[gangzoom]

Rather than take over a PCP thread I thought I share my thoughts on the NHS on a new thread.

I've worked at the Front line of the NHS for 10 years now, I worked in A&E/hospital a few winters ago when we had ambulances waiting at the front door, and through this winter I've worked over Xmas, and starting a nightshift next week. So as you can imagine I'm more than a little but passionate about the NHS, and thought I give my perspective.

Forget the DailyMail / politicians rubbish, and let's look at real number. In proper researched papers on global healthcare the NHS always comes out near the top, and the US at the bottom.

http://www.commonwealthfund.org/publ.../mirror-mirror

The UK spends 9.6% of GDP on health care, the US 17%, and most of Europe 10-11%. This is world bank data

So how can care in the US be worse than the UK?? Some US hospitals have 30-40 ITU beds EACH, and here in the UK we can barely manage 10-20 ITU beds per 700,000 population??!!

Because the majority of the sickness in any country is with-in the poorest groups. Money may not buy you happiness but it does buy you health, this is proven world wide.

60-70% of people I treat are either elderly, longterm disabled, or cannot work. These people are left untreated in places like the US because society has accepted that without money you are denied access to the best health care.

The NHS is close to collapse, eveyone that works in it knows it, but I still get a immense sense of pride been able to deliver some of the best healthcare in world to people regardless of their wallet size.

The UK public are spoilt by the existence of the NHS, the cost of medicine is far more than people realise. For example if you have kidney failure and need dialysis. The cost is £60k per year, for the rest of you life, how many of us can afford £60k per year!!?? In other parts of the world if you cannot stump up the cash, well I'm sorry, you have go leave, and good luck.

On a 'normal' day the NHS is working at 95-100% bed capacity, and anyone who understands system design/management will tell you that if your system is working at 100% on a 'normal' day than there is no way it will cope with any additional 'stress', ie:

Trains and airlines timetables have built in 'buffers' to allow for delays, hence sometimes they are early, there is no such luxury in the NHS. Work load has increased year on year, but capacity hasn't, hence this winter a 5-10% rise in demand is close to bringing the whole system down!!

I'm 100% against privatisation. Privatising may be a solution, it will reduce demand and increase capacity. But it will mean a two tiered health care system. I will get a pay rise because the rich will want the best health care professionals and can afford it, but the poor will suffer. I'm not going to preach socialist ideology, but as a country we need to decided what we are comfortable with morally/financially.

In the next 5 years the politicians need to grow some balls and debate the future of the NHS with the public, and as a society we have to all decide which way to go.

[Pablo68]

Completely agree with the above. We lived in the US for a number of years and my wife is a nurse who has worked both in the NHS and the US extensively. She hates the US "Health Care" system (in the US it is not about health care at all, it is a money making system, along with the insurance and food industries) with a passion.

But what the NHS needs badly before it dies is politicians with some balls to maker radical changes. Changes such as charge for A+E services for drunks. Charge people who abuse it, charge people who are just visiting. It is a NATIONAL health service not a WORLD health service. And mostly address the over stuffing and utter abuse and contempt within the upper management structures of NHS trusts who pay themselves outrageous packages for utter incompetence while cutting frontline clinical staff pay and moral. If the NHS was a private company it would be bankrupt, not because it has a poor product but because it is run by the most incompetent fuckwits imaginable, from ministers down to senior managers at trust level. Fuckwits who would rather piss all over very good clinical staff rather than address their own issues. And politicians who are crippled by the need to pander to SpADS and think tanks and every over-vocal minority special interest group going rather than be radical and actually do what is needed rather than what is "right".

[GBR1]

HI gangzoom,

Nice write up and its good to hear from someone on the front line.

Clearly its an unsustainable situation as it currently is so something has to change, so what is it?

I could be wrong but I don't believe throwing money at the situation (without a plan) will solve anything, its to big an entity and seems to just swallow up any additional money thrown at it..

GBR1

[Tengocity]

Originally Posted by gangzoom

I'm 100% against privatisation. Privatising may be a solution, it will reduce demand and increase capacity. But it will mean a two tiered health care system. I will get a pay rise because the rich will want the best health care professionals and can afford it, but the poor will suffer. I'm not going to preach socialist ideology, but as a country we need to decided what we are comfortable with morally/financially.

In the next 5 years the politicians need to grow some balls and debate the future of the NHS with the public, and as a society we have to all decide which way to go.

Thanks for taking your time to post that. For me, this bit above is the key thing...

How do you decrease inappropriate demand, without changing the founding principles of the NHS being free at the point of delivery?

Is the principle of healthcare being free at the point of delivery more important than the overall quality or outcomes that the service provides?

Unfortunately it seems to be very hard to offer both without then debating what level of taxation we are prepared to have in order to fund whatever the solution is.

So agree completely that a once in a generation type of debate needs to be had about what heathcare we want.

And it will only get worse... the less we smoke and drink, the more we use great treatments and medicines, the longer we ALL live, and there is the great irony in a good healthcare system... it intrinsically (and just about exponentially) costs you more and more money each year.
As an increasingly elderly population we can't all live longer with more manageable diseases without putting increasing burden on the system.

[....,,,,..,,..]

Originally Posted by Tengocity

Thanks for taking your time to post that. For me, this bit above is the key thing...

How do you decrease inappropriate demand, without changing the founding principles of the NHS being free at the point of delivery?

Is the principle of healthcare being free at the point of delivery more important than the overall quality or outcomes that the service provides?

Unfortunately it seems to be very hard to offer both without then debating what level of taxation we are prepared to have in order to fund whatever the solution is.

So agree completely that a once in a generation type of debate needs to be had about what heathcare we want.

And it will only get worse... the less we smoke and drink, the more we use great treatments and medicines, the longer we ALL live, and there is the great irony in a good healthcare system... it intrinsically (and just about exponentially) costs you more and more money each year.
As an increasingly elderly population we can't all live longer with more manageable diseases without putting increasing burden on the system.

+1

Very good write up Gangzoom, I have witnessed first hand just how dedicated and committed staff we have.

Worked with qute a few here and there, also the odd exercise.

To me, my personnal opinion (likely to be wrong) we have far too many people being passed to hospital that could be treat at their own practice - issue with 111?

We have too many hospitals wanting (or expected to) have facilities to treat everything known to man and the associated consultants.
A lot has to do with demographics, I believe at one point East Anglia area (geographical) had more hospitals than greater Manchester but a huge difference in population.

To me the bits we fall short on are ITU (HDU) areas, beds, services etc.

There is no easy and clear answer, it's highly emotive (peoples lives and health, couple with people's money via tax or insurance).

There is also a huge lack of education in the general public over everything connected to health, from use of doctors, 999 service, A&E, etc etc.

However, great write up.

[Ahmed_uk]

Great comments, I have jus deleted my comment from the other thread and tried to copy here but copy/paste messed up

Anyhow, does anyone remember the documentary sicko? That doesn't paint the healthcare of the states in a good light.

If the NHS is privatised then like gangzoom said we will in effect have a two tier system.

For people who can't afford insurance or for people with pre existing conditions you would potentially be screwed unless you had a lot of disposable income.

I'd personally pay more NI to have a free NHS for all.

[SkyJawa]

Originally Posted by Brigand

To me, my personnal opinion (likely to be wrong) we have far too many people being passed to hospital that could be treat at their own practice - issue with 111?

That's because, if the GPs we've had over the last 5 years are anything to go by, they can't be arsed to work with you in the first instance and its like you are bothering them. Then they look stuff up on the internet and send you to a consultant.

They need to be a better "first line of defence".

[....,,,,..,,..]

Originally Posted by SkyJawa

That's because, if the GPs we've had over the last 5 years are anything to go by, they can't be arsed to work with you in the first instance and its like you are bothering them. Then they look stuff up on the internet and send you to a consultant.

They need to be a better "first line of defence".

Yep agreed.

Some are excellent, let down by those that are on the whole rather poor.

Having 'recently' joined normal society I have had to change my doctors twice and will be again next month.

First one was due to moving house, however 2nd one was due to their practice being utterly crap.

Current one is okay, just very poor admin.

So I am moving to the one where my wife works.

[Nick the Greek]

Just to correct the point of privatisation.

There is non in the NHS.

Privatise means to sell.

When people say "privatisation" I believe they mean putting out the service to tender, that includes the private sector.

This is absolutely the right thing to do. If a private company can provide the service to a better standard than the NHS, at a lesser cost, then it should get the contract. With appropriate controls in place.

The problem the nation has is that we were left an annual deficit of £157 billion by the last government. The present administration have reduced this to circa £90 billion for 2014.
The largest calls on our (taxpayers) money are (2015 budget)

Pension in payment - £150 billion
NHS - £133 billion (£100 billion in 2010)
Welfare £110 billion
Education £90 billion
Debt servicing - £55 billion

So we can see

1. There have been substantial increases to NHS spending over the last five years.
2. It is imperative that we reduce the debt,car servicing is now the fifth biggest annual spend!!!!!

So, the next question, given we have a circa £90 billion deficit, is where do the cuts come from next?

Answers on a postcard.

[JD6]

Very interesting debate. I think the US system is completely dis-functional and free at the point of use is a principle that is really important for the NHS. From my perspective, much of the current A&E situation is caused by GPs having managed to offload their out of hours responsibility. If we don't have access to healthcare apart from A&E, it is hardly surprising that they are queuing out of the doors.

So we need a grown up debate about funding. Taxes need to be raised - they need to be cheap to collect and be hard to avoid. We may all be enjoying the fact that the fuel price has dropped sharply, but to my mind, the right thing to do would be to raise fuel duty.

Inheritance tax may be unpopular too, but with an ageing population placing a huge burden on the NHS and welfare system, that would be an opportunity to recover some of the costs. Wealth passing from generation to generation is damaging to social mobility, so I would reduce or remove the allowance. The effect of rising house prices has been to shift wealth towards the elderly in recent decades. Time to get some of that back.

I have never voted Labour, as I think they are financially illiterate, but my view of social policy is closer to theirs, despite having a career that made me comfortable quite quickly and therefore a natural Conservative.

[Pablo68]

Personally I don't believe higher taxes are the answer...after all we already pay quite significant tax as it is, and £133 Billion per year is quite a bill.

What is needed is better spending (and financial recovery where appropriate) controls.

One of the reasons Labour (and the left in general) are so terrible at finances is because it is based on the simple - and incorrect - belief that throwing more money at a problem will solve it. It won't, it may seem so at first but it is just masking problems and creating new ones, just like taking pain killers may at first make a terminal disease seem to be getting better, but underneath the problems are still their and getting worse.

The only solution for the NHS is a complete bottom-up re-working of what it does, and how that should be funded. The NHS as it is was built around 1940's post war requirements and demographics and requirements and the demographics of today are so far removed from that.

We need a proper 21st Century NHS built from the ground up, that meets the needs of an ageing, growing, highly mobile and multicultural society,
not a re-worked, re-hashed 19th Century system clinging on for dear life. Literally.

But we need politicians - from all sides - prepared to make it essentially their mission to make it happen. So first we need ALL politicians to stop using the NHS as a political football and start working together over several parliaments to make it happen. 4 or 5 years will not be enough.

[jusdorange]

I'd rather have a petrol vs Diesel
Sdrive vs Xdrive review

[Kal101]

Thanks gangzoom for setting up a dedicated thread and a good write up.
Lot of good points made
Main issues in my mind are in no particular order

Lack of funding although I accept healthcare is a bottomless pit
People don't know or care that there are limited funds and have and I'm alright jack screw you mentality
People DO abuse the system and face little or no consequences
We are all living longer and will need more spend on us as we get older
Modern treatments are getting more and more expensive
Patients want a pill for every Ill and won't let nature take its course eg antibiotic overuse
The current free supply of medication results in a lack of appreciation for the costs involved- it's free so it's not really worth anything
Appointment of managers to save money- inherently their answer is sack some front line staff I've made my saving thank you and goodbye where's my cheque
A lack of responsibility for example an electronic prescription service was trialled costing several millions never met a deadline and then was abandoned and start again
Poor gp services with appointments taking over a week to book so off to a+e
MP s more concerned about being popular vote getters and thus being afraid to tackle the thorny unpopular issues
Not enough people paying taxes
Poor prioritisation with some services almost having limitless funds and others being capped inappropriately
Too much jobs for the boys!!
People not taking responsibility for their own health

To name but a few.

[Nick the Greek]

Interesting.

No one is prepared to answer my question above.

What do we cut to reduce the deficit?

Remember.

We spent last year, £90 billion, approx more than we earned as a nation.

The national debt is £1.47 trillion.

Or is everyone happy to pass this onto their children and grand children as the labour party are?

[....,,,,..,,..]

Originally Posted by Nick the Greek

Interesting.

No one is prepared to answer my question above.

What do we cut to reduce the deficit?

Remember.

We spent last year, £90 billion, approx more than we earned as a nation.

The national debt is £1.47 trillion.

Or is everyone happy to pass this onto their children and grand children as the labour party are?

Sell Wales or sell Scotland.

Someone must want them......

[73henny]

Originally Posted by Nick the Greek

Interesting.

No one is prepared to answer my question above.

What do we cut to reduce the deficit?

Or is everyone happy to pass this onto their children and grand children as the labour party are?

I think every 'non standard' burden on the NHS should be funded by that burden. For example the treatments for car accident casualties should be paid for by insurance companies. Treatment for smoking related diseases should be paid for by smokers. Treatment / rescue costs for the stupid hill climbers should be paid for by their own insurance policies. I'd also make self-inflicted patients pay up. Why should I pay for some idiot thats smashed his face of the kerb when blind drunk?. I'm quite happy to help pay for someone with a disease or ailment.
A&E departments should be able to turn away all but those who really need it. I guarantee that if someone thought they might be charged an 'A&E fee' for non emergency treatment they'd think twice before turning up at the door with a sore knee.
In Scotland we have 'free prescriptions'. Fine for those who need it, but you get the hypochondriacs and spongers going to GPs for a prescription for paracetamol.
We've got this 'its free the NHS' entrained in society. It's not free, there just shouldn't be a cost at the point of use.

And no, I don't want to pass on the debt to my kids like Labour are determined to do.

[Kal101]

Originally Posted by 73henny

I think every 'non standard' burden on the NHS should be funded by that burden. For example the treatments for car accident casualties should be paid for by insurance companies. Treatment for smoking related diseases should be paid for by smokers. Treatment / rescue costs for the stupid hill climbers should be paid for by their own insurance policies. I'd also make self-inflicted patients pay up. Why should I pay for some idiot thats smashed his face of the kerb when blind drunk?. I'm quite happy to help pay for someone with a disease or ailment.
A&E departments should be able to turn away all but those who really need it. I guarantee that if someone thought they might be charged an 'A&E fee' for non emergency treatment they'd think twice before turning up at the door with a sore knee.
In Scotland we have 'free prescriptions'. Fine for those who need it, but you get the hypochondriacs and spongers going to GPs for a prescription for paracetamol.


We've got this 'its free the NHS' entrained in society. It's not free, there just shouldn't be a cost at the point of use.

And no, I don't want to pass on the debt to my kids like Labour are determined to do.

Right on many counts here, by the way all accident costs are passed onto the motor insurers irrespective of who is to blame

Issue I have with free prescriptions is a lot of people will tick the repeat box every time. It is heartbreaking when you have to destroy £k worth of medicines all issued on a monthly basis and untouched

[....,,,,..,,..]

Originally Posted by 73henny

I think every 'non standard' burden on the NHS should be funded by that burden. For example the treatments for car accident casualties should be paid for by insurance companies. Treatment for smoking related diseases should be paid for by smokers. Treatment / rescue costs for the stupid hill climbers should be paid for by their own insurance policies. I'd also make self-inflicted patients pay up. Why should I pay for some idiot thats smashed his face of the kerb when blind drunk?. I'm quite happy to help pay for someone with a disease or ailment.
A&E departments should be able to turn away all but those who really need it. I guarantee that if someone thought they might be charged an 'A&E fee' for non emergency treatment they'd think twice before turning up at the door with a sore knee.
In Scotland we have 'free prescriptions'. Fine for those who need it, but you get the hypochondriacs and spongers going to GPs for a prescription for paracetamol.
We've got this 'its free the NHS' entrained in society. It's not free, there just shouldn't be a cost at the point of use.

And no, I don't want to pass on the debt to my kids like Labour are determined to do.

Sort of agree up to a point.

Hill walkers, what's difference between someone living rural out walking dog falling and someone on holiday falling? - what one needs insurance and what one does not?

Yes for those idiots in flip flops in Cairngorms etc.

Smoking - active V passive, how long should someone have smoked for?
Actual takes from smokers is well down.

A high number of respiratory illness is also attributable to work, previously unregulated chemicals, clean air issues, ventilation.

Define self inflicted?

Someone goes to A&E with rash and flu like symptoms? Hyperchondriac or meningitis?

I totally agree about miss use of A&E however there is not simple way of working things out.

[Nick the Greek]

So Back To My Question.

What Are We Cutting To Eradicate A £90 Billion Annual Deficit?

[F30AM]

I was an NHS Consultant but decided to take early retirement as the excessive pressures were damaging my health. I was constantly battling with managers who kept tinkering with everything and anything for the sole purpose of justifying their miserable existence.

NHS front line staff are generally amazing, hard working and very dedicated. My beef was always with the rubbish managers who were totally clueless in the extreme. These managers are not regulated and they move from post to post to improve their grades whilst buggering up services on their merry way. Welcome to the clip-board generation.

And I don't agree with any form of privatisation of the NHS as I also have first hand knowledge of privately run hospitals. Some of these are excellent but when push comes to shove, the NHS always comes up trumps.

Always remember: without health there is no wealth.

[....,,,,..,,..]

Originally Posted by F30AM

I was an NHS Consultant but decided to take early retirement as the excessive pressures were damaging my health. I was constantly battling with managers who kept tinkering with everything and anything for the sole purpose of justifying their miserable existence.

NHS front line staff are generally amazing, hard working and very dedicated. My beef was always with the rubbish managers who were totally clueless in the extreme. These managers are not regulated and they move from post to post to improve their grades whilst buggering up services on their merry way. Welcome to the clip-board generation.

And I don't agree with any form of privatisation of the NHS as I also have first hand knowledge of privately run hospitals. Some of these are excellent but when push comes to shove, the NHS always comes up trumps.

Always remember: without health there is no wealth.

Totally agree.

However without wealth there is no health.

[TouringPleb]

Originally Posted by Nick the Greek

So Back To My Question.

What Are We Cutting To Eradicate A 90 Billion Annual Deficit?

These are just my initial thoughts. Not researched or anything like that but gut reaction to your question...

The welfare bill. A few examples. No child benefit after the second child. If you can't afford to raise a child why should the state pay? Unemployment benefits for those who have never paid into the system (ie teenagers) if you haven't put into the pot you can't take out. Housing benefits eg just because 17 yr old jobless johnnie doesn't get on with mum and dad who want him to get a job and stop smoking cannabis, why should he be given a flat/house paid by housing benefit. And no-one should ever be able to claim more benefits than the average wage.

NHS - charge those who get pissed up and fall over. Claim the cost of treatment for car accidents back to the insurance companies. Make those who play or partake in high risk activities take insurance eg rugby/football/cycling. A&E - the clue is in the name. If it's not an accident or emergency charge or go to doctor.

Make sure all government bodies pay absolute lowest cost for computers/bulbs/desks whatever. I shouldn't be able to pay less for one computer than a government department buying 100s.

And yes until the books are balanced higher taxes for all. Then look at tax cuts. And finally, there should be a law that apart from a national emergency it should be illegal for the government to run at deficit. And even when the deficit is cleared, we still have the trillions of pounds to actually pay back at some point.

Just a few ramblings. I'm prepared to be shot down!