[Misc] How can the NHS survive in its current form ?

[One Teddy Maybank]

It’s shocking how someone with zero experience and knowledge of healthcare gets to be the health minister.

Compare this to Germany.

Prof. Dr. Karl Lauterbach – Federal Minister of Health

Prof. Dr. Karl Lauterbach was sworn in as Federal Minister of Health on December 8, 2021.

www.bundesgesundheitsministerium.de

It’s feckin appalling…..

Having reviewed hospitals in Scandinavia and Germany, I have to say it is a completely different environment to the NHS. In fact they wanted to replicate some of what we do, from a scrutiny and review perspective.

 

[Kinky Gerbil]

It’s shocking how someone with zero experience and knowledge of healthcare gets to be the health minister.

Compare this to Germany.

Prof. Dr. Karl Lauterbach – Federal Minister of Health

Prof. Dr. Karl Lauterbach was sworn in as Federal Minister of Health on December 8, 2021.

www.bundesgesundheitsministerium.de

Should be the sort of person in charge here, im not sure there is any with that level of background in any party.

Looks like he worked on insurance model in healthcare before he was appointed?

Imagine the outcry if someone like that was appointed here!

• 2004: Member of the SPD Party Executive’s working group on citizens’ insurance.

 

[Weststander]

@Herr Tubthumper and @One Teddy Maybank, you’ll be aware already that residents in Germany must pay private or public scheme health insurance contributions. The public scheme at 7.3% of gross wages, with employers matching that, up to an annual contributions maximum of €59,850. The self employed not freelancers in the arts must pay in 14.6%. The ‘public’ and private contributions are managed by third party fund intermediaries. So the money doesn’t get lost into the public purse ether. It’s strictly for healthcare, not social care or security.

In addition to that paying:

• Up to €10 per quarter for a doctor visit.
• The first €10 of most prescription medication.
• Approximately €10 per day for hospital stays, for a maximum of 28 days per year.
• The full price for prescription vision aids, such as glasses or contacts.

I think last bit is great, deterring selfish no-shows.

The envy of the world, what’s not to like. But imagine the uproar here if any government tried to evolve our system to that of Germany!

 

[Goldstone Guy]

@Herr Tubthumper and @One Teddy Maybank, you’ll be aware already that residents in Germany must pay private or public scheme health insurance contributions. The public scheme at 7.3% of gross wages, with employers matching that, up to an annual contributions maximum of €59,850. The self employed not freelancers in the arts must pay in 14.6%. The ‘public’ and private contributions are managed by third party fund intermediaries. So the money doesn’t get lost into the public purse ether. It’s strictly for healthcare, not social care or security.

In addition to that paying:

• Up to €10 per quarter for a doctor visit.
• The first €10 of most prescription medication.
• Approximately €10 per day for hospital stays, for a maximum of 28 days per year.
• The full price for prescription vision aids, such as glasses or contacts.

I think last bit is great, deterring selfish no-shows.

The envy of the world, what’s not to like. But imagine the uproar here if any government tried to evolve our system to that of Germany!

Agreed we need a system like that here, and agreed no chance of getting it for the foreseeable future. But there's more to it:

NHS resolution is "an arm’s length body of the Department of Health and Social Care" which deals with 1. claims management (basically patients suing NHS), 2. "practitioner performance advice in relation to concerns about doctors, dentists, and pharmacists", 3. "offering an impartial resolution service for the fair handling of Primary Care contracting services", 4. "supporting the NHS to better understand and learn from claims, concerns and disputes".

I don't know much about 3 and 4 but neither appear to require a large budget (and I suspect they achieve nothing in terms of meaningful output). 2 is redundant, certainly for doctors at least who are regulated by the GMC and I don't think NHS resolution have any meaningful role. So one thing this organisation achieves is to deal with legal claims against the NHS. For the year 21/22, the amount spent on claims (ie what's paid out to people) was £2.5 billion. The total annual budget for NHS Resolution was ............... £128.6 BILLION.

NHS Resolution continues to drive down litigation - Annual report and accounts published for 2021/22 - NHS Resolution

NHS Resolution has today published its annual report and accounts for 2021/22 which sets out how its innovative dispute resolution strategy has continued to drive down litigation against the NHS in England. A record 77% of claims were resolved in 2021/22 without court proceedings, continuing …

resolution.nhs.uk

So in summary, this country spent £126.1 billion in the year 21/22 paying lawyers to sue its own health service (as well as a few other bits of probably unnecessary bureaucracy). I can't claim to know this topic very well, and I might be underestimating what NHS resolution does overall. However the budget appears to be (original deleted) ...... a bit excessive let's say. I have no idea but wouldn't be surprised if the same sort of thing goes on with the railways for example. How else can you explain the ridiculous prices for the service you get?

 

[Weststander]

Agreed we need a system like that here, and agreed no chance of getting it for the foreseeable future. But there's more to it:

NHS resolution is "an arm’s length body of the Department of Health and Social Care" which deals with 1. claims management (basically patients suing NHS), 2. "practitioner performance advice in relation to concerns about doctors, dentists, and pharmacists", 3. "offering an impartial resolution service for the fair handling of Primary Care contracting services", 4. "supporting the NHS to better understand and learn from claims, concerns and disputes".

I don't know much about 3 and 4 but neither appear to require a large budget (and I suspect they achieve nothing in terms of meaningful output). 2 is redundant, certainly for doctors at least who are regulated by the GMC and I don't think NSH resolution have any meaningful role. So one thing this organisation achieves is to deal with legal claims against the NHS. For the year 21/22, the amount spent on claims (ie what's paid out to people) was £2.5 billion. The total annual budget for NHS Resolution was ............... £128.6 BILLION.

NHS Resolution continues to drive down litigation - Annual report and accounts published for 2021/22 - NHS Resolution

NHS Resolution has today published its annual report and accounts for 2021/22 which sets out how its innovative dispute resolution strategy has continued to drive down litigation against the NHS in England. A record 77% of claims were resolved in 2021/22 without court proceedings, continuing …

resolution.nhs.uk

So in summary, this country spent £126.1 billion in the year 21/22 paying lawyers to sue its own health service (as well as a few other bits of probably unnecessary bureaucracy). I can't claim to know this topic very well, and I might be underestimating what NHS resolution does overall. However it appears to be (original deleted) ...... a bit excessive let's say. I have no idea but wouldn't be surprised if that same sort of thing goes on with the railways for example. How else can you explain the ridiculous prices for the service you get?

I listened to an interesting article (R4?) many years ago on how UK hospitals/clinicians have a circle the wagons approach to medical negligence.

Whereas in some other Western nations, it may’ve included the US?, hospitals have what they called an open, systems based culture. Analysing mistakes without internal apportioning of blame in-house, as they look to learn lessons, seeing where it went wrong from start to finish. This started this to cut down on huge medical negligence awards.

 

[One Teddy Maybank]

Harry Wilson’s Tackle

I don’t have a solution- I don’t believe anyone does but the model of the NHS is broken and to continue without drastic reform will not solve the problem. You could pretty much throw £Xbillion at it now and the problems will continue

Every government writes a new white paper and have ‘great ideas’ reform, but none of them are particularly transformational, and some even send the service backwards.

 

[dsr-burnley]

But the front line staff in A&E are often Junior Doctors, so you’ve actually achieved very little and normally would be better off waiting for a GP. In my experience the senior A&E nurse is usually the person with the best advice and can often support junior staff.

The A&E consultant will have oversight, but if it is a site specific issue an on-call teams will be called where necessary.

Re maternity, depends whether you’re a ‘Mum to be’ I would suggest. Fairly significant for me.

I didn't achieve "very little". I achieved a drip, medical treatment, nine days in hospital. You may say that none of that was needed and I would have been better off waiting a couple of days before trying to get a GP appointment; who knows. I think I did right.

That's the problem. Patients don't know what is best. Obviously there are time waters in A&E, there always were; but also there are people who feel that they need to see a doctor and don't have any other way to see one quickly.

 

[Tom Hark Preston Park]

My Dad, long-term NSC poster @Cadiz Seagull is currently on the Stroke ward at the Sussex County with a suspected stroke. The new building and the care he has received in it has been absolutely fantastic, I can’t fault it.

But A&E, my God. I cannot describe how awful it was. I counted 24 people on trolleys in the corridor on Monday, and those were the only ones I could see from my viewpoint, there were a lot more. He was in a cubicle with two other people on beds at one point. So three people to a cubicle, and probably 50+ people piled up on trolleys in the corridors, and a full waiting room. It was literally like a war zone, and when I say ‘literally’ I do genuinely mean ‘literally’. I just couldn’t get my head around how this is happening in Britain in 2023. There is absolutely no excuse for it whatsoever. I was looking at people passed out on the trolleys thinking if they die nobody will know for hours. It’s absolutely appalling that a country like ours has let its emergency healthcare get in that state. I’m still genuinely shocked by it.

My late mum in her later years was a frequent visitor - via ambulance - to A&E. As you say, it was like a war zone. Especially when the pubs chucked out. Friday/Saturday nights were unspeakably vile. The only time these time-waster ****s vanished into the ether was during the early stages of the pandemic. IMHO the triage for A&E should take place some distance from A&E, and the vast majority of these ****s and their half dozen lairy wasted mates sent on their way under threat of arrest for Wasting NHS Time. And if that's not an actual offence, then it certainly should be.

And... RELAX

 

[One Teddy Maybank]

I didn't achieve "very little". I achieved a drip, medical treatment, nine days in hospital. You may say that none of that was needed and I would have been better off waiting a couple of days before trying to get a GP appointment; who knows. I think I did right.

That's the problem. Patients don't know what is best. Obviously there are time waters in A&E, there always were; but also there are people who feel that they need to see a doctor and don't have any other way to see one quickly.

The GP would have got you a direct admission anyway, apologies, my previous comment was intended more generic, but doesn’t read that way.

In terms of the patient, though that is the point of 111, and they will say if symptoms persist etc.. Perhaps GPs should start triaging via A&E, to protect the system a bit more.

 

[seaford]

Very simple really - it needs funding properly.

Do not let anyone tell you otherwise, it comes down to government priorities.

However, due to the lack of investment in the last 13 years, the next government will have huge funding choices to make.

 

[One Teddy Maybank]

Very simple really - it needs funding properly.

Do not let anyone tell you otherwise, it comes down to government priorities.

However, due to the lack of investment in the last 13 years, the next government will have huge funding choices to make.

not just the last 13 years.

New Drugs and new treatments come at a cost, so do specialist workforce, plus social care places, training grants etc…..

 

[Goldstone Guy]

I listened to an interesting article (R4?) many years ago on how UK hospitals/clinicians have a circle the wagons approach to medical negligence.

Whereas some other Western nations, it may’ve included the US?, hospitals have what they called an open, systems based culture. Analysing mistakes without internal apportioning of blame in-house, as they look to learn lessons, seeing it where it went wrong from start to finish. This started seeking to cut down on huge medical negligence awards.

Yes my understanding is the same. When I was a junior doctor starting my hospital jobs we were shown a presentation highlighting the difference between the airline industry and the NHS in how mistakes are dealt with. Airlines have an open, honest, largely blame-free (where this is reasonable) environment when investigating mistakes, the purpose of which was to make sure the same mistakes don't happen again. The NHS was the opposite, and still is as far as I can see - try to pin the blame on an individual so it doesn't look like there are any problems with the system so that no money has to be sent on changing the system.

My point however was not about the money payed out to individuals for medical negligence - this is a relatively small £2.5 billion. The scandal is the rest of the budget - £126.1 billion paying whoever to process these claims (and the other bits and pieces described in my post).

 

[Herr Tubthumper]

@Herr Tubthumper and @One Teddy Maybank, you’ll be aware already that residents in Germany must pay private or public scheme health insurance contributions. The public scheme at 7.3% of gross wages, with employers matching that, up to an annual contributions maximum of €59,850. The self employed not freelancers in the arts must pay in 14.6%. The ‘public’ and private contributions are managed by third party fund intermediaries. So the money doesn’t get lost into the public purse ether. It’s strictly for healthcare, not social care or security.

In addition to that paying:

• Up to €10 per quarter for a doctor visit.
• The first €10 of most prescription medication.
• Approximately €10 per day for hospital stays, for a maximum of 28 days per year.
• The full price for prescription vision aids, such as glasses or contacts.

I think last bit is great, deterring selfish no-shows.

The envy of the world, what’s not to like. But imagine the uproar here if any government tried to evolve our system to that of Germany!

I think the UK could be convinced about the advantages of paying a much higher ring-fenced tax two ways
1) You do not have to sell the family jewels/house to fund care homes
2) Dentistry. Walk around Berlin and you will see a dentist every couple of blocks or so.

There are obviously many other advantages but I feel these two will resonate most.

 

[Commander]

Very simple really - it needs funding properly.

Do not let anyone tell you otherwise, it comes down to government priorities.

However, due to the lack of investment in the last 13 years, the next government will have huge funding choices to make.

Having witnessed the utter incompetence of the NHS (again) for the last 8 days, it is crystal clear to me that the problems are far, far bigger than funding. The Stroke ward at the new Sussex County is like a 5 star hotel. Certainly no short of funding there. The care, however, is appalling, and that is down to the people that work there. Just complete incompetence. I was actually told by the Ward Manager earlier that the reason my Dad hasn't been for the urgent CT scan he was told he needed last Tuesday, was because "they aren't really sure where the CT scanner is because it's a new hospital". Yesterday it was "We've called them but they didn't answer". The day before it was "We took him for the scan but he wasn't able to answer the questions we asked him so we aborted it" He's had a f***ing stroke, of course he can't answer your f***ing questions!!

My brother was there as well for something else and they gave him someone else's prescription by mistake. A&E told us last week they were urgently waiting for a stroke ward bed to come up for my Dad and would get him up there asap, so after 36 hours in A&E I went up to the stroke ward and they had no idea there was anyone waiting. I kicked off and 2 hours later he had a bed there.

It's like trying to deal with Vodafone or someone. You speak to somebody who promises to help you, makes all the right noises and then they finish their shift and you never see them again. The new person takes over, has no notes or knowledge of the situation, and the cycle starts again. God knows how people get through hospital in this country if they don't have friends or family around to make stuff happen.

I'd love to know how / why any of these ridiculous issues are anything to do with under-funding? If you chucked another couple of billion quid at it they'd only waste it. The whole things needs completely reforming, and if that means that some people (who can afford it) have to pay for it, then so be it.

 

[Gazwag]

Very simple really - it needs funding properly.

Do not let anyone tell you otherwise, it comes down to government priorities.

However, due to the lack of investment in the last 13 years, the next government will have huge funding choices to make.

Sorry but its nothing to do with funding as such its how the funding is spent - the NHS wastes so much money and its run my so many totally incompetent people who just waste money, including over employment in non-nursing/caring roles. It needs to be run as a business, that doesn't mean its not going to be free anymore, its just needs to be run properly.

 

[Commander]

Sorry but its nothing to do with funding as such its how the funding is spent - the NHS wastes so much money and its run my so many totally incompetent people who just waste money, including over employment in non-nursing/caring roles. It needs to be run as a business, that doesn't mean its not going to be free anymore, its just needs to be run properly.

Completely agree. People who's skillset is compassion and caring for patients are not generally people who are highly efficient at running businesses. My (nurse) Mum will tell you that the NHS is ruined by 'non-medical people' who don't understand it- I'd say it's the opposite, it's people like her who are skilled and compassionate at nursing but completely inefficient at anything admin-based that are the problem.

Edit: Perhaps blaming the downfall of the NHS on my own Mum might be a bit harsh, thinking about it

 

[HalfaSeatOn]

I don’t see prevention services prioritised that keep the nation healthier. It’s all reactive. The latter is just not sustainable.

 

[One Teddy Maybank]

Sorry but its nothing to do with funding as such its how the funding is spent - the NHS wastes so much money and its run my so many totally incompetent people who just waste money, including over employment in non-nursing/caring roles. It needs to be run as a business, that doesn't mean its not going to be free anymore, its just needs to be run properly.

Absolute nonsense.

Another report published by Institute of Public Policy Research, highlights a significant shortage.

 

[One Teddy Maybank]

Having witnessed the utter incompetence of the NHS (again) for the last 8 days, it is crystal clear to me that the problems are far, far bigger than funding. The Stroke ward at the new Sussex County is like a 5 star hotel. Certainly no short of funding there. The care, however, is appalling, and that is down to the people that work there. Just complete incompetence. I was actually told by the Ward Manager earlier that the reason my Dad hasn't been for the urgent CT scan he was told he needed last Tuesday, was because "they aren't really sure where the CT scanner is because it's a new hospital". Yesterday it was "We've called them but they didn't answer". The day before it was "We took him for the scan but he wasn't able to answer the questions we asked him so we aborted it" He's had a f***ing stroke, of course he can't answer your f***ing questions!!

My brother was there as well for something else and they gave him someone else's prescription by mistake. A&E told us last week they were urgently waiting for a stroke ward bed to come up for my Dad and would get him up there asap, so after 36 hours in A&E I went up to the stroke ward and they had no idea there was anyone waiting. I kicked off and 2 hours later he had a bed there.

It's like trying to deal with Vodafone or someone. You speak to somebody who promises to help you, makes all the right noises and then they finish their shift and you never see them again. The new person takes over, has no notes or knowledge of the situation, and the cycle starts again. God knows how people get through hospital in this country if they don't have friends or family around to make stuff happen.

I'd love to know how / why any of these ridiculous issues are anything to do with under-funding? If you chucked another couple of billion quid at it they'd only waste it. The whole things needs completely reforming, and if that means that some people (who can afford it) have to pay for it, then so be it.

presumably you’ve complained about this?

I would suggest you raise it with the Patient Advice and Liaison Service.

 

[Harry Wilson's tackle]

@Herr Tubthumper and @One Teddy Maybank, you’ll be aware already that residents in Germany must pay private or public scheme health insurance contributions. The public scheme at 7.3% of gross wages, with employers matching that, up to an annual contributions maximum of €59,850. The self employed not freelancers in the arts must pay in 14.6%. The ‘public’ and private contributions are managed by third party fund intermediaries. So the money doesn’t get lost into the public purse ether. It’s strictly for healthcare, not social care or security.

In addition to that paying:

• Up to €10 per quarter for a doctor visit.
• The first €10 of most prescription medication.
• Approximately €10 per day for hospital stays, for a maximum of 28 days per year.
• The full price for prescription vision aids, such as glasses or contacts.

I think last bit is great, deterring selfish no-shows.

The envy of the world, what’s not to like. But imagine the uproar here if any government tried to evolve our system to that of Germany!

No uproar from me. I may be a Labour party member but the only "-ist" I can rightly affiliate with is scientist. Whatever works, short of flogging off the NHS and creating an American style corrupt insurance model, or creating another rubric that is designed to destroy the NHS (which may be what we have now, as I will explain) is game.

The question is how to make the system work. What you have outlined is a charging model. I don't have any problem with that.

However, the elephant in the room is the infrastructure. I would argue that the NHS is now in the worst of all possible worlds. It is ostensibly state owned, and yet swathes of it have been privatized. The franchising of large elements, from cleaning to catering to temping....is all done on a 'for profit' basis. Its a bit like the Albion selling off the centre half position to Crystal Palace to manage.

So a new financial model is all very well, but we need to get all the NHS under one roof in my view. Here is why:

Where I work (a research floor in one of London's major hospitals) I have seen what bringing the market into the rubric has done to the place. A simple thing. We used to have our labs and offices cleaned once a week by an in-house person who did a brilliant job. Twenty years ago cleaning was 'sold' to a cleaning company. Not only are they contracted to clean only half the stuff the old set up cleaned (they won't go near equipment or places where biological waste may accrue, or agree to be trained how to clean this stuff), they routinely neglect the simplest things like emptying bins, sweeping under the chairs etc. And here is the rub. To complain I have to complain to my floor manager, who then leaves a message on the answerphone of the cleaner manager, not the owner of the cleaning company who probably lives in Barbados) who promptly does little or nothing, rinse and repeat.

And even within circles managed by the hospital, there are increasing layers of management that slows change, slows the fixing of errors, delays implementation of fixes and makes crazy decisions. Once you separate the workers from the decision makers you are f***ed. An example. We have three lifts to my floor. On other floors there are patient services. So two or three times a day there may be a patient in a bed in a lift, with other patients, visitors and people coming for hospital appointments, and the researchers on my floor. Apparently on one occasion a patient said something to upset another patient who was being transported in a bed on wheels. Management panicked and with zero consultation made one of the three lifts available for patients in beds only. So this lift stood unused and locked (bed movers had a secret code) for 7 hours and 50 minutes out of every 8 hours of a regular day. Meanwhile the other two lifts were perpetually clogged. I had to tell students to arrive ten minutes before a tutorial in order to ensure they can get to my floor on time. A first world problem? Maybe. But here is the main point. It took 18 months of lobbying and going through various levels of management to get this small but absurd cock up reversed. Imagine what goes one with respect to other aspects of the running of the show, and there you have it.

To fix this we need a streamline accountable coherent system, with all elements under one roof, clear and clean lines of management, and less separation of roles. Only then will new ways of funding have effect.