How to "save" the NHS

Well, it's always more complicated than that. Many people don't have employers, and that's not just layabouts, it includes children, OAPs and those living in areas of low employment opportunities. I probably fall more into the non-socialist side of politics (Genghis was a commie), but I don't mind paying extra to give everyone access to medical treatment without having to worry about the cost. I keep in mind that wedges have thin ends and slopes can be slippery.

Even my employers' health plans weren't worth much to me because the things I knew I'd need treatment for were excluded because I'd already had them. (I started early in the injury and disease collection business and have a diverse portfolio)
The Australian system provides good quality medical care free at the point of use for those who need it. It also pretty much forces (certainly encourages) those who can afford private insurance to have it and use the private system where they can.

Some might call accessing private care when you can afford it queue jumping, but actually it significantly reduces queues in the public system too. And the involvement of the private sector in the delivery of primary care, imaging, pathology etc significantly improves availability.

Having just spent a month in the UK helping my 88 year old mother through surgery, I was gobsmacked how hard it it is to access health services in the UK.
 
I am going to ask a really stupid question so I am expecting to get properly filled in here. ;)

In a conflict zone how does the RAMC deliver medical services from routine to emergency with very limited resources that is different from the NHS way of doing things? Is there anything we can learn or is it too dissimilar?

I am mainly thinking of the way things are organised and managed rather than actual treatments. At a wild guess I assume the ratio of medical staff to 'management' is far higher in the RAMC than the NHS and where there is 'management' it is mainly medically qualified?
Stabilising and then medevacing, rather than having to fully treat a patient

Having patients that are, (generally) young, fit and lacking chronic conditions

Throwing money at the problem.

Having the QARNC etc as well.
 
Someone made the point up thread that wages are so bad for nursing staff in the UK that it is common for NHS trained staff to go abroad where wages and conditions are meant to be better. I've heard of this long before now. Canada, Aus, and the US seem to be the destination of choice I understand.
Is the cost of their training recouped by the NHS?
Personally I'd doubt it very much, but happy to be proven wrong. Because if the NHS can't be arrsed to chase health tourism, I certainly can't imagine that they will chase training costs.
Am I talking bollocks here folks?
My own sister spent four years training as a nurse (I could be wrong about the timeline here) but she wasn't post qualified for long before she jacked nursing in and retrained as a teacher.
An ex neighbour of mine trained as a mid wife and she didn't last too long either. She got pregnant, and as far as I know never went back.
Since they pay their own university fees it would be tricky to get them to pay them back if they leave.
 

Truxx

LE
As far as I can see, every Nationalised industry in the history of nationalised industries ends up the same way ...... burdened with a mighty bureaucracy determined to consume as much money as it takes to serve it's own interests and the NHS is no exception.
We have Nurses, we have Doctors, we have all the staff needed to support the work carried out by those people and then we have "healthcare professionals" whatever they may be.
Indeed.

My own view of the NHS is that it is a galaxy of stunningly dedicated and clever, caring people but desperately disjointed.

Someone asked upthread for examples of incompetence. I could write you a book.

A chum of mine was, before he retired, the chap who, in working for an NHS Trust in the NE, was responsible for dealing with claims against that trust.

1/3 of the trusts annual "working" budget went on settling claims. 33%. A whopping amount.

My own and family experiences have persuaded me that the NHS suffers from organisational incompetence. My wife is loosing her sight due to a number of issues. These are being managed by 4 different clinics in two different hospitals and they never, ever seem to exchange information.

The "dots" might be brilliant, but the construct is totally incapable of joining them up, and that is where the money gets wasted.
 

Cold_Collation

LE
Book Reviewer
The NHS can't be changed until the british people fall out of love with it.
No political party, especially the tories have the guts to truly reform the NHS. All of the mainstream political parties think that it's just easier to throw good money after bad at it. And to hell with the consequences. Even Saint Maggie was scared of it.
People want to believe the myth that the NHS is a free service.
Most people are too stupid to realise that two of three most commonly used parts of the NHS, ie dentistry and opticians you pay for at the point of use.
GP visits will be next.
Fall out of love with it?

Most people are highly critical of it, and many of the people in it.

The only place it is unconditionally adored is Labour Party conferences.
 

Tyk

LE
Fall out of love with it?

Most people are highly critical of it, and many of the people in it.

The only place it is unconditionally adored is Labour Party conferences.

Don't forget the press who love it for crisis stories, alarmism and weaponised purposes. To them it's the gift that keeps on giving.
 
Fair enough, but 25% NI aggregated across employer and employees' contribution is verging on the ridiculous, on top of income tax/corporation tax and then a VAT rate of 20% on most of what's spent from the remainder on goods and services.

As I said, NI isn't all about the NHS, it's largely about other benefits. A problem with transferring costs to the private sector via insurance, direct payment, or the like is that it often just shuffles the payments around but doesn't really effect any marked savings to the consumer. It can also lead to greater inequity in healthcare.
 

Cold_Collation

LE
Book Reviewer
Don't forget the press who love it for crisis stories, alarmism and weaponised purposes. To them it's the gift that keeps on giving.
I almost included the press but the love isn't unconditional - IT scandals, wastefulness and so on.

Loved certainly, but only as you say as a source of stories. Not eulogised as by Labour.



...who didn't create the NHS. They just happened to be in power post-WWII. The studies which led to the NHS were done by a Liberal under a Conservative Prime Minister. Labourites get all frothy when you point that out.
 
Fall out of love with it?

Most people are highly critical of it, and many of the people in it.

The only place it is unconditionally adored is Labour Party conferences.

Hey, you won't find me anywhere near a Labour Party conference, unless I'm confirming the best position for my sarin release mechanisms.

However, apart from some specialist waiting times, I've had excellent treatment from the NHS. I may well be critical of some aspects of it, but I've been critical of various offsprings' ratio of gaming vs homework time - doesn't mean I don't love them.
 

Cold_Collation

LE
Book Reviewer
Hey, you won't find me anywhere near a Labour Party conference, unless I'm confirming the best position for my sarin release mechanisms.

However, apart from some specialist waiting times, I've had excellent treatment from the NHS. I may well be critical of some aspects of it, but I've been critical of various offsprings' ratio of gaming vs homework time - doesn't mean I don't love them.
I've worked briefly in the NHS and have many friends who do. The only place since the army that I've found anything like the camaraderie was the A&E department.

There are some truly excellent individuals.

There are also some complete mongs.

Examples:

The porter at my local hospital who would develop a mysterious back condition once a year. A former girlfriend was the outpatients physio boss. There was nothing wrong with the bloke; he had just decided that his annual leave allowance wasn't enough and so would every year throw a fortnight's sick.

He would openly admit this to my ex but because of how the organisation is set up she couldn't report the reality.

Or, someone close to me has a chronic condition. Gets a phone call from a receptionist.

"We've got an appointment slot for you at 10.30am."
"That's no good. I work for a living."
"Oh. Will 10.50am work better for you?"

...no concept of a world outside the organisation.
 

TractorStats

War Hero
Stabilising and then medevacing, rather than having to fully treat a patient

Having patients that are, (generally) young, fit and lacking chronic conditions

Throwing money at the problem.

Having the QARNC etc as well.
Interesting post. Reading between the lines RMAC and QARNC do what they do very well but that is probably more akin to true emergency A&E with some GP work on the bases? Their role is tightly defined.

If the NHS was like the motor industry it would actually have four parts:

Hand built luxury and super cars = specialist medicine

Mass produced cars = routine elective surgery

Recovery and crash repairs = ambulance plus A&E

Routine maintenance and annual repairs = geriatric care and community health

The problem the NHS has is that it tries to do everything with the same business model. Could you imagine a sports car manufacturing facility suddenly trying do mass production. Expensive and chaotic.

What it needs to do is bring in the private sector to do 10,000 hip jobs at lowest cost. Keep ambulance and A&E 'in house' but make it work like RMAC and triage out low level stuff with well trained QARNC type staff. The big teaching hospitals do specialist medicine only and geriatric care needs totally different facilities in the community. GP care scrap it all together and put them at the hospital A&E and local geriatric care centres.

Breaking up the NHS into parts and bringing in the private sector to do the routine bits in high volume and lowest cost with minimal delays is surely the way to go.
 
The Australian system provides good quality medical care free at the point of use for those who need it. It also pretty much forces (certainly encourages) those who can afford private insurance to have it and use the private system where they can.

So it's a kind of tax but without calling it one? Very Zen.

Some might call accessing private care when you can afford it queue jumping, but actually it significantly reduces queues in the public system too.

I'm fine with that ... sort of. I've paid for initial specialist consultations and x-rays/MRIs; usually to go straight on the consultant's NHS waiting list, but able to get quicker diagnosis/treatment. I do feel a bit bad when I sit in a waiting room and look at all the poor buggers in for their first appointments, though.

And the involvement of the private sector in the delivery of primary care, imaging, pathology etc significantly improves availability.

I don't have a problem with the integration of private health care into the NHS if it improves service and availability. So long as payments for such NHS services are invisible to the patients. iSTR, that the Royal Surrey had a portakabin-type affair for a private firm to handle MRI demand and it didn't cost me a penny - not even parking.

Having just spent a month in the UK helping my 88 year old mother through surgery, I was gobsmacked how hard it it is to access health services in the UK.

Experiences vary. I've generally been lucky - my wife doesn't understand how I can get GP appointments so quickly and it really annoys her. However, the lack of NHS orthopaedic consultants is a considerable nuisance up here in Jocklandshire, and is an area that might profit from outsourcing.
 
The Australian system provides good quality medical care free at the point of use for those who need it. It also pretty much forces (certainly encourages) those who can afford private insurance to have it and use the private system where they can.

Some might call accessing private care when you can afford it queue jumping, but actually it significantly reduces queues in the public system too. And the involvement of the private sector in the delivery of primary care, imaging, pathology etc significantly improves availability.

Having just spent a month in the UK helping my 88 year old mother through surgery, I was gobsmacked how hard it it is to access health services in the UK.
It's either a postcode lottery or a you're lucky if you have a good doctor in UK. My daughter, S Wales, Hadn't seen a doctor for over 2 years, just prescribing stuff over the phone if she had something wrong. Ended up with a dozen different tablets and stuff at age 50 which is totally wrong.

A trip to A&E, where she was stuck in a chair for 3 days before discharging herself, finally got a face to face appointment and 10 of the prescribed things were cancelled.

On the other hand, wife's friend in Derbyshire in her 80s got to see her GP within 2 days, immediate referral to a specialist within a couple of days and diagnosed with cancer. She says the treatment she has is excellent and very caring.

Shame it has to come to a toss up which type of treatment you get.
But I could see it over 10 years ago at the surgery I worked at. The 4 partners were the old school who still did home visits, night calls, made sure the patient saw the same doctor each time etc. Then they started retiring and the younger ones came in. They were more interested in money than the patient, in my view. One only worked a day and a half but was sitting on committees and health research bits which brought in more money but meant we had to rely on locums. Another wanted us to become a private travel vaccine centre where anyone could come in and were given priority over registered patients. Meant the nurses and admin staff did most of the work thus cutting their time to regular patients more and more. Another made no secret of the fact he was just upping his knowledge before buggering off to do more private work.

I used to keep money back and pay their income tax bills when they came in. They then decided they'd take all the money and stick it into their accounts to earn the interest and pay their own. All well and good until the tax bills came in and they didn't have enough to pay them as they'd been on holiday or something. Concentrate on your patients and I'll look after the money but, nope, money didn't seem to bother the older ones so much but for the newer ones it was the most important thing.

A real shame and one of the reasons I took early retirement.
 
I've worked briefly in the NHS and have many friends who do. The only place since the army that I've found anything like the camaraderie was the A&E department.

There are some truly excellent individuals.

There are also some complete mongs.

Indeedydeed. 'Twas ever thus, and some individuals need careful management. I've slowly learned over the years not to look at "specialists" like something I trod in and say "Really? But the <affected part> doesn't work like that ...".

As one of my GPs readily admitted, there's often a mindset of "If it doesn't accord with the Ladybird Book of Diseases and Disorders, then it doesn't exist", even with otherwise very good doctors. Not NHS but civilian MO told me I was too young to have cervical spondylosis (bugger the x-rays and MRI). Similar experiences are available.

However, when I balance that against the very good care I've been give overall, I think the NHS are ahead of the game in my case. People are people and there will be that "few" almost anywhere you go in the world.

Examples:

The porter at my local hospital who would develop a mysterious back condition once a year. A former girlfriend was the outpatients physio boss. There was nothing wrong with the bloke; he had just decided that his annual leave allowance wasn't enough and so would every year throw a fortnight's sick.

He would openly admit this to my ex but because of how the organisation is set up she couldn't report the reality.

Common in several places of work. A friend of my wife's worked in university administration (building maintenance) and often spoke of the difficulties getting rid of or even discipling such people. She did have a system for reporting these things, but HR didn't like boats that rocked ...

Or, someone close to me has a chronic condition. Gets a phone call from a receptionist.


"We've got an appointment slot for you at 10.30am."
"That's no good. I work for a living."
"Oh. Will 10.50am work better for you?"

...no concept of a world outside the organisation.

:-D

I usually find a calm and friendly explanation works wonders in such situations.
 
As I said, NI isn't all about the NHS, it's largely about other benefits. A problem with transferring costs to the private sector via insurance, direct payment, or the like is that it often just shuffles the payments around but doesn't really effect any marked savings to the consumer. It can also lead to greater inequity in healthcare.
Where’s your proof? Across the developed world, there are two extremes of healthcare funding; taxation funded free at the point of use and public sector in the UK and entirely insured, paid for at the point of use and near entirely private sector in the USA. No-one sane would argue that either leads the world in terms of quality, value universal healthcare.
 

Mbongwe

War Hero
James Martin (the TV chef) did a programme at Scarborough hospital which is my parent's local hospital that was quite revealing on that score. One particularly shocking bit I remember was whole cooked chicken breasts being thrown away after lunch. He worked out how much waste that was in money terms per week/month/year and asked the kitchen staff why they weren't budgeting properly and just working out how many portions to cook as the money saved could be used to treat people.

The answer came back was along the lines of: "because we always cook that many".
Tackling food waste in the patient catering chain is a tricky one to handle, given that it's difficult to predict how much an ill person will eat.

Many patients will be nutritionally-compromised, some patients cannot swallow solids / need certain textures, then pregnant women are advised against certain foods, old people are often advised against egg products / mayonnaise etc...
 
Fall out of love with it?

Most people are highly critical of it, and many of the people in it.

The only place it is unconditionally adored is Labour Party conferences.

Interesting post. Reading between the lines RMAC and QARNC do what they do very well but that is probably more akin to true emergency A&E with some GP work on the bases? Their role is tightly defined.

If the NHS was like the motor industry it would actually have four parts:

Hand built luxury and super cars = specialist medicine

Mass produced cars = routine elective surgery

Recovery and crash repairs = ambulance plus A&E

Routine maintenance and annual repairs = geriatric care and community health

The problem the NHS has is that it tries to do everything with the same business model. Could you imagine a sports car manufacturing facility suddenly trying do mass production. Expensive and chaotic.

What it needs to do is bring in the private sector to do 10,000 hip jobs at lowest cost. Keep ambulance and A&E 'in house' but make it work like RMAC and triage out low level stuff with well trained QARNC type staff. The big teaching hospitals do specialist medicine only and geriatric care needs totally different facilities in the community. GP care scrap it all together and put them at the hospital A&E and local geriatric care centres.

Breaking up the NHS into parts and bringing in the private sector to do the routine bits in high volume and lowest cost with minimal delays is surely the way to go.

It already does this, they're called Trusts.
 

Mbongwe

War Hero
Preventing something that hasn't happened yet is more akin to fortune telling than healthcare.
Not at all. High-sugar low-exercise lifestyle is a likely precursor to diabetes, smoking often leads to circulatory problems, drinking to cirrhosis.

In the UK the communities with the worst health outcomes are those with the most glaringly obvious precursors to conditions.
 

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