The NHS Debate (Merged threads)

[Martyn Sadler]

Tell you what you right wingers, as a social experiment, lets do away with the NHs and go back to the days where if working class people went to hospital it was to die, back to the days where if you couldn't afford treatment, guess what? yep you died.

 

 

Personal note my great grandfather died after cutting himself shaving!!! Got the cut infected working on the farm and pegged it of septicaemia, ok penicillin wasn't around then but basically he died because he and his family couldn't afford medical treatment.

 

All the rest of it, fiscal ###### and ###### about inefficient management hierarchies is just smoke and mirrors to obfuscate the main point, without the NHS a good proportion of people on this board would be dead by now because they wouldn't be able to afford treatment, no more, no less, that's the reality.

 

Prior to the NHS your chances of surviving an infection of the sort that killed your great grandfather depended on where you lived.

 

In the London County Council area there were more hospital beds prior to the NHS than there are now, while some parts of the country were badly under-provided for.

 

Hospitals were either run by charities or by local authorities. Only those in employment were entitled to free treatment under the national insurance provisions then in place.

[JohnM]

If you want a sensible discussion, Phil,  you need to cut out the class-war empty rhetoric.

 

1. You want examples? I and my contemporaries were born before the NHS yet still we survive somehow.  My mother in law is 94 and still survives, which is more than can be said for  over 200 of Shipman's patients or of those killed by Stafford Hospital or those harmed by Andrew Wakefield.

 

2. I know no one who wants to get rid of the NHS, or to change its commitment to  "free at the point of use"..though it will be interesting to see if Jezza reverses the Labour Party decision to charge for dental treatment and spectacles only a few years after the NHS was set up.

 

3. Cameron et al do not want to  scrap the NHS, nor do they want to charge for its services nor do they want to privatise it and to say otherwise is arrant rabble rousing  nonsense

 

4. Even CKN with his huge experience - almost one whole year -  working in the NHS would agree, I think, that there is room for huge improvement. i am sure that there are those om here who have actually worked for the NHS for much much longer

 

5. Given that it seems that the NHS annual spend is around £120 billion a year excluding the sums that local authorities spend, it seems to me that the amount of spend,the way it is spent and the way it is raised is  of legitimate public concern.

 

6. I tell you what, though. give the NHS an extra £10 billion a year and nothing..zero..zilch will change..apart from pay and even then the lower paid will get nowt...

 

7. Give it £20 million? £30 million? Whose money? not yours. It'll be the politics of envy and ignorance again: tax the rich, tax the rich, 

[Phil]

You can't resist it can you John "politics of envy" I'm not envious of anyone.

Class war? Absolutely, I believe in it and prosecute it to the best of my ability

But back to my point John, smoke and mirrors

[WearyRhino]

The private health sector have the advantage of picking and choosing who and what they would like to treat, the NHS have to treat everyone with every condition.

 

Not only that, they also get a fully trained workforce directly from the NHS courtesy of the tax payer. Another case of how the private sector has a parasitical relationship with the tax payer.

 

They are also in the position of being able to, as Griff says, pick and choose who and what they would like to treat in the knowledge that if anything goes wrong the NHS will step in and take over. Routine aftercare is also often carried out by the NHS and local authority social care as private health sector often time limits it's commitment, particularly in the case of older people.

 

I'm sure some health economists have undertaken studies into how much subsidy private health gets from the state in the UK, but frankly I cannot be bothered looking for it at the moment. 

[Griff9of13]

It'll be the politics of envy and ignorance again: tax the rich, tax the rich, 

 

Envy of who and/or what?

 

For income tax purposes I am classed as "the rich".

 

But whale we're on the sublet of tax: UK deficit rises steeply after surprise fall in tax receipts

 

"A fall in income tax receipts sent Britain’s deficit spiralling to £12.1bn in August, the widest shortfall in government funding since 2012.

 

The Office for National Statistics said a dip in corporation tax receipts was also to blame for the worsening situation, which will put pressure on George Osborne ahead of tough expenditure decisions due in November when Whitehall agrees its five-year spending targets."

 

So they reduce corporation tax to a ridiculously low level (far lower than any comparative economy in the world) and are then "suprised" when corporation tax receipts drop! Not very bright are they.

[JohnM]

...back to that sacred cow the NHS. anyone over 67 was born prior to the NHS...but probably cant remember it.

you are all self-appointed health care experts, so put your Jezza-like politics on one side for a moment ( for ever would be better)

are the French/German/Italianb/Spanish/Polish/Canadian/Brazilian etc systems "better" than ours?

how are they funded?

how much are they funded?

how much does the patient pay and how much does the state pay and the health insurance company pay?

[JohnM]

Envy of who and/or what?

For income tax purposes I am classed as "the rich".

But whale we're on the sublet of tax: UK deficit rises steeply after surprise fall in tax receipts

"A fall in income tax receipts sent Britain’s deficit spiralling to £12.1bn in August, the widest shortfall in government funding since 2012.

The Office for National Statistics said a dip in corporation tax receipts was also to blame for the worsening situation, which will put pressure on George Osborne ahead of tough expenditure decisions due in November when Whitehall agrees its five-year spending targets."

So they reduce corporation tax to a ridiculously low level (far lower than any comparative economy in the world) and are then "suprised" when corporation tax receipts drop! Not very bright are they.

bright?you're the one spending your afternoon on a small internet forum.

[Griff9of13]

bright?you're the one spending your afternoon on a small internet forum.

 

Personal digs? Is that the best you can come up with?

 

[JohnM]

wrong again, it wasn't a personal attack. You can have one if you want, but its against the Ts and Cs.

nor was your post a political argument. you'll have to do far better than that,

[Derwent]

There is no such thing as the NHS these days. "NHS" is just a brand name, with the actual treatment of patients being administered by franchises, no different to McDonalds or KFC. Some franchises (trusts) will be well run, others will be poorly run, it's the luck of the draw if you live in a well run area. For this reason anyone who talks about "the NHS", I.e. A single organisation, being in crisis is talking rhubarb. Localised trusts may be in crisis in several areas but that is different.

[Bedford Roughyed]

One of the biggest (probably biggest) problems the NHS has is PFI's.  The blame for these is firmly at the doors of Labour.  

 

We needed new hospitals, but PFI's have crippled the NHS for decades.  Take the PFI repayments out of the NHS budget and we might actually see what the NHS really costs. 

[damp squib]

I wonder whether any of the NHS critics here have ever lived in another country and experienced a different healthcare system. I lived in the UK briefly and I can honestly say the the NHS is the best thing about your country by a long way. My girlfriend has lived in the UK, Germany and France and the NHS beats them all. Just providing some anecdotal evidence since real evidence doesn't seem to be convincing the critics.

[gingerjon]

There is no such thing as the NHS these days. "NHS" is just a brand name, with the actual treatment of patients being administered by franchises, no different to McDonalds or KFC. Some franchises (trusts) will be well run, others will be poorly run, it's the luck of the draw if you live in a well run area. For this reason anyone who talks about "the NHS", I.e. A single organisation, being in crisis is talking rhubarb. Localised trusts may be in crisis in several areas but that is different.

 

Broadly that's true  - and indeed I was in a meeting yesterday where part of the discussion was why one area (a grouping above trusts in this case) was able to be doing Thing X really well but most other areas weren't even trying - but there are issues (for eg: contracts, drug/treatment approval, national directives) which cover the national service, just as there are some conditions which are linked by dedicated centres operating in a unified way, again not on a trust basis.

[gingerjon]

bright?you're the one spending your afternoon on a small internet forum.

 

It's good that you weren't here so couldn't make that post.

[PCarter]

If it's as bad as you say it's become that way under the Tories.  Satisfaction with the NHS was at a record high in 2010. So much so that the Tories' election strategy was not to mention it.  And then when they got it begin to dismantle it.  We know what the Tories think of the NHS privately, that it was (in 2008) a 60 year old mistake.   Health care in the US is far more inefficient than here because of all the bureaucracy making charges.  Which is what the Tories want for here. God help us.

 

The satisfaction survey you mention was Burnham spin to cover for Mid Staffs.  If you'd care to do a little research this 'satisfaction' was based upon an incredibly tiny sample from a single department in one hospital.

 

The fact you are using it as a bulwark for your argument is rather telling.

[amm]

Working within the NHS for 10 years in two different trusts, having previously worked in the utilities industry for 25 years, I have experienced de-nationalisation, de-regulation and worked under many managers, including the customer service company that UU spawned to take outsourced contacts from local government to betting and M&S, I think I have a feel from a low level administrative perspective.

 

The most frustrating things for me are

 

1. The fact that even in 2005 I was truly shocked at how far behind the rest of the world the NHS trusts were in IT, and how nepotism and only ever having worked in one industry was rife. They haven't advanced much further since but it is getting better, but just far too slowly.

 

2. The reduction in admin roles has meant clinicians having to do that work - but they of course either haven't the time or inclination to do it when they have patients to see to. We lose I don't know how many millions because of it. For example, each outcome from opd has to be updated and coded, so that we account for the work we do. They are mostly left blank, or just the same boxes ticked and things missed all the time. The clerk uploading this information wasn't even in the room to know if anything is missing, and even if someone like me with a bit of nous returns them to the clinician as they look to be missing information, they still come back as bad or you're given a wry look for challenging the status quo. I know they haven't the time nor should they, it's often the nurses who fill them in, contrary to what is supposed to happen, but the blind ignorance that they have that ultimately jobs are lost and future budgets are produced from this data seems to pass them completely by.

 

3. Private health organisations, more often that not employing exactly the same consultants, cherry pick the NHS referrals they deal with (simple, no emergency or follow up of any significance required), so of course you can get an appointment sooner than with the NHS trusts (happy patient). Thus leaving the more complex to the trusts (long waiting times and unhappy patients). Then these same consultants refer into the trusts (often to themselves) to take up the follow up. This all plays into the political media's hands and people are conned into thinking Private = good, NHS = bad. Complex operations cannot be done in the private forum, so again more costly ones are done in the trusts. Is it any wonder there is no money left.

 

4. When the utilities industry was deregulated it was painful too, but I felt confident we were moving in the right direction. In the NHS I feel we're dying to prove a political point 

 

5. When I was Tupe transferred in the utilites industry having applied for a role in the new structure, my skill set was recognised and I got  5% pay rise. In the last 5 years my grade 2 job in the NHS has changed dramatically (expected) but I don't know how long I can do previous grade 3 & 4 work as well, under so much pressure with a no recruitment policy. Very good people are burning out and clinicians are leaving in droves. One or two have jumped before they are pushed, but we need the new blood in before a new structure. We have some inclination of a new structure, but no confidence that it will be managed successfully. Because we haven't recruited, people will be kept on in roles they have already deemed to have failed in, because of fear that we cannot handle the massive impact of moving as many people out or across etc as needed. 

 

6. The slowness of it all - it drives me nuts - get the plan out there, and get on with it - but the problem is the plan changes every minute through all the politics and rhetoric.

 

It's one humongous elephant - I always say the only way to tackle one is a bite at a time - but we're biting off nibbles all over the place then trying to eat it all at once, then overnight it turns into an even bigger elephant, with larger tusks.

 

I hope I'm able to stick with it and we do get there eventually. I feel we can if the right managers are in place, but at the moment I don't see any that inspire me unfortunately. It's all doom & gloom, and looking after number one. Most importantly I hope we look after all our patients whether via the trusts or via private health care, whilst all the changes happen.

[Griff9of13]

Thanks Maggie, good to get a view from the "coal face".

[amm]

Thanks Maggie, good to get a view from the "coal face".

 

If anyone knows of any permanent jobs in the Huddersfield area, I would seriously be grateful for the leads, via private message please.

[Trojan]

Prior to the NHS your chances of surviving an infection of the sort that killed your great grandfather depended on where you lived.

 

In the London County Council area there were more hospital beds prior to the NHS than there are now, while some parts of the country were badly under-provided for.

 

Hospitals were either run by charities or by local authorities. Only those in employment were entitled to free treatment under the national insurance provisions then in place.

My aunt died in 1920 (aged 4) my grandad died in 1921.  My grandma was still paying off the doctor's bills in 1930.  That's the fear that "In Place of Fear" meant.

[tonyXIII]

My aunt died in 1920 (aged 4) my grandad died in 1921.  My grandma was still paying off the doctor's bills in 1930.  That's the fear that "In Place of Fear" meant.

 

But there was health insurance in those days! Did your grandparents not pay into a scheme? From what my dad (born 1919) told me, the insurance man used to call round every week to collect a shilling (a not insignificant sum in those days!). It might have been sixpence; I'm not sure.

 

The NHS was introduced to make sure everybody paid in and was entitled to draw on the service as needed.

[Trojan]

The satisfaction survey you mention was Burnham spin to cover for Mid Staffs.  If you'd care to do a little research this 'satisfaction' was based upon an incredibly tiny sample from a single department in one hospital.

 

The fact you are using it as a bulwark for your argument is rather telling.

Waiting times for operations, waiting times in A&E, waiting times to see a consultant have all deteriorated drastically since 2010..  It's not a bulwark for my argument, it's a fact. Labour promised in 1997 to improve the NHS, but didn't because they stuck to Ken Clarke's spending plans, plans which Clarke subsequently admitted were unrealistic and just there to trap Labour. At the 2001 election Blair got monstered by the public because the NHS hadn't improved.  That's when  the money went in and that's when things improved.  And now we've got the Tories back and the NHS is declining again.   They say all they care but that's all they do say it, and yes the North Staffs affair was appalling.  Because of those who suffered by it and because it's allowed Tories (like you) to use it as a fig leaf for letting the NHS disappear. 

[Trojan]

But there was health insurance in those days! Did your grandparents not pay into a scheme? From what my dad (born 1919) told me, the insurance man used to call round every week to collect a shilling (a not insignificant sum in those days!). It might have been sixpence; I'm not sure.

 

The NHS was introduced to make sure everybody paid in and was entitled to draw on the service as needed.

Do you really think if they could have afforded insurance they wouldn't have had it?  My father was one of seven, there wasn't even enough for sufficient food, let alone insurance.  I was born in 1946, and can recall when going through my parents things finding bills from the doctor.  I needed eye surgery, but they couldn't afford it, fortunately the NHS came in and probably saved my sight.

[ckn]

Do you really think if they could have afforded insurance they wouldn't have had it?  My father was one of seven, there wasn't even enough for sufficient food, let alone insurance.  I was born in 1946, and can recall when going through my parents things finding bills from the doctor.  I needed eye surgery, but they couldn't afford it, fortunately the NHS came in and probably saved my sight.

"Mr Scrooge, ... it is more than usually desirable that we should make some slight provision for the Poor and destitute, who suffer greatly at the present time. Many thousands are in want of common necessaries; hundreds of thousands are in want of common comforts, sir."

"Are there no prisons?"

"Plenty of prisons..."

"And the Union workhouses." demanded Scrooge. "Are they still in operation?"

"Both very busy, sir..."

"Those who are badly off must go there."

"Many can't go there; and many would rather die."

"If they would rather die," said Scrooge, "they had better do it, and decrease the surplus population."

 

Sometimes I read this forum and wonder...  Those who get chubbies over the Tories' desire to return us to the days of Dickensian servitude to our corporate and social betters are quite often those who would suffer the most under them.

 

On narrow topic though, those who idolise free-market healthcare should have a good look at the US.  The number one cause of personal bankruptcy is healthcare costs.  The number one case of poor performance dismissal is people having the audacity to get ill.  The two are linked, people are sacked for being ill, their workplace health insurance lapses immediately and a relatively minor illness can turn into losing your house and, most likely, your entire future.  Most American workers don't have that protection though and have to provide their own insurance, a basic policy for a two adult, two child household in good health will cost about £1000 p/m (yep, children without insurance also are left in the skip of humanity) and that's with huge co-pays often up to 50%.  And $deity forbid that you dare to get ill because your insurance policy will link it to everything possible meaning you can't claim again.

 

Anyone who genuinely thinks we should go to the US insurance type model (Mr Farage, take a bow) deserves to be repeatedly punted in the nuts until they're removed from the gene pool.

 

And here's how I know.  I mentioned it a few years ago on here that my wife was very ill.  The NHS can't help her despite her being seriously and chronically ill because first the Labour government from 2005 to 2010 cut mental health care, the Coalition decided to ramp up the cuts and the nice new government is imposing yet more "efficiency" cuts.  Thankfully I had been self-employed in a very good job for a while otherwise I seriously doubt my wife would be here, I've paid out now over £70,000 of taxed income for private treatment plus having to take probably a year in total off my old self-employed job to care for her.  I've seen first hand the implications of these cuts, ward and hospital closures in the last five years to a scale that would have brought down the Thatcher government, clinicians worked to tears because the Trust can't afford to hire to vacant posts.  This is why I work for the NHS, I want to bring my skills to make it better.  I've even had some people I thought were friends who called me stupid for taking essentially a 60% pay cut to come into the NHS, they just can't see beyond money as the sole status symbol for how great a job you're doing.

 

Because of my job, I know one area where for an entire area of around 1m people there is ONE single acute mental health assessment bed, if two people dare to be mentally ill requiring immediate assistance then, ah well, that's just unfortunate.  I saw one incident of a 16 year old girl being sent 250 miles from her family because that was the closest bed for her.  It's almost unrecoverable now.  It would take the government to invest many extra billions to stop it failing now.

 

I see very well run but struggling units targeted for "cost improvement plans" despite it being clear that there are no more costs to be cut without compromising patient care.

 

Those who sit at the side and sneer about NHS management inefficiencies, the NHS typically has 70% fewer managers than private healthcare for equivalent sized units, they get paid about half of what private equivalents get paid and get the blame for every single bit of government mismanagement.  You have nurses doing the job of Ward Manager who are part nurse, part administrator, part budget holder, part wellbeing coach, part miracle worker and all for a pay that's just shocking for their level of responsibility.

 

I may seem like a bit of an evangelist on this issue but then I probably am.  I know that I wouldn't have seen the inside dirty laundry of the NHS if my wife hadn't become ill with something the NHS can't afford to treat because of cuts.  I see the good people fighting on the inside trying to help patients but being blocked time and time again by dictat from central that has only the goal of cutting costs and "encouraging" private involvement.

[Saint Toppy]

Regardless of the overall funding issues of the NHS (and both main ploitical parties have been responsible for cuts over the years), the main issue appears to be what the NHS does with the money its receives. So much of it is 'wasted' on non-patient care.

 

Like education its now just as important to fill in the right forms, put the tick in the righ boxes, get the right score in an endless tream of assessments than it is to actually treat the sick. Whats fundamentally wrong is the way politicians (and civil servants) put beaurocracy and statistics ahead of patient care. Let doctors & nurses actually be doctors and nurses not meaningless bean counters & form fillers, let teachers teach instead of having to manipulate their classes to score highly on some government assessment.

 

The tories have been guilty of funding cuts and it was the Blair govenmnent who set us on the path on a statistics based system, one which the tories have failed to undo at all.

 

You can throw as much money at the NHS as you like but its pointless when the same percentage just gets wasted every year by political & whitehall interference.

[ckn]

I do see your point but it just needs careful thought rather than scrapping.  Without those statistics, we'd never know the true extent of the scandals.  They provide a nice anchor for proper investigation.  That's where the government and the regulators get it wrong, they look at the statistics and swing their political axes rather than looking to see what the root cause of identified problems are.

 

For example, the scandal at Colchester hospital around them fudging waiting lists for cancer patients wouldn't have been caught without the statistical oversight at NHS England level.

 

There's a lot of power in those statistics.  For example, NHS commissioners have at their power access to GP statistics for over-prescribing antibiotics, those who give the most sick notes, those who refuse to use generics and so on but there's not the political will to tackle this.  We can do so much with those statistics if we put the right thought and political will to it.  And this stuff isn't onerous on the clinicians, it's all captured in the background whenever a GP types a prescription or puts a note on the system about a sick note.