I love the NHS but is it broken?

Is there a reliable link to back that claim up?

😀 Of course not, this is a mountain biking forum.  However, if you believe the young adults of today are as tolerant and robust of aches and pains than our grandparents are then I would suggest you are very much mistaken.

I don’t see the connection.

Of course you don’t, try reading again.  Despite having far more expendable income than our grandparents , the modern generation (I include myself in this) usually put the value against the cost to self rather than the cost to serve.  Increased taxes to support the NHS will be no more promotable for any electable government than it is for a supermarket to charge more for ‘fair’ priced products, manufacturers to source from the UK, etc.  The british public have the deciding vote and we vote with our wallets (and purses).

Is 2% of the overall budget an outrageous amount for running the estate?

You are very dismissive of the crippling PFI costs to the NHS, have you asked yourself why the government announced in October 2018 that PFI would be scrapped?

Hammond abolishes PFI contracts for new infrastructure projects

Controversial funding model has been heavily criticised following high-profile disasters

https://www.theguardian.com/uk-news/2018/oct/29/hammond-abolishes-pfi-contracts-for-new-infrastructure-projects

8hrs my mum waited on an ambulance last year after a fall where she broke her hip.

Its an absolutely travesty the state of the social care system in this country.

Yes theres waste and people abusing it but even still its suffering from years of political point scoring.

It shouldn’t be controlled by one party. Should be removed from being a point scoring tool and should be cross party ran with agreed funding and policy to stop this yo yo effect

You are very dismissive of the crippling PFI costs to the NHS

Because; by any measure 2% of the overall NHS budget cannot be described as crippling. That’s why I dismiss it. This also needs to come under the folder marked – “long term funding solution agreed by all political parties”, as it’s currently just used by both parties [and their supporters] as political point scoring and not a solution.
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Speaking from the inside, is it broken? Pretty much yes. There’s too much bureaucracy, it’s poorly run and 95% of this because of the government. Whether or not this is deliberate is a discussion for another thread.

The other issue is career opportunities and salary. In a staff of 24 my department has 10 vacancies which the remaining 14 have to cover not including annual leave or sickness cover. 80% of the vacancies are because staff have gone to other less stressful jobs that pay more money.

This means backlogs get bigger and in turn increases the stress. We are metaphorically just about putting the fires out ATM but soon the blaze is going to take hold and burn down the building

My mum also had a couple of hours on a pavement after tripping a few months back. But she votes tory so <shrug>. FiL has now spent 4 nights in hospital awaiting the relevant expert to take a look at his broken elbow. 4 nights! He’s just been strapped up and offered painkillers. Dementia so he’s got little idea what is going on, not that we have much more of a clue. It took them fully 24h to even phone my wife (named PoA on his medical records).

Anyone who thinks that the NHS is remotely adequate probably hasn’t experienced healthcare in any modern successful economy. (I don’t blame the front-line staff.)

Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

Every hear of a corporation going bust? You have? Me too!

Everything is broken.

And from what I hear no-one seems to have an answer, not even the pretty certain nailed-on future Labour government.

The biggest visual thing we see every day is the state of the roads. Major A and B roads are just crumbling away and nothing is done. Chuck a bit of tarmac in and kick the repair down the road to next years budget. Repairs that needed doing after last winter have been left and we’ll soon have roads like those in countries we used to laugh at on Top Gear.

IME [both working inside and outside the NHS in healthcare] the NHS needs both more and better management, most noticeably at the junior and mid levels. Politicians make headlines from saying things like “All the money will go to front-line service and not bureaucracy ” but in reality what then happens is that doctors/nurses end up with a 2nd unpaid job – The manager of their particular unit. And while I admire and like my clinical colleagues they’re often shockingly bad managers of people, budgets and regulation, and who can blame them? They often don’t want the job, haven’t been trained properly to do it, and don’t get paid to either.

This is 100% correct from my own limited experience working within the NHS.

The common trope is that spending on management hurts frontline services. The correct expression is that spending on bad management hurts frontline services. Comparing the percentage of ‘managers’ in the NHS with a corporate entity of any size reveals that the NHS is chronically under-managed. On top of that, as you say, those in ‘middle management’ tend to be drawn from the clinical ranks. And many of these have no appetite for management, or aptitude, it is simply that this is an alternative to front line work because they are burned out completely. Basically a whole tier of management occupied by people with shell-shock.

There are unnecessary management roles in the NHS (I used to briefly occupy one), but the NHS needs more overall, not fewer.

I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

I agree. You only need to look at how Circle health ran Hinchingbrooke hospital to see how much better things would be.

@nickc

IME [both working inside and outside the NHS in healthcare] the NHS needs both more and better management, most noticeably at the junior and mid levels. Politicians make headlines from saying things like “All the money will go to front-line service and not bureaucracy ” but in reality what then happens is that doctors/nurses end up with a 2nd unpaid job – The manager of their particular unit. And while I admire and like my clinical colleagues they’re often shockingly bad managers of people, budgets and regulation, and who can blame them? They often don’t want the job, haven’t been trained properly to do it, and don’t get paid to either. 

I second this.

Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

Can I suggest that you’ve probably had a very limited exposure to the ‘corporate world’, either by sector or seniority?

For me it’s very simple, it’s being changed into something very different – one where those that can afford it will get better outcomes at the expense of those that can’t and moving profits into the private sector.

There will be an overall saving for some folk, only those that never actually need healthcare AND aren’t paying for insurance.

Look at the USA, they spend far, far more on healthcare per capita than we do, and millions can’t get affordable healthcare (and when they have to spend the money, healthcare bankruptcies of approx. 500k pa).

Did you vote for Brexit in 2016 or Tory in 2019 – if you did, this is one of the many things you actually voted for.  You may deny it, but that just shows continuing ignorance IMO.

I agree. You only need to look at how Circle health ran Hinchingbrooke hospital to see how much better things would be.

Ran being the operative word. 😉

As far as I can see the nhs was largely privatised already over the last few decades. Its a tangled Web of private company surgeries, increasingly owned by offshore capital, and complex trusts. Let’s face it, we pay over the odds for the buildings on PFI, we buy medicine and supplies through multinationals that make significant margins (the same companies that are embroiled in serious scandal). The staff is all the NHS has left, and increasingly they are treated like shite.

The very private partnerships that are touted as the solution have a huge interest in the NHS failing and an insurance model coming. Just look at the cost of procedures in vetinary care or car repairs as an indicator of what happens then. Especially as the gatekeepers and policymakers often also benifit…as certain underwear tycoon peers have shown recently.

For me, privatisation of critical infrastructure and services in the UK has only benifited shareholders. 

My Families interactions with the NHS over the last couple of years have convinced me it is already broken and quickly becoming worse, but I know who I hold responsible; filthy, conniving Tories that want to nudge us all into the hands of private healthcare.

Breaking the service is only half the trick, they’ve been chipping away at it since getting back in in 2010, the other side to the coin is the narrative/propaganda bit and that was somewhat defeated by the Pandemic. The original expectation was probably that by the end of Boris’ second term we’d all be demanding the end of a ‘flawed’ health service and begging the likes of Eli Lilly and UnitedHealth Group to take our money and cure our various ills.
Of course Covid happened and the NHS demonstrated it’s value, those same Tory bastards had to rely on the thing they’d been actively trying to kill in a big way, and of course their narrative had to shift as well NHS workers got clapped an everything…

Fast forward to 23/24 and the current behaviour of the government sits in stark contrast to two years ago; screw down the wages of those working in a demonstrably essential service during a cost of living crisis, try to vilify them as being greedy against that same COL backdrop, try and coax NHS staff towards the private sector, and further cripple the NHS and care sector by waging another ideological war on the immigration needed to fill the staffing gaps.

The problem here is time, how much damage will they do before the Tories are gone?
How far will the service standards drop before (hopefully) Labour take up the task of rebuilding and reinvesting?
How many people will suffer sub-standard care (and potentially die) due to the wilful neglect of those in power?

I’ll admit I’ve been eyeing up private health insurance for my family recently having seen the cluster my Parents/MIL/older relatives have endured after a lifetime of paying for the NHS. It’s not the NHS staff’s fault it’s the bastards in charge, but that doesn’t change my priorities if/when one of my family needs prompt access to good healthcare.
Which is of course the mindset the Tories want people like me in…

Privatisation isn’t particularly the answer but neither is is specifically the problem IMO. Healthcare in Japan is private but it’s also heavily managed by the govt (compulsory insurance schemes and price capping etc). I wouldn’t care to say whether it is efficient or not, but it certainly worked well for us while we were there, with sophisticated and expensive services (for non-urgent issues) provided on a time scale that you wouldn’t believe. The doctor apologised to me for having to wait *one day* for an MRI scan on chronic back pain. He was gobsmacked I hadn’t come in earlier, it had been dragging on for months but I knew that the UK approach would be to have a few pain killers and see if it got better, so I’d already done that for a while.

One feature that I believe possibly helped was to have a small charge for most services (20% of a fee that was itself capped at a low level). This must surely discourage the time-wasters compared to the UK’s “free at the point of delivery” while not really being a big problem for people who genuinely need care. But of course even discussing such an idea would be completely impossible in the UK with its infantile politics and toxic media.

Also worth stating that transfer of national assets to corporate custodians usually ends in the primary goal of the organisation being profit, secondary being service. The assets are usually leveraged (stripped). Look at rail/power/water. Just sayin’

A brief list of the problems with the NHS:

• Paying lip service to the fact that we should be a safety critical service
• Group think
• A blame culture that relies on personal responsibility
• Hierarchical management structures
• Too little professional management
• Management seen as a way out of front line service provision
• Constant re-organisation
• Secondary care centric
• Targets and inspections
• Opaque performance data
• Lack of staff
• Lack of infrastructure

The doctor apologised to me for having to wait *one day* for an MRI scan on chronic back pain.

For most back pain, MRI scans are pointless.

In fact I’d go so far as to say that this is a classic example of wasteful over-diagnosis that plagues private healthcare systems.

Healthcare in Japan is private but it’s also heavily managed by the govt (compulsory insurance schemes and price capping etc). I wouldn’t care to say whether it is efficient or not, but it certainly worked well for us while we were there, with sophisticated and expensive services (for non-urgent issues) provided on a time scale that you wouldn’t believe.

Japan has one of the lowest obesity levels in the western world and a lot of “free” in work access to fitness regimes, gyms, pools etc and compulsory fitness/weight levels expected of the work force. All this helps in when it comes to the sharp end @ the hospitals. This sort of thing is rare in this country as the middle classes don’t like the poor getting things for free that they have to pay for.

[dooosuk]

dooosuk

Free Member

There is huge amounts of waste and poor management in the NHS (well certainly the Trust I hear about from my wife). Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

I think that experience of other privatised industries says that what would actually happen is efficiency is improved, but instead of improving care, the savings would be extracted as shareholder/exec profits. Look at water for example.

My experience of the NHS in recent years has been truly woeful though. Aside from the care (which was genuinely terrible – for example a friends child almost lost a kidney after doctors repeatedly dismissed her concerns), basic stuff such as incorrect signage, broken lifts, filthy toilets (and I mean really filthy, bloody, piss, shit everywhere), no hand gel or soap, etc. Across multiple wards and hospitals.

I’ve unfortunately had to experience Austrian hospitals recently after a relative broke her hip whilst on holiday and I came away feeling utterly ashamed of how bad our health service is in comparison.

This is not a criticism of the NHS staff to be clear, from what I saw they were all grafting hard all day.  I don’t know what the problem is but something major is wrong.

[dooosuk]

There is huge amounts of waste and poor management in the NHS (well certainly the Trust I hear about from my wife). Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

As far as I can see the nhs was largely privatised already over the last few decades. Its a tangled Web of private company surgeries

It pretty much always has been from the get-go. Your occasional reminder that more or less every GP practice, high street pharmacist, optician and dentist is a ‘for profit’ privately run business.

A large part of the problem that all healthcare systems face, is that what lay-people’s perception of what a good service is, and what actually is a good service are two entirely different things.

It’s a classic asymmetric market, which is why free market measures and things that focus on patient experience don’t work.

One feature that I believe possibly helped was to have a small charge for most services (20% of a fee that was itself capped at a low level). This must surely discourage the time-wasters compared to the UK’s “free at the point of delivery” while not really being a big problem for people who genuinely need care.

Really?  When people can’t afford to eat or heat their homes, you want to charge them to see a doctor?

Privatisation isn’t particularly the answer but neither is is specifically the problem IMO. Healthcare in Japan is private but it’s also heavily managed by the govt (compulsory insurance schemes and price capping etc).

Companies run to derive a profit for shareholders must inherently be more expensive than a public service, introducing profit seeking into healthcare does not benefit those needing healthcare. I just can’t square that circle TBH, not after the whole ethos of a general taxation funded health service having worked for 50 odd years. If capitalism ends up damaging peoples health how can the solution be more capitalism?

One feature that I believe possibly helped was to have a small charge for most services (20% of a fee that was itself capped at a low level). This must surely discourage the time-wasters compared to the UK’s “free at the point of delivery” while not really being a big problem for people who genuinely need care. But of course even discussing such an idea would be completely impossible in the UK with its infantile politics and toxic media.

We already have capped charges for prescription medicines (with sensible exemptions) I can’t help worrying that charging for access to GPs would just result in more conditions remaining undetected for longer, ultimately resulting in greater costs and resource requirements and poorer outcomes… I’d rather see investment in GPs surgeries, community nursing and health screening initiatives pitched towards earlier interventions and prevention, but that’s really a discussion for the next government, and maybe not even until their second term(?)

A brief list of the problems with the NHS:

Paying lip service to the fact that we should be a safety critical service
Group think
A blame culture that relies on personal responsibility
Hierarchical management structures
Too little professional management
Management seen as a way out of front line service provision
Constant re-organisation
Secondary care centric
Targets and inspections
Opaque performance data
Lack of staff
Lack of infrastructure

I’d agree reforms are needed alongside investment.
Many of those issues exist in other workplaces in both the public and private sectors.

Yes it is broken and we all know who has broken it and why.

The people with the greatest need for NHS services tend to be the people with the least resources to access it.

I’ve always felt that the current de-facto system whereby the people with the most time on their hands are most likely to be able to access the system is as fair as any for managing demand, but you’ll never find a politician willing to say that.

Another part of the problem is that for healthcare systems to be the most effective, for any given level of resources, those resources should be targeted at the poorer sections of society, to the expense of those who are more well off.

is that what lay-people’s perception of what a good service is, and what actually is a good service are two entirely different things.

OMG this.. at my practice we triage every patient request, TBF this drives nearly every patient potty becasue they “feel” they should be able to ring and book an appointment with a GP. When you explain to them that our triage system means they’ll get seen more quickly by an appropriate clinician rather than suffer for 2 more weeks while they wait for an appointment that may not have to be with a GP anyway; they often either just straight up don’t understand or don’t believe you.

Also the Friends and Family test can get in the sea. [irony] Are you better? Who cares, whether you liked the doctor is much more important [/irony]

[irony] Are you better? Who cares, whether you liked the doctor is much more important [/irony]

Indeed. See also the number of “nice” colleagues who take the easy route rather than have the difficult conversation.

One of the unfortunate things about the UK is how little people look at other countries’ experiences and reflect on them. In France I have had absolutely excellent healthcare mainly funded by taxes (it’s a little bit complicated but basically emergency care and long term health conditions are entirely funded, the rest is 80% funded unless you are on benefits).

However the health and social care component of taxes are a flat 23% of everything I earn. The annual income only adds a few percentage points but it does mean that overall I pay more tax here than I did in the UK. NI is tiny in comparison.

The UK has got more (ok a lot) for less out of the NHS for decades and somehow doesn’t seem to appreciate it.

I believe that Harold Shipman was almost universally thought of as a “nice” doctor too… 😉

In France I have had absolutely excellent healthcare

Most people who I’ve known who’ve visited doctors in France have been absolutely delighted with the number of unnecessary and ineffective treatments that the doctor has given them.

taxes? someone in HMRC has the temerity to suggest that tax evasion is tightened a little and STW massive have a meltdown in case the sale of their bike has a tax implication (clue for the h.o.t. – unless you ‘sell bikes’, probably not)

i met an 81y.o. yesterday who had recently had an incident with a dog walker (6 dogs) – one of the dogs bit him.  ouch.  He went to A&E and sat there for 4 hours before being sent away to Minor Injuries for a tetnus shot.   Its ok tho, cos he knew the recetionist who managed to grab him a packed lunch bag, because otherwise he might have been really hungry…….. i give up.

selfish, fudging, idiots, everywhere.

100% behind the current strikes.

On management.

Estate management is utterly shocking, I did a PSSR course recently and every single bad example bar one or two came from hospitals. Stuff that would get anywhere else shut down immediately.

Why? The NHS run the hospital but the PFI company own it, neither wants to take responsibility (or understands because it’s “just” a heating system) so it gets left to rot and get bodged along by janitors who don’t understand or care either.

It’s not a case of if, it’s when one of these fails catastrophically.

Reading through all of this and in the cold light of day – waiting 30 mins for an ambulance to be dispatched seems quick compared to what others have gone through – but it is wholly depressing.

At the time I posted, it was a few hours after and I was shaken by the experience which doesn’t generally happen easily.

These posts show we really do need change at a mammoth level to support the NHS as a whole.

A couple of things came into my head this morning (out biking on my own). I went through the person’s wallet and found his driving licence – so his daughter was quickly on the scene with family care and knowledge of medical history. The other is that he didn’t have emergency contacts on his phone and attempts to unlock it were unsuccessful.

I know it is a bit stupid but going through his wallet was really uncomfortable. I’m sharing that because it was important to push past the thought!

Thanks for sharing thoughts and experience. While it paints a hellish picture it has helped my understanding. I’ll be looking carefully at political promises come election time but that is clearly no silver bullet.

Another part of the problem is that for healthcare systems to be the most effective, for any given level of resources, those resources should be targeted at the poorer sections of society, to the expense of those who are more well off.

This, we are all selfish and really only care about ourselves and our loved ones. Why should I pay more tax to treat the drug users and smokers? Or those idiots who ride bikes off road and crash into things. So break the system and introduce private healthcare for the people who can afford it. The rest can just fight it out in the wastelands of the north.

Or at least I think this is the approach we are going for.

absolutely db, i love the idea of a national health system, but everyone wants to pick apart what it will and wont treat (to suit their own personal ends, rather than those of the, er, nation…)this extrapolates up to the political level where it competes with the rest of public spending and can then be split up and sold to the highest biddder, or the lowest bidder with the best kick backs.

I’d agree reforms are needed alongside investment.

Constant reform has been pretty disastrous for the NHS over the past three decades. They are running out of acronyms for all the bodies they’ve created and then scrapped.

And none of these reforms stood any chance, because reform in the NHS is a multi-decade project, and incoming governments just reflexively tinker with everything, or just rip it up and start again.

A true enemy of the NHS is the five-year electoral cycle.

For most back pain, MRI scans are pointless.

In fact I’d go so far as to say that this is a classic example of wasteful over-diagnosis that plagues private healthcare systems.

Nice try but this was after about 6 months of pain and with a view to the possibility of surgery. I know surgery isn’t aways (or even usually) the best approach but it wasn’t being suggested as a first resort.