How would you save the NHS?
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Original post by joe cooley
What the **** are you on about?
Tell you what, when you can get a coherent argument together get back to me.
For future reference,are you a taxpayer yet?
Tell you what, when you can get a coherent argument together get back to me.
For future reference,are you a taxpayer yet?
Children contribute nothing as they don't pay tax. Therefore, none of them are entitled to any healthcare under your system unless parents pay for it.
Not everybody's gonna be able to afford all that, hence very blunt point.
My current tax status is irrelevant to me being right or wrong, as is yours.
Original post by Mathemagicien
Of course they do. The problem is that they have too high expectation of what their wages should be. They don't want to work for the minimum wage, so they stay unemployed in the vain hope of getting a much higher wage, which they cannot hope to achieve.
Bit simplistic really. they arent allowed to turn down min wage jobs and will be sanctioned for it. There are many problems with why they cant get jobs and they arent all the fault of the unemployed.
Original post by Retired_Messiah
Children contribute nothing as they don't pay tax. Therefore, none of them are entitled to any healthcare under your system unless parents pay for it.
Not everybody's gonna be able to afford all that, hence very blunt point.
My current tax status is irrelevant to me being right or wrong, as is yours.
Not everybody's gonna be able to afford all that, hence very blunt point.
My current tax status is irrelevant to me being right or wrong, as is yours.
So, what you could have asked is:
What about children?
As i have stated previously on a thread about charging to see a GP
Those unable to work because of physical/mental issues should be provided for by the taxpayer.
That you would agree covers children,yes?
Your current tax status is indeed irrelevant to you being right or wrong, but not irrelevant to the debate.
If,as i would guess,you are not a taxpayer obviously you have a vested interest in forcing others to pay for your health care.
Whereas i,as a taxpayer, have a vested interest in not being forced 6to pay for your health care.
Original post by Len Goodman
I will - privatise it. Transform the health sector from a socialist service based on want and greed to an insurance service based on the free market.
The hardworking taxpayer shouldn't have to cough up for the benefit of jobless little oiks.
The hardworking taxpayer shouldn't have to cough up for the benefit of jobless little oiks.
Except by far the biggest user of resources are older people.
I work in the NHS. This is how I would fix it:
0) Firstly, if anyone in charge had been acting for anything other than self-interest in the last 50 years we would not be in this situation. We knew a population bubble of elderly was coming literally since the 50s. We should have been saving for this event as a nation for 30 years, we should have increased the number of med school places and hospital beds starting 10 years ago, we should have increased nursing school places 5 years ago. We'd then have enough money, beds, doctors and nurses to live out the crisis over the next 10-15 years or so.
Instead, we've got the biggest national debt since WWII, 12% vacancy rate for doctors (with loads about to retire/return to Europe), 8% vacancy rate for nurses (with loads about to retire/return to Europe), and a bed crisis that means we rarely have free beds in the summer in year 1-2 of this 15+ year problem. We have been totally betrayed by the previous generation and so are totally screwed now no matter what we do. BUT there are some things we can do to ease it...
0a) Don't declare war on your staff immediately before the big crisis. Its really bad for staff retention and morale. Hunt didn't just introduce a new contract. He deliberately, repeatedly and publicly belittled and insulted his workforce (doctors and other). No wonder so many are looking abroad and 50% of 2nd year doctors didn't apply to continue (most will come back after a break, but that's a lot of doctor-years to lose).
1) Reduce the bureaucratic workload for front line staff. The current trend, which is ingrained into how doctors/nurses are hired and promoted, is that when there is a problem you introduce a new form to fill. There is no consideration that time spent form filling leads to problems in itself. Change the training and clinical governance structure to recognise that time is a commodity, and time having clinical staff filling out forms is a waste, not a good thing.
2) Don't leave the EU/soft brexit due to impact on recruitment. I know - boo not more brexit talk - but the NHS is one of the bodies set to lose out the most from Brexit. About 10% of doctors are from the EU. About a third of newly recruited nurses last year were from the EU. EU nurses are broadly better trained than UK ones (their training is longer and they practice more independently) and their English tends to be better than non-EU nurses.
It will also significantly impact on medical research, where funding, personnel and collaboration have become very intertwined with our EU neighbours.
3) No more PFI. Another way in which we've been sold out is PFI. My local hospital spends 22% of its budget on PFI buildings. Its now being asked to cut 20% of its budget... but PFI can't be cut. So that's actually 25% of its non-PFI budget.
25% cost-cutting whilst maintaining the same service. No business can do that.
4) Stop the national mandate to charge immigrants for emergency care. The government mandates hospitals create specific teams to chase payment from non-EU nationals for emergency treatment they received. These goon squads cost the NHS about twice what they make (unpublished data). Let the hospitals decide locally how to deal with such bills - it is them who get the money, its not like they lack incentive.
5) Increase funding to be in line with similar EU countries. We spend substantially less than e.g. France, Germany, Netherlands. I know its hard times what with needing to pay for Trident and brexit etc but simple fact is: you can't expect the NHS to deliver a comparable service to those who spend so much more.
OR
5a) Be honest to the public. Tell the public which services are going to be cut because the NHS can't afford it. Carrying on as we are is just illogical and bad for everyone. Surgeons sit around doing nothing because there are no beds to send patients to. Paramedics hang around outside as they can't drop off their patients. All the while cancer ops get cancelled and true life threatening emergencies have to wait hours for an ambulance. Someone needs to strap on their man pants and tell the public which expensive cancer drugs are going to be pulled and which operations aren't going to be offered so that we can free up money for more beds and staff. So that we can go back to having a functioning service.
6) Put most of the above funding and newly retained/acquired EU workforce into social services and care homes. An NHS bed costs about £200 per day even without any treatment being provided. A care home bed costs a lot less. Stop being inefficient and sort it out.
Additionally, care homes need to be banned from refusing to accept new patients on Fridays and weekends (as is common currently). For all Hunt's rhetoric on 7 day NHS, this is something he hasn't even attempted to tackle.
7) Reduce spend on locums, but not by just banning hospitals from paying for the staff they need as is the current approach. Reduce locum spending by making jobs attractive so you have enough staff in the first place. Insulting staff = bad for locum spending. Treating staff well = good. Revolutionary.
8) Reduce legal threat to hospital staff. I appreciate that the courts play a vital role in regulating the medical profession, but if we're to be able to deal with the current crisis we need to be able to look after patients, not filling out forms for a hypothetical legal case just in case someone sues, as is the case currently. I'm not saying it has to be total or permanent, but dealing with a crisis means making sacrifices. Closely linked to point 5a).
9) Rationalise private sector involvement. I believe there is a role for the private sector, but not in the way the government is doing things. Long contracts that give private companies effective monopolies (e.g. catering contracts in hospitals), and contracts where the company is minimally accountable for its standards (e.g. contracts to perform clinical scans or lab tests without then implementing substantial government-run quality control measures) just waste NHS resources. Hitchingbrooke was a complete scandal yet the government doesn't seem the slightest bit deterred (?).
10) Stop faffing around and get an IT system that works. Europe manages it - doctors/students there find it funny that we still have paper systems. Just pay them money and take their system. Denmark's is good, go with that. How hard can it be?
IT has so much potential to solve so many inefficiencies in day to day ward work, yet no one seems to take any action.
11) Proper education, but more about palliative care and options surrounding end of life rather than when/when not to attend A&E. Teaching people when to go to A&E is no small task, and there's loads of info out there - not least 111 (a terrible example of privatisation btw, but its still better than nothing). I think a large advertising campaign saying don't come to A&E because e.g. your finger nail came off will be expensive and have limited impact. They are also fairly easy cases to deal with.
HOWEVER - end of life is the opposite of that. Its something we don't often talk about, but surveys show there is a huge discrepancy between where people want to die (generally at home) vs where they do die (generally in hospital). Now its nowhere near as simple as just telling people to stay at home then - its a distressing time for relatives and they need support. But so often you see people coming in and going through the full works and getting admitted because obviously they're really sick... but actually they didn't want to be there. Their family brought them in because they were worried. I think clear education, for the patient and the family, on what the options are, on what might happen and how we can deal with that (in or out of hospital) would have a much bigger impact on hospital beds AND improve dignity regarding end of live.
But no matter what we do - and i suspect it will be none of the above - we are going to be for a hard hard time over the next few years. Pray that you/your loved ones don't get sick
TL.DR points in bold.
0) Firstly, if anyone in charge had been acting for anything other than self-interest in the last 50 years we would not be in this situation. We knew a population bubble of elderly was coming literally since the 50s. We should have been saving for this event as a nation for 30 years, we should have increased the number of med school places and hospital beds starting 10 years ago, we should have increased nursing school places 5 years ago. We'd then have enough money, beds, doctors and nurses to live out the crisis over the next 10-15 years or so.
Instead, we've got the biggest national debt since WWII, 12% vacancy rate for doctors (with loads about to retire/return to Europe), 8% vacancy rate for nurses (with loads about to retire/return to Europe), and a bed crisis that means we rarely have free beds in the summer in year 1-2 of this 15+ year problem. We have been totally betrayed by the previous generation and so are totally screwed now no matter what we do. BUT there are some things we can do to ease it...
0a) Don't declare war on your staff immediately before the big crisis. Its really bad for staff retention and morale. Hunt didn't just introduce a new contract. He deliberately, repeatedly and publicly belittled and insulted his workforce (doctors and other). No wonder so many are looking abroad and 50% of 2nd year doctors didn't apply to continue (most will come back after a break, but that's a lot of doctor-years to lose).
1) Reduce the bureaucratic workload for front line staff. The current trend, which is ingrained into how doctors/nurses are hired and promoted, is that when there is a problem you introduce a new form to fill. There is no consideration that time spent form filling leads to problems in itself. Change the training and clinical governance structure to recognise that time is a commodity, and time having clinical staff filling out forms is a waste, not a good thing.
2) Don't leave the EU/soft brexit due to impact on recruitment. I know - boo not more brexit talk - but the NHS is one of the bodies set to lose out the most from Brexit. About 10% of doctors are from the EU. About a third of newly recruited nurses last year were from the EU. EU nurses are broadly better trained than UK ones (their training is longer and they practice more independently) and their English tends to be better than non-EU nurses.
It will also significantly impact on medical research, where funding, personnel and collaboration have become very intertwined with our EU neighbours.
3) No more PFI. Another way in which we've been sold out is PFI. My local hospital spends 22% of its budget on PFI buildings. Its now being asked to cut 20% of its budget... but PFI can't be cut. So that's actually 25% of its non-PFI budget.
25% cost-cutting whilst maintaining the same service. No business can do that.
4) Stop the national mandate to charge immigrants for emergency care. The government mandates hospitals create specific teams to chase payment from non-EU nationals for emergency treatment they received. These goon squads cost the NHS about twice what they make (unpublished data). Let the hospitals decide locally how to deal with such bills - it is them who get the money, its not like they lack incentive.
5) Increase funding to be in line with similar EU countries. We spend substantially less than e.g. France, Germany, Netherlands. I know its hard times what with needing to pay for Trident and brexit etc but simple fact is: you can't expect the NHS to deliver a comparable service to those who spend so much more.
OR
5a) Be honest to the public. Tell the public which services are going to be cut because the NHS can't afford it. Carrying on as we are is just illogical and bad for everyone. Surgeons sit around doing nothing because there are no beds to send patients to. Paramedics hang around outside as they can't drop off their patients. All the while cancer ops get cancelled and true life threatening emergencies have to wait hours for an ambulance. Someone needs to strap on their man pants and tell the public which expensive cancer drugs are going to be pulled and which operations aren't going to be offered so that we can free up money for more beds and staff. So that we can go back to having a functioning service.
6) Put most of the above funding and newly retained/acquired EU workforce into social services and care homes. An NHS bed costs about £200 per day even without any treatment being provided. A care home bed costs a lot less. Stop being inefficient and sort it out.
Additionally, care homes need to be banned from refusing to accept new patients on Fridays and weekends (as is common currently). For all Hunt's rhetoric on 7 day NHS, this is something he hasn't even attempted to tackle.
7) Reduce spend on locums, but not by just banning hospitals from paying for the staff they need as is the current approach. Reduce locum spending by making jobs attractive so you have enough staff in the first place. Insulting staff = bad for locum spending. Treating staff well = good. Revolutionary.
8) Reduce legal threat to hospital staff. I appreciate that the courts play a vital role in regulating the medical profession, but if we're to be able to deal with the current crisis we need to be able to look after patients, not filling out forms for a hypothetical legal case just in case someone sues, as is the case currently. I'm not saying it has to be total or permanent, but dealing with a crisis means making sacrifices. Closely linked to point 5a).
9) Rationalise private sector involvement. I believe there is a role for the private sector, but not in the way the government is doing things. Long contracts that give private companies effective monopolies (e.g. catering contracts in hospitals), and contracts where the company is minimally accountable for its standards (e.g. contracts to perform clinical scans or lab tests without then implementing substantial government-run quality control measures) just waste NHS resources. Hitchingbrooke was a complete scandal yet the government doesn't seem the slightest bit deterred (?).
10) Stop faffing around and get an IT system that works. Europe manages it - doctors/students there find it funny that we still have paper systems. Just pay them money and take their system. Denmark's is good, go with that. How hard can it be?
IT has so much potential to solve so many inefficiencies in day to day ward work, yet no one seems to take any action.
11) Proper education, but more about palliative care and options surrounding end of life rather than when/when not to attend A&E. Teaching people when to go to A&E is no small task, and there's loads of info out there - not least 111 (a terrible example of privatisation btw, but its still better than nothing). I think a large advertising campaign saying don't come to A&E because e.g. your finger nail came off will be expensive and have limited impact. They are also fairly easy cases to deal with.
HOWEVER - end of life is the opposite of that. Its something we don't often talk about, but surveys show there is a huge discrepancy between where people want to die (generally at home) vs where they do die (generally in hospital). Now its nowhere near as simple as just telling people to stay at home then - its a distressing time for relatives and they need support. But so often you see people coming in and going through the full works and getting admitted because obviously they're really sick... but actually they didn't want to be there. Their family brought them in because they were worried. I think clear education, for the patient and the family, on what the options are, on what might happen and how we can deal with that (in or out of hospital) would have a much bigger impact on hospital beds AND improve dignity regarding end of live.
But no matter what we do - and i suspect it will be none of the above - we are going to be for a hard hard time over the next few years. Pray that you/your loved ones don't get sick
TL.DR points in bold.
(edited 7 years ago)
Original post by mobbsy91
Also, not that I'm blaming GPs but I do think we need to have longer opening hours for GP surgeries - not for every surgery, but for those where there's evidence that the extended hours would be used... For example where waiting times are 2 weeks + I think it'd be appropriate to at least trial longer opening hours... Also educating people on when to go to A&E and when they just need to man up a bit... 
How are those two problems related? If all of their appointments are full then how is moving them around going to help? Rearranging the deckchairs much?
Recruiting more GPs is definitely a priority.
Original post by nexttime
How are those two problems related? If all of their appointments are full then how is moving them around going to help? Rearranging the deckchairs much?
Recruiting more GPs is definitely a priority.
Recruiting more GPs is definitely a priority.
How is it not related?! Hospitals are so inundated with issues that could be solved by that person going to their GP, but they can't go to their GP in a reasonable time frame and so go to A&E - where they take up beds whilst they wait to be seen by a doctor - often for more than the 4 hour time limit set!
Original post by mobbsy91
How is it not related?! Hospitals are so inundated with issues that could be solved by that person going to their GP, but they can't go to their GP in a reasonable time frame and so go to A&E - where they take up beds whilst they wait to be seen by a doctor - often for more than the 4 hour time limit set!
You say that there is a 2 week waiting list (pretty conservative tbh) and that to solve that you are going to move GP appointments from the daytime to the evening.
There is still the same number of appointments, That 2 week wait is not going to decrease.
But if you're separately saying there should be more GPs, then yes i agree.
Original post by Mathemagicien
Euthanise old people.
Spoiler
you did this 65 times
Original post by nexttime
You say that there is a 2 week waiting list (pretty conservative tbh) and that to solve that you are going to move GP appointments from the daytime to the evening.
There is still the same number of appointments, That 2 week wait is not going to decrease.
But if you're separately saying there should be more GPs, then yes i agree.
There is still the same number of appointments, That 2 week wait is not going to decrease.
But if you're separately saying there should be more GPs, then yes i agree.
Where did you get moving opening times from me saying having LONGER opening times...
by mostly privatising it to be honest
there are countires like singapore and taiwan that operate under mostly private delivery but they operate under some basic regulations i.e. price ceilings for certain treatments, less red tape for small business entry, etc and they are some of the best quality health systems in the world - in fact, singapore is rated higher than the UK.
the NHS is becoming a bit of a ruin. the last 3 times I went to the doctors (and I was actually very ill) I waited 35 minutes, then 50 minutes, then ****ing 1 hour and 15 minutes for my ****ing appointments - and the latter was for a ****ing nurse. why am I waiting so long for somebody to give me a ****ing permission slip for anti-biotics? let me get it myself ffs
I've also been hospitalised by some drunk thug and I waited 7 HOURS to get treatments. because it took so long my injuries scarred. they never even gave me ****ing ice.
there are countires like singapore and taiwan that operate under mostly private delivery but they operate under some basic regulations i.e. price ceilings for certain treatments, less red tape for small business entry, etc and they are some of the best quality health systems in the world - in fact, singapore is rated higher than the UK.
the NHS is becoming a bit of a ruin. the last 3 times I went to the doctors (and I was actually very ill) I waited 35 minutes, then 50 minutes, then ****ing 1 hour and 15 minutes for my ****ing appointments - and the latter was for a ****ing nurse. why am I waiting so long for somebody to give me a ****ing permission slip for anti-biotics? let me get it myself ffs
I've also been hospitalised by some drunk thug and I waited 7 HOURS to get treatments. because it took so long my injuries scarred. they never even gave me ****ing ice.
(edited 7 years ago)
Original post by Mathemagicien
You clicked on it 65 times? lol
Its a lot less effort for me to type it 64 times than it is for you to click on it 64 times.
I write both things once, and have 2 levels. Copy paste. Copy paste. Copy paste. Copy paste. Copy paste. Done
But you?
"Hmm, I wonder what's in the spoiler"
Click
"Damn it. I wonder what's in the next spoiler"
Click.
*repeated 62 more times*
"Wow, that was worth it" - ehh, probably not.
Its a lot less effort for me to type it 64 times than it is for you to click on it 64 times.
I write both things once, and have 2 levels. Copy paste. Copy paste. Copy paste. Copy paste. Copy paste. Done
But you?
"Hmm, I wonder what's in the spoiler"
Click
"Damn it. I wonder what's in the next spoiler"
Click.
*repeated 62 more times*
"Wow, that was worth it" - ehh, probably not.
yes.
this entire thing is so stupid and I can't believe how funny I found it tbh but yeah. I am laughing quite a bit and it was actually quite relaxing, I mean like it was just pressing a button a few times and shaking my head at knowing what was going to come up and still doing it anyways lol
Original post by aj123456
How would you save the NHS?
For me it's get out what you put in. ATM britain although lower than years ago under labor has a terrifying welfare problem. Too many people who can't be arsed to get off their arse and work to earn the money to be taxed and pay for the services they use. I should know, i live near a notorious estate full of benefit bummers. There's also a problem with the immigration and the healthcare automatically guaranteed to people. People who haven't been paying into the system there whole life. We the natives or long time immigrants(love you guys) have been paying into the system our whole lives (so long as we're working) and so have our families incase our health need the services we've paid for OUR WHOLE WORKING LIVES. I would say that fella Jeremy **** isnt the answer either. 3 solutions:
1. immigrant health insurance until a british citizen; immigrants must have health insurance to pay for medical expenses till they become citizens.
2. A contribution based system not based off money but how many working months.
3. Sack Jeremy **** for his incapability to lead nationwide healthcare.
I love the NHS, I don't want to see it like it is and I don't want to see it abused.
give it life support and First aid treatment
"Privatise" it, possibly even privatise it.
Original post by mobbsy91
Where did you get moving opening times from me saying having LONGER opening times...
So you just want to try to force all GPs to work like 60 hour weeks? And for the same pay, I take it?
We can wave goodbye to all our GPs then...
Original post by sleepysnooze
by mostly privatising it to be honest
there are countires like singapore and taiwan that operate under mostly private delivery but they operate under some basic regulations i.e. price ceilings for certain treatments, less red tape for small business entry, etc and they are some of the best quality health systems in the world - in fact, singapore is rated higher than the UK.
there are countires like singapore and taiwan that operate under mostly private delivery but they operate under some basic regulations i.e. price ceilings for certain treatments, less red tape for small business entry, etc and they are some of the best quality health systems in the world - in fact, singapore is rated higher than the UK.
Comparing the UK and Singapore is a complete falsehood. If we had their young person to old person ratio we'd have amazing healthcare too.
Original post by nexttime
So you just want to try to force all GPs to work like 60 hour weeks? And for the same pay, I take it?
We can wave goodbye to all our GPs then...
Comparing the UK and Singapore is a complete falsehood. If we had their young person to old person ratio we'd have amazing healthcare too.
We can wave goodbye to all our GPs then...
Comparing the UK and Singapore is a complete falsehood. If we had their young person to old person ratio we'd have amazing healthcare too.
No... are you actually reading what I've said... I also agreed with you that we need MORE GPs...
So, MORE GPs, LONGER opening times for specific surgeries where it's clear that it's really needed, with continued monitoring to ensure that they're being deployed in the right surgeries.
Original post by mobbsy91
No... are you actually reading what I've said...
I specifically, clearly stated in both of my initial posts to you that if you're saying you also want more GPs then i agree with you, whereas you didn't once mention GP numbers...
(edited 7 years ago)
Original post by nexttime
I specifically, clearly stated in both of my initial posts to you that if you're saying you also want more GPs then i agree with you...
So, then we're definitely in agreement! Now just to really sort the problem and get more GPs and be able to pay them all
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