| Any ideas on how to protect our NHS? on 08:15 - Apr 8 with 753 views | DanTheMan |
| Any ideas on how to protect our NHS? on 10:40 - Apr 7 by GlasgowBlue |
Been saying this for ages. It’s a health service. Not a religion. But try to have a grown up debate about how it could be better funded and you are branded a heretic.
None of our ‘progressive’ European neighbours have the same system as the NHS. They aren’t third world countries. And offer good health care.
But try to open a debate and you are given a binary choice between the NHS or the USA health system.
The people who work in it deserve better and the general public deserve better. |
You've still never explained to me how changing the funding model from one purely based through tax to something that is Tax + Mandatory insurance (or pure mandatory insurance), without changing the funding amount helps the NHS.
Because if the sole amount of funding is still coming from the people, and those people are not paying more, then I don't see how changing the method of funding is going to help.
And also everyone always says they want to have an adult debate on this and then that time comes and nobody can explain what it is they actually want to talk about. [Post edited 8 Apr 2022 8:16]
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| Any ideas on how to protect our NHS? on 08:30 - Apr 8 with 729 views | You_Bloo_Right |
| Any ideas on how to protect our NHS? on 08:06 - Apr 8 by BanksterDebtSlave |
A very informative post. I was really only thinking in terms of the current high rates of covid admissions [remember, Stay home, protect the NHS, Save lives] but these threads always take a course of their own.
I have no doubt that the NHS is a bloated, bureaucratic mess with more layers of management than you can shake a stick at. |
" .. these threads always take a course of their own."
Well this one has suddenly stopped being "people banging on on the internet". 
Wouldn't it be good if the major political parties in this country could all agree to set up some some of commission to conduct a proper review of health and social care services, led by and comprised of clinicians and the like (rather than, say, politicians, pharma, etc)?
Obviously some basic priciples would need to be established rather than allow complete free reign but they could do worse than take the "free at the point of use", "funded by general taxation" and "everyone eligible for care" statements as the guiding lights.
Sounds way too altruisitic for most modern senior politicians. |  |
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| Any ideas on how to protect our NHS? on 10:08 - Apr 8 with 690 views | IPS_wich |
| Any ideas on how to protect our NHS? on 08:30 - Apr 8 by You_Bloo_Right |
" .. these threads always take a course of their own."
Well this one has suddenly stopped being "people banging on on the internet".
Wouldn't it be good if the major political parties in this country could all agree to set up some some of commission to conduct a proper review of health and social care services, led by and comprised of clinicians and the like (rather than, say, politicians, pharma, etc)?
Obviously some basic priciples would need to be established rather than allow complete free reign but they could do worse than take the "free at the point of use", "funded by general taxation" and "everyone eligible for care" statements as the guiding lights.
Sounds way too altruisitic for most modern senior politicians. |
A great starting set of principles.
I would also add: 'Patients should be in hospital as a last resort'.
The NHS is based upon an archaic premise that people should be cared for in institutions - and there is still a direct line of site to the work of Florence Nightingale in the Crimean War.
Without wanting to go in to specifics, I was part of a management team that closed most of the acute services in a very poor performing small hospital - shifting them 20 miles up the road to a high performing specialist teaching hospital. Over 30,000 people marched in protest and accused those of us involved in it of condemning people to death on the hard shoulder. Well - 10 years later a review concluded that not one single person has died due to moving the services, and in fact 100s of lives have been saved because of the type of care they were able to receive in the specialist hospital.
Doesn't stop the local people feeling like their basic human rights have been assaulted; because we've created a narrative that hospitals = healthcare. |  | | |
| Any ideas on how to protect our NHS? on 10:17 - Apr 8 with 677 views | IPS_wich |
| Any ideas on how to protect our NHS? on 08:15 - Apr 8 by DanTheMan |
You've still never explained to me how changing the funding model from one purely based through tax to something that is Tax + Mandatory insurance (or pure mandatory insurance), without changing the funding amount helps the NHS.
Because if the sole amount of funding is still coming from the people, and those people are not paying more, then I don't see how changing the method of funding is going to help.
And also everyone always says they want to have an adult debate on this and then that time comes and nobody can explain what it is they actually want to talk about. [Post edited 8 Apr 2022 8:16]
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The model in the Netherlands is interesting.
Everybody pays a wage related mandatory health insurance. The role of government is to collect the insurance and allocate it to 3-4 non-government not for profit health insurers. The health insurers are then responsible for funding the health system (I believe on a geographic basis). The secondary role of government is to hold the health insurers to account to delivering care to an agreed set of standards.
This has removed political influence to a large extent because the insurers are only accountable for meeting their KPIs and the government doesn't have any say on how they meet their KPIs. The government can change the funding/geographic allocation to the insurers if one is not performing to the same extent as others - which drives competition between the insurers to pursue continuous improvement (a large number of the KPIs are patient report experience and outcome measures, so the insurers can't cut corners in the quality of care).
From a population perspective, they pay a 'tax', they know that that tax is going straight to the health system, services are high quality and free at the point of use. They also know their feedback will directly influence whether that insurer meets its KPIs.
Just one innovation that the insurers have introduced is a GP at the front door of every large A&E department - so no one goes in to the ED if a GP can help them. | | | |
| Any ideas on how to protect our NHS? on 11:25 - Apr 8 with 643 views | DanTheMan |
| Any ideas on how to protect our NHS? on 10:17 - Apr 8 by IPS_wich |
The model in the Netherlands is interesting.
Everybody pays a wage related mandatory health insurance. The role of government is to collect the insurance and allocate it to 3-4 non-government not for profit health insurers. The health insurers are then responsible for funding the health system (I believe on a geographic basis). The secondary role of government is to hold the health insurers to account to delivering care to an agreed set of standards.
This has removed political influence to a large extent because the insurers are only accountable for meeting their KPIs and the government doesn't have any say on how they meet their KPIs. The government can change the funding/geographic allocation to the insurers if one is not performing to the same extent as others - which drives competition between the insurers to pursue continuous improvement (a large number of the KPIs are patient report experience and outcome measures, so the insurers can't cut corners in the quality of care).
From a population perspective, they pay a 'tax', they know that that tax is going straight to the health system, services are high quality and free at the point of use. They also know their feedback will directly influence whether that insurer meets its KPIs.
Just one innovation that the insurers have introduced is a GP at the front door of every large A&E department - so no one goes in to the ED if a GP can help them. |
Thank you for actually answering the question that I must have asked people about 6 times and have never got an answer to.
One thing I would be interested in with these health insurers are whether you run into issues seen with other insurance companies where they will try and say you aren't covered for X because of whatever reason. It has always made me feel incredibly uncomfortable that people might not be covered for potentially life threatening illnesses because they're insurance company decided so. | |
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| Any ideas on how to protect our NHS? on 11:44 - Apr 8 with 618 views | Swansea_Blue |
| Any ideas on how to protect our NHS? on 03:32 - Apr 8 by IPS_wich |
OK - here goes - and I've got my hard hat as this won't please everyone. The views below are based upon 17 years as a health planner/advisor - for 9 years in England with various NHS bodies and trusts; 8 years in Australia. And yes, all of that work is as an external consultant working for private sector firms that (shock) charged for our services.
I have several points:
1) Your premise is flawed - no policy should ever be about 'protecting the NHS', it should be about fiercely protecting the right for everyone across the UK to have timely access to high quality healthcare, free at the point of use to the user. Anything that starts with the premise of protecting a multi billion pound bloated bureaucratic mess that is the NHS is to completely miss what is so special and unique about the NHS. No other country in the world manages to so effectively balance high quality care with services that are free at the point of use. To characterise this as public vs private sector is protectionist and certainly robs the health system of expertise and technology that would improve outcomes. Private sector involvement should be encouraged where it is better placed than the public sector and where it complements the public sector. That said, ANY involvement of the private sector has to go through the most stringent of competitive and fair procurement processes - any cronyism or contracts for mates/family members should see those involved behind bars. The narrative of 'the tories are selling the NHS to the private sector' is just a scare tactic - they've been in power for 12 years and guess what - the NHS is still the largest public sector health employer in the world. The question should be 'how can we equip the NHS to effectively partner with the private sector' - because there are so many wasted/missed opportunities.
2) The NHS needs greater funding. In 2017, the NHS cost approximately 7.5% of the UK's GDP. Health systems in countries like Germany, France, Switzerland, Australia cost between 9-10% (ignore the US - it costs around 16% and doesn't deliver equitable care). This can only be achieved by either reallocating expenditure from other public services into the NHS - or a 2-3% rise in NI payments - neither of those are vote winners...
3) About 80-100 district general hospitals need to be downgraded to community hospitals, with the majority of acute services consolidated into a smaller number of 'specialist' hospitals. Back in the late 60s, the government embarked upon a program of building 'general' hospitals in every town with a population of more than 50,000. Now, 50 years later, we are seeing fewer and fewer doctors, nurses and other health professionals coming out of training and education wanting to be generalists. Without the generalists, these small hospitals can no longer sustain safe services 24/7. Consolidating specialist services (delivered by specialist clinicians, using specialist equipment and drugs) will save lives and support people to have better recoveries from life changing illnesses and injuries (think Patrice Muamba and his cardiac arrest - the ambulance drove past 3-4 general hospitals to go straight to the specialist cardiac unit - took longer but saved his life). These smaller community hospitals should primarily focus on child health, simple elective surgeries, geriatric care and rehabilitation - and should be complemented by: (a) greater use of virtual care, so people don't have to travel to the specialist hospital for follow up appointments - they go to the local community hospital to speak with the specialist via videolink; (b) more services out of hospital and in the community. But that involves having an honest dialogue with the country about the need to downgrade almost half of the hospitals and that this will mean for many they will have to travel to access the services they need and to visit their loved ones in a hospital 50 miles away - again, not a vote winner so will never happen which means there will be more and more of these scandals in sub-scale hospitals (Mid Staffs, Shrewsbury. Telford etc.).
4) Give a greater remit to nurse practitioners and pharmacists to prescribe for routine medicines - therefore reducing the burden on GPs (another group whose numbers are reducing) so that they can focus more on diagnosis and chronic disease management - keeping people out of hospital. But 'doctors' claim this is unsafe (which is BS).
5) Charge anyone 100 pounds who presents to an A&E when they could have seen a GP. They shouldn't be there and they are clogging up the system.
6) Create a separate mental health system from the ground up. Shoehorning it into a hospital based health system is not only inefficient/expensive, but it compromises outcomes for mental health patients and for physical health patients. Only people with the highest risk of suicide should be in a hospital - in many cases being in hospital exacerbates the individual's mental health. We are clogging up hospitals with mental health patients because there are no appropriate services to support them either at home or in non-clinical residential mental health facilities (purpose built to focus on managing their mental health within a community/home setting). Some of the states in Australia have established community mental health residential services that are dramatically improving patient outcomes and reducing the burden on hospitals.
7) Stop the merry go round of failed NHS executives and make it easier to sack NHS staff who can't do their job (as opposed to hiding them in roles where 'they can do least damage').
8) Increase pay for nurses, allied health workers, social workers - not 1-2% but 15-20%.
9) Industrialise the capability to drive innovation and roll it out across the whole health system. There's no coincidence that Frimley Park Hospital in Hampshire is one of the highest performing hospitals in England - most of the doctors there are army doctors based nearby at Aldershot who split their time being deployed across the world and then working at Frimley Park. Some of the ideas that have been brought back from how they set up hospitals in Afghanistan and Iraq have been translated into services back at Frimley Park - but there is no mechanism to then quickly disseminate these great ideas across the NHS. Liam Donaldson said back in 2011 that a study he had commissioned showed it takes an average of 12 years for a new idea that works in one hospital to be rolled out as good practice across all NHS hospitals.
10) I believe this has started to happen - but bring health and social care together. Not just from a governance and funding perspective, but on the ground as well. Especially for support provided to older people in the home (where most older people want to be) - so they can get clinical care alongside social care when needed.
11) Stop charging people to park at hospitals - it's wrong on so many levels.
12) Increase the amount of money being spent on health prevention, early intervention and health education of school aged children AND parents. The majority of life long health and mental health issues and behaviours are baked in by the age of 16. This will have the single biggest return on investment of any intervention - but because that return is realised over a 25+ year period it doesn't appeal to governments because they want to see the return within 1-2 election cycles.
There are many many other things at a local level - these are the main systemic changes though. |
Interesting. Your point 1 and point 3 clash in some ways though (although yes, with increasing specialism I understand the benefits your highlighting too). That shift to specialist super hospitals is a major point of contention with patients. We see it here in the SW, where patients who previously could have been treated in Pembrokeshire now have to go to Cardiff or even sometimes Bristol - we're talking 2-3 hour trips. It's not a good outcome on so many levels.
Could not more effort be put into recruiting more generalists to enable services to be delivered closer to communities? I'm not convinced it's alway about specialism - there just seems to be a trend towards super hospitals for all types of care. |  |
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| Any ideas on how to protect our NHS? on 11:56 - Apr 8 with 613 views | ellerblue |
| Any ideas on how to protect our NHS? on 11:25 - Apr 8 by DanTheMan |
Thank you for actually answering the question that I must have asked people about 6 times and have never got an answer to.
One thing I would be interested in with these health insurers are whether you run into issues seen with other insurance companies where they will try and say you aren't covered for X because of whatever reason. It has always made me feel incredibly uncomfortable that people might not be covered for potentially life threatening illnesses because they're insurance company decided so. |
I live in Germany where it is compulsory to have medical insurance, most of the big insurers such as AOK who i am insured with cover all medical illness , but things like the patient charge for being in Hospital (10euro per day) and precriptions, and some dental procedures are not covered most of them charge the same amount around 14 per cent of salary split equally between yourself and your employer, although there is a bit of a price war at the moment as some are raising the percent blaming covoid costs, the insurance carries on even when you retire , my wife retires in 1 month her pension is roughly about 1000 euros per month , but out of that she still has to pay 147 euros health insurance and receives no extra benefits as in Uk. When i see my local Dr , he always without fail tells me stories of working in the NHS and what a fantastic service it supplies as opposed to medical insurance and wishes Germany had the same system instead of medical insurance companies makin money from peoples ill health, i know a lot of people may dis-agree but the German health system is not a patch on the NHS especially if it is funded correctly lets hope they never ever go down the route of compulsary medical insurance. | |
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| Any ideas on how to protect our NHS? on 12:17 - Apr 8 with 588 views | IPS_wich |
| Any ideas on how to protect our NHS? on 11:44 - Apr 8 by Swansea_Blue |
Interesting. Your point 1 and point 3 clash in some ways though (although yes, with increasing specialism I understand the benefits your highlighting too). That shift to specialist super hospitals is a major point of contention with patients. We see it here in the SW, where patients who previously could have been treated in Pembrokeshire now have to go to Cardiff or even sometimes Bristol - we're talking 2-3 hour trips. It's not a good outcome on so many levels.
Could not more effort be put into recruiting more generalists to enable services to be delivered closer to communities? I'm not convinced it's alway about specialism - there just seems to be a trend towards super hospitals for all types of care. |
You’ve touched on the biggest challenge there. The downgrading of general hospitals and investment in the larger specialist hospitals becomes very problematic in the more rural peripheral areas of the country. I can’t comment upon SW Wales because I just know the geography well enough, but in an east Anglian context, you’d probably be looking at four specialist hospitals in Norwich, Ipswich, Cambridge and Chelmsford. Colchester would be problematic and would suffer from its geographic location between Ipswich and Chelmsford. But the types of hospitals that would definitely by candidates for downgrading would be BSE, Kings Lynn, Lowestoft, Braintree.
As for your second point, the issue isn’t about recruitment, it’s about the graduates coming out of medical schools. They are already specialising during their degrees, so less are coming into general placements out of university. As we see doctors retiring who graduated in the 70s/80s - most of them as generalists - they are being replaced by new graduates who are far far more specialised across the overall cohort. Why - because it’s more sexy to be a specialist and because they get paid more. | | | |
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| Any ideas on how to protect our NHS? on 16:09 - Apr 8 with 528 views | eireblue |
| Any ideas on how to protect our NHS? on 11:25 - Apr 8 by DanTheMan |
Thank you for actually answering the question that I must have asked people about 6 times and have never got an answer to.
One thing I would be interested in with these health insurers are whether you run into issues seen with other insurance companies where they will try and say you aren't covered for X because of whatever reason. It has always made me feel incredibly uncomfortable that people might not be covered for potentially life threatening illnesses because they're insurance company decided so. |
I believe I shared a document once on health care spend per capita vs outcomes.
The US was an outlier, e.g. per capita spend was much larger compared to the outcome.
But apart from that, the more money spent on healthcare, irrespective of method, resulted in better outcomes.
The U.K. was a little bit below the curve, you would have expected slightly better outcomes, given the spend.
There is very little correlation between how you get the money vs the outcome.
There is some correlation between how much is spent vs outcomes.
So really, the only question is, given that you want to get to a certain level of spend, what is the most efficient way of getting the money.
E.g. if everyone gets on average a tenner a month healthcare, and one system costs 50p to get the tenner, and another 2 pounds, then clearly, the one costing 50p is better.
So it should be an easy enough argument to make, that has nothing to do with health, just efficiency in getting the money from a to b. |  | | |
| Any ideas on how to protect our NHS? on 18:10 - Apr 8 with 488 views | ghostofescobar |
Exercise more, eat less, enforce Logan's Run principles. |  |
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| Any ideas on how to protect our NHS? on 09:11 - Apr 9 with 401 views | fab_lover |
Yes.
Urgently re-assess our viewpoints on euthanasia and the desirability of living long lives.
I apologise in advance for any offence this post might cause.
My parents are baby boomers; yesterday was their 50th wedding anniversary, and the cracks are beginning to show in their friends in terms of mobility etc.
As per the graph on here:
https://ukhsa.blog.gov.uk/2019/01/29/ageing-and-health-expenditure/
the cost of an ageing population in terms of healthcare is immense. On average, people are living nearly 20 years in what is described as "poor health".
Why ?
Well IMHO and unqualified opinion, this is another example of the pendulum swinging way too far the other way.
When the NHS was set up, the average age of death was 64:
https://www.statista.com/statistics/1040159/life-expectancy-united-kingdom-all-t
It's now 80.
Now, giving people extra years so they could have a decade or so of retirement after working all their lives seems fair enough.
However the (body) parts still wear out.
I don't think any adult under 60, if asked "if the cost of prolonging your life means 20 years of ill health ?" would take that as an option. But of course, we all think it happens to someone else.
No-one would choose to end up dying in hospital - yet over 50% of us do. Or choose to lose their mental and physical faculties. Or spend the last years of our lives watching TV all day. However this is what we end up, in the main, being condemned to do.
Given the choice, I think most of us would say "no" to that. "No" to being resuscitated after a certain age. "No" to being a burden on our children.
I certainly would and at an age where I'm closer to 60 than 50, it's not like I'm not going to face this myself.
Life should be about quality, not quantity. We should start having conversations about this now. Otherwise, in 10 years, the boomer generation will effectively finish the NHS off. |  | | |
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