Manter
Lunch Mob
I feel certain they wouldn’t be for all the reasons I have argued over the last 6 pages. And Germany is a capitalist country. Has been for decades, so
The NHS is broken, what should happen?
- Thread starter Edie
- Start date
Dogsauce
I’ve got Skol but I’m not a Scholar
I’ve been an NHS frequent flyer for a couple of decades, and it’s mostly been excellent. Where it hasn’t been so good:
1. overburdened GPs and long waits for appointments, meaning a delay in getting care. Often just on general stuff.
2. Slowness in transferring care between different authorities - I was looked after by a team in Leeds for the best part of two decades, knew them very well, moving back down south and it took about half a year to get to see anyone again and go through my details, lots of back and forth via the GP (who’d told me the hospital team could just do it direct without going through GP, which was bollocks, they had to do a referral). Not sure what bureaucratic hurdles there were in the way, some of it was down to individual budgets or something that are managed by GP? Possibly that thing someone mentioned up thread about using GPs as gatekeepers for care.
3. Procurement has been one of those things that throws up problems for decades, and probably where improvements can be made. I remember years back nurses complaining about the quality of the new canulas they were using, how they’d often break. Somewhere someone on a high salary probably selected a new supplier to save a few pence each on these items, which would have been lost in wasted time and materials when used. Staff at the coal face absolutely have to be engaged with stuff like this and give feedback, share what is and isn’t good, and suppliers/purchasers held accountable.
A lot of stuff can be fixed by throwing a decent amount of money at recruitment and community resources to keep people out of hospitals in the first place. Maybe it’s a problem with our political system that favours short-termism. But there are also structural/managerial stuff that can be changed without throwing everything at the private sector wolves.
1. overburdened GPs and long waits for appointments, meaning a delay in getting care. Often just on general stuff.
2. Slowness in transferring care between different authorities - I was looked after by a team in Leeds for the best part of two decades, knew them very well, moving back down south and it took about half a year to get to see anyone again and go through my details, lots of back and forth via the GP (who’d told me the hospital team could just do it direct without going through GP, which was bollocks, they had to do a referral). Not sure what bureaucratic hurdles there were in the way, some of it was down to individual budgets or something that are managed by GP? Possibly that thing someone mentioned up thread about using GPs as gatekeepers for care.
3. Procurement has been one of those things that throws up problems for decades, and probably where improvements can be made. I remember years back nurses complaining about the quality of the new canulas they were using, how they’d often break. Somewhere someone on a high salary probably selected a new supplier to save a few pence each on these items, which would have been lost in wasted time and materials when used. Staff at the coal face absolutely have to be engaged with stuff like this and give feedback, share what is and isn’t good, and suppliers/purchasers held accountable.
A lot of stuff can be fixed by throwing a decent amount of money at recruitment and community resources to keep people out of hospitals in the first place. Maybe it’s a problem with our political system that favours short-termism. But there are also structural/managerial stuff that can be changed without throwing everything at the private sector wolves.
Athos
Well-Known Member
I feel certain they wouldn’t be for all the reasons I have argued over the last 6 pages. And Germany is a capitalist country. Has been for decades, so
Fair enough. I remain unconvinced by what you feel, though.*
Yes, and so has the UK, but it remains the case we're moving closer to giving everything over to the market (and at an increasing pace).
ETA: *I don't mean to sound terse, but I find it so utterly dispiriting that people have fallen completely for such a transparent con; underfunding the NHS to the point of crisis, then claiming the issue is that it's inefficient because it's public, by comparing it private systems which actually cost more!
Because once you let the market into medicine it will grow and grow, and, ultimately, so will inequality. The NHS was probably this country's greatest achievement, and the envy of the world. But it's been cynically wound down (to the massive detriment of the vast majority of us) as part of an ideology that benefits a tiny minority.
Of course more money is not the only improvement, but it'd go a long way. And let's not pretend it's not been been starved of cash so that the wealthy can avoid pay their share towards a decent society.
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oryx
Sitting on the bok of the day
The NHS isn't a totally free service and hasn't been for some time - most people pay for prescriptions, dental and optical care.
Your points about challenges for the NHS since the 40s are good ones - and most of these are very tied in with social care with all its related issues. The other thing worth mentioning in terms of your first, third and fourth points is that social care (usually provision for the frail elderly) isn't free unless you are on a very low income. I think (happy to stand corrected) that most of this type of provision is now private (BUPA, independent nursing homes etc.) and you pay accordingly.
Manter
Lunch Mob
I have said repeatedly over a dozen or so posts that I think the NHS needs more money, and I’m not some halfwit falling for a ‘transparent con’. I have also said repeatedly that chucking money into a pit only gets you so far and there is some other stuff that needs doing too. Lots of what needs doing will cost money.... as I have said..... but in a fast changing world with the issues we have, chucking money at the NHS as it currently stands isn’t a silver bullet. It needs money and change, and some tough conversations.
The market is already in healthcare. It always has been, and over the last 20+ years under tory and labour governments that has got completely out of control with internal market places and piecemeal privatisation. It risks becoming the very worst of both a nationalised and an insured model.
I’m not entirely sure where this ‘envy of the world’ stuff comes from. The NHS has and has always had good characteristics. The US healthcare system is an abomination but has some good characteristics. Sharing what I know about the German model (or the Spanish model or anything else for that matter) isn’t the same as advocating for it. I do think it has significant advantages, but they are not directly replicable in our healthcare system with its history, complexity and social context. That doesn’t mean we should ignore it or pretend it doesn’t exist- instead we should learn and question, and see what can be carried over to the UK.
One example- of the heath centres and pharmacies locally who do things like daily physio after a break; that massively improves outcomes but in our current model would never get off the ground because of cost issues. So why is that, why can they afford and we can’t? Is it something worth doing? Etc etc etc
Athos
Well-Known Member
Even putting aside things like prescription charges and dental costs, it's not free. We all pay for it through taxation. If it needs more money to cope with current demands, more tax has to be raised (through progressive taxation). The idea that some pay at the point of delivery will increasingly introduce the market, leading to further inequality.
Athos
Well-Known Member
Yes, it would be better if we e.g. had physio after a break. Of course, more money would increase the availability of such services. But I accept that's not to say other tweaks can't also increase efficiency. You're right that the market has crept in more and more, and that the current halfway house is sub-optimal. Unequivocally, my solution would be to drive it out. I'd interpreted your lauding of the German model as an endorsement if the principle of private industry in healthcare. What is your position on that question?
Manter
Lunch Mob
Eek at national service, and I’d probably level salaries up not down.... but other than that....
Manter
Lunch Mob
I think that’s a very loaded question to try and force me to say something where you can go ‘gotcha’. My position is that healthcare systems have to be competent wholes. I have no issue with an effective universal multipayer insured model, nor an effective universal state funded model.*
I think our current system is the worst of both, ineffective, and is being driven into the ground. I think privatising bits of a universal state model is disastrous, and PPPs are an abomination.
What I like about the German model is that it is universal, and multi-payer. There are churches, charities, unions, parts of federal and state government, business and individuals all involved in provision of service and all with a stake in the success of that service; and that the service is conceived of from end to end- prevention and education, public health and social infrastructure, medical and surgical intervention, rehabilitation, social care- it’s one ecosystem.
We can’t replicate everyone having a stem in our system, it’s a fundamentally different beast working in a fundamentally different society. But we can look at the good things and see what we can learn. Healthcare centres in the community, holistic attitudes to health and social care, healthcare taken slightly to the side of every day political argy-bargy.... I think they are all good things. How do we replicate them?
*edit to add- I have huge issues with non universal healthcare systems, primary payer insured systems eg the US, and systems that have been cannibalised
Proper Tidy
Arsed
Not trying to sit on discussion but the NHS being a 'sacred cow' is a net positive, at least imo. If anybody thinks capital or the party of capital would transform healthcare using an insurance model while ensuring availability of healthcare for all with improved outcomes across the board if it weren't for the public's irrational romantic attachment to the tops down bureaucratic model we have then, well, they're fucking well off. Privatisation is happening, it's already hollowed out, yeah, but public support for the NHS is its bulwark against what these cunts would do given half the chance
Athos
Well-Known Member
It's not a loaded question; it's a very straigtforward ideological one. But you've given a mealy-mouthed answer. I mean who doesn't think a healthcare system should be a "competent whole", ffs?
Manter
Lunch Mob
Sorry if you can’t understand the answer. Let’s see if I can make it easier for you. I don’t think privatisation in the NHS is a good idea. Leave the other stuff for the grown ups, eh?
Athos
Well-Known Member
What about private healthcare in the UK outside the NHS?
Proper Tidy
Arsed
Well multipayer insurance models formalise that the affluent can pay for shorter waits and better care, it's intrinsic in the model. Dunno enough about german system but risk with that model is always that those without the means get second rate healthcare. State funded doesn't entrench that, although perhaps academic given that's the reality and can't really stop the wealthy buying better provision, although can mitigate this negatively effecting quality of care available to everybody else
Cloo
Banana for scale
Yes, really it's all about the social care. My brother in law works in public health and when there was the first of the really bad NHS winters a few years back I remember him saying this was all about lack of social care, not NHS incompetence.
THIS THIS THIS
edit: if everyone would just read this post, and properly understand it, they would have some degree of insight into what the problem is.
edit again: I don’t know if you call this Too Big, or flat structure, or too much middle management, or underfunded, or what you call it, the fact is this is not working.
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Shorter waits yes better care not so much any sign of a patient going south they will bundle them off to the NHS to ensure they get the necessary care. (this refers to private health care in the U.K.)
Cid
Proper break this time
But no-one here would deny what Kali said. Or what you said. Or what anyone with direct experience of working in the NHS says on a regular basis. The thing is that that, for all it's impact, tells us nothing beyond the fact that the NHS as currently run and funded is partly broken. It doesn't tell us that moving to a European part-insured system would work. It doesn't tell us that the NHS is irredeemable. It doesn't tell us single payer can't work.
Perhaps it would be better to ask whether the NHS ever works now (e.g whether care is better in affluent areas), and whether it has ever worked in the past. And if so, what changes/changed?
We are staring down the barrel of 5/10/15 years of Tory government. You cannot trust them to manage a transition to a fair insured system based on patient outcomes rather than cost. They're as likely to set up big, bureaucratic public insurance bodies with regulated premiums as they are to institute a program of rent regulation and tenancy rights (i.e not very). Nor are they going to promote unionisation as a means by which healthcare professionals can influence wider policy. And, if the burden of healthcare falls on employers, how does that pan out in a country that makes such wide use of things like zero hours contracts, or has high levels of self-employment (15% UK to 10% Germany)?
The other thing is that NHS doesn't do badly. I mean we know it does do badly in some ways, because many have experienced it. But it ranks fairly well... And the things that tend to let it down are staffing levels and available beds. Of course we can, and should, have major reviews of spending... But to get the house in order means increasing staffing and increasing beds. New hospitals, subsidised health professional education, fair wages... And, as a has been mentioned upthread, looking at social care in a wider sense.
In the end I think I simply don't want to live in a country where people have to think about whether getting a diabetes diagnosis would affect thier premium. Or just getting old. And in Germany, they do.
Puddy_Tat
naturally fluffy
I'd start from this point
going from there, I'm not sure I know exactly what the answer is, but I'm very wary of anyone falling for the tories' approach to public services which is underfund / run down / spread negativity which in turn demoralises staff further so that people think those services are 'not working' and are more inclined to accept 'solutions' that involve closure and / or privatisation...
is the whole thing too big? or would having lots of local organisations result in even more fragmentation / duplication / problems if people live close to an area boundary / move house?
if you ask people whether the local hospital should be 'run from an office in whitehall' they will probably say no. but then if you have different policies and priorities in different areas, then people start talking about 'a postcode lottery'.
then there's how to balance accountability / democracy against political interference? and targets and performance data against having some idea what's going on? and bureaucracy against preventing fraud?
it would obviously not make sense for skilled nurses / doctors to be devoting time to admin tasks, so there needs to be an admin element within the NHS, but the impression from where i'm sitting is that there's too many decisions being made by 'managers' rather than proper medical professionals.
i'm not a worker at any level in the NHS or a frequent enough user of the NHS to be able to offer much in the way of informed opinions, but i know enough to say that if the tories are advocating for a particular course of action, it's almost certainly the wrong answer...
going from there, I'm not sure I know exactly what the answer is, but I'm very wary of anyone falling for the tories' approach to public services which is underfund / run down / spread negativity which in turn demoralises staff further so that people think those services are 'not working' and are more inclined to accept 'solutions' that involve closure and / or privatisation...
is the whole thing too big? or would having lots of local organisations result in even more fragmentation / duplication / problems if people live close to an area boundary / move house?
if you ask people whether the local hospital should be 'run from an office in whitehall' they will probably say no. but then if you have different policies and priorities in different areas, then people start talking about 'a postcode lottery'.
then there's how to balance accountability / democracy against political interference? and targets and performance data against having some idea what's going on? and bureaucracy against preventing fraud?
it would obviously not make sense for skilled nurses / doctors to be devoting time to admin tasks, so there needs to be an admin element within the NHS, but the impression from where i'm sitting is that there's too many decisions being made by 'managers' rather than proper medical professionals.
i'm not a worker at any level in the NHS or a frequent enough user of the NHS to be able to offer much in the way of informed opinions, but i know enough to say that if the tories are advocating for a particular course of action, it's almost certainly the wrong answer...
Manter
Lunch Mob
This was shared by a dr mate of mine and some of the stories then shared in the comments were horrifying. Being told off for getting a glass of water, being sent to cover a geriatric ward when she was a consultant in orthopaedics, fainting with exhaustion when driving home.... so many seriously wtf stories.
metro.co.uk
she offers some very tactical suggestions in here- they won’t solve the problem, but they are just common sense to do to treat people better.....
If we don't start looking after doctors there will be no one left for patients
I’ve found more than one distraught junior doctor who has resorted to using a cupboard as a bolt hole.
metro.co.uk
she offers some very tactical suggestions in here- they won’t solve the problem, but they are just common sense to do to treat people better.....
hash tag
Books, not bombs
Revolving doors and lack of care like this does not help
BBC News - Dementia patients being 'dumped in hospital'
BBC News - Dementia patients being 'dumped in hospital'
Dementia patients being 'dumped in hospital'
One in 10 dementia patients spends over a month in hospital after being admitted as an emergency.
www.bbc.co.uk
hash tag
Books, not bombs
I was loath to start a new virus thread and every virus has a silver lining; if there is one good thing to come out of all this panic is it will again highlight how broken the NHS really is IE. Lack is standard beds, lack of ICU beds, lack of doctors and nurses, especially if some of them have to self isolate and lack of funding.
It’s been highlighted. People voted in the Tories. It’s all pretty clear.
ska invita
back on the other side
Anyone know what hell the Tories have got lined up for their coming NHS reforms?
Johnson has been trailing this week that more will be brought "in house" and privatisation pushed back
i believe not a word of it - he is a professional liar
Hancock today says "we've been working on this for a long time now", which is ominous in the extreme
anyone heard anything more concrete?
Johnson has been trailing this week that more will be brought "in house" and privatisation pushed back
i believe not a word of it - he is a professional liar
Hancock today says "we've been working on this for a long time now", which is ominous in the extreme
anyone heard anything more concrete?
ska invita
back on the other side
.
ska invita
back on the other side
heres the white paper
BBC report that
"The proposals include scrapping the tendering rule, which sees providers and private companies compete to win contracts to run services.
This rule made it complicated for councils and different parts of the NHS to set up joint teams and pool their budgets, with some having to set up separate bodies to bid for contracts.
Instead, the NHS and councils will be left to run services and told to collaborate with each other to pool resources."
...that could be okay, but we've just seen what not putting out for tender means in practice - open cheques written for friendly pub managers
BBC report that
"The proposals include scrapping the tendering rule, which sees providers and private companies compete to win contracts to run services.
This rule made it complicated for councils and different parts of the NHS to set up joint teams and pool their budgets, with some having to set up separate bodies to bid for contracts.
Instead, the NHS and councils will be left to run services and told to collaborate with each other to pool resources."
...that could be okay, but we've just seen what not putting out for tender means in practice - open cheques written for friendly pub managers
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