Nhs

[luxinterior]

During the election there has been a load of talk about the NHS - labour saying they will spend more and accusations that the tories will privatise

From my view giving more money to the NHS would be a waste of time. it is a brilliant service but so inefficient.

Took my daughter a few times to A+E and you have the same checks maybe 5 times, they is no reliance on the previous checks. Also you keep moving up the system in terms of expertise until you get the person who knows the answer. Instead of the initial nurse you meet concluding that this is a child with X condition so you need a specialist in that area who works with children. Even I worked that out!

So more money would just increase the inefficiency and would be totally unsustainable

[PiesAreGood]

I think the whole system would be much more efficient if it was rejigged to prioritise prevention rather than cure. At the moment the NHS is set up to wait until someone has a problem and then try to fix them. Surely a system of regular maintenance and checks to prevent so many people having problems that need to be fixed would be cheaper in the long run.
Of course we'd want to keep all the fantastic systems we have for fixing people that need fixing but if less people broke down those systems would be less strained.

Well that's my uninformed opinion anyway.

[Wheeze]

Both points are important but there is no doubt that the finances of the NHS are in a total mess and subject to massive massaging of so-called 'facts' by politicians and pressure groups alike.
What is not in doubt is that the percentage of GDP that goes to the NHS is reducing...and reducing below the levels from other equivalent nations.

For me, the real problem is the failure or inability of the government to have a mature discussion with the electorate about what the electorate expects the NHS to deliver. The mantra of everything free at the point of need is so engrained that people trot it out with their minds closed.
Well, that worked fine in 1948. Before the pharmacology explosion in the 50's. Before the advent of complex surgery that those drugs allowed. Before the ability to preserve life in ITU's. Before the ability to scan everything that moves.
The first cracks appeared only a few years after inception of the NHS when the budgets could not handle the burgeoning range and use of drugs in the post war era. So co-payments in the form of prescription charges became a necessary tool to prop the whole thing up. But since then, nothing.

Well, lets have that mature discussion about what should be universally free. My view is it should be what I call the Big C's.
Cancer, Cardiac, Casualty, Chronic physical and mental Conditions, Childbirth and Childcare should be free to all.

But what about IVF, breast enlargement, gender reassignment? Free? Co-paid?

What about waste? Ask any GP about missed appointments? A nominal appointment fee (means tested if you want) like a nominal prescription charge would help cut down this waste as well as support the services for those with no means of paying.

A 70 year old business plan is just that. 70 years old and ripe for overhaul to fit the modern age.

[PiesAreGood]

the real problem is the failure or inability of the government to have a mature discussion with the electorate

That is a very good point, well made. Hmm now where else would that be handy right now...

Well, lets have that mature discussion about what should be universally free. My view is it should be what I call the Big C's.
Cancer, Cardiac, Casualty, Chronic physical and mental Conditions, Childbirth and Childcare should be free to all.

But what about IVF, breast enlargement, gender reassignment? Free? Co-paid?

Also agreeing with you there Wheeze. If there isn't enough money, there should be an adult debate (oh no!) about what really is important and should be "free". In my mind, it should in the first instance, be limited to the things which are directly related to keeping the population healthy and fit. Certainly I wouldn't class gender reassignment, breast enlargement or IVF in that list. I have absolutely no problem with people choosing to have these procedures! but if cuts have to be made, that's the type of thing I would cut.

[Witton Park]

I'm with you Wheeze.
But what is clear to me is that the politicians don't know.
It also seems clear that the medical staff don't know what to do, just that it isn't right.
Money is the easy solution but I think it is deeper than that, as you say a 70 year old business plan is not fit for use now.

So if I was in charge now I would

• Immediate increase in spending on NHS and Social Care through the term of this Parliament to the tune of around £20 Billion in total in addition to the current spending plans.
• Make trusts work within budget.
• Set up a Royal Commission on the future of health provision in the UK to report by the end of 2020.

I would set up a Royal Commission joint chaired by a high profile medical professional and business person and let them put a small team together to examine health systems in the developed world and best practice here in the UK.
Sir Robert Winston and Sir Digby Jones would be the two people I personally would choose.
There would be two questions.
“If you were to set up a National Health and Social Care system from scratch now with a view to the next 40 years what would you do, assuming nothing was in place?”
“How best could we implement a transition to this new structure?”
I would do my best to bind all parties in Parliament to the resulting plan. I cannot see how any party could object to such a plan.

[noel]

As PiesAreGood points out, preventative medicine is a great way to reduce costs. But it only works in the long-term. In the now, it costs more because we need to fund people to deal with all the crisis cases we have at the moment PLUS people to start doing the regular maintenance check-ups everyone agrees is a good idea. So perhaps we need to increase spending to phase this in.

Cutting edge cancer therapies are very expensive. NICE tried to reduce the amount of the NHS budget that was spent on this, saying the money would be better spent elsewhere (and showing the data to back up their arguments). The government side-stepped NICE's advice and set up the cancer drugs fund. Who here would vote to reduce the amount of money we spend on cutting edge cancer therapies?

It would be nice to get a price list when we vote. Something like:
Option A: A&E waits more than 4 hours, old drugs - same tax as currently
Option B: A&E waits between 3 and 4 hours; slightly newer drugs - an extra 1p in every pound of income tax
Option C: A&E waits less than 3 hours; new drugs when needed - an extra 2p in every pound of income tax

That way we could make an informed decision.

[Mike T]

Aren't options B and C just two different levels of private insurance? No UK electorate will vote for tax increases like these, so the NHS, for the foreseeable future, will continue to be deliberately underfunded and run down.
As to prevention, it is mainly delay rather than prevention, and is only really helpful if all common illnesses can be delayed - particularly cancer and vascular disease. The best bangs for your bucks are of course diet, exercise, stop smoking, and minimise alcohol. But the public know this, and find it too hard to comply: one third of children are overweight or obese when they leave primary school, and two thirds of adults are in the same category. Two thirds! But of course they do not have to pay directly for the extra care they will need. Huge can of worms here!

[Mossdog]

Aren't options B and C just two different levels of private insurance? No UK electorate will vote for tax increases like these, so the NHS, for the foreseeable future, will continue to be deliberately underfunded and run down.
As to prevention, it is mainly delay rather than prevention, and is only really helpful if all common illnesses can be delayed - particularly cancer and vascular disease. The best bangs for your bucks are of course diet, exercise, stop smoking, and minimise alcohol. But the public know this, and find it too hard to comply: one third of children are overweight or obese when they leave primary school, and two thirds of adults are in the same category. Two thirds! But of course they do not have to pay directly for the extra care they will need. Huge can of worms here!

Some good points there. It doesn't help that one of the most powerful lobbying groups consists of the food industry whose primary aim is to maximize profits and aren't bothered if it's at the expense of children's and adults' health, supported by swish advertising campaigns. These groups are unlikely to be challenged as they contribute funds to certain politicians and political groups (usually right-wing - listen to for example http://www.bbc.co.uk/programmes/b08n2ltq ). The present Government also has little appetite ('cuse the pun) for solving the NHS' difficulties as it's ultimate goal is to adhere ostensibly to their promise of maintaining the NHS, while also ensuring that the Service becomes the health choice of utter last resort, where only the very poor and desperate resort to it, while others are forced to take out health insurance and fund private medical provision (creating more money grabbing and controlling opportunites for the greedy 'few' £££££ ).

[Rob Furness]

I would happily pay extra tax to properly fund the NHS. I don't think dividing what's covered and what isn't is really the right way to go. For me the NHS is one of the things that makes this country great. If you ever need it, it's there. No caveats. Why change that? Personally, I think a large proportion of the electorate would have no problem paying extra taxes to fund it, provided they trusted the money actually went directly to the NHS and didn't get used elsewhere!

[CL]

But the NHS isn't always there when you need it. People often find that out in the most distressing of ways.

I'd rather wind the NHS down and buy private health cover thanks.