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Mutts Nuts · May 10, 2015

Clearly under funded by which ever party is in control , is the system out of date and ready for the bin, any one else think that the German Healthcare system works pretty well and should be introduced by our current government
http://www.civitas.org.uk/pubs/bb3Germany.php

pastafarian · May 10, 2015

Mutts Nuts said:
Clearly under funded by which ever party is in control , is the system out of date and ready for the bin, any one else think that the German Healthcare system works pretty well and should be introduced by our current government
http://www.civitas.org.uk/pubs/bb3Germany.php

i wouldnt say its out of date or ready for the bin,i would say though the NHS gets nowhere being used as a political football every election cycle. I would like it removed from political handbags all together,its too important. Enshrine it in some sort of law that makes it above political posturing or policies. The new buzzword is proportional representation so how about the NHS is above politics but run by a committee with representatives of political parties according to PR lines whose task and mandate is to make it work and always be free at the point of delivery for all .....difficult task but i believe it needs taking out of the hands of the government of the day.

and edit,........parties need to reach a compromise on how much is through the private sector. Labour had it at about 5 % ,i think im right its currently 6% ish with the tories.......maybe a threshold of 10% max ever......it does have its place and helps people,if people are serious about the NHS they at least need to listen and try and understand a minimal private roll ...(but always free at delivery to the punter) simply saying no based on ideological political thinking is not going to help an institution which needs a serious re-think at the very least

Mutts Nuts · May 10, 2015

pastafarian said:
i wouldnt say its out of date or ready for the bin,i would say though the NHS gets nowhere being used as a political football every election cycle. I would like it removed from political handbags all together,its too important. Enshrine it in some sort of law that makes it above political posturing or policies. The new buzzword is proportional representation so how about the NHS is above politics but run by a committee with representatives of political parties according to PR lines whose task and mandate is to make it work and always be free at the point of delivery for all .....difficult task but i believe it needs taking out of the hands of the government of the day.

and edit,........parties need to reach a compromise on how much is through the private sector. Labour had it at about 5 % ,i think im right its currently 6% ish with the tories.......maybe a threshold of 10% max ever......it does have its place and helps people,if people are serious about the NHS they at least listen and try and understand a minimal private roll .........simply saying no based on ideological political thinking is not going to help an institution which needs a serious re-think at the very least

Funding seems to be the issue in this country,one of the benefits of the German system is that a lot less G P`s are required releasing funds for doctors that can actually treat the patients.If you have an ear ache in Germany you go to ENT, your average person is intelligent enough to work that out .The funding and administration is not controlled by ever changing governments which as you rightly say is an underlying problem the NHS is up against.The NHS is not working which is clear for all to see, a government at some point is going to have to have big enough bollocks to get rid of it and instate a system that works in the 21st century

pastafarian · May 10, 2015

Mutts Nuts said:
Funding seems to be the issue in this country,one of the benefits of the German system is that a lot less G P`s are required releasing funds for doctors that can actually treat the patients.If you have an ear ache in Germany you go to ENT, your average person is intelligent enough to work that out .The funding and administration is not controlled by ever changing governments which as you rightly say is an underlying problem the NHS is up against.The NHS is not working which is clear for all to see, a government at some point is going to have to have big enough bollocks to get rid of it and instate a system that works in the 21st century

I have no idea how it works in germany perhaps herr tub could shed some light,i just dont agree with your last point,i see no reason to get rid of the NHS and replace it with something more modern.Yes its messed up,yes the finances are screwed and not working but its a wonderful institution,dont mind saying as a tory voter,probably the best thing Labour have ever done for this country.We must fight for it and im sure it can be fixed and work for everyone but at the same time people must realise there must be a degree of privatisation if it is to survive......this low level percentage of private care in the NHS but still free to me and you really shouldnt scare poeple.......my father benefited from it,probably saved his life......ask [MENTION=1365]Westdene Seagull[/MENTION];as well

Hampster Gull · May 10, 2015

pastafarian said:
i wouldnt say its out of date or ready for the bin,i would say though the NHS gets nowhere being used as a political football every election cycle. I would like it removed from political handbags all together,its too important. Enshrine it in some sort of law that makes it above political posturing or policies. The new buzzword is proportional representation so how about the NHS is above politics but run by a committee with representatives of political parties according to PR lines whose task and mandate is to make it work and always be free at the point of delivery for all .....difficult task but i believe it needs taking out of the hands of the government of the day.

and edit,........parties need to reach a compromise on how much is through the private sector. Labour had it at about 5 % ,i think im right its currently 6% ish with the tories.......maybe a threshold of 10% max ever......it does have its place and helps people,if people are serious about the NHS they at least need to listen and try and understand a minimal private roll ...(but always free at delivery to the punter) simply saying no based on ideological political thinking is not going to help an institution which needs a serious re-think at the very least

I get the sentiment but why propose to limit who provides the health services we need? the vast bulk of this country want a free at point of use service and if that remains the case then no government will move from that. So why not have additional providers of services that will drive better quality and VFM? Its very common in other countries

Mutts Nuts · May 10, 2015

pastafarian said:
I have no idea how it works in germany perhaps herr tub could shed some light,i just dont agree with your last point,i see no reason to get rid of the NHS and replace it with something more modern.Yes its messed up,yes the finances are screwed and not working but its a wonderful institution,dont mind saying as a tory voter,probably the best thing Labour have ever done for this country.We must fight for it and im sure it can be fixed and work for everyone but at the same time people must realise there must be a degree of privatisation if it is to survive......this low level percentage of private care in the NHS but still free to me and you really shouldnt scare poeple.......my father benefited from it,probably saved his life......ask [MENTION=1365]Westdene Seagull[/MENTION];as well

The link in 1st post outlines the set up, it caters for all and would work fine in this country, if not abused by layabouts and malingerers,as the current system is.The Germans are a hard working and very honest bunch

drew · May 10, 2015

Since 2009, the statutory insurance schemes are funded by taxing payroll to the tune of 15.5% of gross wage of which 8.3% is paid by the employee and the balance by the employer. As for MN comments about ear ache, what a joke. You go to a GP because he is far more local and you get treatment. The vast majority of cases of earache can be treated by a GP. If it is not a simple case then you go to the ENT specialist. The clue is in the name.

With regard to funding, according to George's pie charts last year, it was estimated that a person on £60k would contribute £3442 towards the NHS, that's about 5.7%, roughly a third of the german's costs. Perhaps if we increased our funding to the German level then our NHS wouldn't be in trouble.

Edit. According to world bank data, Germany spends 2.2% more of GDP on health than we do. Hopefully I've got my maths right but in 2013 our GDP was US$2.678T. 2.2% is US$59B (approx £38b). Quite a bit more than what is alleged to be required.

Chuck in the population size to see what the spend is per person. Germany's GDP per capita was US$46,251 and the UK US$41,787. As the world bank figures show Germany's spend on health is 11.3% making the per capita contribution of US$5,226 whereas in the UK it is 9.1% making US$3,802

The german model may well be better or more efficient but then if we invested the same amount of money then I think most people would see a massive improvement in our system. If it were on a level playing field, I believe our system would prove to be better.

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

One Teddy Maybank · May 10, 2015

As said in another thread, for me, people who do not attend appointments should be fined, a more robust system including some form of income generation should be applied to 'health tourists', recruitment agencies should be called to account and legislation should be put in place, to prevent them paying more to nursing and medical staff than the NHS.

Drug companies should also be called to account to justify costs.

One Teddy Maybank · May 10, 2015

drew said:
Since 2009, the statutory insurance schemes are funded by taxing payroll to the tune of 15.5% of gross wage of which 8.3% is paid by the employee and the balance by the employer. As for MN comments about ear ache, what a joke. You go to a GP because he is far more local and you get treatment. The vast majority of cases of earache can be treated by a GP. If it is not a simple case then you go to the ENT specialist. The clue is in the name.

With regard to funding, according to George's pie charts last year, it was estimated that a person on £60k would contribute £3442 towards the NHS, that's about 5.7%, roughly a third of the german's costs. Perhaps if we increased our funding to the German level then our NHS wouldn't be in trouble.

I understand its just an example, but why not go to a Pharmacist, for this type of lower case, whilst it could be a perforated ear-drum or alike, perhaps GPs should be a second point of call in terms of escalation. You do need GPs, but effectively they are a gatekeeper to hospital services and should be contacted for persistent cases.

Alternatively, empower Practice Nurses more (which seems to be happening anyway).

yxee · May 10, 2015

drew said:
Since 2009, the statutory insurance schemes are funded by taxing payroll to the tune of 15.5% of gross wage of which 8.3% is paid by the employee and the balance by the employer. As for MN comments about ear ache, what a joke. You go to a GP because he is far more local and you get treatment. The vast majority of cases of earache can be treated by a GP. If it is not a simple case then you go to the ENT specialist. The clue is in the name.

With regard to funding, according to George's pie charts last year, it was estimated that a person on £60k would contribute £3442 towards the NHS, that's about 5.7%, roughly a third of the german's costs. Perhaps if we increased our funding to the German level then our NHS wouldn't be in trouble.

£9,000 a year to the NHS from someone who may not ever need it? At some point you've got to say "enough is enough, I actually want to spend some of my salary on things that I want".

East Preston Gull · May 10, 2015

yxee said:
£9,000 a year to the NHS from someone who may not ever need it? At some point you've got to say "enough is enough, I actually want to spend some of my salary on things that I want".

This. I could get a top level medical health policy for me and my family. When the state provides a service it becomes inefficient and too bloody expensive. Give us our NI money back and let us invest in health for ourselves. Liberty for all!

drew · May 10, 2015

One Teddy Maybank said:
I understand its just an example, but why not go to a Pharmacist, for this type of lower case, whilst it could be a perforated ear-drum or alike, perhaps GPs should be a second point of call in terms of escalation. You do need GPs, but effectively they are a gatekeeper to hospital services and should be contacted for persistent cases.

Alternatively, empower Practice Nurses more (which seems to be happening anyway).

I wouldn't argue with that.

drew · May 10, 2015

yxee said:
£9,000 a year to the NHS from someone who may not ever need it? At some point you've got to say "enough is enough, I actually want to spend some of my salary on things that I want".

Marvellous. Could you get a health policy for your and your family for £3442, assuming you are earning £60k? Would your policy cover emergency treatment, ambulances etc etc.
Not quite sure where you get the £9k from unless you are basing it on 15% of £60k. Remember, based on the German system you would only pay £4,980 (your employer stumping up the rest.

The point I was making was that MN was not comparing like for like.

sir albion · May 10, 2015

Yes it's seriously under funded and as the population rises at a rate of knots it will only get worse....A big issue is the amount forked out on agency staff or should we say the middle man in which is astronomical.
http://www.dailymail.co.uk/health/article-188363/NHS-hit-2-5bn-agency-staff-bill.html

PILTDOWN MAN · May 10, 2015

pastafarian said:
i wouldnt say its out of date or ready for the bin,i would say though the NHS gets nowhere being used as a political football every election cycle. I would like it removed from political handbags all together,its too important. Enshrine it in some sort of law that makes it above political posturing or policies. The new buzzword is proportional representation so how about the NHS is above politics but run by a committee with representatives of political parties according to PR lines whose task and mandate is to make it work and always be free at the point of delivery for all .....difficult task but i believe it needs taking out of the hands of the government of the day.

and edit,........parties need to reach a compromise on how much is through the private sector. Labour had it at about 5 % ,i think im right its currently 6% ish with the tories.......maybe a threshold of 10% max ever......it does have its place and helps people,if people are serious about the NHS they at least need to listen and try and understand a minimal private roll ...(but always free at delivery to the punter) simply saying no based on ideological political thinking is not going to help an institution which needs a serious re-think at the very least

Some very good points. The largest being that it is used as a political football. It should be a cross party arrangement.

I used to know a CEO of a local NHS trust. Unfortunately she died a few years ago but she used to drink in the pub I owned. She was in charge when Labour changed the way trusts were governed. Being a true Labour person she had hoped that the investment and organisation would be sorted once and for all. She became rapidly disillusioned with it. Her job, one she had done for many years become one of four. The extra money promised, which they at the time made a huge issue of, disappeared. This went on the extra tiers of management and mostly on one of the biggest mistakes Labour ever made regarding the NHS, GP's. They had renegotiated the GP contracts, giving them all a huge pay rise, whilst removing their obligation to work out of hours. Furthermore they changed from central payments to local trust payments. This meant the local trusts paid the increased wages. She had to reapply for her position (she didn't and took retirement) and the whole thing turned in to a farce.

The last government didn't really do anything to alter the status quo. They attempted to get a better NHS, in their eyes anyway, but again have failed.

It's time this was taken away from party politics and an agreement reached with all sides including the medical people to see if we as a nation can guide the NHS in to a better position. Allow the fighting to take place in the background and an agreement reached. There is so much waste within the organisation, claim backs from tourists are not collected (apparently too expensive to claim) and too many bigwigs earning huge amounts and producing very little.

beorhthelm · May 10, 2015

drew said:
With regard to funding, according to George's pie charts last year, it was estimated that a person on £60k would contribute £3442 towards the NHS, that's about 5.7%, roughly a third of the german's costs. Perhaps if we increased our funding to the German level then our NHS wouldn't be in trouble.
...
Chuck in the population size to see what the spend is per person. Germany's GDP per capita was US$46,251 and the UK US$41,787. As the world bank figures show Germany's spend on health is 11.3% making the per capita contribution of US$5,226 whereas in the UK it is 9.1% making US$3,802

two points here. first, the NHS is not in trouble, we are constantly told this because it serves people to do so. some parts of the system are overstretched and under pressure, and we seem to focus on those a great deal while ignoring how much is working. consider the highprofile A&E targets being missed, to start theres an arbitary metric that may have no bearing on clinical effect. then theres the numbers, if some hospitals are missing the target across the whole NHS, it doesnt mean they all are. and then theres nothing in the stats to tell you why an A&E is missing targets, it could be a number of reasons that have nothing to do with A&E itself, so proposing to throw money there means the problem isnt fixed.

this is very important because thats how we end up with an inefficient costly service. money is spent on x to deal with a problem seen there, when in fact the problem is y. when this is realised money is spent on y, but the extra spending on x continues with no affect (this happens in companies too, just in state sector there is no periodic round of restructuring to identify and clear out these problems).

secondly, i would take numbers on GDP spend with a pinch of salt as they are not always like for like, they rely heavily on what countries report as spending on health and what is in and outside the healthcare budget. the cost for US healthcare can vary from something like 6-14% of GDP depending what is included. i read a very interesting review of healthcare economics a while ago that illustrated how on some measures we are world leaders, on other we are in the bottom. depending on whos doing the analysis the wieghting of different metrics makes the NHS look good or bad. the one we are never bad on is universal access to medical care, and thats somthing we should focus on, the costs are so much accountancy for those that want to play politics.

drew · May 10, 2015

beorhthelm said:
two points here. first, the NHS is not in trouble, we are constantly told this because it serves people to do so. some parts of the system are overstretched and under pressure, and we seem to focus on those a great deal while ignoring how much is working. consider the highprofile A&E targets being missed, to start theres an arbitary metric that may have no bearing on clinical effect. then theres the numbers, if some hospitals are missing the target across the whole NHS, it doesnt mean they all are. and then theres nothing in the stats to tell you why an A&E is missing targets, it could be a number of reasons that have nothing to do with A&E itself, so proposing to throw money there means the problem isnt fixed.

this is very important because thats how we end up with an inefficient costly service. money is spent on x to deal with a problem seen there, when in fact the problem is y. when this is realised money is spent on y, but the extra spending on x continues with no affect (this happens in companies too, just in state sector there is no periodic round of restructuring to identify and clear out these problems).

secondly, i would take numbers on GDP spend with a pinch of salt as they are not always like for like, they rely heavily on what countries report as spending on health and what is in and outside the healthcare budget. the cost for US healthcare can vary from something like 6-14% of GDP depending what is included. i read a very interesting review of healthcare economics a while ago that illustrated how on some measures we are world leaders, on other we are in the bottom. depending on whos doing the analysis the wieghting of different metrics makes the NHS look good or bad. the one we are never bad on is universal access to medical care, and thats somthing we should focus on, the costs are so much accountancy for those that want to play politics.

I will have to disagree that the NHS is not in trouble. Knowing, many people that work in the NHS I see first hand the tremendous strain being put on them at the moment partly due to the increased use of the service and partly due to the lack of joined up thinking. Staffing levels are not what they should be and because too many qualified staff have been lost over the years there has been an increased cost of agency staff. There are plenty of staff who give up the full time role to work as agency. That in turn then leads to overseas recruitment. Look at the GP services, whilst not actually employees of the NHS, they are paid for their services. 10 minute appointments in which they are to garner what exactly is wrong with a patient. Easy if it is a straightforward ear ache but not so if it is depression, stress, maybe domestic violence etc etc. Part of that problem were the new contracts introduced by Labour for GPs. They were trying to solve one problem but in doing so created others.

As for finance of the NHS, I agree that it shouldn't just be a case of chucking money into a bottomless pit. I only used the GDP as a guide to compare what is spent on the different systems. Of course you could drill right down into the figures to get a more accurate comparison but that might be a 5 year study in itself, just in time for the next election!

Cheshire Cat · May 10, 2015

The NHS actually has loads of money, and a very good publicity machine which complains all the time how skint it is. The real problem is how the money gets spent, and what it gets spent on - its a fantastically wasteful process based on doctors vested interests, rather than patient needs.

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