The state of the NHS

[Bacchus]

But I've never suggested this and never pretended it doesn't cost anything. I'm just sick and tired of the crap waiting times and patients not being given the best medication due to costs. We have a Prime Minister who doesn't seem to give a toss about the NHS and I just find it annoying. They need to pull their finger out.

Maybe I misunderstood you, but you seemed to suggest that cost shouldn't come into it. My point was simply that it has to. I agree that the NHS is chronically underfunded and being left to rot by the government though (and we all know why - there would be no such thing as publicly funded services if the Tories really had their way.)

[Roosterbooster]

Well my consultant is saying something different to you. I'd have thought you should be reading off the same hymn sheet, but there you go. I also think you're taking me literally. Obviously, the cheapest thing to do is leave it, but take Methotrexate and other DMARDS. You have Infliximab which costs a lot but is the best drug available for things such as Rheumatoid Arthritis. You need to fullfil a checklist before a drug is granted - purely because of it's cost.

My point is, cost comes into it.. big time. A patient isn't often treated with the best medication/treatment because of this. Which, again, is my point - it shouldn't be like that. You should get the treatment that is best for your condition.

The NHS cannot afford to run this way though. It isn't a bottomless pit. Which is why certain expensive drugs are reserved for those who get less benefit from the cheaper ones.
And one of the best treatments a doctor can offer is doing absolutely nothing. The MOST cost effective. The BEST treatment. And the cheapest. All in one. I'm not sure I am saying a different thing to your consultant, rather the phrasing is different.

The point is, with only a certain amount of resources the NHS can only do so much. Pound for pound it is said to be the best healthcare system in the world. Time and again. But there are limitations. And with those limitations has to come efficiency management. If a drug gives a person 10 more years of quality life, and another drug gives someone 11 years of quality life, but costs 50 times as much, then it seems sensible to offer the cheaper one. It allows money to be used elsewhere. I'm not for one minute supporting how the NHS is currently being run, I am outraged by it, but it does have its principles, and being cost effective is one of them.

[DavidEyresLeftFoot]

NHS drugs are bought and negotiated on a national basis. Is it still NICE?

That's not strictly true. Hospitals (foundation trusts) are essentially separate businesses so procure their own drugs and equipment. This led to huge variation in how much different hospitals were paying for the same items. The Carter Review identified this as an area to target and I think this is starting to change. The NHS is such a huge institution it should be able to say to pharmaceutical companies... we bought x million of these tablets last year therefore next year we will be paying price Y. These companies have been allowed to rip off the NHS for years.

NICE is slightly different. They review all the evidence relating to new therapies, from indications to side-effects to cost. They produce a report to say whether the balance of all those things is worth providing from the NHS' point of view and therefore whether hospitals are allowed to provide it. Unfortunately the newspapers are very quick to criticise about not allowing "miracle cures" when in reality they are providing best practice based on research evidence. It's one of the troubles with the american system of healthcare in that because of the money involved, there become some very dubious practices - only given to patients because someone stands to make money out of it.

[DavidEyresLeftFoot]

The problem isn't so much whether NHS funding has been marginally cut in real terms or not

That's exactly the crux of the matter. Health inflation increases by 4% per year so you need this level of funding increase just to stand still. Government rhetoric is that they're giving the NHS more money than it's ever had - that it's swimming in the stuff. Yet it's lies when funding overall is on the decline. That's followed up by blaming the staff for not working hard enough. As I said, if we want first world healthcare we need to pay for it - not moan when doing it on the cheap doesn't provide everything we need.

[FactualFrank]

The NHS cannot afford to run this way though. It isn't a bottomless pit. Which is why certain expensive drugs are reserved for those who get less benefit from the cheaper ones.
And one of the best treatments a doctor can offer is doing absolutely nothing. The MOST cost effective. The BEST treatment. And the cheapest. All in one. I'm not sure I am saying a different thing to your consultant, rather the phrasing is different.

The point is, with only a certain amount of resources the NHS can only do so much. Pound for pound it is said to be the best healthcare system in the world. Time and again. But there are limitations. And with those limitations has to come efficiency management. If a drug gives a person 10 more years of quality life, and another drug gives someone 11 years of quality life, but costs 50 times as much, then it seems sensible to offer the cheaper one. It allows money to be used elsewhere. I'm not for one minute supporting how the NHS is currently being run, I am outraged by it, but it does have its principles, and being cost effective is one of them.

I know what you're saying and I respect you for the job you do. Normally when I talk medication to people I might as well be talking Chinese. I'm sure you know a bit about the drugs I mentioned previously. I guess my main point is purely that the NHS isn't being given enough. I don't really care too much about comparing it to other countries as that doesn't relate to the underlying problem. I just think the government need to invest more money into the NHS and they come across as not really giving a toss.

[Mala591]

Worked in the NHS for 35 years. Biggest problem is BED BLOCKING. The answer is totally obvious. Open up LOCAL COMMUNITY REHABILITATION HOSPITALS. They cost a fraction of acute hospitals to run and relations / relatives find them much easier to access.

[Bacchus]

That's exactly the crux of the matter. Health inflation increases by 4% per year so you need this level of funding increase just to stand still. Government rhetoric is that they're giving the NHS more money than it's ever had - that it's swimming in the stuff. Yet it's lies when funding overall is on the decline. That's followed up by blaming the staff for not working hard enough. As I said, if we want first world healthcare we need to pay for it - not moan when doing it on the cheap doesn't provide everything we need.

i think we agree here - this is exactly the point I was trying (maybe clumsily) to make. The government can't just point at the normal 2%ish inflation numbers and shout real terms funding increase when there are so many other factors that are driving the cost of maintaining the service up by far more than that. The public, by and large, wants a properly funded, publicly owned and managed, fully comprehensive and free at the point of access healthcare system. Unfortunately the public also wants a low tax society (and the current government certainly values that above any kind of public service provision) and the two concepts aren't entirely compatible.

[Bordeauxclaret]

Worked in the NHS for 35 years. Biggest problem is BED BLOCKING. The answer is totally obvious. Open up LOCAL COMMUNITY REHABILITATION HOSPITALS. They cost a fraction of acute hospitals to run and relations / relatives find them much easier to access.

The problem is only getting worse with the cuts to social care. People who should be able to leave hospital have nowhere to go so have to stay there.

[Bordeauxclaret]

Edit - duplicate

[summitclaret]

Just wonder if the way forward is for all political parties to sign up to an independent royal commission (given a tightish timescale) and to have a national referendum shortly after. That could put any decision to increase funding and/or a different system in the hands of the people, especially if all the parties agreed to be bound by the outcome.

I know it would be difficult to do with a single question. So maybe have 2 stages - 1 on the principles and 2 ( sometime later) on the new system.

The second question would also be an opportunity to avoid the unions stopping radical ideas if these could be shown to be workable.

I guess people will say it won''t work, but I wonder if we are getting to the stage where something radical is needed.

[taio]

SC, seems an entirely reasonable suggestion to me. As you say there needs to be radical change for the long term rather than short term decision making for political reasons.

[Colburn_Claret]

In terms of electability but in terms of results.

John Major's bad public perception didn't stop us enjoying the lavish fruits of the economy he bequeathed to Tony Blair. We rode the economic prosperity he brought the country for nearly a decade until Gordon Brown wrecked it and completely trashed the public finances.

His election defeat had everything to do with perception but the prosperity was actual, real prosperity.

Gob smacked, totally gob smacked.
One of us must have slept through that decade, I'm sure it wasn't me.

[Colburn_Claret]

SC, seems an entirely reasonable suggestion to me. As you say there needs to be radical change for the long term rather than short term decision making for political reasons.

Making changes is half the problem.
Each government moves the goal posts after every budget. A change of government and the changes are drastic. It doesn't matter whether the changes are for good or bad, there is a cost in implementing all these changes. Just more money that could be spent on the frontline being ****** away on the pen pushers.
Surely common sense should dictate that you keep what is good, and just tweak the bad, it shouldn't matter what colour rosette you wear on election day.

[Lowbankclaret]

I watched the Hospital programme on BBC2 on wednesday. Watch it, whats going on is crazy.

It shows the reality of the current situation.

[hampsteadclaret]

Rowls..34..you say -

'We rode the economic prosperity he brought the country for nearly a decade until Gordon Brown wrecked it and completely trashed the public finances..'

Don't do this..you're better informed than that.

Shall I talk you through the World Banking and Financial Crisis that beset pretty much the whole planet eventually..? - or can you look it up for yourself?

This is one paragraph of what WIKI says..

'The financial crisis of 2007–2008, also known as the global financial crisis and the 2008 financial crisis, is considered by many economists to have been the worst financial crisis since the Great Depression of the 1930s..
It began in 2007 with a crisis in the subprime mortgage market in the USA, and developed into a full-blown international banking crisis in 2008. Massive bail-outs of financial institutions and other palliative monetary and fiscal policies were employed to prevent a possible collapse of the world's financial system. The crisis was nonetheless followed by a global economic downturn, the Great Recession. The Eurozone crisis, a crisis in the banking system of the European countries using the euro, followed later.[END]

Funny that - no mention of Gordon Brown.

-----------------------------------------------

**On the NHS I will say one thing only, amongst all these other words.

Never ever ever trust the Tories with it..it is not safe in their hands, and never will be, whatever weasel words they use.

They wouldn't dare close it down, or commit to dismantling it. the outcry will be deafening.

They will instead, where we let them, 'salami slice' it..they will reduce it, cut it, privatise it, 'reform' it, 'slim it' bit by bit, year by year until there is ^^^^all left of it...when it disappears by stealth, we will all wonder what happened...where did it go?

We must always be alive to that aim...do not trust them.

There is waste there I guess, [that can be sensibly dealt with] but on balance it is a wonderful organisation - a very valuable institution that we should look after properly.

It does need some reform...it would be great IF we could get some cross-party consensus on the way forward for it , over the next 50 years...if all the major parties value it LIKE THEY SAY THEY DO..this should be possible.

Finally..amongst all the stats that get chucked around, including those on this thread, one thing stands out..


DEMAND [for all medical services] including a rising population, an ageing population that is living a lot longer, more and better increasingly expensive drugs, AND equipment, the costs of key research etc..

ARE GROWING FASTER than

SUPPLY [of all medical services...even when we include REAL increases in monetary funding, to compensate for the effects of inflation].

If this is true then the service will be insufficiently provided for..it is bound to deteriorate..crisis points will occur [as now] and as this DELIBERATE rundown of provision occurs, you will hear more of the siren voices screaming 'Privatisation'...we know where that goes.


Fight for it, or lose it.

[Pieater2]

Try not to start taking tablets and medicines supplied by multinational pharmaceutical companies.
Once you start taking them, you will need more pills to counteract the side effects of the ones you have already taken, its a rollercoaster money making machine.

Oh and try and keep away from doctors, and hospitals if you can, except for emergencies, and even thats going out of the window soon.

We get posioned with most of the food and drink they supply us with, then when we become ill, they charge us the earth to poison us more.....we need to wake up and do something about it soon

[HatfieldClaret]

Some interesting opinions. I too work for the NHS (non-clinical) and there are several reasons why it doesn't work as well as it should.

Too many layers of bureaucracy; NHS England, CCGs and autonomous Trusts.
Too big an organisation, should be more locally controlled with more continuity of service provision
The NHS is not jeopardising care to save money; the Trust I work for was overspent by £30m for the first 6 months of last year.
Typical public sector, you can't get rid of crap staff but have to keep developing them...when I worked for NHS England I couldn't get rid of someone who was totally useless because HR employed them without even a probationary period...
Is it a National or International Health Service
Too high expectations for some people, attending A&E with coughs, colds and split lips. There needs to be a cross party consensus about what should be provided on the NHS, what the level of funding is and how it is paid for.
We need to take politics out of the equation altogether. Look at how systems work elsewhere and learn from their best practice.
In Eire it costs 60 Euros to see the GP and more to see a consultant, depending on causes. No politician wants to mention payments for fear of political suicide. This has to be discussed, even if discounted.

But let's not pretend that this is just Tory cuts. Labour introduced PFI, closed hospitals and oversaw the Staffordshire crisis. So let's stop the blame game. It's not the government funding the NHS, it's us the taxpayer.

My 85 yr old mother suffered a severe stroke a month ago and, on a brighter note, has just been discharged from hospital. The level of care and treatment she received from start to finish was absolutely fantastic and I have nothing but praise for those (from all over the world/commonwealth) who treated and cared for her, and continue to do so helping her to learn to walk, speak and eat again.

(Because she worked hard all her life, including being a nurse at Burnley General in her early years, and saved money she pays over £1k a week for her care home on top of her taxes.)

[CrosspoolClarets]

Some interesting opinions. I too work for the NHS (non-clinical) and there are several reasons why it doesn't work as well as it should.

Very true. Many reasons but in my 25 years working in or advising the NHS I've not come across a problem as stark as the social care cuts. I also advise local authorities and some of the things I hear are incredible. Normally I have little sympathy for the LAs due to general competence issues, but in this case there is often little they can do.

There are 3 issues - how health and social care are funded, how the money is spent, and how it is accessed.

Personally I would ring-fence social care out of council control, as a separate Dept of Social Care. You can't merge it with health because it isn't free at the point of use.

I would then tie overall funding to a minimum of an average of a basket of major countries as a % of GDP. Should our GDP fall (e.g. in a recession) I would then allow health spending to stay high by having the % as a floor not a ceiling.

How the money is spent and how the services are accessed are far too big topics for me to post an opinion while I am waiting for kick off on Clarets Player.

[Rowls]

In absolute numbers you're correct...as has every single government since the inception of the NHS. What you fail to mention is that health inflation is estimated at 4% per year. Therefore this current parliament will .... [blah] [blah] [blah]

What I think you mean when you said "what you failed to mention" is the thing that I specifically acknowledged.

[DavidEyresLeftFoot]

My point is Rowls is that the government is shouting from the rooftops about how they've left the NHS awash with cash. In reality they've lied about how much money they're putting in. Most of it is recycled from other areas of health. It's not enough to sustain current levels of service, never mind increasing the range and number of services we offer.

You claim that no cuts have been made. You might want to look at the cuts made to the Public Health budget - the department that deals with health promotion and disease prevention. This is more short-sighted planning which will cost the NHS in the long-run.

You might also want to look at the Nicholson Review - an unprecedented 20billion savings programme between 2011-14. The government are following this up with a further 22 billion in "efficiency saving" i.e. cuts in this parliament. Nicholson himself has described this latest round of savings as unachievable. So it's no wonder the system's on its arse.

[Rowls]

My point is Rowls is that the government is shouting from the rooftops about how they've left the NHS awash with cash. In reality they've lied about how much money they're putting in. Most of it is recycled from other areas of health. It's not enough to sustain current levels of service, never mind increasing the range and number of services we offer.

I don't think the government are "shouting from the rooftops". They're rightly telling the public they are increasing NHS spending - because they are.

In the age of simpletons in which we're living in (thank you Paul McCartney) they've decided that's the best way to get their policy over. Brilliant? No. True? Yes.

THE big problem is this - the country still hasn't got a frigging pit to poss in. There's no money left. We're STILL spending more money than we make because of Gordon Brown's spending commitments. In particular, the PFI contracts he lumbered the NHS with are CRIPPLING their budgets. The people who signed off on these contracts ought to be held account because, IMO, they are so bad they constitute negligence of public finances. Not that this is a real crime, but everybody who was part of the PFI disaster should be named and shamed publicly and it should be explained over and over and over again just how much tax payers money they have wasted by signing these contracts.

Until we break the back of the deficit this will continue to be the case.

It's a simple thing to understand and I'm not going to waste any more time explaining it or "arguing" with you. The majority of the electorate understand it to.

As for right now, I'm off to have a few beers and celebrate Burnley's win. All the best.

[DavidEyresLeftFoot]

Completely agree re PFI. It's a national scandal and is most certainly one of the contributing factors to the current financial problems. My post wasn't intended to be Tory bashing. You can point to failures of successive governments of both persuasions. However, TM has repeatedly lied by saying they've invested "10 billion pounds....more than the NHS asked for." This is despite that figure being wholly discredited. Yet she still persists on trotting out the same line.

The public needs to be told the facts about what we can fund, how much extra we need to spend and what the options are for bridging that gap. Then we can make a rational decision about how we take that forward. Personally I think that's through taxation and a publicly funded, publicly accountable service.

[Inchy]

I work in the NHS and believe me when I say it is the most challenging it has ever been, at least since I started.

The NHS is underfunded and money is wasted, although that seems to be getting better as trusts are really having to find savings that do not effect patient care.

PFI absolutely screwed many trusts. I know how much my trusts pays on PFI a year and its eye watering. Labour are to blame for that mess.

The issue is people are living longer and we have less beds in community which clogs up acute beds. The NHS would be able to cope
If there were more community beds.

[Inchy]

It's already been mentioned on here about the need to train more nurses. Nurses and many other healthcare degrees were funded by the governement, but they have scrapped that.

So the situation is destined to get worse

[FactualFrank]

I don't think it helps either when we have people on benefits who know it's not worth getting a job, because the difference between working and earning, to sitting on your arse and getting a benefit, is very little. The difference should be huge, but it isn't. I don't think it's just down to money either, it's down to braincells. Our government don't have enough of them.

[Lancasterclaret]

It's a simple thing to understand and I'm not going to waste any more time explaining it or "arguing" with you.

Sigh

Enjoy your beer Rowls

[Inchy]

My trust has just opened a 30 bedded ward which will essentially act as a community care bed. It will be run privately.

This seems to be the plan of the Tories. Underfund the NHS meaning it goes into crisis forcing trusts to cancel elective surgeries. Trusts get fined for Long waiting lists so they sell those cases to the private sector.

[bfcjg]

Pulled this up from over three years ago.
My God how we need these people. Heroes one and all from the cleaning staff to the surgeons, we owe them and the NHS such a debt of gratitude.
When this is over and it will be, the NHS must never ever again be allowed to be underfunded regardless of what tax we have to pay. It must never be allowed to be abused by time wasters and anyone who ever lays a finger on or swears at a member of the NHS should be harshly dealt with.
Thank you one and all.

[Zlatan]

Too many people.
Too many people getting old.

Not a lot we can do about either really.

Looks like China has the answer...

[Damo]

One thing I hope we take from all of this Corona nonsense, is that the NHS continue to tell fit and healthy people to stay away from hospitals and doctors surgeries.
It may just be the thing that saves it

[BennyD]

All quiet in Leighton A&E today.