Facts About the NHS

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Re: Facts About the NHS

Post by Colburn_Claret » Fri Nov 08, 2019 3:57 pm

I worked in the NHS from 85 - 97. Loved the work but the wage was crap. The biggest problem then was the waste of money, so as bad as it seems, it is right to try to reduce costs, but that doesn't mean you have to cut the service.
A modern world needs a modern service. Back when most of us were young Hospitals were run by one person assisted by a Senior Physician, Surgeon, Anaesthetist and Matron. During those years prior to me starting there, the number of pen pushers increased dramatically, even Secretaries had Secretaries.
Somehow we need to cut costs without losing the Service, and the best people to see that through are the same Surgeons, Physicians and Matrons. People who understand that a suture is more important than a new coffee machine, or a new desk.
I've mentioned before about the misuse, and extra cost of Bank Nurses. I don't know if its still the same today, but paying a Nurse or Doctor, 3 times the wage, to cover for someone off sick is ridiculous. Working Bank means your hours are flexible, you can pick and choose which shifts you want to pick up, you already have a benefit over the regular staff, to pay them more is insulting.

The NHS, like most branches of Government suffer most from the political footballism of modern day parties. So do the Fire, Police and Education. Rather like a new manager in football it can be expensive to change direction every 4 years.In reality, the service these provide should be an accepted standard by all Political Parties, the only real debate should be, how do you fund it. So I suggest that Labour, The Tories, Lib Dems or anyone who is interested, get together and agree on what exactly the NHS or any of the other services, should be providing as a bare minimum. Then they all agree to stick with these targets, whatever the cost. Then they all know how much money they have to find to provide it.
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Re: Facts About the NHS

Post by HieronymousBoschHobs » Fri Nov 08, 2019 5:32 pm

A few clarifications based on the discussion so far:

The argument here is not about how the NHS is funded.

For-profit healthcare providers who are involved in the NHS get their money from the taxpayer. They are given that money because the Conservatives, like New Labour before them, believe that the private sector, with its profit motive, makes more effective use of resources.

The evidence suggests that the involvement in the private sector in the NHS has NOT led to an improved service for patients.

There is also evidence to suggest that these measures have NOT been cost-effective:
  • 'A 2010 report commissioned by the Department of Health estimated management and administration costs at 14 per cent of total NHS spending, more than twice the figure in 1990. '

    'Tony Blair’s 1997 National Health Service Act..turned NHS hospitals into trusts able to operate as commercial businesses. Many formed Private Finance Initiative partnerships to build and maintain hospitals – these deals, originally worth £11.4 billion, have lumbered the NHS with more than £80 billion of debt.'

    'Commercial confidentiality laws and opaque NHS accounting make the costs of privatisation hard to quantify but privatisation is probably adding at least £9 billion a year to the NHS budget.'
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Re: Facts About the NHS

Post by AndrewJB » Fri Nov 08, 2019 6:01 pm

Sproggy wrote:Labour offered GPs a gold-plated contract with big pay increases that allowed most of them to abandon emergency cover.

The number of NHS managers doubled under the last Labour government.

Labour spent £10bn on a patient records system which never went live.

1997 - Labour's magical solution to under-investment in NHS infrastructure - PFI. The total bill for NHS PFI hospitals will be £80bn, vs. build costs of £12bn. That doesn't factor in “facilities maintenance” where PFI contractors have to change or fix certain equipment. A Daily Telegraph investigation found that one hospital was charged £52,000 for a job which should have cost £750. Some trusts spend a sixth of their budget repaying PFI (and will continue to until 2050)

2003 - Labour introduced Independent Sector Treatment Centres (ISTCs). Run by private companies for profit, ISTCs were contracted (on very favourable terms) to provide solely NHS elective procedures, creating extra capacity in the system to bring down waiting lists.

2009 - Labour introduced the “any qualified provider” (AQP) initiative, which allowed the private sector to undertake NHS work outside the ISTC programme. Under AQP, patients who require elective procedures can choose to use their nearby private hospital rather than their local general hospital.
That’s why Labour members picked Corbyn as leader. To change the direction of the party away from those Neo liberal ideas.

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Re: Facts About the NHS

Post by burnleymik » Fri Nov 08, 2019 6:11 pm

I wouldn't trust that current Labour front bench to run a bath. Frightening.

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Re: Facts About the NHS

Post by AndrewJB » Fri Nov 08, 2019 6:37 pm

If we ended most private healthcare and everyone relied on the NHS, it would be better looked after. The same with schools.
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Re: Facts About the NHS

Post by Rick_Muller » Fri Nov 08, 2019 6:49 pm

AndrewJB wrote:If we ended most private healthcare and everyone relied on the NHS, it would be better looked after. The same with schools.
You’re such a commie...

[not my real thoughts, I actually agree, but this is what I have been called]

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Re: Facts About the NHS

Post by Inchy » Fri Nov 08, 2019 7:28 pm

Colburn_Claret wrote:I worked in the NHS from 85 - 97. Loved the work but the wage was crap. The biggest problem then was the waste of money, so as bad as it seems, it is right to try to reduce costs, but that doesn't mean you have to cut the service.
A modern world needs a modern service. Back when most of us were young Hospitals were run by one person assisted by a Senior Physician, Surgeon, Anaesthetist and Matron. During those years prior to me starting there, the number of pen pushers increased dramatically, even Secretaries had Secretaries.
Somehow we need to cut costs without losing the Service, and the best people to see that through are the same Surgeons, Physicians and Matrons. People who understand that a suture is more important than a new coffee machine, or a new desk.
I've mentioned before about the misuse, and extra cost of Bank Nurses. I don't know if its still the same today, but paying a Nurse or Doctor, 3 times the wage, to cover for someone off sick is ridiculous. Working Bank means your hours are flexible, you can pick and choose which shifts you want to pick up, you already have a benefit over the regular staff, to pay them more is insulting.

The NHS, like most branches of Government suffer most from the political footballism of modern day parties. So do the Fire, Police and Education. Rather like a new manager in football it can be expensive to change direction every 4 years.In reality, the service these provide should be an accepted standard by all Political Parties, the only real debate should be, how do you fund it. So I suggest that Labour, The Tories, Lib Dems or anyone who is interested, get together and agree on what exactly the NHS or any of the other services, should be providing as a bare minimum. Then they all agree to stick with these targets, whatever the cost. Then they all know how much money they have to find to provide it.
Regarding bank staff. Bank staff are rarely hired to cover sickness for front line staff. Bank staff are used to cover shifts that are not filled due to lack of staffing across the board. Most bank staff at my hospital are staff that already work at the hospital.

I used to do bank quite a lot but the government put pressures on trusts to cut down on it due to the cost and negative media articles. My trust did that and low and behold there wasn’t enough staff about. So instead they offer overtime which is double time plus a cash bonus. I got paid the same for bank as I do overtime now, it just means the trust don’t call it bank and so the government don’t care.

It’s weird that a Tory government makes it inevitable for cuts to staffing but then doesn’t believe in supply and demand

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Re: Facts About the NHS

Post by Paul Waine » Fri Nov 08, 2019 8:49 pm

If it be your will wrote:Ha, yes. Obviously not those that get up and try and do their job. But the gradual imposition of structures that were so blindingly ill-considered the only way to make sense of them is to believe they were done deliberately. Layer upon layer of idiocy making the whole thing unmanageable, no matter how many managers you employ. This can't be explained away by incompetence, they were just too incompetent for that.
Hi iibyw, the thing is, if the situations you describe existed in the private sector their management would either (1) sort it out or (2) go bankrupt and be replaced by someone who could sort it out.

Therein lies the problem with any state owned activities, if the state (tax payer) will always pay the bill whatever is spent there will always be inefficiency and waste. If the NHS wastes some of the money provided by the taxpayer, then the "less urgent" (decided by the NHS, not chosen by the patient) patients have to wait.

We should be looking at the health services in most of the major countries in Europe, all insurance based, all have arrangements that the less well-off can also access the health service, according to their "(lesser) means. No big "excitement" about the government having to be the owner of the health care providers or the employers of the hospital staff (the GPs aren't employed by the NHS, they are private and choose to contract their services to NHS).

Lancs makes a good point - he was able to keep pace with a little more effort being asked of the staff, whereas those who'd only ever worked in the NHS found it challenging. I'm sure there are many great NHS staff who would prove this statement wrong - but, we should give them old-fashioned and inefficient systems to do 21st century tasks. I saw a consultant a few weeks back using a Dictaphone! I think they disappeared from private sector in 1980s. Similarly, who uses fax today? The NHS is the biggest buyer of fax machines in the world! And (2 years ago), I took a copy of my hospital report from one hospital I'd been treated at to my consultant at its "sister hospital." No, the consultant hadn't seen the report - "the NHS doesn't work like that he said." He then spent 10 mins copying, by hand, from my notes into his records..... a photocopy/scan would have saved him more than half that time. An efficient NHS would have saved him all that time, the records would already have been available to him.

Then, I'll stop before I say anything about all the doctors who aren't working because of the pension tax rules.

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Re: Facts About the NHS

Post by Paul Waine » Fri Nov 08, 2019 8:51 pm

Inchy wrote:Regarding bank staff. Bank staff are rarely hired to cover sickness for front line staff. Bank staff are used to cover shifts that are not filled due to lack of staffing across the board. Most bank staff at my hospital are staff that already work at the hospital.

I used to do bank quite a lot but the government put pressures on trusts to cut down on it due to the cost and negative media articles. My trust did that and low and behold there wasn’t enough staff about. So instead they offer overtime which is double time plus a cash bonus. I got paid the same for bank as I do overtime now, it just means the trust don’t call it bank and so the government don’t care.

It’s weird that a Tory government makes it inevitable for cuts to staffing but then doesn’t believe in supply and demand
Hi Inchy, and, again, if this was a private sector activity, this nonsense would soon be sorted out.

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Re: Facts About the NHS

Post by If it be your will » Fri Nov 08, 2019 9:21 pm

Paul Waine wrote:Hi iibyw, the thing is, if the situations you describe existed in the private sector their management would either (1) sort it out or (2) go bankrupt and be replaced by someone who could sort it out.

Therein lies the problem with any state owned activities, if the state (tax payer) will always pay the bill whatever is spent there will always be inefficiency and waste. If the NHS wastes some of the money provided by the taxpayer, then the "less urgent" (decided by the NHS, not chosen by the patient) patients have to wait.

We should be looking at the health services in most of the major countries in Europe, all insurance based, all have arrangements that the less well-off can also access the health service, according to their "(lesser) means. No big "excitement" about the government having to be the owner of the health care providers or the employers of the hospital staff (the GPs aren't employed by the NHS, they are private and choose to contract their services to NHS).

Lancs makes a good point - he was able to keep pace with a little more effort being asked of the staff, whereas those who'd only ever worked in the NHS found it challenging. I'm sure there are many great NHS staff who would prove this statement wrong - but, we should give them old-fashioned and inefficient systems to do 21st century tasks. I saw a consultant a few weeks back using a Dictaphone! I think they disappeared from private sector in 1980s. Similarly, who uses fax today? The NHS is the biggest buyer of fax machines in the world! And (2 years ago), I took a copy of my hospital report from one hospital I'd been treated at to my consultant at its "sister hospital." No, the consultant hadn't seen the report - "the NHS doesn't work like that he said." He then spent 10 mins copying, by hand, from my notes into his records..... a photocopy/scan would have saved him more than half that time. An efficient NHS would have saved him all that time, the records would already have been available to him.

Then, I'll stop before I say anything about all the doctors who aren't working because of the pension tax rules.
The NHS worked fine 20-25 years ago, at least compared with now. It's becoming an increasingly useless institution now. I do agree, though. If it is to be run like a corporation, where every decision, however trivial, has to be financially accountable, every motive to be profit-driven, every staff member assumed to be equally 'profit-driven' and motivated by self-interest, and every service to be outsourced to the private sector, then it would be more sensible simply to make the whole thing private and insurance based. At the moment we have the worst of all worlds.
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Re: Facts About the NHS

Post by Paul Waine » Fri Nov 08, 2019 9:52 pm

If it be your will wrote:The NHS worked fine 20-25 years ago, at least compared with now. It's becoming an increasingly useless institution now. I do agree, though. If it is to be run like a corporation, where every decision, however trivial, has to be financially accountable, every motive to be profit-driven, every staff member assumed to be equally 'profit-driven' and motivated by self-interest, and every service to be outsourced to the private sector, then it would be more sensible simply to make the whole thing private and insurance based. At the moment we have the worst of all worlds.
I'm not sure the NHS worked fine "20-25 years ago" - 1990s. I've had personal experience of NHS in early 1960s (yes, I was a youngster back then) and again in mid-70s. My personal experience was then through my parents until I reached my 60s and started experiencing how the NHS deals with urgent situations - where they looked after me very well, but same hospital had somewhere around 3 times the expected failure rates for other patients receiving the same treatment I experienced - and, then experience of the slow pace of things when they judge that your needs might not be "life threatening." Rationing by queuing is the best way to describe it. In 1962 I recovered from a minor op/general anaesthetic on a hospital trolley in a corridor at Accrington Vic. Oh, and, same year, I received a postcard asking me to come in for another minor procedure the day after the appointment date on the card. Ended up never getting another appointment.

An insurance based system can also operate with charitable hospital foundations. I understand there a lot of those in France - and maybe many other European countries.

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Re: Facts About the NHS

Post by Rick_Muller » Fri Nov 08, 2019 10:04 pm

Can I just point out the obvious flaw with everyone who wants an insurance based service - how would you manage the transition? I mean, how much insurance do you have to pay? What about people with pre-existing conditions that are expensive? How is that managed?

I only ask because I can’t get insurance based health care as it stands currently because I can’t afford the premiums - the last quote I had was £200/month but they refused to cover my bowel disease or any treatment or complications associated with it, dont get me wrong, I fully understand why - but it’s why I want answers to the questions above.

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Re: Facts About the NHS

Post by jojomk1 » Fri Nov 08, 2019 10:21 pm

[quote="Rick_Muller" I am still here, but I fear for my own life if the Tories get in[/quote]

Are you on some form of medication ?

Well, I presume you really are (and sorry for that), but please don't point the blame at the Cons

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Re: Facts About the NHS

Post by HieronymousBoschHobs » Fri Nov 08, 2019 10:31 pm

Paul Waine wrote:Hi iibyw, the thing is, if the situations you describe existed in the private sector their management would either (1) sort it out or (2) go bankrupt and be replaced by someone who could sort it out.

Therein lies the problem with any state owned activities, if the state (tax payer) will always pay the bill whatever is spent there will always be inefficiency and waste. If the NHS wastes some of the money provided by the taxpayer, then the "less urgent" (decided by the NHS, not chosen by the patient) patients have to wait.
Absolute rubbish: you clearly haven't read a single thing I've posted which provides ample evidence that your claims are simply not based in reality.

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Re: Facts About the NHS

Post by If it be your will » Fri Nov 08, 2019 10:36 pm

Paul Waine wrote:I'm not sure the NHS worked fine "20-25 years ago" - 1990s.
Obviously it is somewhat subjective. Whilst not faultless, the 1990s version of the NHS worked like a dream when compared to the current one.

We need to make a decision: full insurance based system, motivated by the self-interest of all players (including consumers) and accountable to market forces and shareholders, or one based on a public service ethos, motivated by patient and staff outcomes and democratically accountable to the electorate. This half-way-house farce just isn't working.

There are good arguments for either. You know which one I'd pick.
Last edited by If it be your will on Fri Nov 08, 2019 10:38 pm, edited 1 time in total.

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Re: Facts About the NHS

Post by Rick_Muller » Fri Nov 08, 2019 10:37 pm

jojomk1 wrote: Are you on some form of medication ?

Well, I presume you really are (and sorry for that), but please don't point the blame at the Cons
Yes, life changing medication. Detailed in my posts on this thread. If what is being stated about the real intentions of Boris and what he is willing to deal with the US in regards to pharmaceuticals then I won’t get this treatment and it increases the risk to my health. So if the Tories get in, Brexit in terms of what Boris wants will affect me and thousands like me who are on long term chronic care.

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Re: Facts About the NHS

Post by Rick_Muller » Fri Nov 08, 2019 10:41 pm

https://www.theguardian.com/society/201 ... p_WhatsApp" onclick="window.open(this.href);return false;

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Re: Facts About the NHS

Post by Paul Waine » Fri Nov 08, 2019 10:53 pm

HieronymousBoschHobs wrote:Absolute rubbish: you clearly haven't read a single thing I've posted which provides ample evidence that your claims are simply not based in reality.
Hi HBH, I disagree. I read what you posted. There's no evidence that supports the arguments made. I've direct experience of health system in Netherlands - I lived there for a time. The Dutch operate a better health care system than the NHS. Netherlands is predominantly a social-democracy society (I think all the danger of flooding makes them very community minded). They run an insurance based health care system. There are lost more examples across the whole of Europe - and worth staying in the EU if we could adopt one of their better health care systems.

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Re: Facts About the NHS

Post by dsr » Fri Nov 08, 2019 10:58 pm

martin_p wrote:No one has a problem with people being paid for what they do, especially when there’s a link between what they do and the treatment of patients (whether direct or indirect). However the privatisation of the NHS is handing money to people who have done nothing more than invest in shares.
What do you mean by privatisation? Do you mean that the government is selling shares in the NHS and then paying dividends out of the NHS "profits"? Or do you mean that the NHS is using McAlpine to build its hospitals and GlaxoSmithKline to produce its drugs and the shareholders of those companies are profiting? If the latter, unless the NHS moves to a system where they have their own in-house builders and drugs companies, I don't see what you do about it.

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Re: Facts About the NHS

Post by Rick_Muller » Fri Nov 08, 2019 11:07 pm

Rick_Muller wrote:Can I just point out the obvious flaw with everyone who wants an insurance based service - how would you manage the transition? I mean, how much insurance do you have to pay? What about people with pre-existing conditions that are expensive? How is that managed?

I only ask because I can’t get insurance based health care as it stands currently because I can’t afford the premiums - the last quote I had was £200/month but they refused to cover my bowel disease or any treatment or complications associated with it, dont get me wrong, I fully understand why - but it’s why I want answers to the questions above.
Paul Waine wrote:Hi HBH, I disagree. I read what you posted. There's no evidence that supports the arguments made. I've direct experience of health system in Netherlands - I lived there for a time. The Dutch operate a better health care system than the NHS. Netherlands is predominantly a social-democracy society (I think all the danger of flooding makes them very community minded). They run an insurance based health care system. There are lost more examples across the whole of Europe - and worth staying in the EU if we could adopt one of their better health care systems.
Paul, with your experience of the Dutch system could you try and answer my questions?

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Re: Facts About the NHS

Post by Paul Waine » Fri Nov 08, 2019 11:10 pm

Rick_Muller wrote:Can I just point out the obvious flaw with everyone who wants an insurance based service - how would you manage the transition? I mean, how much insurance do you have to pay? What about people with pre-existing conditions that are expensive? How is that managed?

I only ask because I can’t get insurance based health care as it stands currently because I can’t afford the premiums - the last quote I had was £200/month but they refused to cover my bowel disease or any treatment or complications associated with it, dont get me wrong, I fully understand why - but it’s why I want answers to the questions above.
Hi Rick, a national health system which is paid for by insurance deals with your concerns. If we buy health insurance in the UK it is a "top up" or "opt out" from NHS, so the insurance companies price it like that, the premiums "select" those that can pay and, yes, will "de-select" those with pre-existing conditions. A state compulsory health insurance system doesn't do that. If the whole population has to have health insurance in order to access the health service then the costs are spread across the whole population. When I was in Netherlands their system regulates the prices depending on income - and family unit - the better off pay a higher insurance premium, lower earners pay a lower premium. Effectively the better-off paid part of the lower earners insurance. Similarly, the "self-contribution" is set based on earnings levels. When I was over there my self contribution was around £250 p.a. The insurance covered all medical expenses that family had above that level. I remember we had a bill of over £1,000 for some treatment - the insurance covered it all.

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Re: Facts About the NHS

Post by If it be your will » Fri Nov 08, 2019 11:14 pm

dsr wrote:What do you mean by privatisation? Do you mean that the government is selling shares in the NHS and then paying dividends out of the NHS "profits"? Or do you mean that the NHS is using McAlpine to build its hospitals and GlaxoSmithKline to produce its drugs and the shareholders of those companies are profiting? If the latter, unless the NHS moves to a system where they have their own in-house builders and drugs companies, I don't see what you do about it.
It's a question of degree. Which aspects should be 'in-house' and accountable to the electorate, and which aspects should be put to the private sector, and be motivated by profit.

Perhaps Martin_p could have said However the increasing degree of privatisation of the NHS is handing an increasing amount of money to people who have done nothing more than invest in shares.?
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Re: Facts About the NHS

Post by dsr » Fri Nov 08, 2019 11:23 pm

If it be your will wrote:It's a question of degree. Which aspects should be 'in-house' and accountable to the electorate, and which aspects should be put to the private sector, and be motivated by profit.

Perhaps Martin_p could have said However the increasing degree of privatisation of the NHS is handing an increasing amount of money to people who have done nothing more than invest in shares.?
That's what I thought, too. This stink about alleged privatisation isn't saying (at least, most people aren't) that no aspect of healthcare should ever be prvided by a limited company; it's saying that the current degree of private enterprise employed by the NHS is about right or too high and it shouldn't increase. It's not a question of principle, just of practicality.
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Re: Facts About the NHS

Post by Rick_Muller » Fri Nov 08, 2019 11:24 pm

Paul Waine wrote:Hi Rick, a national health system which is paid for by insurance deals with your concerns. If we buy health insurance in the UK it is a "top up" or "opt out" from NHS, so the insurance companies price it like that, the premiums "select" those that can pay and, yes, will "de-select" those with pre-existing conditions. A state compulsory health insurance system doesn't do that. If the whole population has to have health insurance in order to access the health service then the costs are spread across the whole population. When I was in Netherlands their system regulates the prices depending on income - and family unit - the better off pay a higher insurance premium, lower earners pay a lower premium. Effectively the better-off paid part of the lower earners insurance. Similarly, the "self-contribution" is set based on earnings levels. When I was over there my self contribution was around £250 p.a. The insurance covered all medical expenses that family had above that level. I remember we had a bill of over £1,000 for some treatment - the insurance covered it all.
Thanks Paul, it’s the excluding pre-existing conditions that I don’t agree with - it would literally be a death sentence for many people, almost cleansing of a certain population type. I have a real deep moral issue with that as I am sure many others would too.

Of course the counter argument would be “why should others have to pay for my healthcare?” if my pre-existing condition was covered (it is expensive treatment as detailed before). I would argue that it should cost as much as it currently does because there are healthcare firms profiting from my disease - something else I have issues with (and I don’t just mean normal profits, I mean the astronomical profits that US firms make - my condition in the US costs approximately £150k/year to treat when it shouldn’t do!) At the moment the NHS is being shafted in a similar way and they are getting the extortionate bills which is crippling the service.

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Re: Facts About the NHS

Post by Wile E Coyote » Fri Nov 08, 2019 11:38 pm

in essence, its a fantastic, iconic british institution, but ruined by ******* govenmental dpartments and abused by the public its there to care for.
not to mention the millions wasted on delivering services for the undeserving scamsters, and those permitted to screw it for every penny without ever having contributed, small wonder its on its arse.

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Re: Facts About the NHS

Post by If it be your will » Fri Nov 08, 2019 11:40 pm

dsr wrote:That's what I thought, too. This stink about alleged privatisation isn't saying (at least, most people aren't) that no aspect of healthcare should ever be prvided by a limited company; it's saying that the current degree of private enterprise employed by the NHS is about right or too high and it shouldn't increase. It's not a question of principle, just of practicality.
Yes. There are practical arguments in favour of a behemoth NHS that is largely 'in-house'. There are practical arguments in favour of a largely outsourced NHS that is largely subject to market forces. There are practical arguments in favour of an ability-to-pay health service.

There are also principles at play, too. though. Such as what 'character' the NHS should have, what ethos it should uphold, or what the motivation behind the provision should be. Speaking purely for myself, when I am subjected to a bad service, it annoys me more if an individual has profited from providing me with that bad service, than it would if society - of which I am part, and therefore partly responsible for - had provided me with that bad service. But that's just me. You might not think this way. It's a matter of principle.

In all this maelstrom, the politicians, elected by us, to represent our will, have to find the right balance.

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Re: Facts About the NHS

Post by If it be your will » Fri Nov 08, 2019 11:49 pm

Wile E Coyote wrote:in essence, its a fantastic, iconic british institution, but ruined by ******* govenmental dpartments and abused by the public its there to care for.
not to mention the millions wasted on delivering services for the undeserving scamsters, and those permitted to screw it for every penny without ever having contributed, small wonder its on its arse.
Every socialist institution will be abused by some people. The police, schools, fire service, roads, NHS, social security, you name it. But that, of itself, is not an all-conquering reason to chuck it all away and replace them all with private provision.

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Re: Facts About the NHS

Post by Jakubclaret » Fri Nov 08, 2019 11:59 pm

Wile E Coyote wrote:in essence, its a fantastic, iconic british institution, but ruined by ******* govenmental dpartments and abused by the public its there to care for.
not to mention the millions wasted on delivering services for the undeserving scamsters, and those permitted to screw it for every penny without ever having contributed, small wonder its on its arse.
It is, a couple of years ago I had to go to A&E at Airedale in the middle of the night, the waiting room was just full of drunks & paramedics were dealing with a ketamine overdose, whilst some genuine people had hours to wait, as the staff were rushed off the feet dealing with them.

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Re: Facts About the NHS

Post by If it be your will » Sat Nov 09, 2019 12:08 am

Rick_Muller wrote:Of course the counter argument would be “why should others have to pay for my healthcare?”
There are practical and principled arguments:

In principle, I should not welcome a sentient being suffering a miserable and untimely demise on account of a condition he had absolutely no control over.

In practice, even if we were willing to live by the ethos of everyone for themselves, it is unlikely you would take your plight lying down. For the sake of yourself and your children, it is reasonable to suppose you would resort to criminal activity to fund your care if you could not do so by legal means. By the time we've all invested in necessary security measures, private security staff, prisons and the rest of it to keep you out of our hair, as well as losing your economic output, it would probably work out cheaper for us all to just club together and pay for your care.

I am still wincing at your willingness to willfully overtake me in a traffic jam, though.
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Re: Facts About the NHS

Post by Wile E Coyote » Sat Nov 09, 2019 12:11 am

i know for a fact labour will never criticise the slob uk public, or the undeserving selfish ***** who plunder the system. just more fancy sloganeering and against a stupid backdrop of colossal debt. insanity.

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Re: Facts About the NHS

Post by HieronymousBoschHobs » Sat Nov 09, 2019 12:24 am

Paul Waine wrote:Hi HBH, I disagree. I read what you posted. There's no evidence that supports the arguments made. I've direct experience of health system in Netherlands - I lived there for a time. The Dutch operate a better health care system than the NHS. Netherlands is predominantly a social-democracy society (I think all the danger of flooding makes them very community minded). They run an insurance based health care system. There are lost more examples across the whole of Europe - and worth staying in the EU if we could adopt one of their better health care systems.
The argument is that the involvement of the private sector in this country has been unsuccessful. It is not about the health system in the Netherlands. Likewise, you have introduced the concept of an 'insurance based health care system' into this debate, an idea which has no political backing whatsoever in this country.

If you think the NHS should follow the lead of health services on the continent so be it, but the present discussion is about the decisions which have been made about the health service in the United Kingdom.

I fail to see how the evidence I have presented, along with the ample testimony we can find from current and past users of the NHS, does not support the idea that the move towards privatisation in this country has been a failure.

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Re: Facts About the NHS

Post by Jakubclaret » Sat Nov 09, 2019 12:42 am

AndrewJB wrote:If we ended most private healthcare and everyone relied on the NHS, it would be better looked after. The same with schools.
I fail to see that idea working, it’s more & likely the wealthy anyway who would use bupa etc for faster service & maybe preferred specialists, not everybody feels confident solely relying on the NHS for multiple reasons. If everybody felt confident & used the NHS, the need for private healthcare wouldn’t exist in the first place & it does for a very good reason, you could use the same example for a bog standard comps & Harrow, etc. if people can afford it & choose to use private schools or healthcare, where’s the problem?

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Re: Facts About the NHS

Post by martin_p » Sat Nov 09, 2019 8:32 am

If it be your will wrote:It's a question of degree. Which aspects should be 'in-house' and accountable to the electorate, and which aspects should be put to the private sector, and be motivated by profit.

Perhaps Martin_p could have said However the increasing degree of privatisation of the NHS is handing an increasing amount of money to people who have done nothing more than invest in shares.?
Precisely this. The NHS is not in the business of building or manufacturing drugs and doesn’t need to be. Neither does it need to manufacture stethoscopes or scalpels. The tools of care giving have always been in the private sector. It’s the privatisation of and resulting profiteering from the care giving aspects that is wrong in my opinion.

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Re: Facts About the NHS

Post by CrosspoolClarets » Sat Nov 09, 2019 8:49 am

martin_p wrote:Precisely this. The NHS is not in the business of building or manufacturing drugs and doesn’t need to be. Neither does it need to manufacture stethoscopes or scalpels. The tools of care giving have always been in the private sector. It’s the privatisation of and resulting profiteering from the care giving aspects that is wrong in my opinion.
Actually the NHS does manufacture its own drugs in one sense, in aseptic units (sterile units where injections and other things are prepared). This is a minority though.

The NHS also has to have strong partnerships with many drug companies, working together on clinical trials and similar projects. I was asked by one big drug company to do some consultancy for them about 8 years ago - I quoted more than double my normal rate and they readily agreed to it. The difference was stark to the NHS - shiny facilities, massive security etc.

I do get why people are precious about this private sector collaboration - in some instances it I myself get wary about private hospital firms, but the reality is the NHS needs extra capacity or people die, and you cannot just build a new hospital in 10 minutes, flexing it as demand rises and falls. That’s where the private sector keeps people alive, and massively adds to the quality of life for others by ensuring there isnt a 2 year waiting list like the good old days.

I am quite conscious that indirectly decisions or recommendations I make in my business save lives (or cost them). I don’t have the luxury of a moral high ground about privatisation, sometimes you just have to make the right decision for the public.

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Re: Facts About the NHS

Post by mdd2 » Sat Nov 09, 2019 10:05 am

Paul. You may be interested in the current situation for some of us and see how some of the "new" technology has made matters worse not better-but some technology like imaging is light years ahead of the past.
Old system paper driven- see patient write in records go to foot of bed check observations. Look at results and pending results in records-pick up X-ray film go to viewing box and look at films. Write down treatment plan, prescribe medication; move to next patient. Where you needed to, rifle through old records for more info. Old records on hand in over 90% of cases within 30minutes of admission.
New system-old records off site will have them in 48hrs. So see patient, write in new records, try and find a computer, sometimes all in use, log on with PW, find observations site, log on with PW, search for patient, find obs.
Investigations, log on with password- (oh and of course there may be a flag- password expired, new pass word and log on) find patient look at results and order a new test electronically, but you computer you are at may not be one which prints labels for said blood tests so someone has to find another computer with the appropriate machine attached to print label-(after of course you have logged on and entered PW again). X-rays-find the appropriate window-log on with PW find the patient, look at X-rays. Return to patient and advise what is to be done and what the problem(s) may be. And Paul that is not the half. Takes longer to see someone properly and I stress the word properly than 20 years ago.
No hand held dictaphone so again find a computer with appropriate software for dictating, log on enter PW dictate letter whereas before one could do that where appropriate at the bedside. Oh and I haven't even mentioned the European working time directive and what that has done to the NHS and patient care and when the network is off line for maintenance or crashes
I am afraid searching on line the electronic records takes longer than paper driven if papers filed correctly-but it does cut down on paper, filing clerks lose jobs and I imagine that saves money as well as paper until someone decides to print off any records when you get pages and pages and pages of mostly the same stuff but with additional entries per sheet.
I am sure it is possible to have a monitor at every bed where one can access all of this with one PW-but guess the cost is a no no. Meanwhile in an 8 hour shift I reckon you now lose 1-2 patient reviews due to time wasted with the above and it maybe more given additional things that have to be done on-line of no benefit to the patient but needed to audit practice because the spies do not have enough time to get the info needed from the patient record.

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Re: Facts About the NHS

Post by mdd2 » Sat Nov 09, 2019 10:15 am

CrosspoolClarets wrote:Actually the NHS does manufacture its own drugs in one sense, in aseptic units (sterile units where injections and other things are prepared). This is a minority though.

The NHS also has to have strong partnerships with many drug companies, working together on clinical trials and similar projects. I was asked by one big drug company to do some consultancy for them about 8 years ago - I quoted more than double my normal rate and they readily agreed to it. The difference was stark to the NHS - shiny facilities, massive security etc.

I do get why people are precious about this private sector collaboration - in some instances it I myself get wary about private hospital firms, but the reality is the NHS needs extra capacity or people die, and you cannot just build a new hospital in 10 minutes, flexing it as demand rises and falls. That’s where the private sector keeps people alive, and massively adds to the quality of life for others by ensuring there isnt a 2 year waiting list like the good old days.

I am quite conscious that indirectly decisions or recommendations I make in my business save lives (or cost them). I don’t have the luxury of a moral high ground about privatisation, sometimes you just have to make the right decision for the public.
Correct. I note a big headline in some of the papers about more use of the Private sector for NHS patients and no doubt that will be used to dupe the public about the NHS being carved up.
Tony Blair started this and it will continue apace until or unless we put more beds into the community or NHS hospitals.
NHS worked by having long waiting lists. In winter elective surgery often stopped because non-surgical patients overspilled into surgical beds.
That is now a problem in most hospitals 365 days/year. Once deadlines for completion of treatments were brought in the only way for many was to use the slack in the private sector for low risk procedures to avoid over shooting waiting times-then of course the NHS had more complicated surgical procedures to deal with as a percentage of its total surgery so length of stay goes up and some brains of Britain see a) a less efficient NHS b) privatisation by stealth.
The same also applies to radiological investigations hived off to the private sector because too many demands on the NHS imaging facilities.

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Re: Facts About the NHS

Post by Rick_Muller » Sat Nov 09, 2019 10:22 am

mdd2 wrote:Paul. You may be interested in the current situation for some of us and see how some of the "new" technology has made matters worse not better-but some technology like imaging is light years ahead of the past.
Old system paper driven- see patient write in records go to foot of bed check observations. Look at results and pending results in records-pick up X-ray film go to viewing box and look at films. Write down treatment plan, prescribe medication; move to next patient. Where you needed to, rifle through old records for more info. Old records on hand in over 90% of cases within 30minutes of admission.
New system-old records off site will have them in 48hrs. So see patient, write in new records, try and find a computer, sometimes all in use, log on with PW, find observations site, log on with PW, search for patient, find obs.
Investigations, log on with password- (oh and of course there may be a flag- password expired, new pass word and log on) find patient look at results and order a new test electronically, but you computer you are at may not be one which prints labels for said blood tests so someone has to find another computer with the appropriate machine attached to print label-(after of course you have logged on and entered PW again). X-rays-find the appropriate window-log on with PW find the patient, look at X-rays. Return to patient and advise what is to be done and what the problem(s) may be. And Paul that is not the half. Takes longer to see someone properly and I stress the word properly than 20 years ago.
No hand held dictaphone so again find a computer with appropriate software for dictating, log on enter PW dictate letter whereas before one could do that where appropriate at the bedside. Oh and I haven't even mentioned the European working time directive and what that has done to the NHS and patient care and when the network is off line for maintenance or crashes
I am afraid searching on line the electronic records takes longer than paper driven if papers filed correctly-but it does cut down on paper, filing clerks lose jobs and I imagine that saves money as well as paper until someone decides to print off any records when you get pages and pages and pages of mostly the same stuff but with additional entries per sheet.
I am sure it is possible to have a monitor at every bed where one can access all of this with one PW-but guess the cost is a no no. Meanwhile in an 8 hour shift I reckon you now lose 1-2 patient reviews due to time wasted with the above and it maybe more given additional things that have to be done on-line of no benefit to the patient but needed to audit practice because the spies do not have enough time to get the info needed from the patient record.
I don’t think we’ll be that far off having an App for all your patient data, which is presented on the patients device but stored in the NHS cloud. Doctor could use patients device to access records and authorise treatment direct from there. I say not far off, within 10 years I think.

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Re: Facts About the NHS

Post by Paul Waine » Sat Nov 09, 2019 10:23 am

Rick_Muller wrote:Thanks Paul, it’s the excluding pre-existing conditions that I don’t agree with - it would literally be a death sentence for many people, almost cleansing of a certain population type. I have a real deep moral issue with that as I am sure many others would too.

Of course the counter argument would be “why should others have to pay for my healthcare?” if my pre-existing condition was covered (it is expensive treatment as detailed before). I would argue that it should cost as much as it currently does because there are healthcare firms profiting from my disease - something else I have issues with (and I don’t just mean normal profits, I mean the astronomical profits that US firms make - my condition in the US costs approximately £150k/year to treat when it shouldn’t do!) At the moment the NHS is being shafted in a similar way and they are getting the extortionate bills which is crippling the service.
Hi Rick, you have my sympathy for your health issues. A close friend has similar situation - and has lived in US for over 30 years (employer covers health insurance for employee and family through that time). Me, I've now got cardiovascular disease for the rest of my natural, adds at least double to my travel insurance.

The enormous difference between compulsory health insurance, as in Netherlands, Germany etc etc, is that everyone has to have insurance and so there is no "adverse selection." The costs of the (many) people with pre-existing conditions is absorbed by everyone and is, therefore, a modest part of everyone's insurance. The same applies with the employer paid for health insurance in US, their costs are the same for all employees, regardless of pre-existing conditions.

A compulsory system has got 3 groups of participants, including the population with the insurance: 1) the Gov't the sets the rules, including the standards to be met by the health care providers, the health insurance providers and the earnings related contributions by family units with different means; 2) the health insurance providers - there is no reason why there would be only one and 3) the health care providers, GPs, hospitals and others - again there can be more than one hospital service, as well as a choice of GPs.

Money is important. It incentivises the GPs and hospitals to provide the treatment that patients need and when they need it. Yes, much like Tesco and Asda, Sainsbury's and M&S all compete for our groceries spend and more. If you are told there is a 3 months wait for food to be delivered by Tesco, maybe you will chose to go to Asda instead. if there's a new, better, more effective way of treating a health problem the hospitals will be incentivised to be the first to provide it.
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Re: Facts About the NHS

Post by Paul Waine » Sat Nov 09, 2019 10:30 am

HieronymousBoschHobs wrote:The argument is that the involvement of the private sector in this country has been unsuccessful. It is not about the health system in the Netherlands. Likewise, you have introduced the concept of an 'insurance based health care system' into this debate, an idea which has no political backing whatsoever in this country.

If you think the NHS should follow the lead of health services on the continent so be it, but the present discussion is about the decisions which have been made about the health service in the United Kingdom.

I fail to see how the evidence I have presented, along with the ample testimony we can find from current and past users of the NHS, does not support the idea that the move towards privatisation in this country has been a failure.
Hi HBH, it's odd isn't it. Lot's of our politicians believe the UK is better off as part of the EU, but very few politicians dare take a look at how the health care systems in the major EU countries are all deliver better healthcare outcomes than the NHS. Why is that?

Of course, "privatisation" of the NHS is a failure. 1) it's not privatisation and 2) it is the state ownership and funding of the NHS that is the point of failure. Putting it graphically, it's not the gas in the balloon that is the problem, it's the fact that we are trying to fly a lead balloon.

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Re: Facts About the NHS

Post by Paul Waine » Sat Nov 09, 2019 10:48 am

mdd2 wrote:Paul. You may be interested in the current situation for some of us and see how some of the "new" technology has made matters worse not better-but some technology like imaging is light years ahead of the past.
Old system paper driven- see patient write in records go to foot of bed check observations. Look at results and pending results in records-pick up X-ray film go to viewing box and look at films. Write down treatment plan, prescribe medication; move to next patient. Where you needed to, rifle through old records for more info. Old records on hand in over 90% of cases within 30minutes of admission.
New system-old records off site will have them in 48hrs. So see patient, write in new records, try and find a computer, sometimes all in use, log on with PW, find observations site, log on with PW, search for patient, find obs.
Investigations, log on with password- (oh and of course there may be a flag- password expired, new pass word and log on) find patient look at results and order a new test electronically, but you computer you are at may not be one which prints labels for said blood tests so someone has to find another computer with the appropriate machine attached to print label-(after of course you have logged on and entered PW again). X-rays-find the appropriate window-log on with PW find the patient, look at X-rays. Return to patient and advise what is to be done and what the problem(s) may be. And Paul that is not the half. Takes longer to see someone properly and I stress the word properly than 20 years ago.
No hand held dictaphone so again find a computer with appropriate software for dictating, log on enter PW dictate letter whereas before one could do that where appropriate at the bedside. Oh and I haven't even mentioned the European working time directive and what that has done to the NHS and patient care and when the network is off line for maintenance or crashes
I am afraid searching on line the electronic records takes longer than paper driven if papers filed correctly-but it does cut down on paper, filing clerks lose jobs and I imagine that saves money as well as paper until someone decides to print off any records when you get pages and pages and pages of mostly the same stuff but with additional entries per sheet.
I am sure it is possible to have a monitor at every bed where one can access all of this with one PW-but guess the cost is a no no. Meanwhile in an 8 hour shift I reckon you now lose 1-2 patient reviews due to time wasted with the above and it maybe more given additional things that have to be done on-line of no benefit to the patient but needed to audit practice because the spies do not have enough time to get the info needed from the patient record.
Hi mdd2, yes, fully agree. I've been a patient in the system you describe. Of course, it shouldn't be as you describe. The technology should be available for the medical staff to do their jobs - but, gov't (civil service) has a very bad record with IT, so we just get very bad IT. Change the system, take out the state ownership and funding of the hospitals and this would be sorted very quickly. Yes, privatise the lot - but with compulsory health insurance arrangements as I've described exist in Netherlands and Germany (and other major EU countries).

I'm on regular medication, need to re-order every 2 months (it used to be 3, but seems someone think they save money by reducing interval to 2!). I was told over the summer that I could no longer email my request - I now needed to use their new on-line system - but, I also needed to re-register for the system as they'd "upgraded" it - passport/photo ID and driving licence/proof of address. So, I do all of this and re-set my password to access my patient records. The "computer says No!" It shows I have no approved medication to re-order - the previous prescriptions are all recorded, but I can't do what the GP said I had to do. So, back to the GPs.... no one seemed interested that their new computer system isn't working, no one seemed to think it needs fixing. Instead they said, "use our old system on-line system, but when it asks are you registered to order repeat prescriptions answer "no." Then it will let you send an email...… Aggh! I'm not supposed to have to deal with stress, I've got cardio disease!

It would all be sorted if the system was allowed to make a profit (and a loss if they got it wrong).

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Re: Facts About the NHS

Post by AndrewJB » Sat Nov 09, 2019 12:29 pm

Paul Waine wrote:Hi Rick, a national health system which is paid for by insurance deals with your concerns. If we buy health insurance in the UK it is a "top up" or "opt out" from NHS, so the insurance companies price it like that, the premiums "select" those that can pay and, yes, will "de-select" those with pre-existing conditions. A state compulsory health insurance system doesn't do that. If the whole population has to have health insurance in order to access the health service then the costs are spread across the whole population. When I was in Netherlands their system regulates the prices depending on income - and family unit - the better off pay a higher insurance premium, lower earners pay a lower premium. Effectively the better-off paid part of the lower earners insurance. Similarly, the "self-contribution" is set based on earnings levels. When I was over there my self contribution was around £250 p.a. The insurance covered all medical expenses that family had above that level. I remember we had a bill of over £1,000 for some treatment - the insurance covered it all.
How is this different to paying for healthcare through taxation?
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Re: Facts About the NHS

Post by Paul Waine » Sat Nov 09, 2019 2:48 pm

AndrewJB wrote:How is this different to paying for healthcare through taxation?
Hi Andrew, let's think about it:

1) GPs and Hospitals receive their money from treating patients - payments being all/mostly paid by insurance companies;
2) Big incentive for GPs and Hospitals to be as efficient as they can be in their activities;
3) Big incentive to offer the best health care - because other wise patients might choose to go elsewhere;
4) Big incentive to offer treatment quickly - rather than "rationing" healthcare by extended waiting lists and cancellations;
5) GPs and Hospitals look at their own staffing needs - rather than waiting for state to decide we need 5,000 more GPs and XXX,000 more nurses;
6) Speedy resolution to the pension taxation situation that is resulting in many senior GPs and Consultants saying "no" to extra work - and, in many case, deciding to retire earlier than originally planned;
7) With insurance there will be no distinction between "public health care" and "private health care" - everyone will be "wealthy" and be able to afford private health care...
8) GPs and Hospitals will sort out their own IT systems, so they can operate in the 21st century - rather than being reliant on the state suddenly becoming good at appropriate developing IT systems.
9) Add other benefits from the patient controlling the money that pays for their health care - rather than the state making these decisions for everybody.
10) I'm sure there are many more we can add to this list.....

Of course, if we changed the NHS into a compulsory insurance based national health service we would need to have a state regulator that would set standards etc. etc. We might call this regulator the Office of Sickness and Health, Off-Sick, for short. ;)

Enjoy the game this afternoon.

UTC

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