cause.
We’ve got obesity levels which have almost trebled in the past 40 years, diabetes cases have doubled in the UK in the past 15 years, other illnesses are also on the rise.
Many of these are, arguably, lifestyle based illnesses and are therefore preventable.

Now I understand that trying to fix the mindset and lifestyle of a population is a near-impossible task but these are a huge drain on the NHS resources and surely fixing these problem in turn eases the burden on health services?

Yes some of the external factors such as an aging population are universal and need grown up conversations but the nhs crisis comes down to one major issue. Lack of funding as a result of deliberate tory policy to create a crisis so the can sell it off

Just needs more money. We should be looking to spend a similar amount of GDP as other Western European countries.

Labour should talk about funding for the NHS in terms of % of GDP.

So many billions or X amount of new hospitals is not really useful.

https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/

Just needs more money

NB doesn't just need more money but needs more money first. Reforms including social care and ways of keeping people from getting ill in the first place need to be thought of and implemented.

I’d argue that the problems in the NHS are a symptom and not a cause.
We’ve got obesity levels which have almost trebled in the past 40 years, diabetes cases have doubled in the UK in the past 15 years, other illnesses are also on the rise.
Many of these are, arguably, lifestyle based illnesses and are therefore preventable.

This is something that rarely gets discussed because its a touchy subject with the public not wanting to be told what to do. It is a political one, less about telling people what to do and more about creating environments where people will thrive.

In an environment where the only or easiest option most people have is to drive, and the easiest, cheapest food is McDonald's, it's no accident the 2/3 of the population is overweight or obese, it's inevitable.

No country can fund the impact that an aging population is set to have on healthcare load using the systems that we currently have.

Lots of literature out there about how if spending trajectories continue apace the cost will exceed GDP.

I haven’t seen the answer to the problem yet though…

There is no magic bullet.

You do not see all these obese people in other countries. Thats also a result of tory policy.

Yes the aging population creates issues that are huge but make no mistake. The problems in the nhs are deliberately caused by tory policy

Nhs funding as a % of gdp has fallen.

TJ try and remove your political blinkering from the issue.

Yes the tories are far from innocent but neither is Labour (reducing nursing and doctor training posts to name but one)

Put Labour in tomorrow and the ageing population with complex health needs will still be there.

Yes, but there might be more willingness/honesty to describe the situation and fix it, in ways that work beyond nonsense.

I wonder what the health impact of all those people breathing in exhaust and tyre rubber particulates is.

Under blair spending went up from 8% of gdp to almost 10%. Most countries spend 12% or more. US nearly 20%

This is a deliberately created crisis by the tories. Deliberate.

The figures around the world don't really show this, bar the US, who spend an astronomical amount on health, whilst still mainly being seen as the most expensive place on the planet for healthcare.

The dot for the UK is side by side by France above the line at around 45k.

Also worth noting the original article for this thread was in the Guardian, and was raised by a thinktank supporting healthcare looking at ways of providing extra funding for the NHS, so direct charging via NHS, £8 a day for staying in hospital, over 60s being charged for prescriptions, etc, etc.

The problems in the nhs are deliberately caused by tory policy

Whilst I largely agree, the language used needs to be carefully done to not lose the argument. We could get very tinfoil hat and think that devilish groups of tories have been sitting around 'plotting' the deliberate downfall of the NHS. I think that's overplaying the hand. Or, we could argue that the tory agenda and tory priorities have not given the NHS what it has needed. It is a death by a thousand cuts (or the boiling frog - take your metaphor of choice) and I think they (the tories) have worked on a principle that the great unwashed won't notice the small degradation in the 5 years of a single government cycle but will remember the 'benefits' of a low taxation mindset. It is NHS death by neglect rather than active destruction.

Unfortunately, I still don't think it's the tories that are at fault - it's us the voting public. There are just too many stupid individuals on the voting register who can't be sold a higher taxation for better quality of life. The views of the upper middle class who could pay for private health care (the old fashioned image of a tory voter) are largely irrelevant in this as they are such a small percentage of the population. Tragically it's the swathes of average to slightly below average income households (working and pensioners) who still percisist in voting tory who would be most deprived of quality medical care if the NHS was abolished - the people who would see their net outgoings (income tax plus private health insurance) shoot up if we went to an American style system and they wanted as good as they currently receive. People are too fixated on taxation as an evil outgoing from their pay packet and too 'jam today' to appreciate it is the total outgoings that really matter - a smaller income tax bill with a big private medical insurance bill hurts just as much if not more than a bigger income tax bill.

Yes, but there might be more willingness/honesty to describe the situation and fix it, in ways that work beyond nonsense.

Agreed all people in the NHS and social care would love some support. Labour are keeping very very quiet whilst the NHS crumbles. They have no policy, strategy or are even beginning to hold the Tories accountable for the NHS

The SNP,s hands are all over this as well. At devolution NHS spending was 22% higher per head in Scotland compared to England. Now it is 3%.

Other areas of the budget prioritised over health.

. For example, during the 2000s, official estimates imply that real-terms spending per person increased by 63% in Scotland, compared with 80% in England. And during the 2010s, it increased by 3%, compared with 10% in England.

https://ifs.org.uk/publications/15396

Under Blair nhs spending increased hugely

Under the tories its decreased

And yes. Its deliberate to create the imoression its unsustainable to prepare the public for selling it off

Irc. Now look at where the money went. Scotland nhs admin is half England's all that extra money in england went on admin for the stupid fake market and continual reforms

Irc. Now look at where the money went. Scotland nhs admin is half England’s all that extra money in england went on admin for the stupid fake market and continual reforms

NHS Scotland use the NHS Business Services Authority, which is part of the NHS England and Wales, which as the name suggests, is predominantly administration for the services provided, so i'd fully expect Scotlands admin costs to be substantially lower and England and Wales to be higher, it's how it's set up.

FWIW the NHS in the Scottish Highlands does provide social care. It's a regional thing. It does this because there is a recognition that folk do better in their home environment - both post-op and long-term. This frees up hospital beds and helps avoid re-admission. It's this sort of joined up thinking that is required. Add smoking bans, sugar taxes, minimum alcohol pricing to those measures - all designed to reduce the load on the NHS. More draconian measures would be unpopular but one of the biggest factors remaining is tackling endemic poverty. Maybe when the middle-classes can't get any NHS treatment they'll consider how the tax system could be better and more fairly used.

Its a range of things, aging / less healthy population, crisis in social care, an expectation it can fix everything, a lack of seperate government funding into research (bring down the cost of new treatments), a culture amongst all staff that needs to change, efficiency and funding.

I've had varied experience over the years from amazing to downright dangerous within the NHS, putting all the staff on a pedestal is not helpful. Look at all the national scandals weve had over the years, they are not isolated incidents and are the tip of the iceberg. Problems are complex but lack of funding is not the biggest issue although I agree more funding now may be needed to be invested to the changes.

It's too big a job with too much baggage for the politicians to sort. Its always been in crisis as long as I can remember and I'm the wrong side of 50.

We could get very tinfoil hat and think that devilish groups of tories have been sitting around ‘plotting’

Or that the Chancellor had been spending his time meeting with US healthcare providers. Oh, hang on a mo...

I think we are being prepared to reply to 2 questions:
1. Are you satisfied with the NHS as it is?
2. If it would meet your needs would you be willing to pay (eg 25 quid a pop) to use the services

Answer to (1) is already "no". Answer to (2) depends on your bank balance, but an increasing number will say "yes", at which point those deals lined up by Slimy Sunak will come into effect and another tranche of our country will be sold off to the oligarchy.

On a separate subject, I know we are all supposed to love our NHS workers, and like most people my experience of the folk doing the medical bit has been fantastic, but I also experienced the collective skills of a group of NHS managers doing an MBA, and frankly I was reminded of piss-up and brewery.

Its deliberate to create the impression its unsustainable to prepare the public for selling it off

This I 100% agree with. "Oh its failing but we have a private ambulance service who can step in and help. Actually its run by a good friend and donor I know, great person."

Its happening already. Virgin Care now provide hundreds of millions pounds worth of services and the trend will only grow.

Unfortunately the great British public will only realise what they have lots when its gone.

Also forgot to mention the NHS is not all free at point of use, optical, dental, prescriptions for starters.

Virgin Care now provide hundreds of millions pounds worth of services

Your occasional reminder that 99% of NHS GP and dental practices are privately run for-profit businesses.

i left the nhs in 2003, even then nurses were quitting on a friday and coming back to the same ward working for an agency on £5 more an hour, whilst the agency was getting a £10-15 an hour cut on top. it was very difficult to budget a ward. nearly 20 years later its snowballed.

the other bad practise i kept seeing was around pensions, one PA's salary was bumped upto £36k a year to ensure she got a decent 2/3rds pension on retirement. even then the directors were earning big money

a lot of money in the NHS to be made, doctors setup a surgery with a few others, they then cream £200-300k each a year on top of their wages, my local surgery 3 docs on the board. in the limited info i can see, they increased cash £1.1m in the second year of trading.
is it any wonder doctors can retire younger.

its the lower levels HCA/nurses i feel for..
the UK needs a pipeline of future staff strategy

a lot of money in the NHS to be made, doctors setup a surgery with a few others, they then cream £200-300k each a year on top of their wages, my local surgery 3 docs on the board. in the limited info i can see, they increased cash £1.1m in the second year of trading.

That simply isn’t true anymore.
GP’s do not want to be partners, more and more are turning down partnerships and looking for salaried jobs

even then the directors were earning big money

If you want competent skilled people running the NHS then you have to pay the appropriate market rate.

The same flawed argument with charities, I won't donate to Oxfam as their CEO is paid for than threpence happeny an hour!

As an 'inside man', amongst all the challenges facing the NHS I would certainly say the increase in the 'frail and ageing population' is one of the biggest, TBH.
Yes, the NHS is massively underfunded, but...
the impact this cohort has is significant - both on health AND social care.
Quite frankly put, they use a LOT of resource whilst nolonger contributing to the tax pot (for the most part).

Now don't get me wrong, I'm not saying that 'old people are awful' AT ALL, but we're just not set up to manage them well.
We need to be realistic about how and what we offer this cohort - in the same way paediatric patients aren't just 'small adults' in terms of how we look after them, the very elderly and frail aren't just 'older adults'.

Care needs are a huge issue, and I agree a LOT of this cohort who are in hospital REALLY shouldn't be. But where else can they safely go?

DrP

As an ‘inside man’, amongst all the challenges facing the NHS I would certainly say the increase in the ‘frail and ageing population’ is one of the biggest, TBH.
Yes, the NHS is massively underfunded, but…

Two valid points and combined, what you also get is rapidly deteriorating patients who because they can't be treated quickly, go on to cost far more to treat when they finally get seen.