[Closed] Why should we save the NHS?

So only the sporty types should get free health care. Why should the pie eaters have to pay tax for you fall of your bike and break you arm?

well that is not what I said, is it?

I never implied having to partake in a sport to stay healthy, just that why should people who make an effort to remain healthy pay for the deliberate risks taken by someone who decides to overeat and become obese?

If I were to pay insurance and be assessed on risks, then the risks I am taking by using my bike would be taken into account.

[i]We'll never agree then if you think that is better. [/i]

Oh dear. It's Drac's way, or no way. Not that Drac is biased or anything.

Bottomless pit into which our money disappears under the threat of emotional black mail, should anyone speak out about the mind boggling mountains of cash the NHS consumes.
Yet nay a word from the experienced on how the NHS could do better with the money it already receives.
And are we paying for NHS employees to sit at a computer and stir things up on a cycling forum ?
Shouldn't such types be doing something more career related while on shift ?

The job is the job, do it and stop the belly aching. Or find alternative employment.

[i]If I were to pay insurance and be assessed on risks[/i]

Including genetic ones?

Personally i think that the NHS is one of the best things we have in Britain. Without it you can only imagine the suffering that a lot of people would go though.

Having spent some time in a hospital recently and visiting its changed a great deal from when i was a lad from what i could see from the outside. I have no idea how things work there but from what i saw and experienced at both the NHS level and privately shocked me. A lot of the people just didn't care anymore. It was just a job to go to and get a wage. They had little consideration of patient care at all. Infact in Sheffield my mother (an ex ward sister) actually ended up doing some of their jobs for them as the nurses were not capable of doing them properly. In Barnsley we had to stop one nurse from giving a double dose as she hadnt read the notes! it was poor imo for what was once a world class service.

Anyhow i think that this has crept in because the nurses themselves are not valued as a profession. Why should they bother if no one is looking after them. The amount of uncertainty cant be good for morale? these guys need a massive shakeup at top management level, get it run like a proper business instill trust back in the job for both the patients and the nurses and tax us more if it needs it but just don't bloody privatise it else it wont be long before we cant afford the proper care and then what do we do?

my 2penneth.

wwaswas - Member
If I were to pay insurance and be assessed on risks

Including genetic ones?

Turneyguy. The reason you have to pay for those who do not exercise, drink etc is because the electorate keep returning Governments who support tax funded NHS. Other electorates in other countries make different decisions. Democracy - after a fashion anyway...

Including genetic ones?

there are some risks that I can control and some that I cant.

So morally you can easily say no to genetic risk assessment, whereas it would be fair to make risk assessments based on lifestyle choices.

And you still don't pay for them thanks to well the NHS which is also one of the big researchers for such things.

You do pay for them through taxes.

And where do you think these new drugs, technologies and drive to improve living standards were conceived, tested, refined, trialed and implemented ?

The reason the were trialed for the UK market in the NHS, is there isn't really anywhere else. You think that the Fence, Germans, Yanks etc don't bring new drugs and tech into their hospitals?

Shouldn't such types be doing something more career related while on shift ?

Yes, I mean right now I could be eating a big box of quality street at the nurses station, whilst taking a selfie. Actually, seeing as it's my day off - I should be on my bike.

The job is the job, do it and stop the belly aching.

I've been a nursing auxiliary, on and off, for the best part of twenty years - I'm not belly-aching about [or scared of] "the work". The issue is a sh1te set of reforms - reforms which are actually [i]wasting[/i] money the NHS "already receives". What's doubly stupid is that this effectively counters existing efficiency measures (e.g. the infamous Nicholson challenge) - not to mention having to re-hire staff due to poorly considered redundancies, etc.

this has crept in

Poor care follows burn-out follows poor morale, as sure as night follows day. That's not to excuse neglect, of course - but if you read the Francis Report, the wards concerned were in free-fall. Paradoxically, the actions of some of the nursing staff attempting to hold the line were nothing short of exemplary.

Although there are issues re the "correct" numbers of staff (e.g. there's different levels of acuity/dependency), the single biggest improvement would be better nurse:patient ratios on general wards.

Bottomless pit into which our money disappears under the threat of emotional black mail, should anyone speak out about the mind boggling mountains of cash the NHS consumes.
Yet nay a word from the experienced on how the NHS could do better with the money it already receives.
And are we paying for NHS employees to sit at a computer and stir things up on a cycling forum ?
Shouldn't such types be doing something more career related while on shift ?

The problem with BS right wing speak like this is that it never listens to the evidence. The evidence being that the NHS is the 2nd most cost efficient service in the world.

he reason the were trialed for the UK market in the NHS, is there isn't really anywhere else. You think that the Fence, Germans, Yanks etc don't bring new drugs and tech into their hospitals?

The NHS does research that biotech companies are not willing to do as they don't see en economic incentive, eg rare disorders.

[img] [/img]

[i]there are some risks that I can control and some that I cant. [/i]

They could test you and your choice of partner when having children and assess the risk of any inherited conditions or predispositions and then charge extra for insurance of both partners to cover possible extra costs associated with their children. Who you choose to have children with is a lifestyle choice?

Drac when I bust my knee the hospital visit cost about £20, each time I saw a special knee surgeon it was about £50, the MRI scan was £200 and I had it immediately at my request not months later after pestering a UK GP, the physio was £25 a session. All of this (ex hospital) was in Paris, ie expensive for France. Even if you double these amounts to reflect UK wages I still think it's good value and had I had health insurance I could have claimed it. BTW under the EU rules I am supposed to have been able to claim from the NHS but they declined my claim.

Colleague is off at the moment having a busted knee repaired, he didn't wait months and it's cost him 100% less.

And are we paying for NHS employees to sit at a computer and stir things up on a cycling forum ?
Shouldn't such types be doing something more career related while on shift ?

I'm not at work until tonight so might want to try harder with your trolling.

Yet nay a word from the experienced on how the NHS could do better with the money it already receives.

Scarp pointless target, scrap PFI, scrap procurement there's plenty that can be done but that's not the discussion here is it. Of course you didn't look at that you just waded in looking to start an argument.

Have to admit I'm always bemused by statements such as "The Tories are privatising the NHS" as many people who say things like that mostly seem to work on the principle that saying it enough times actually makes it so.

If we take a step back and look at what's really going on, there are several forces at play

1.The move from secondary to primary care (enabled partly by technology and advances in medicines that mean fewer things are treated in hospital, and of those that are, less time spent in hospital for recovery)
2.A rapidly ageing AND rising population who are putting a lot more pressure on Primary Care
3.The urgent need for a step change in Leadership, Culture and Patient Outcomes in the NHS so that the experience isn’t a complete lottery depending where you are in the country and things like the Mid Staffs don’t get covered up / no-one being held accountable
4.The move to more GPs working part time / retiring early following their massive increase in pay 10 years ago and end of night-time responsibilities
5.The urgent need to improve the patient experience by joining up Health & Social Care.

Both of the first two forces really require a change in prioritisation of funding from Secondary Care to Primary Care. Pretty much every analysis done over the last 15 years shows that fewer beds are needed in Secondary Care than we currently have, and that clinical outcomes typically approve fastest when specialties treat a higher volume of patients i.e. you get better results when the Hospital Consultant treating you spends most of his / her time treating patients with that condition rather than doing it a few times a year.

Most of the NHS Secondary Care budget after staff is tied up in buildings and estates - so in order to make more money available to Primary Care where the demand is greatest there needs to be a commensurate reduction in the size and number of hospitals to meet the current level of demand. Many of the 150+ hospitals we have now are too old and cost too much to run now that patient volumes have fallen not to mention are pretty depressing places to work for staff.

As we've seen many times recently, very few politicians are willing to be honest about the shift that's required so they generally support efforts by the public and staff to resist the necessary changes with the consequence that the NHS is stuck in limbo with GPs effectively under siege and hospital utilisation continuing to fall, wards mothballed and patients with treatable illnesses getting very hit and miss care.

As for the public / private point, Primary Care has always mostly been private even if Labour and the Trade Unions would have you believe otherwise. Where "Privatisation" has actually taken place it's actually pretty limited in scale if you set aside the wave of very poor PFI deals completed under the last government. From memory around 5% of the total NHS budget is now allocated for external provision but importantly, the providers aren’t all “private” – they include the likes of MacMillan and other charities for cancer care and Bupa for some diagnostics / imaging.

The level of private activity hasn't changed much year to year under the current government so despite the amount of noise that vested interests make, the facts don’t really support the argument that the Tories are trying to destroy the NHS, not least as they have protected it from spending cuts, something that Alistair Darling refused to commit to in his forward look just before the last election.

If we also look at what type of private activity has taken place the facts are pretty interesting:

- Independent Sector Treatment Centres – were set up under the Labour Government to create a “challenge” to NHS Trusts and force greater competition and reduce waiting lists. They were very successful in that regard.
- Alternative Providers for Primary Care Services – were set up by the last Labour Government and overseen by Tony Blair’s healthcare advisor and staunch “Blairite” Simon Stevens. He’s recently started as the new NHS CEO so hardly a sign that the current government are taking a different approach to Labour.
- Tendering for things like Pathology Services also started under the last Government.
- Takeovers of failing Trusts by "private" management teams (like the arrangement at Hitchingbrooke) was enabled by regulations laid down under the last parliament.
- Transfer of GP night time responsibilities to companies was completed under the last Government and contributed to many of the current problems with continuity of care

It’s always interesting to hear Andy Burnham re-writing history when he’s interviewed as the timing of many of the “privatisation” activities go firmly back to his door when he was Secretary of State for Health, not that he would ever admit this. Interestingly in his speech this week he made a case for Hospitals to drive the integration with social care but many would say that this will only make the current problem worse as what’s really required is smaller Secondary Care, and more investment in seamless Primary Care / Social Care.

Finally, to the original point, if the Tories were really trying to privatise the NHS they would probably have done a lot more than just maintain a similar scale of private sector activity to the last Labour Government – if they were as evil as people claim wouldn’t they have by now copied the approach taken by Labour when NuLab effectively dismantled NHS Dental care and moved it to a service that most people now expect to pay for?

Bottomless pit into which our money disappears under the threat of emotional black mail, should anyone speak out about the mind boggling mountains of cash the NHS consumes.

It has been argued that as societies develop they spend a bigger proportion of GDP on health systems (of whatever sort). On a per unit basis, the NHS is actually cheaper than the US system.

Personally I don't have a problem with this, as our standard of living increases, we demand better and better health care.

Solo, are you the milk conspiracy therory guy?

Just saying.

[url= http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=0 ]NY Times: After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know[/url]

You do pay for them through taxes.

Yes I know that.

This is the OECD's breakdown of health costs as a percentage of GDP and further split by private/public. UK seems to be a relatively low spender, tbh.

[img] [/img]

They could test you and your choice of partner when having children and assess the risk of any inherited conditions or predispositions and then charge extra for insurance of both partners to cover possible extra costs associated with their children. Who you choose to have children with is a lifestyle choice?

By extension, it is.

What makes people attractive at a basic level - it is either because they look like good providers for your offspring, or they look like a source of good genes for your offspring, both increasing the chances of your offspring surviving.

your're right wwaswas - the spend on healthcare isn't as high as some other countries but several bits of data are missing so it's not as clear cut as the graph suggests:

1. We now spend 50.5% of GDP on the public sector compared to c45% in 1997.
2. We spend more on the NHS than everything else in the public sector put together i.e. we're spending more and the NHS is taking a bigger share of the increased spend but the trend clearly isn't sustainable
3. The spend on the NHS is net of parallel spend on social care - which in some of the examples above are included
4. The total healthcare costs for other countries e.g. USA, Netherlands, Germany include the cost of retirement benefits. The NHS annual budget does not include this and will rise to c30% of the total budget over the next 15 years - making the NHS much more expensive than most other health systems and about the same cost as the USA.

The evidence being that the NHS is the 2nd most cost efficient service in the world.

I'm not sure where you read that but looking from the inside out, I very much doubt that!

This is the OECD's breakdown of health costs as a percentage of GDP and further split by private/public. UK seems to be a relatively low spender, tbh.

I genuinely don't understand how anyone could look at that graph and conclude that our health provision should be more like the US model.

Unless of course they had some dogmatic ideological attachment to privatisation...

[i]We spend more on the NHS than everything else in the public sector[/i]

nope.

NHS 105bn, Work and Pensions 160Bn. Not the most recent data but it won't have changed by 50%.

[url= http://www.theguardian.com/news/datablog/interactive/2011/oct/26/public-spending-uk-government-department ]http://www.theguardian.com/news/datablog/interactive/2011/oct/26/public-spending-uk-government-department[/url]

The NHS does research that biotech companies are not willing to do as they don't see en economic incentive.

That is missing the point, the point is that improved drugs e.g. antibiotics and imaging techniques like X-rays, ultrasound and MRI, have all had big impacts on healthcare and had very little to do with the NHS. If the NHS was as wonderful as claimed you'd expect to see an increase in things like life expectancy in the UK over similar countries over time but you don't.

irony is that large US corporations rely on the state to subsidize their employees health care;

[img] [/img]

I wish they'd let him do that with notes instead of the bloody awful and insincere auto-cue. No one should ever use them unless they are very very good at it and no one is aware they are using it. And it also felt like they'd got a speech writer to improve his words, again it takes away from the message.

I want to live in a country that looks after everyone when they are sick or hurt or they are old, and if that means spending my money on **** ups as well as the "deserving" then I'll give it equally willingly to both. Life can go horribly wrong for any of us at any time, non of us know if it'll happen to us, but if it does for me or any of you then I want to know that something will be there to help us through it.

As for who will make a better job of making sure that exists I'm not sure I know.

Takeovers of failing Trusts by "private" management teams (like the arrangement at Hitchingbrooke) was enabled by regulations laid down under the last parliament.

Given both the franchise terms & DoH's [arguably special] treatment of Hinchingbrooke, it's hard to view it as anything but a kind of stalking horse for Circle and their backers... not that it's necessarily working out for 'em, despite the media PR rubbish.

As for the general point - if it looks, walks, talks like a duck, etc etc. Services are being commissioned from the private sector with an NHS "in-partnership" kitemark, left, right & centre. It's a big jump from ye olde GP practice to, say, Virgin providing community nursing (though could anything match Serco's frankly spectacular effort at providing OOH cover in Cornwall?) And, again, the reality is that the big corps will seek to win contracts by bidding artificially low & then cutting back - Care_UK being a prime example. None of this - despite the political rhetoric - is putting the patient at the heart of decision-making, or (even more laughably) "putting doctors in the driving seat", as I seem to remember [endlessly] hearing.

And yes, NuLav set much of this in motion - aided by a veritable army of Blairite advisors, many of whom are still hanging around. But that doesn't change what's happening... besides, there's not much difference between Red and Blue teams (or their acquiescence to lobbyists).

They were very successful in that regard.

As long as your definition of successful doesn't include "dealing with anything tricky and/or post-op complications"...

I genuinely don't understand how anyone could look at that graph and conclude that our health provision should be more like the US model.

Unless of course they had some dogmatic ideological attachment to privatisation...

NHS 105bn, Work and Pensions 160Bn

The NHS figures are for England alone, once you factor in the devolved regions it is just shy of 130bn.

Its the Tories opponents who are trying to label NHS reforms as privitisation,

No one in their right mind would want a system more like the American one. Sky high costs to the user, a tendency to over medicate and huge costs to the government as well due to the admin costs in administering medicare. It's a ****ed system.

The NHS, while not perfect, is really very good. Anything that could threaten the free at point of use principle on which it was built should be given a very wide birth.

Given the usual pattern for privatised services, I think we're right to view the increasing use of private companies providing the services that they're being encouraged to supply with great suspicion. It's the thin edge of the wedge and when the NHS can't compete because it's been de-skilled it'll be used as the argument for properly privatising the whole thing.

and when the NHS can't compete because it's been de-skilled it'll be used as the argument for properly privatising the whole thing.

[Regulatory body] Monitor is packed with management consultants and big group accountants - it's not hard to imagine that kind of conversation... in that respect, I hope the CQC doesn't end up becoming a blunt tool.

[url= http://myemail.constantcontact.com/Delighted-to-help-him.html?soid=1102665899193&aid=z4cWsb5bPWo ]"The Machiavellians will say it is part of a sinister plot to soften the NHS up... sell it to the private sector. I would have refuted that. Now, I'm not so sure."[/url]

[i]The NHS figures are for England alone, once you factor in the devolved regions it is just shy of 130bn. [/i]

so still less than work and pensions?

@Drac when I bust my knee the hospital visit cost about £20, each time I saw a special knee surgeon it was about £50, the MRI scan was £200 and I had it immediately at my request not months later after pestering a UK GP, the physio was £25 a session. All of this (ex hospital) was in Paris, ie expensive for France. Even if you double these amounts to reflect UK wages I still think it's good value and had I had health insurance I could have claimed it. BTW under the EU rules I am supposed to have been able to claim from the NHS but they declined my claim.

you see this is why Jambo

I fell off my bike, was seen at a hospital, no charge, saw a consultants, no charge was sent to physio, no charge, physio didnt work saw consultant again on the friday, had surgery on the tuesday, no charge, had more physio, no charge, went to see consultant again told when doing op they found a snapped acl, no charge, had surgery to repair acl, no charge, now seeing physio again still no charge. How much would all this have cost if I was in France and didnt have insurance?

and my bike didnt cost a grand, the ****ing thing!

although I do concede my 6 operations on my legs in the last 8 years are likely to be the major cause of the NHS being broke... sorry

This is one example of "Privatisation" - very few people step back and think about what was happening before the change which was 15+ years of constant changes / pay offs to the Senior Management Team who by all accounts failed to turn round the trust or deliver good healthcare to the local population:

[url= http://news.bbc.co.uk/democracylive/hi/house_of_lords/newsid_9636000/9636182.stm ]2012 - A financial and clinical basket case[/url]
[url= http://www.bbc.co.uk/news/health-17936745 ]2012 - step change in performance in a matter of months[/url]
[url= http://www.cambridge-news.co.uk/Quality-Hinchingbrooke-Hospitals-care-isbest-country/story-22368467-detail/story.html ]2014 - delivers best care in the country[/url]

If a new team can take the same staff, same buildings, same level of spend and very quickly improve outcomes and patient experience, is this really such a bad thing?

Does it make sense to incentivise a team to do drive a rapid improvement but levy penalties if they fail, rather than continue to use a changing cast of NHS senior managers who effectively get paid off whether they succeed or fail - with one off "early retirement" pension contributions well into the £million+ range...

And what's best for the patient? Sticking to the "public" model that at Hitchingbrooke exposed them to a significant risk of serious untoward incidents / mistakes in routine care or recognising that the most important thing to patients is good care and making a rapid change to turn things round?

If Hitchingbrooke was our local hospital, would we rather that our families and loved ones get treated by a hospital that has caused avoidable injury and suffering for many years, or go to a hospital that costs the same to run but now offers excellent clinical outcomes and first rate patient care? Is the principle of "managed by the state" more important than the impact on real people?

so a "healthcare consultancy" decided they were great?

And what's best for the patient?

What you're doing there is conflating private delivery with good care. There's no rule that says that has to be the case.

There are four options:

Bad public care
Good public care
Bad private care
Good private care

Which is best now?

so a "healthcare consultancy" decided they were great?

Not only that - a "healthcare consultancy" (CHKS - organiser of said awards-dinner) owned by outsourcing firm Capita - themselves partners with Circle in a joint venture to bid for NHS contracts!

The Hinchingbrooke "award" was spun in very, [i]very[/i] misleading fashion - it's nonsense to claim (as the [i]Daily Failograph[/i] repeatedly did) that it's now "the best hospital in the country for patient care". There was also no mention of the terms of the franchise (inc elevated levels of DoH support), no mention of acuity/casemix (i.e. Circle not having to deal with complex stuff - whereas, say, Addenbrookes has to) and no mention of how Circle's cosy "employee co-op" image glosses over its somewhat opaque financial structure.

In fact, the media BS was such that one might almost suspect an orchestrated campaign.

Edit: right, I really do need to get out on my bike. 🙂

@aa I am glad it worked for you. When I tried to see my doctor it was a 3 day wait and then no certainty as to when I could get to see a specialist. My experience with NHS provided physio was that the process was a nightmare and they did all they could to stop the treatments. The other thing I love about the French system is you have to have a French Carte Vitale ("NHS ID" card) or you have to pay in full upfront. Such a system would cut out a lot of abuse of the UK system.

noteeth - Member

And yes, NuLav set much of this in motion - aided by a veritable army of Blairite advisors,

Like they said- tories.

French system is you have to have a French Carte Vitale ("NHS ID" card) or you have to pay in full upfront. Such a system would cut out a lot of abuse of the UK system.

What abuse is that then that you need identify yourself to get care discounted?

anagallis_arvensis - Member

you see this is why Jambo

I fell off my bike, was seen at a hospital, no charge, saw a consultants, no charge was sent to physio, no charge, physio didnt work saw consultant again on the friday, had surgery on the tuesday, no charge, had more physio, no charge, went to see consultant again told when doing op they found a snapped acl, no charge, had surgery to repair acl, no charge, now seeing physio again still no charge. How much would all this have cost if I was in France and didnt have insurance?

and my bike didnt cost a grand, the **** thing!

That's good, but I could run off probably 10 stories from my friends and immediate family about having to wait months for simple procedures, being constantly and repeatedly fobbed off by GPs, inedible food and poor cleaning in hospitals, relatively minor issues becoming serious even life threatening due to repeated failures in care, never mind being able to get an appointment for the doctor or finding an NHS dentist.
I reckon most people could do so too if they have a proper think about it.

I don't think we need major reform though, for the most part it is very very good; more just a careful look at why the same old failures crop up again and again.

I could ream off 100s of stories of people who have received exceptional care in the NHS, sadly you're right and know of a few who haven't. This won't any difference if you pay at source the care itself may not be any better.

I don't think we need major reform though, just a careful look at why the same old failures crop up again and again.

Very much this.