What is the future of the NHS?

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themartinipolice
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So I'm still a sixth former, but I'm looking into applying to medicine. I'm like 70% set on it. I was talking with my (NHS nurse) mum about it, to get her insight in lieu of any in-person experience, when I said I was worried about graduating into the NHS, her very blunt response was "in 7 years there might not be an NHS"

Sounds dramatic, but the government seem hell bent on destroying it, and it's been struggling for a long time. Again I don't work in it, but from a public point of view, this doesn't seem sustainable long term. There was lots of talk pre-covid about privatisation, I seem to recall Donald trump leaking that Boris Johnson told him the NHS was very much on the table, even now the tories have voted against protecting the nhs is future trade bills, signalling their intentions.

Based on everything happening in recent years and the present, and just everything, what do you see as the future of the NHS in the next 10,20,30 years? Greater funding and success? Continued failure and no change? Complete/significant privatisation?
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ecolier
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(Original post by themartinipolice)
So I'm still a sixth former, but I'm looking into applying to medicine. I'm like 70% set on it. I was talking with my (NHS nurse) mum about it, to get her insight in lieu of any in-person experience, when I said I was worried about graduating into the NHS, her very blunt response was "in 7 years there might not be an NHS"

Sounds dramatic, but the government seem hell bent on destroying it, and it's been struggling for a long time. Again I don't work in it, but from a public point of view, this doesn't seem sustainable long term. There was lots of talk pre-covid about privatisation, I seem to recall Donald trump leaking that Boris Johnson told him the NHS was very much on the table, even now the tories have voted against protecting the nhs is future trade bills, signalling their intentions.

Based on everything happening in recent years and the present, and just everything, what do you see as the future of the NHS in the next 10,20,30 years? Greater funding and success? Continued failure and no change? Complete/significant privatisation?
I have moved your thread here to the Debate and Current Affairs section because the Medicine forum is really for medicine admission queries, and although you wanted to apply to medicine this thread is much better here!

Hopefully you'll get the debate and discussion that you wanted.

:bump:
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mnot
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(Original post by themartinipolice)
So I'm still a sixth former, but I'm looking into applying to medicine. I'm like 70% set on it. I was talking with my (NHS nurse) mum about it, to get her insight in lieu of any in-person experience, when I said I was worried about graduating into the NHS, her very blunt response was "in 7 years there might not be an NHS"

Sounds dramatic, but the government seem hell bent on destroying it, and it's been struggling for a long time. Again I don't work in it, but from a public point of view, this doesn't seem sustainable long term. There was lots of talk pre-covid about privatisation, I seem to recall Donald trump leaking that Boris Johnson told him the NHS was very much on the table, even now the tories have voted against protecting the nhs is future trade bills, signalling their intentions.

Based on everything happening in recent years and the present, and just everything, what do you see as the future of the NHS in the next 10,20,30 years? Greater funding and success? Continued failure and no change? Complete/significant privatisation?
In 7 years their wont be an NHS is laughable. The NHS has more than 7% of UK GDP. It makes most FTSE 100 companies look tiny.

The NHS has plenty of money, just needs to be better managed. The public sector always burn through cash and ask for more, they look at the states income as an ATM.
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linedpaper
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Firstly medicine is a very stable career path, whether the NHS exists or not as we will always need treatment.

Right now I think we are at a tipping point with the NHS. Obviously we have recognised its worth at this moment in time and seen that it needs more funding, but the general public is very easy to fool by the media, who control belief and opinion. I’m sure they could run a campaign stating the NHS would be better privatised- and anyway millions of people still vote for the Conservatives who have stripped back NHS funding for years and even engaged in NHS trade talks with Trump.

I personally think the NHS is a failure. It does many great things but it is inefficient and outdated. The tech is cheap or old, the systems are full of flaws, the waiting lists are ridiculous- 2 years for braces? Years for surgery? Top dogs in NHS trusts get paid in excessive amounts and leech money whilst the actual staff are underpaid and the units underfunded.

However I can see more funding for it- I expect many people’s passiveness towards privatisation has changed as a result of the pandemic, the NHS becoming something to rally round, although the Tories managed to quietly put the NHS on the table before. Maybe even it will be rethought with more money available- its flaws may be recognised and restructured. Although our country is moving further right we do not have the same ingrained healthcare culture as the USA- people will want to preserve the service.
But if we do nothing and do not ‘fix’ it, it will become more of a cesspit and a further leech on GDP.
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Zarek
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You can be pretty sure of continuing demand for health care professionals. As to the NHS, it’s iconic and extremely popular so no government is going to axe it, although the Tories will look for ever more ways to privatise and eat away at the concept of free at the point of use. The best question is if you feel enthusiastic about this respected, rewarding but demanding career choice.
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username4969948
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There is no serious movement within the Conservatives to get rid of the NHS. They may tinker with it, but the NHS is not going anywhere anytime soon.
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glassalice
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Doing away with the NHS would be political suicide for any party. The NHS is a (missplaced) source of national pride for 80% + of the population.

Whether or not we call it the NHS and regardless of who can use it for free at the point of access, we will always have some form of health system.

Maybe the 'downfall' of the NHS and the introduction of a new model wouldn't be a bad thing anyway. As it stands the NHS is extremely inefficient, waiting lists can be ridiculous and it is best described by the phrase 'post code lottery'. Staff often feel under paid, under valued and under an unreasonable amount of pressure.

No NHS doesn't necessarily equate to letting children and adults from poor socioeconomic backgrounds die of preventable/ treatable diseases. That's just fear mongering.
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imlikeahermit
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It needs serious reform. The NHS gets away with being such a poor performer because it’s seen as the apple of the eye of most Brits which is total fallacy. It is good, it isn’t great, and other major powers have much better healthcare systems. It is seriously flawed in several ways, and gets away with it because it was created for the right reasons, but then not followed through.

I don’t believe in full privatisation of it, but I do believe in some contracts being given out to private providers. I have received much better treatment in the past when the NHS has passed me on to private companies. I do also believe that at times the ‘free’ aspect of it allows there to be no consequences to things such as pregnancy and obesity. “Doesn’t matter if I get fat the NHS will give me bariatric surgery.” The same applies to why we have some parents in this country who firstly shouldn’t be parents, and cannot afford the costs that raising a child brings which the state then pays for through the taxpayers purse.
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JOSH4598
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(Original post by imlikeahermit)
I do also believe that at times the ‘free’ aspect of it allows there to be no consequences to things such as pregnancy and obesity. “Doesn’t matter if I get fat the NHS will give me bariatric surgery.” The same applies to why we have some parents in this country who firstly shouldn’t be parents, and cannot afford the costs that raising a child brings which the state then pays for through the taxpayers purse.
I agree - its biggest success is its biggest problem. Having free healthcare is great, but it encourages people to use it more than they may need. There are some people who call for an ambulance, book a doctors appointment or even turn up at A&E for the most minor problems which they could have phoned 111 about. This is why demand on the NHS is so high, not solely because its funding has been restricted in the past decade like many like to believe.

But this is a problem with the whole welfare system. You get some people who work their entire lives having never claimed benefits or who rarely use the NHS. You get others who live off the state, contribute nothing and use every public service going as much as they can.
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hotpud
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(Original post by mnot)
The NHS has plenty of money, just needs to be better managed. The public sector always burn through cash and ask for more, they look at the states income as an ATM.
Why do you say it is ill managed?

Pound for pound if you compare patient outcomes, the NHS is one of the best value for money healh services in the world.

The NHS is always an easy target because we spend so much on it. But successive governments over many years have failed to make efficiency savings mainly because there aren't efficiency savings to make.
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mnot
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(Original post by hotpud)
Why do you say it is ill managed?

Pound for pound if you compare patient outcomes, the NHS is one of the best value for money healh services in the world.

The NHS is always an easy target because we spend so much on it. But successive governments over many years have failed to make efficiency savings mainly because there aren't efficiency savings to make.
Waiting times seem to consistent issue. Just takes too long wether it be surgery or GP. I generally think public satisfaction with treatment isn’t that great, at least with people I know of who have used services.


I also don’t think the NHS management or highly compensated staff are accountable enough to the public.

I suspect the NHS could be improved, it has an enormous budget, I just can’t believe their isn’t substantial amounts of room for improvement. I loosely think it fails to utilise its budget wisely.

I also think the tribal ideological defence of anything NHS related has prevented any pragmatic political debate on how to structure the national healthcare system.
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DiddyDec
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(Original post by hotpud)
Why do you say it is ill managed?

Pound for pound if you compare patient outcomes, the NHS is one of the best value for money healh services in the world.

The NHS is always an easy target because we spend so much on it. But successive governments over many years have failed to make efficiency savings mainly because there aren't efficiency savings to make.
They spend vast amount of money on private contractors when they could quite easily hire their own staff to do it far cheaper.

Last year I worked on £1m NHS contract and I was pretty much the only person working on it, the NHS could have just hired me for less than £30K a year.
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L i b
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(Original post by mnot)
I also don’t think the NHS management or highly compensated staff are accountable enough to the public.
Do we really want it to become more accountable to the public?

After all, what if the public start telling us what they want are homeopathic hospitals, or limited budgets spent on whichever cause gets in the newspaper that week without a rounded look at whether it will work? Or to keep open local facilities even though patients would be better served by larger, more distant specialised facilities?

That's not to say we should simply defer to the judgment of clinicians over everything. Half of them are bonkers too. But I'm not sure I really want more democratisation in all this.
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Starship Trooper
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As others have said or indicated there is s bizarre cult like mentality around the NHS (esp its workers) with some apocalypse of privation from the Tories being a regular fixture of general elections. Instead funding Increases.

I think some degree of privatisation and a culture of personal responsibility should be put forward. Oh you smoke, eat rubbish and don't exercise? Back of the queue/ additional charges.

GP surgeries should operate more like dental surgeries
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mnot
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(Original post by L i b)
Do we really want it to become more accountable to the public?

After all, what if the public start telling us what they want are homeopathic hospitals, or limited budgets spent on whichever cause gets in the newspaper that week without a rounded look at whether it will work? Or to keep open local facilities even though patients would be better served by larger, more distant specialised facilities?

That's not to say we should simply defer to the judgment of clinicians over everything. Half of them are bonkers too. But I'm not sure I really want more democratisation in all this.
I wasnt thinking every medical policy would go to public ballet, ultimately the extensive lack of expertise and tremendous bureaucracy that would cause means its not even viable. I was more thinking the key senior management positions would have an element of public input in their selection, with their position being fixed term and reviewable. And yes I do think the NHS should be accountable to the public as I think all areas of the state should be, I think public have a right to scrutinise how every penny is spent.

I personally would like to see a whole scale review of heath service structures and options. However the current media and twitter protectionism of anything but the status quo means this is unlikely to happen; its very difficult to even have any discussions of change & thus no novel concepts even get tabled for discussion.
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DiddyDec
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(Original post by mnot)
I wasnt thinking every medical policy would go to public ballet, ultimately the extensive lack of expertise and tremendous bureaucracy that would cause means its not even viable. I was more thinking the key senior management positions would have an element of public input in their selection, with their position being fixed term and reviewable. And yes I do think the NHS should be accountable to the public as I think all areas of the state should be, I think public have a right to scrutinise how every penny is spent.

I personally would like to see a whole scale review of heath service structures and options. However the current media and twitter protectionism of anything but the status quo means this is unlikely to happen; its very difficult to even have any discussions of change & thus no novel concepts even get tabled for discussion.
To be fair to NHS Digital they publish reams and reams of financial data that very few people ever read outside of the NHS.

This report in particular shows the level of data collection going on. If you open the Site Level data tab you get a pretty good overview of estate running costs.
https://digital.nhs.uk/data-and-info...ngland-2019-20
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L i b
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(Original post by mnot)
I wasnt thinking every medical policy would go to public ballet, ultimately the extensive lack of expertise and tremendous bureaucracy that would cause means its not even viable. I was more thinking the key senior management positions would have an element of public input in their selection, with their position being fixed term and reviewable. And yes I do think the NHS should be accountable to the public as I think all areas of the state should be, I think public have a right to scrutinise how every penny is spent.

I personally would like to see a whole scale review of heath service structures and options. However the current media and twitter protectionism of anything but the status quo means this is unlikely to happen; its very difficult to even have any discussions of change & thus no novel concepts even get tabled for discussion.
I mean, elected NHS boards have been trialled. Just, a bit like Police and Crime Commissioners, no-one much seems to give a **** about voting for these things - and the sort of people that you end up with can sometimes be a pretty sketchy lot.

In terms of NHS reform, both Tony Blair and David Cameron managed to enact fairly significant reforms. It's not like it's trundled on unchanged since the 1940s.
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mnot
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(Original post by L i b)
I mean, elected NHS boards have been trialled. Just, a bit like Police and Crime Commissioners, no-one much seems to give a **** about voting for these things - and the sort of people that you end up with can sometimes be a pretty sketchy lot.

In terms of NHS reform, both Tony Blair and David Cameron managed to enact fairly significant reforms. It's not like it's trundled on unchanged since the 1940s.
Fair enough, perhaps the concept of how you have public oversight of management needs more concept development, and a nuanced process would be required.

I understand their have been reforms implemented, but it seems wholistic reviews of the system seemed to be kept at arms length. Perhaps it's an outsiders view of the NHS but it certainly seems like their is one system and even the mere suggestion of looking and comparing a variety of concepts from a national viewpoint is shut down by what seems like a cults devotion to the current system.
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hotpud
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(Original post by DiddyDec)
They spend vast amount of money on private contractors when they could quite easily hire their own staff to do it far cheaper.

Last year I worked on £1m NHS contract and I was pretty much the only person working on it, the NHS could have just hired me for less than £30K a year.
True - but you are missing the hidden costs. If they had hired you, they would also be paying your national insurance, pension and other perks. They would have had to make room for you to sit somewhere, bought you the equipment you needed. No doubt you would have needed managing etc etc. It all adds up. Perhaps not quite to £1 million but you get my point. It is certainly significantly more than your take home pay.
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DiddyDec
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(Original post by hotpud)
True - but you are missing the hidden costs. If they had hired you, they would also be paying your national insurance, pension and other perks. They would have had to make room for you to sit somewhere, bought you the equipment you needed. No doubt you would have needed managing etc etc. It all adds up. Perhaps not quite to £1 million but you get my point. It is certainly significantly more than your take home pay.
It wouldn't cost them £1m and I pretty much only work on NHS contracts, in fact the entire business runs 99% off NHS contracts. So we make decent profit from the NHS that could be completely mitigated if the NHS just hired us in house.
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