[Politics] Tory meltdown finally arrived [was: incoming]...

[Herr Tubthumper]

I get that there is variable service across the country (and even within towns as per the post from [MENTION=25615]Igzilla[/MENTION] and others). I also get the massive new demands on doctors. The Guardian article is very moving and reminds me of the ‘This is going to hurt’ series we are watching. The issues in the article, particularly around life longetivity and survival of one serious health issue to then have another one are particularly pertinent to me. I have used up very expensive intensive care services twice when perhaps in the past the first one would have killed me off. Who knows what the future holds. I have though had brilliant care both in and out of hospital and am a massive fan of the NHS. Maybe I have also been very lucky.

My experience with myself (9 years ago) parents and friends is that

1) The staff are first class.
2) For simple and tangible things like broken bones, cuts etc it’s perfect.
3) There’s a lack of joining up thinking and processes when you need referring to multiple different departments. It’s a ball ache and slow process.
4) Less tangible illnesses like mental health - forget it.
5) NHS Dentistry is utter shit on every level.

 

[Harry Wilson's tackle]

I get that there is variable service across the country (and even within towns as per the post from [MENTION=25615]Igzilla[/MENTION] and others). I also get the massive new demands on doctors. The Guardian article is very moving and reminds me of the ‘This is going to hurt’ series we are watching. The issues in the article, particularly around life longetivity and survival of one serious health issue to then have another one are particularly pertinent to me. I have used up very expensive intensive care services twice when perhaps in the past the first one would have killed me off. Who knows what the future holds. I have though had brilliant care both in and out of hospital and am a massive fan of the NHS. Maybe I have also been very lucky.

It is a measure of society how it treats the ill. I wouldn't say 'lucky'. I'd say 'deserved'.

It would be terrific, I think, if we dropped any plan to have a 'national debate' on the future of the NHS, like we are about to have a 'national debate' on the future of the BBC. But we won't, not with the present government.

Once efforts were directed into making the NHS pay its way (and Blair's assimilation of Major's 'public-private initiative' was the most reprehensible yet understandable aspect of his tenure) we were down the slippery slope. Not wasting money, sure, I get that. The rest, though? No. And devolving bits of the NHS to local control means health care rationing, and even the most perverse phenomenon of all - local authorities competing with one another, like they do over schools, for who can offer the best value for money. If this isn't a headline aspect of the rubric yet, it will be soon.

 

[beorhthelm]

What exactly do you object to, though

objection was with the GP setup in particular. its the gatekeeper and jolly well loves to enjoys that role. nothing to do with market as they are a monopoly. best service has been at walk in centres, do exactly what they say and quickly. bin the GP structure and replace it with something meeting the needs of different type of user. hospital care seems OK but with odd rules and controls.

i know internal market is a mixed bag, i'd offer that underlying that is the institution is too big, it shares the inefficencies and intransigence all large organisations have. false market doesnt really help, adds more managment and perverse priorities.

its funny though how its argued its providing such a fine service on the one hand and how under-resourced it is on the other.

 

[Machiavelli]

you're fortunate. for most, if not elderly or child the GP doesnt want to know. not fit for purpose and should be overhauled. would be good to look at the German model, sadly too many see any change as sacrilege and we wont pay for it, as seen by upraor at paying 1% more for health and social care.

Hopefully you or others won't dispute this: you're mixing up two factors here. One is how healthcare is delivered (public, private, insurance, mixed, etc). The other is how much is put into it.
I think we should keep the NHS model of delivery, but substantially increase its funding. Over the past 12 years, Tory-run governments have been starving it of necessary funds, as demand has risen considerably during that period.

 

[Harry Wilson's tackle]

objection was with the GP setup in particular. its the gatekeeper and jolly well loves to enjoys that role. nothing to do with market as they are a monopoly. best service has been at walk in centres, do exactly what they say and quickly. bin the GP structure and replace it with something meeting the needs of different type of user. hospital care seems OK but with odd rules and controls.

i know internal market is a mixed bag, i'd offer that underlying that is the institution is too big, it shares the inefficencies and intransigence all large organisations have. false market doesnt really help, adds more managment and perverse priorities.

its funny though how its argued its providing such a fine service on the one hand and how under-resourced it is on the other.

A bit like the Albion

Your points are interesting

 

[Machiavelli]

I get that there is variable service across the country (and even within towns as per the post from [MENTION=25615]Igzilla[/MENTION] and others). I also get the massive new demands on doctors. The Guardian article is very moving and reminds me of the ‘This is going to hurt’ series we are watching. The issues in the article, particularly around life longetivity and survival of one serious health issue to then have another one are particularly pertinent to me. I have used up very expensive intensive care services twice when perhaps in the past the first one would have killed me off. Who knows what the future holds. I have though had brilliant care both in and out of hospital and am a massive fan of the NHS. Maybe I have also been very lucky.

I don't think you have been lucky. It's a world-renowned healthcare system, see ^ for a succinct overview of my position on it.

 

[Neville's Breakfast]

It is a measure of society how it treats the ill. I wouldn't say 'lucky'. I'd say 'deserved'.

It would be terrific, I think, if we dropped any plan to have a 'national debate' on the future of the NHS, like we are about to have a 'national debate' on the future of the BBC. But we won't, not with the present government.

Once efforts were directed into making the NHS pay its way (and Blair's assimilation of Major's 'public-private initiative' was the most reprehensible yet understandable aspect of his tenure) we were down the slippery slope. Not wasting money, sure, I get that. The rest, though? No. And devolving bits of the NHS to local control means health care rationing, and even the most perverse phenomenon of all - local authorities competing with one another, like they do over schools, for who can offer the best value for money. If this isn't a headline aspect of the rubric yet, it will be soon.

Thank you HWT and yes I agree philosophically with everything in your post. A joined up state system is the dream. Unfortunately demands on healthcare just keep on growing. Perhaps we should have gone down a route similar to Germany or Switzerland but unfortunately there is no UK political party making this proposal.

 

[Neville's Breakfast]

I don't think you have been lucky. It's a world-renowned healthcare system, see ^ for a succinct overview of my position on it.

Oh yes, I agree. The thing I am most lucky about is having access to such a quality system.

 

[rogersix]

More likely there has been a surge in demand this week in anticipation of the changes. We ordered some at the end of last week for exactly this reason. If you expected it then perhaps you should have done the same.

panic acquiring?

 

[Neville's Breakfast]

My experience with myself (9 years ago) parents and friends is that

1) The staff are first class.
2) For simple and tangible things like broken bones, cuts etc it’s perfect.
3) There’s a lack of joining up thinking and processes when you need referring to multiple different departments. It’s a ball ache and slow process.
4) Less tangible illnesses like mental health - forget it.
5) NHS Dentistry is utter shit on every level.

There’s good and bad. Multiple different departments looked after me excellently as an in patient. The number of different consultants I spoke to and who managed my conditions was amazing. More of a mixed bag outside hospital with Warrington still looking after my heart issues and not being aware of my seizures whilst living in Merseyside. That’s quite a major lack of joined up ness, which supports your point. I have had excellent care from my GP.

 

[Neville's Breakfast]

panic acquiring?

Nope, didn’t feel panicked at all. Just took the rational decision to get what we need before everyone else did the same. We had also run out.

 

[Trevor]

It is a measure of society how it treats the ill. I wouldn't say 'lucky'. I'd say 'deserved'.

It would be terrific, I think, if we dropped any plan to have a 'national debate' on the future of the NHS, like we are about to have a 'national debate' on the future of the BBC. But we won't, not with the present government.

Once efforts were directed into making the NHS pay its way (and Blair's assimilation of Major's 'public-private initiative' was the most reprehensible yet understandable aspect of his tenure) we were down the slippery slope. Not wasting money, sure, I get that. The rest, though? No. And devolving bits of the NHS to local control means health care rationing, and even the most perverse phenomenon of all - local authorities competing with one another, like they do over schools, for who can offer the best value for money. If this isn't a headline aspect of the rubric yet, it will be soon.

Agree with most of this H -

Certainly annoys me that we pay providers and commissioners to participate in a bidding process for services - I'm to be convinced that this makes us better off.And you are correct, arguably it makes for a race to the bottom in terms of care provision

I do think that Blair should be given credit for

1) Larger investment in the NHS than before or since (he also sadly more widely used the technique of announcing the same new money multiple times to make his government look better - but make it more difficult for the rest of us to understand what is going on (and a detrimental affect on people's trust of politicians)
2) The introduction of targets such as the 2-week cancer wait, 4-hour A&E wait and the 18 week referral to treatment wait all of which led to a better patient experience and (arguably) better clinical care

(these are all purely personal views and may not reflect those of my employer)

 

[Lower West Stander]

Hopefully you or others won't dispute this: you're mixing up two factors here. One is how healthcare is delivered (public, private, insurance, mixed, etc). The other is how much is put into it.
I think we should keep the NHS model of delivery, but substantially increase its funding. Over the past 12 years, Tory-run governments have been starving it of necessary funds, as demand has risen considerably during that period.

Clearly the NHS needs more funding but it needs to be run a hell of a lot better.

The stories my ward sister partner has told me during COVID up to the present would just make you shake your head. This post would go on forever if I went into detail but in a nutshell, they need more frontline medical staff and less jobsworth admin staff who seem to spend most of their days sending pointless emails and generally doing f all.


Sent from my iPad using Tapatalk

 

[Baldseagull]

Agree with most of this H -

Certainly annoys me that we pay providers and commissioners to participate in a bidding process for services - I'm to be convinced that this makes us better off.And you are correct, arguably it makes for a race to the bottom in terms of care provision

I do think that Blair should be given credit for

1) Larger investment in the NHS than before or since (he also sadly more widely used the technique of announcing the same new money multiple times to make his government look better - but make it more difficult for the rest of us to understand what is going on (and a detrimental affect on people's trust of politicians)
2) The introduction of targets such as the 2-week cancer wait, 4-hour A&E wait and the 18 week referral to treatment wait all of which led to a better patient experience and (arguably) better clinical care

(these are all purely personal views and may not reflect those of my employer)

Some of those targets created issues with providers gaming the system to hit targets. I was working in a GP surgery in Swindon when the target for no patient to wait more than a week for an appointment came in, the surgery decided to make the booking system just not be able to accept an appointment more than 7 days away, meaning a patient that had just left the Doctor with a prescription and an instruction to return in 9 days time had to remember to call back in two days time to make the appointment, if there were any available. If the week was booked up, patients with non urgent issues had to just keep calling back till they could make one.
I also had a small surgery to remove a cyst that my GP referred to the hospital surgery team, I presumed he would cut it out himself when I made the appointment. To comply with the waiting time rules I received an appointment every 3 months, where I was told that there was no time currently, and they would be in touch. I appreciated being kept informed, but a letter would have sufficed, except that the target was to be seen by a doctor.

 

[Trevor]

Some of those targets created issues with providers gaming the system to hit targets. I was working in a GP surgery in Swindon when the target for no patient to wait more than a week for an appointment came in, the surgery decided to make the booking system just not be able to accept an appointment more than 7 days away, meaning a patient that had just left the Doctor with a prescription and an instruction to return in 9 days time had to remember to call back in two days time to make the appointment, if there were any available. If the week was booked up, patients with non urgent issues had to just keep calling back till they could make one.
I also had a small surgery to remove a cyst that my GP referred to the hospital surgery team, I presumed he would cut it out himself when I made the appointment. To comply with the waiting time rules I received an appointment every 3 months, where I was told that there was no time currently, and they would be in touch. I appreciated being kept informed, but a letter would have sufficed, except that the target was to be seen by a doctor.

Yes, I agree with you. A variety of things happen when you set a target and not all of them good. From my one experience though, the focus that they provide does bring improvements. They also provide a standard which is hard to take down later on (although a pandemic doesn't help). In smaller organisations, targets get tweaked or replaced as appropriate - sadly the NHS is a bit more unwieldy.

I could also give examples to support the point that you made from my own experience..... but I won't

 

[zefarelly]

I agree the NHS has suffered over the years, and I don't think it is much to do with underfunding, but the consequences of making it like a business, with a market model imposed at every level of resourcing, whether it makes sense (when buying from outside the NHS it does) or not (charging my department for the use of my office, employing hoards of people to shuffle money from one department to another, and a load of other people to count every penny transferred, using a ****ing employment agency to assign students to help run my practicals, and employing hoards of people to calculate, acquire and manage overheads charged when one department provides a service to another department, etc etc).

What exactly do you object to, though - not being seen on the day (well, go private, then) or having to hand over your hard earned cash, by way of taxation, to fund a socialist health care system (meaning that other people may benefit from your hard earned cash, taken by taxation)?

If you simply object to it being a bit shit, we could all pay a bit more tax to make it better, of course. But that isn't part of the conservative vision, and even labour are reluctant to suggest it (although think Corbyn did so) because, as you rightly infer we all want a great health service bur refuse to pay for it (with that bit of your post I agree).

So we have this market model that was brought in to stop the NHS wasting money. It is an absolute joke.

However I maintain that free at the point of use is a brilliant element of the NHS. It won't get better by making it 'pay at the door'.

I have been working in the same hospital for most of the last 33 years, and I have seen a shabby but slick operation turned into a shiny but clunky and constipated behemoth owing to the imposition of market values, outsourcing, privatization and the like.

A cynic might think it has been modified in order that it will fail and have to be sold off in chunks to the private sector.

Well said. . . .and in context, I'm a cynic.

A late friend was Head of Path in Worthing and worked there, until retirement for a similar duration and I know, shared the same sentiments. He ended up back at work, for his last few days, it was the best place for him, much to his chargrin!

As for Neville, flukey or private & lying to cover his support for those who instigate and facilitate the erosion? Or is that me being cynical again?

 

[Harry Wilson's tackle]

Well said. . . .and in context, I'm a cynic.

A late friend was Head of Path in Worthing and worked there, until retirement for a similar duration and I know, shared the same sentiments. He ended up back at work, for his last few days, it was the best place for him, much to his chargrin!

As for Neville, flukey or private & lying to cover his support for those who instigate and facilitate the erosion? Or is that me being cynical again?

No, a thoughtful bloke I would say. Easily misunderstood because never accepting of anyone's complete manifesto without some caveat

 

[Baldseagull]

Yes, I agree with you. A variety of things happen when you set a target and not all of them good. From my one experience though, the focus that they provide does bring improvements. They also provide a standard which is hard to take down later on (although a pandemic doesn't help). In smaller organisations, targets get tweaked or replaced as appropriate - sadly the NHS is a bit more unwieldy.

I could also give examples to support the point that you made from my own experience..... but I won't

I agree there are benefits, I am I suppose just highlighting the issue with politicians alone setting the targets, because they tend to do it in a simplistic way, they want a snappy soundbite, as much if not more than the result. "No one will have to wait more than a week to see a GP, except where the Doctor has prescribed a course of medication that runs for more than seven days and needs to see the patient at the end of that course of medication, or other sensible reason" just doesn't have the same ring to it.

 

[Audax]

Might be a controversial opinion over here in the UK - where you've been used to having free-at-the-point-of-access to the NHS for decades - but I think for the long term health (excuse the pun) of the NHS, we should switch to a means-tested system. Retain the existing NI / tax funding, retain free-at-access for those who do not have the means to pay, but for those who are better off switch to a subsidised system where those individuals who can afford to pay do so on a sliding scale dependent on their ability to pay.

I would also suggest that for those who can afford it, we should be encouraged to get private health cover. The NHS and private health should provide the same levels of cover, but the only way to achieve that IMO is to move more people into the private system and take some of the pressure off the NHS. Perhaps one way to do that is to legislate that employers must provide private health care to their employees who earn over a certain amount (tie it to existing thresholds, such as when Child Benefit gets phased out). Payment to be taken from the pre-tax salary. Wouldn't be too hard to do - a lot of employers already give their employees the option of doing this, it would just be a shift to having it mandated instead.

And yes, under the above ideas I would be one who would be (at least partially) "paying my own way". And I would happily do so.

I would also suggest that there should be some cases where "free-at-access" can be waived and an individual forced to pay full whack. It's harsh, but if someone goes out on a Saturday night, gets sloshed, and falls over breaking a leg or something stupid like that ... they should be (if they can afford it) be paying the full cost of their treatment. Ambulance call outs aren't cheap, it's high time people in this country became a little more aware of what it costs the NHS when they choose to do something stupid and end up needing an ambulance trip. (Been there, done that, got the hole in my bank account a little over 20 years ago in Australia).

 

[Neville's Breakfast]

Well said. . . .and in context, I'm a cynic.

A late friend was Head of Path in Worthing and worked there, until retirement for a similar duration and I know, shared the same sentiments. He ended up back at work, for his last few days, it was the best place for him, much to his chargrin!

As for Neville, flukey or private & lying to cover his support for those who instigate and facilitate the erosion? Or is that me being cynical again?

That’s a deeply unpleasant comment. I’m really not sure what motivates people like you to go on to the internet to abuse people they don’t even know.