I love the NHS but is it broken?

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

Yes, so long as there is a safety net for those who can’t afford it. Currently there’s a substantial cost of accessing basic healthcare for someone in work due to the time and energy it takes to negotiate the system and the lost productivity due to untreated sickness and injury. Whereas the unemployed and retired can toddle along to their GP for the price of a (possibly free) bus fare and sit in a warm waiting room for a couple of hours so they have someone to chat to. Anything that discourages them from wasting everyone else’s time can only be a good thing.

@martinhutch

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.

Agreed, it’s cultural reform that’s needed not organisational reform. Unfortunately cultural reform starts from the top down.

Anything that discourages them from wasting everyone else’s time can only be a good thing.

Leaving aside the rather odd idea the unemployed and oaps use the doctors surgery as a social club the problem with making people pay is you make it more likely people will put off going until their condition has worsened significantly.
Not only does this give worse probable results for them but can cost the NHS more as well since treating something early is often more cost effectively than trying to treat it later.
You are also, of course, adding additional costs to those people in work and making it less likely they will be taking that time off.

Yes, so long as there is a safety net for those who can’t afford it. Currently there’s a substantial cost of accessing basic healthcare for someone in work due to the time and energy it takes to negotiate the system and the lost productivity due to untreated sickness and injury. Whereas the unemployed and retired can toddle along to their GP for the price of a (possibly free) bus fare and sit in a warm waiting room for a couple of hours so they have someone to chat to. Anything that discourages them from wasting everyone else’s time can only be a good thing.

• The people most likely to benefit from health care are the ones who do have the time, please see my earlier post on this.
• Most of those people would be picked up by your safety net anyway,  so wouldn’t be charged.

I cannot stress this enough. Ill health is extremely strongly associated with poverty.

I think that this thread illustrates nicely the problem with uninformed people’s perceptions of what the problems with and solutions are to providing effective healthcare:

• Being happy because “something has been done” for them.
• Being unhappy with “nothing being done”, even though often it is the better course of action.
• Various tired old tropes about private sector & NHS efficiency.
• Stop those people from wasting precious NHS resources so that I can get better access.

Stop those people from wasting precious NHS resources so that I can get better access.

This one worries me the most. Trying to price off old or vulnerable people from accessing healthcare seems an odd motivation, these are the people that need help most, and it wouldn’t work anyway. If charges came in, it will be working busy people paying them, in the main, and older and unable to work people not being asked to pay.

Even if old people are toodling down to sit in a warm waiting room, (which I doubt) that points to a societal issue that needs fixing outside the NHS, not within it.

Disincentivising people to visit their GP would be the same as making it tougher to get free prescriptions – people would die as a result.

People who miss appointments and timewasters have been present in the NHS since its inception. The difference is that successive falls in funding and staffing mean that this annoying but unavoidable part of the job has become something that is harming access for people who actually might have stuff wrong with them.

The question is, do you think free-at-the-point-of-need healthcare (such as it is), is worth fighting for, is it a social good?

And when you look at those clamouring loudest for extra charges, and private sector involvement, do you see people who are trying to make things better for everyone, or mostly a collection of Right Wing Think Tank shills who just see opportunity for them and their mates?

Anything that discourages them from wasting everyone else’s time can only be a good thing.

Here’s a thing that will surprise you…We (the folks in primary healthcare) can spot timewasters,  and we have ways of dealing with it. We don’t need (or largely want) any additional bureaucratic* tools to help with that.

* As GPs (where the payment would no doubt be taken) we’re entirely not set up to take money from patients routinely. That’s not to say we don’t do it currently, we do, but it’s once or twice a day, I can think of any other patient facing activates I’d rather my admin staff did for patient healthcare than deal with all the issues that having to take payments off people would cause.

Oh yes, the other amazing thing in France is the sheer number of people devoted to healthcare admin. Because it’s free but run on an insurance basis there are immense amounts of paperwork and you get to see what your broken ankle (to give a pertinent recent example) would have cost if social care hadn’t picked up the bill. I am totally not sure about whether this is an unnecessary waste that contributes to the higher social care levy here but it’s interesting.

Whereas the unemployed and retired can toddle along to their GP for the price of a (possibly free) bus fare and sit in a warm waiting room for a couple of hours so they have someone to chat to. Anything that discourages them from wasting everyone else’s time can only be a good thing.

How big an issue is this? Do you have any statistics?

Yes.

Literally today my wife has been refused a consultation due to “capacity issues”.   She’ll now attempt the morning internet trial that is a Dr’s appointment.    She has a Thyroid issue, and on the last two occasions the GP was in shock and manipulated an appointment on the basis my wife is “…at serious risk of a heart attack…”   The reason she is calling is her resting HR is up to 90bpm and other symptoms put her levels at risk.   A 12hr wait in A&E won’t help.

Gov.UK doesn’t give a shit about the proles dying as long as they make their money.

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.

Or Serco’s butchery of Suffolk Community Services. They under-bid the NHS providers by £22m and then lost £22m trying and failing to run it. And that was a fairly straightforward set of services. They **** it so badly that they haven’t bid for a clinical service since. 
The answer is not privatisation, it’s acknowledging that in a civilised but aging society we’ve all got to pay a bit more tax.

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

Plus adding in a load of admin to charge/collect fees along with shipping out debt-recovery from those who’s cheques bounced etc or weren’t actually allowed not to pay.

Any healthcare system that ‘decides’ who will be treated and to what level has a far larger admin overhead than one that doesn’t.  Most of the NHS admin is related to staffing, buildings, logistics & procurement plus managing the constant Govt changes (waiting lists and the like) – not payables, invoicing, recovery etc etc.

One of the reasons the USA has a healthcare problem is folk don’t go until it’s really serious, even those with good insurance – check out “healthcare deductible”.

The NHS needs root and branch reform before more money is chucked at it.  Should still be free at the point of use for those who cannot afford to pay, but surely some sort of health insurance based type system, like in most of Europe (where healthcare outcomes are generally better) would be far preferable to the shitshow we currently have which seems to serve no-one very well?

The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.  I am not excusing the Tories as they are utterly shit too, but just saying that the problems clearly run much deeper than whichever political party is in power.

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 have no idea but I do know that their grandparents were likely to have asked their GP for a home visit if they were feeling poorly and had a bit of a temperature.

I also know that back in the day their grandparents could pop down to see their GP on a whim, they didn’t even need an appointment – they could just turn up any weekday and expect to be seen!

I also remember a time when a GP would sometimes ask you to come back after completing a course of treatment to see how you were. Imagine that, a GP having the time to see someone with a cured medical complaint!

The NHS needs root and branch reform before more money is chucked at it.

Yay, more reform.

 some sort of health insurance based type system, like in most of Europe (where healthcare outcomes are generally better)

Where they also spend more of their GDP on healthcare you mean?

Yay, more reform.

It is one thing the various governments have been competent at with regards to the NHS.
Shouting loudly about “sacred cows” and “cant criticise the NHS” and “needs reform” to cover up all of them have been buggering around with it since about the year dot never allowing anything to settle in before they dive into their own personal dream of how to “improve” it.

I kind of think that @Kramer (et al) has summed things up and made much of this thread superfluous… including the stuff I have written below.

As users of the system each of us who expresses an opinion here is doing so on the basis of anecdotal evidence; gained from our experiences and those of people we know.  The people we should listen to are those that understand and work in the system.

I can cite examples of things where I think the system didn’t work as it should… but in many cases the outcome would have been the same if things had been done differently.

In the end I feel we need to pay more to the system as a whole and invest in primary care and prevention.   At the moment too many NHS users let themselves get unhealthy, moan about tax and then moan about how long an ambulance takes to turn up. On top of that they moan about immigration whilst relying on an immigrant for their healthcare and so on… all the time they are subject to the drip drip gaslighting of the billionaire press and think tanks so they vote for parties who perpetuate the situation we have.

WRT to prevention, the current Health Secretary refuses to take action on obesity, because she doesn’t believe in the “nanny state” and prefers to use education (which isn’t effective) instead.

note sure this’ll work

WATCH | A&E is v busy today at GRH with sick patients who need specialist care. If it’s not a life-threatening condition or serious injury, get advice at https://t.co/ovsaPkUP5S or call 111. The 111 service can book you into local NHS services if needed #clickorcallfirst pic.twitter.com/Fg7CX16TJb

— Gloucestershire Hospitals NHS Foundation Trust (@gloshospitals) January 3, 2024

When you have the NHS telling people to stay away you aren’t in a good place.

Just don’t go stuffing yourself into trees or on rocks for the next week.

I was well looked after as an in patient for 6 weeks after breaking my spine, express delivery through A&E straight into resus.

That was a while ago. 

The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.

I wonder why a Tory government might act in a way to make a labour government look worse?

Charge to be seen? I can’t even get seen.

My local practice regularly has people calling over 100 times to get through. They don’t allow walk in appointments and have a couple of phone operators if you’re lucky.

They used to run e-consult which was great, fling in symptoms, bish bash bosh, wait to get triaged and they would contact you for an appointment. Then they made it run during opening hours only. Then they scrapped it entirely.

So if you have an urgent medical issue how do you get seen? Or an issue that’s not that urgent but you don’t want to take half a day off work to sit on the phone hoping you get through. **** if I or anyone else knows, it’s an utter shit show.

@kramer I doubt you mean it but you are coming across as quite dismissive and arrogant regarding other countries medical services. If there’s one thing I’ve learned it’s that we always have something to learn from our peers and there is always room for improvement.

I had cause to pop into minor injuries last week.
Angle grinder spark in my eye.
Walk in , 4 people waiting. Booked in within a minute.
Fab .
Triage within 5 mins , usual ” are you an athlete?” HR around 60 , BP 105/67.
Back out to waiting room for 10mins, then called to see eye specialist.
Just a burn and no debris so ointment for a week and don’t be a dickhead with an angle grinder chat.
Out the door within 30 mins. So , in this instance on a sample of 1 , amazing service from the NHS .
Queue was more or less the same when I left ,

The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.

How do you know it’s worse? If it is, how do you know if the reason is due to the Welsh Govt and not other variables? Are any differences significant when corrected for population and other regional variables?

Don’t forget how desperate the current UK govt is to show Labour in Wales as failing.  I’m not saying WG or its institutions are perfect and beyond reproach but the current UK govt works hard to shaft the WG whilst making it look like they are trying oh so hard to do the opposite.

Then they made it run during opening hours only. Then they scrapped it entirely.

I know its frustrating, but I know why GPs do this. Web based triage systems are like building an extra lane on the motorway, for a bit they divert people from walk in or the phone, like the extra lane makes traffic move faster for a bit… But soon patients overwhelm them as they think they’ll get seen quicker, and they still rely on GPs to triage them, if I divert  a GP to look at those, that’s a GP who’s not seeing patients. If I left our web-system on 24/7 we’d never get through it ever, and we’d be back to square one. It might be boring and a bit beyond scope of the thread, but GPs pay contracts are based around seeing a number of patients each year “at the expense” of other patients on the register who never really come in. I don’t know of many GP practices who’re are within hat contract ratio anymore, and we haven’t been for a while now.

edited to make more sense and typos.

@kramerI doubt you mean it but you are coming across as quite dismissive and arrogant regarding other countries medical services. If there’s one thing I’ve learned it’s that we always have something to learn from our peers and there is always room for improvement.

I refer you back to my point about “something was done” therefore people judging it as being good when in fact it isn’t.

Overtreatment and over diagnosis is a massive issue in health care systems, especially insurance based ones.

The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.

Something to consider, when the system is short of frontline staff, and we’re not talking one or two, but 10’s thousands there will be an impact. To train a nurse is going to take 5+ years, a doctor a decade. Throw in an aging population, decades of underfunding, not exactly great conditions, staffing is going to be an ongoing issue.

Privatisation isn’t going to fix anything when the staff don’t exist. Remember the farce of the nightingale photo ops. no staff to populate the buildings.

Spending money on consolations and reorganisations is easy, getting staff when you tell all the foreigners to f*** off less so.

To see how well privatisation works, take a look at dentistry.

It’s ****. 

a doctor a decade.

I think it took about 5 years after I finished my GP training that I started to become a productive GP, so for a GP ~ 15 years or so. Most of our learning is done in practice.

I work for the NHS (Mental Health, and I’m a MSc Student Dietitian, so partly funded via the NHS) what I see from a work point of view and from the other side of the coin is completely different, mental health, bloated mess, no discharges, bed blocking, huge buildings and wards for 45 patients, managers for managers, 90% of discharges into private residential, at huge cost

however, on a couple of occasions in the last month I’ve been on the other side of the coin

1st, had a kid, waters went a month early, 5 day stay for baby mama, discharged with a plan, went back in, augmented, baby safe, flawless, couldn’t ask for more (ok maybe a bit quicker from you’re getting discharged, to you can go, but it is what it is), baby readmitted 8 days later, phone call at 8pm after blood results were back for 24 hours due to jaundice and feeding issues, bit of a staffing issues and access to a machine but it was 9pm new years day, they were understaffed, he wasn’t a priority

2nd, friends partner hung himself, arse end of nowhere in Lincolnshire, took me 40 minutes to get there, by the time we had, there was already 2x police, and an ambulance, he’d been resused and worked on for a good couple of hours before the ambulance left for the hospital, unfortunately he died a couple of days later having never regained consciousness however, you literally couldn’t have asked for more

lots of other stuff like missed appointments, and other stuff, but when you need it sometimes, it’s still good

My OH is a band 9 leader and I can say from the utterly crushing amount of BS she has to deal with as a direct result of this government’s relentless pursuit of dismantling  the NHS, then yes, it is screwed. 

How do you know it’s worse? If it is, how do you know if the reason is due to the Welsh Govt and not other variables? Are any differences significant when corrected for population and other regional variables?

I’m not sure of the politics, but my brother has been waiting 2.5 years to see a dermatologist in Wales for a fairly unpleasant and progressive skin disorder.  Still no joy to see anyone despite his GP trying to expedite his referral – twice.  His next door neighbour has just had both knees done as she was getting to the stage where she was unable to go to work with it.  She paid and went private in the end as the wait for her operations on the Welsh NHS was 5 years.  5 years – just let that sink in for someone of working age who is struggling to stay mobile.

So pretty f**king sh*t I would say.

Yeah Scotland and Northern Ireland aren’t great either.

@mrmo dentistry, well that’s a whole separate thread but the death of nhs dentistry is already a foregone conclusion & broadly speaking it’s the result of massive under investment going back to the last labour government and includes both parties ignoring the profession telling them what was going to happen about 20 years ago.

The dentists themselves would tell you that privatisation has not massively increased incomes compared to the heyday of the nhs but it has eased workloads to under burnout levels and has allowed clinicians to practice the dentistry they were taught to do not some speeded up bargain basement version that doesn’t really help the patient or the dentist in the long run. So it has worked just not on a whole population level.

ever wonder why dentists were in the top three of professions that committed suicide?

anyway carry on.

@ceepers I think it started even longer than 20 years ago. I remember my father stopping being an NHS dentist ~35 years ago because they brought in a new contract that made it (in his eyes) unviable to continue as a dentist.

@kramer yep that was the first nail for sure and it’s only got worse.
Back then it became unviable to practice really high standard dentistry. Now it’s pretty much unviable no matter how many corners you are prepared to cut & nhs dentistry only really exists wheee a business has a private side to subsidise it!

as a business owner I am increasingly wondering why my personal finances are subsidising a health service provision that the government won’t fund properly and yet we and many others continue  do So as far as we can because it’s “the right thing to do” as healthcare professionals

I’m not sure of the politics, but my brother has been waiting 2.5 years to see a dermatologist in Wales for a fairly unpleasant and progressive skin disorder.  Still no joy to see anyone despite his GP trying to expedite his referral – twice.  His next door neighbour has just had both knees done as she was getting to the stage where she was unable to go to work with it.  She paid and went private in the end as the wait for her operations on the Welsh NHS was 5 years.  5 years – just let that sink in for someone of working age who is struggling to stay mobile.

So pretty f**king sh*t I would say.

That sounds crap and indefensible… but you can find similar counter claims the other way.  A friend who went private in England for an op that another friend had done on the NHS in no time in Wales. Other people I know who have all kinds of issues in Cumbria with geriatric care that I haven’t had here with my folks.  My brother was an audiologist in England and his service got privatised… he came home. Wales does have some significant problems I know.  But my point is 

1. Our observations are anecdotal and not the whole picture.  2. If Wales is worse then it isn’t an order of magnitude worse; it’s in the same ballpark.3. That Wales is screwed over by the current government; they have the magic money tree but WG doesn’t. It simply hasn’t got a tree to shake. 4. Wales lacks the economy of scale in all kinds of public sector services that England relies on. But again this is kind of by the by.  The issues stem from a Govt and its support systems/influencers (press, think tanks, the USA corporate lobbyists, the Brexit lobby) that have not looked after us and our public services.  

The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.

Exactly… yet the Govt(s) and wannabe govt as well as the likes of Kelvin MacKenzie will have you believe the opposite.  The comments you hear from them on issues such as NHS pay are reprehensible to put it politely. 

@nickc but now nobody can be seen at all unless they have the spare time to phone 100odd times before they get through.

I appreciate your explanation, I just think there’s a sensible middle ground somewhere. Have the e-consult for those that can use it and leave the phones free for those who can’t or urgently need an appointment.

The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.

@kramer That makes more sense, cheers.