The state of the NHS

[ecc]

NHS Crisis: BBC Report Of Meeting Between Trust And Doctors Shared By Campaigners Online

‘I’ve never heard words like this and I’ve been a journalist for 27 years.’





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[FactualFrank]

I get the feeling that Theresa May doesn't give a flying feck about the NHS. I'm also convinced that £0 more will be given to the NHS even if we are saving money with Brexit. It's certainly a headshaker, but what can you do.

[Lancasterclaret]

This is seriously old ground here

Lab threw money at it, and we had horrible financial settlements and a very high amount of wastage

Cons cut it like mad (but more importantly, slash the council budgets so there is nowhere else to go but to the NHS) and services start to fail

The only solution is multi party consensus, but good luck with that!

[NottsClaret]

It's a strange one, you only read how it's continually at crisis point, the worst ever, morale at an all time low, no resources, no funding.

But every time I've used it, either for myself or mostly for the kids, it's been absolutely brilliant. Even up to last week. And for all it's apparently been privatised, I've still not paid owt except my taxes and the odd prescription.

Must be huge variations in service I guess.

[FactualFrank]

The NHS as a whole I don't think is bad (service wise anyway), but I use it a lot for an ongoing medical illness and I can tell you now the waiting lists are a joke. When you see somebody it's generally fine, but the length of time you have to wait for something is pathethic.

[bob-the-scutter]

If they cut out the waste, got rid of 90% of managers & administrators and keep politics out of it then it would be a much better service all round!

[Claretmatt4]

Too many people.
Too many people getting old.

Not a lot we can do about either really.

[Colburn_Claret]

I think the NHS is always going to have 'bad news stories', trying to prevent them is like trying to predict the weather.
The problem starts when those stories become common place. As most people know from their own experiences it isn't all doom and gloom.
There is a danger that under May things may get worse, and with an ineffective opposition there is no one to stop her. I agree with Lancs, the health service and education should be run by a cross party committee instead of being used by a political football.
Having worked in the health service for 12 years I can vouch that the problem isn't underfunding but waste. So many pen pushers and 'service providers ' dipping their noses in the trough before it gets to where it is needed. Successive governments have also been too lazy to regulate it properly, much easier to let some quango full of well intentioned boffins who have no experience of working in the NHS to bring to the table.
Let parliament pick a quango of surgeons, doctors, nurses and health visitors to decide what is required. I have faith we have enough talent in this country to sort this, but only if they get no interference from the paymaster.

[9thMay1987]

Took the ambulance 4 hours to arrive at the old lady living next door.

Half an hour for basic treatment then 3/4 hour to A&E.

Almost 5 hours to get to hospital, which is not counted, in A&E waiting time.

From ambulance people - "too many ill people, not enough ambulances".

[bob-the-scutter]

I think the NHS is always going to have 'bad news stories', trying to prevent them is like trying to predict the weather.
The problem starts when those stories become common place. As most people know from their own experiences it isn't all doom and gloom.
There is a danger that under May things may get worse, and with an ineffective opposition there is no one to stop her. I agree with Lancs, the health service and education should be run by a cross party committee instead of being used by a political football.
Having worked in the health service for 12 years I can vouch that the problem isn't underfunding but waste. So many pen pushers and 'service providers ' dipping their noses in the trough before it gets to where it is needed. Successive governments have also been too lazy to regulate it properly, much easier to let some quango full of well intentioned boffins who have no experience of working in the NHS to bring to the table.
Let parliament pick a quango of surgeons, doctors, nurses and health visitors to decide what is required. I have faith we have enough talent in this country to sort this, but only if they get no interference from the paymaster.

Nail on head there mate!
The real damage (PFI) is yet to surface and the stupid ideas of building these idiotic and unwanted Super Hospitals where half have had to be mothballed because they can`t afford to be open and then closing hundreds of local A & E units...whoever`s idea that was should be horsewhipped!

[Paul Waine]

France and Germany are both mentioned as having better health systems - better outcomes, more seriously ill people cured etc etc. Both are reported to spend a larger proportion of GDP on the health systems.

I understand both countries operate insurance based systems - and patients contribute towards their care costs (and, I believe, contributions depend on their income/wealth/means).

I understand that in France hospitals can be either "state owned" or privately owned - and they operate together.

Has anyone on here lived in France or Germany? Are you able to comment on their systems? How do they compare with NHS?

[jurek]

The inevitable is happening following the cuts imposed by the Tories in particular to soclal care.
Everyone knew it was likely to happen sooner rather than later.
The Tories seem to be in denial and keep coming out with the same old lines but the situation
isn't improving and I think they actually don't give a damn.

It's about time somebody grasped the nettle and said they're going to put income tax up
by a penny in the pound and that this increase will go directly to the NHS and improving social care.
That should go a long way towards alleviating the current problem.

Will they do this? Very unlikely albeit if they don't do something then the situation
is only going to get worse and by the time of the next election could be the decisive issue.

[DCWat]

That could of course be a timing issue. If there are a large number of more severe cases to deal with, less severe (and I don't know the ladies medical issue) will rightly be delayed.

Every place I've worked there are cuts and efficiencies being made. For the past five or more years it seams that is what everywhere is focussing in, it's not just the NHS and it's not solely because of Labour or The Conservatives a but it is a great pawn for both parties to continue to play when both should be wanting the same or very similar.

[Bordeauxclaret]

Too many people.
Too many people getting old.

Not a lot we can do about either really.

Yet we cut spending on social care. Figure that one out.

[FactualFrank]

France and Germany are both mentioned as having better health systems - better outcomes, more seriously ill people cured etc etc. Both are reported to spend a larger proportion of GDP on the health systems.

I understand both countries operate insurance based systems - and patients contribute towards their care costs (and, I believe, contributions depend on their income/wealth/means).

I understand that in France hospitals can be either "state owned" or privately owned - and they operate together.

Has anyone on here lived in France or Germany? Are you able to comment on their systems? How do they compare with NHS?

But we pay national insurance (dependent on income) and we have the option of going private. The treatment I'm on would cost £1000 a month. Can I afford it? Yes, but that's not the point. Treatment to patients is often down to cost - patients are often given the cheapest drug, NOT the best drug. It shouldn't be like that.

[summitclaret]

The following won't solve the current mess now, but needs considering for the longer term.

We don't train enough of our own doctors and nurses etc. Yet lots of bright people do nothing degrees. Why? When we do get people trained up too many go abroad to work as doctors etc. Too many qualified people are working for agencies, which charge high fees to the NHS. That is the madness of accounting.

Incentives are needed, e.g. paying off the tuition fees of jnr. doctors on a sliding scale, provided that they stay here in the NHS.

There has been talk for years about joining up the NHS and social services but little seems to be happening. Personally I would give local government a much bigger role, partly because of local accountability.

Clearly the pressure is getting more and more on the NHS, e.g immigration, age demographics and new treatment and drugs meaning more and more money is needed. An all party consensus is needed. Naive I know but it just does. The elephant in the room is funding. Succesive governments have treated NI as tax and won't raise taxes because of elections. A grown up conversation is needed with the public. Would it really be the end of the world if everyone had health insurance paid for by the Government and agreed service standards and their was no NHS in the current form?

The development of new drugs (and the costs thereafter) is something that might benefit from at least some public involvement.. I am thinking joint public private ventures.

Lastly and this is something that could have an immediate impact. Why is it acceptable that our older people are being sent home on their own from hospital and many being being re-admitted within hours/days. Surely more of us can help with our own families at least in the short term

Edit. None british would have to have their own insurance unless we have a reciprical agreement with their country.

[FactualFrank]

It also doesn't help that only 6% of doctors are happy with their job, and most doctor's surgeries don't bother opening on weekends. Oh, and they have 'training days' when they totally close. All surgeries should be open every weekend, including Sundays - this is health afterall.

[LoveCurryPies]

My daughter is a nurse in a city casualty and for assessing people's injuries on arrival. Every Friday & Saturday evenings and nearly every incoming person has an alcohol related injury. Excessive drinking is costing the NHS huge amounts.

My Mum was a nurse in the 50's & 60's and often talked about the increasing range and complexity of operations being undertaken. Look at how Heart surgery is now a daily event. But it all costs.

Of course we also live in a world where people are living much longer. That's bringing many age related illnesses.

The NHS faces the perfect storm of medical costs and each year it's growing.

I'm a massive supporter of the NHS and don't want to see the privatisation of this brilliant British institute.

[lucs86]

The Tories want it privatised but if they were open about it it could lose them an election. But Labour aren't effective enough to fight them so if they're quick they can allow it to fail, talk up the crisis and offer privatisation as the solution. Get a few newspapers onside and job done, get Jeremy Hunt's knighthood ready. We probably wouldn't even get a vote on it.

[bfcjg]

I think one of the problems is the I want it now attitude to everything in life including health care. If a doctor can't give an appointment in 48hrs it's of to A and E for routine aches and pains. People get things on prescription that could and should be bought at the health care aisle in asda. Drug companies rip of the NHS and nobody seems to mind. Operations are so complicated now and that is added expense.Transplants are routine and cosmetic surgery all adds up. Also not enough people contribute. Scrap the national insurance stamp and put it on Vat so everyone contributes especially smokers drinkers fast food users etc plus tourists. I think the suggestion of moving it out of politics is brilliant and nothing should be ruled out of how it should be funded. It is a fantastic service with brilliant underpaid staff who deserve better likewise so do the users. Look at the shambles in America at least Obama tried his best to help all Americans heaven help them when the lunatic takes over and profit is the motive.

[Rowls]

This is seriously old ground here
Lab threw money at it, and we had horrible financial settlements and a very high amount of wastage

Cons cut it like mad (but more importantly, slash the council budgets so there is nowhere else to go but to the NHS) and services start to fail
The only solution is multi party consensus, but good luck with that!

Part 1 is true.

Part 2 is false. It is plainly untrue. In the words of Donald Trump and other modern morons it is "Fake News".

Conservatives have maintained or increased the NHS budget since taking power, including the coalition government. Real term rises have meant the increases have been smaller than inflation at times (but they have been higher than inflation for the majority of the time). Medical advances also mean that more and more money is required so if you spend more and more money just to "keep up" with what the NHS wants, you are always spending more money -as we are.

What is completely untrue is the fake idea that there have been cuts. There have been no cuts to public spending in the NHS at all. NHS chiefs may have prioritised certain departments over others but there have been no cuts.

This was confirmed by the BBC's Question Time twitter account last night.

See below:

[Spijed]

Rowls, that may be true but Theresa May is doing her best to destroy the credibility of the Conservatives on the issue. She looks like she's out of her depth on the issue.

[summitclaret]

She has only one thing on her mind right now and I can't blame her. It is the biggest issue since WW2. She won't be judged by the NHS.

[jurek]

Rowls, there might have not been cuts directly in the NHS budgets
but they've had to make 'efficiency gains' (I think Cameron called them)
of £20b or more since 2010.
Now, whichever way you look at it and the Tories will continue to tell folk that
they've increased the money going into the NHS but forget to mention the
massive efficiency gains that the NHS have had to make.

It's very simple really. You promise to increase the budget by x% a year
so let say the NHS got 100 billion in 2010 and you increase it by 2% for 5 years - say 10% over 5 years.
What you then ask the NHS to do (and it probably wasn't a month after
Cameron said the NHS budget was safe with the Tories), is to make these efficiencies
of 20bn (I think it was) over 5 years.

Of course any organisation can be more efficient but what was asked of the NHS was
a huge amount/percentage.

They give with one hand and chop with the other.
And because of increasing demand (as a result of cuts in social care as well)
you end up worse off.

I really think they must think the majority of folk are dimwits
if they think we believe them.

[Pieater2]

Create a problem, wait for the reaction, come up with a solution, they kid you with this all the time. and the masses fall for it... ever since bexit all I've seen , heard or read is, oh no, look how difficult it is running the nhs, oh no, look how we struggle with money to look after the peoples health, yet we can buy and produce bombs stuff, plenty money for that!... P.R.S.... Problem, reaction, Solution.... It was planned years ago, wake up.... privatisation its coming. the rich get richer the poor stay poor.

[Pieater2]

Forget which party, they are all pissin in the same pot.

[Pieater2]

Forget which party, they are all pissin in the same pot.

[Bordeauxclaret]

I see Rowls Tory Alarm is still working.

[joey13]

France and Germany are both mentioned as having better health systems - better outcomes, more seriously ill people cured etc etc. Both are reported to spend a larger proportion of GDP on the health systems.

I understand both countries operate insurance based systems - and patients contribute towards their care costs (and, I believe, contributions depend on their income/wealth/means).

I understand that in France hospitals can be either "state owned" or privately owned - and they operate together.

Has anyone on here lived in France or Germany? Are you able to comment on their systems? How do they compare with NHS?

Contributions depends on their income/wealth, you mean like the UK ,national insurance?

[Rowls]

Rowls, that may be true but Theresa May is doing her best to destroy the credibility of the Conservatives on the issue. She looks like she's out of her depth on the issue.

Not "may be true" - It IS true. The fact that Theresa May is publicly awkward and does come across well has little to do with it.

[Spijed]

Not "may be true" - It IS true. The fact that Theresa May is publicly awkward and does come across well has little to do with it.

That's just it Rowls, perception means everything in politics.

[Rowls]

Rowls, there might have not been cuts directly in the NHS budgets
but they've had to make 'efficiency gains' (I think Cameron called them)
of £20b or more since 2010.
Now, whichever way you look at it and the Tories will continue to tell folk that
they've increased the money going into the NHS but forget to mention the
massive efficiency gains that the NHS have had to make.

It's very simple really. You promise to increase the budget by x% a year
so let say the NHS got 100 billion in 2010 and you increase it by 2% for 5 years - say 10% over 5 years.
What you then ask the NHS to do (and it probably wasn't a month after
Cameron said the NHS budget was safe with the Tories), is to make these efficiencies
of 20bn (I think it was) over 5 years.

Of course any organisation can be more efficient but what was asked of the NHS was
a huge amount/percentage.

They give with one hand and chop with the other.
And because of increasing demand (as a result of cuts in social care as well)
you end up worse off.

I really think they must think the majority of folk are dimwits
if they think we believe them.

Heaven forbid we ask our health services to be efficient. Lord have mercy on our souls!

It's almost as if they've been asked to prioritize clinical need over administrative costs or something!

If you want to argue against 'efficiency savings' [sic] then you could at least explain in detail what they are. In layman's terms efficiency savings usually means paying a nurse instead of an administrator, a doctor instead of a manager etc etc.

Of course a lot was asked of the NHS - because we all want and expect a lot from the NHS.

If you want an inefficient NHS that funds management consultants, executives and pen-pushers and is inefficient then carry on opposing efficiency.

Good night.

[Rowls]

I see Rowls Tory Alarm is still working.

Hmmmm.

Lancaster said something that was out-and-out incorrect.

I simply corrected him.

In turn, THREE people have engaged me.

Seems like there are more "anti-Tory alarms" out there than "Tory Alarms".

[Rowls]

That's just it Rowls, perception means everything in politics.

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.

[Roosterbooster]

But we pay national insurance (dependent on income) and we have the option of going private. The treatment I'm on would cost £1000 a month. Can I afford it? Yes, but that's not the point. Treatment to patients is often down to cost - patients are often given the cheapest drug, NOT the best drug. It shouldn't be like that.

Patients aren't given the best or the cheapest drug. They are given what has been shown to be most cost effective.

[Rowls]

Thank you Roosterbooster. Glad someone pointed that out.

[Diesel]

David Cameron promised and delivered 4500 new health visitors, now all their positions are under threat. Disgusting.

[jurek]

Oh dear Rowls, I really thought you were brighter than that.
Nobody is arguing against efficiency gains not even those who work in the NHS but I know and have
spoken to enough doctors, nurses, health professionals and the like over the last 10 years or so not too mention
personal experience with my elderly parents (both in East Lancs and more recently the West Midlands)
to know that they've gone too far.
Alongside the social care issues and reduction in funding and increased demand the NHS is now
in crisis and will remain so until there is more money going into the system alongside better funding for social care
and better health education.
The Tories should stop trying to extend the NHS to seven days on the cheap and start addressing the real issues.

I bid you goodnight too Rowls and hope you don't have to rely on A&E in the near future.
Or have to travel to Blackburn A&E (a 25 mile + journey) which I had to do on many occasions with my folks
as a result of the closure of A&E at Burnley which was, if memory serves me well, an efficiency gain.

[FactualFrank]

Thank you Roosterbooster. Glad someone pointed that out.

Pointing something out that is incorrect, doesn't really qualify. Even the consultant I see admits that they start with the cheapest. Straight from the horse's mouth.

[Paul Waine]

Contributions depends on their income/wealth, you mean like the UK ,national insurance?

Hi joey13, I'm asking the question if anyone knows how France and Germany organise their health services.

I don't get the impression it is exactly the same as national insurance - as others have posted, NI is just a tax.

I lived in Netherlands for a year some time back. Their system required everyone to pay for their own health insurance. The amount you paid was in part related to the family unit and included an element that paid for/contributed to the health insurance for those who weren't earning. There was also a deductible or "self-payment" element - this was determined by your earnings. When I took my son to A&E (erste hulp) with a cut from a fall the first question was "how are you going to pay?"). You paid the invoices, whether A&E, GP or hospital - and then claimed back from insurance for costs above the deductible amount. I think all the health service providers were "private sector" (though I wouldn't swear to this - there may be some state owned hospitals). Netherlands health care was very good when I was there.

I don't know if system I experienced in Netherlands is the same as the systems in Germany and France.

The key things: everyone seems to say Germany and France spend more on health and have better systems than UK.

I think it matters. If we all had health insurance there is an incentive for health care providers to treat us all quickly - and the insurance funds the health care. In theory, there should never be a shortage of money... (I'd imagine there needs to be control over at least one of the health insurance providers and guarantees of cover for pre-existing conditions). The challenge for the NHS is that if there isn't enough money they have to choose who gets treated and when, the waiting lists get longer, appointments/operations get cancelled.

So, again, can we learn something from how health care is organised in Germany and France?

[Lancasterclaret]

Rowls, the king of the "selective quotes".

Apparently saying the Tories cut services is "fake news".

[Roosterbooster]

Pointing something out that is incorrect, doesn't really qualify. Even the consultant I see admits that they start with the cheapest. Straight from the horse's mouth.

I'm a doctor. I know what I'm talking about. They do not just start with the cheapest. It's not allowed to work that way. All drugs have to go through trials. If they aren't shown to work, they aren't used. They might start with a drug that is cheaper than another, but that is because it's cost benefit is higher. If someone breaks an arm, the cheapest thing to do is nothing. The bone will heal. It's much more expensive to do an operation and insert thousands of pounds worth of metal. But we do. A lot.

[Lancasterclaret]

One thing I would say though in defence of the Tories is that I don't think they want to privatise the NHS*

*parts of it they do, but even those bits will still be free.**

**if they thought they could get away with it, they might. Thank God we've got a viable opposition part......oh

[Lancasterclaret]

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

[FactualFrank]

I'm a doctor. I know what I'm talking about. They do not just start with the cheapest. It's not allowed to work that way. All drugs have to go through trials. If they aren't shown to work, they aren't used. They might start with a drug that is cheaper than another, but that is because it's cost benefit is higher. If someone breaks an arm, the cheapest thing to do is nothing. The bone will heal. It's much more expensive to do an operation and insert thousands of pounds worth of metal. But we do. A lot.

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.

[taio]

Patients are not just given the cheapest drug - that's complete nonsense. As said it's based on effectiveness measures. NICE do make the recommendations based on methodologies such as quality adjusted life years.

[DavidEyresLeftFoot]

Conservatives have maintained or increased the NHS budget since taking power

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 see the largest sustained fall in health spending as a percentage of GDP since 1951. The projected increase in 2018-19 of I think 0.8% will actually mean a net fall in health expenditure per head of population for the first time. The social care budget has been cut by 3.5 billion since 2010 which is now becoming the NHS' problem due to inability to move patients out who are medically fit.

The fact of the matter is that we spend far less on healthcare than all other comparable nations. The World Health Organisation estimates that public expenditure on healthcare is around £2200 in the UK. Germany spends around £1000 more. The latest King's Fund reports show we have 2.8 hospital beds per 1000 people (Germany has 8.3); 6 ICU beds per 1000 (Germany has 29).

So before we all listen to the bluster from the main stream media about how the NHS can't manage its finances and how inefficient it is, we should all be perfectly clear. We do more, with markedly less resources and yet have comparable outcomes to most of our european neighbours. This is a political choice to spend what we do. We need to stop pretending that we can do everything within the confines of our current budget. How we fund that gap is another discussion but its existence is indisputable.

[Bacchus]

The problem isn't so much whether NHS funding has been marginally cut in real terms or not - it's that spending needs to increase significantly to cope with a growing population, an ageing population and cuts elsewhere (primarily to social care.) The Tories are setting the NHS up to fail - that's pretty inarguable. Almost 50% of hospitals were at the highest state of alert last week - either there's an intention for the NHS to be seen to be in crisis or there is an utter failure in management and funding. Neither reflects well on the government.

Of course, as with pensions, living longer comes at a cost. If we're to fund the NHS properly we probably all need to pay a bit more one way or another - either through increased taxes or in means-tested payments for certain services. Neither is a popular idea, but I really don't see another viable way around this. Whatever the plan though, it needs cross-party support or it will be doomed to death by politics.

[Bacchus]

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.

We all want the best, but you can't just pretend that it doesn't cost anything. There isn't a money tree outside every hospital.

[FactualFrank]

We all want the best, but you can't just pretend that it doesn't cost anything. There isn't a money tree outside every hospital.

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.