[Misc] UK healthcare/NHS funding

Weststander · Oct 7, 2021

[I posted something similar in 2019 after I’d witnessed NHS semi-chaos and substandard infrastructure. Not inclined to look for it].

Would you be willing to see a not insignificant rise in income tax rates (as is the case in Scandinavia) or compulsory private medical insurance (as explained by [MENTION=409]Herr Tubthumper[/MENTION] in the past) to go to frontline NHS services? Now!

To me, a no-brainer yes.

We have a bit of an emergency with one of our teenage kids. We were told over the phone to head to Brighton A&E immediately.

The queue’s out of the door, people on plastic chairs or crutches outside, thank God it’s not raining.

We were allowed to walk through the Major Trauma centre to get here. As I experienced myself in 2019 there are dozens and dozens of poor souls on beds and wheelchairs in the corridors.

An astonishing eye-opener, it’s shocking, but preventable with huge investment. Not just in buildings (the new £480m towers will be great), but with a recruitment drive, better working conditions.

In fairness it’s always been too busy here, I came as a kid in 1980 and remember 6 hour queues to be seen and get an x-ray.

It’s broken.

The Clamp · Oct 7, 2021

Weststander said:
[I posted something similar in 2019 after I’d witnessed NHS semi-chaos and substandard infrastructure. Not inclined to look for it].

Would you be willing to see a not insignificant rise in income tax rates (as is the case in Scandinavia) or compulsory private medical insurance (as explained by [MENTION=409]Herr Tubthumper[/MENTION] in the past) to go to frontline NHS services? Now!

To me, a no-brainer yes.

We have a bit of an emergency with one of our teenage kids. We were told over the phone to head to Brighton A&E immediately.

The queue’s out of the door, people on plastic chairs or crutches outside, thank God it’s not raining.

We were allowed to walk through the Major Trauma centre to get here. As I experienced myself in 2019 there are dozens and dozens of poor souls on beds and wheelchairs in the corridors.

An astonishing eye-opener, it’s shocking, but preventable with huge investment. Not just in buildings (the new £480m towers will be great), but with a recruitment drive, better working conditions.

In fairness it’s always been too busy here, I came as a kid in 1980 and remember 6 hour queues to be seen and get an x-ray.

It’s broken.

You’ll be seen far quicker heading to Worthing hospital. I hope your kid is okay now.

Swansman · Oct 7, 2021

Do something about the richest 0,1% putting all their money in tax havens and a significant part of the problem is solved.

Unfortunately, throughout history - regardless of nation and regardless of ruler - no one has seemed to be willing to solve this.

southstandandy · Oct 7, 2021

Problem is money is not the sole answer.

It's not like there are thousands of doctors and nurses sitting at home unemployed with nothing to do and just waiting for a job opportunity to come along in this sector. If you're qualified you could pretty much bag a job tomorrow.

It's the shortage of staff that's the main problem with insufficient numbers to meet the ongoing demand. Undoubtedly more money would help but we need to attract future doctor's and nurses to enter this sector. If you gave the NHS £1billion every day of the week, there are only so many operations that the exisiting staff could do. Infrastructure and recruitment (along with finance) are required to sort out the current state of affairs. And thats a major long term problem.

Butch Willykins · Oct 7, 2021

It's the biggest employer in Europe, but something like 90% work in non-medical roles? Isn't that the problem?

Kinky Gerbil · Oct 7, 2021

Weststander said:
[I posted something similar in 2019 after I’d witnessed NHS semi-chaos and substandard infrastructure. Not inclined to look for it].

Would you be willing to see a not insignificant rise in income tax rates (as is the case in Scandinavia) or compulsory private medical insurance (as explained by [MENTION=409]Herr Tubthumper[/MENTION] in the past) to go to frontline NHS services? Now!

To me, a no-brainer yes.

We have a bit of an emergency with one of our teenage kids. We were told over the phone to head to Brighton A&E immediately.

The queue’s out of the door, people on plastic chairs or crutches outside, thank God it’s not raining.

We were allowed to walk through the Major Trauma centre to get here. As I experienced myself in 2019 there are dozens and dozens of poor souls on beds and wheelchairs in the corridors.

An astonishing eye-opener, it’s shocking, but preventable with huge investment. Not just in buildings (the new £480m towers will be great), but with a recruitment drive, better working conditions.

In fairness it’s always been too busy here, I came as a kid in 1980 and remember 6 hour queues to be seen and get an x-ray.

It’s broken.

Hope they are ok

On the bigger question, I’m all for a hybrid private/public health system.

The NHS is a mess and I’m not sure how you fix it, would labour fix it if got into power? I’m not sure as the answer always seems to be throw more money at it.

the slow norris · Oct 7, 2021

Butch Willykins said:
It's the biggest employer in Europe, but something like 90% work in non-medical roles? Isn't that the problem?

How many pilots are there in the RAF? and how many people are employed by the RAF? Or should we be getting the pilots to design the planes, build the planes, fuel the planes, build the hangars, maintain the planes and the hangars as well as flying the planes? Shall the pilots pay themselves and pay all their suppliers?

Just googled - roughly 2000 pilots out of total staff of 33k, so 94% of RAF staff don't fly planes.

Nobby Cybergoat · Oct 7, 2021

Yes.

I would be willing to pay significantly higher tax for better public services.

Butch Willykins · Oct 7, 2021

the slow norris said:
How many pilots are there in the RAF? and how many people are employed by the RAF? Or should we be getting the pilots to design the planes, build the planes, fuel the planes, build the hangars, maintain the planes and the hangars as well as flying the planes? Shall the pilots pay themselves and pay all their suppliers?

Just googled - roughly 2000 pilots out of total staff of 33k, so 94% of RAF staff don't fly planes.

I take your point. But I would say the RAF seem to look like they know what they're doing. Although admittedly I've never had any reason to use them. Whereas large parts of the NHS are a total shambles.

Harry Wilson's tackle · Oct 7, 2021

Weststander said:
[I posted something similar in 2019 after I’d witnessed NHS semi-chaos and substandard infrastructure. Not inclined to look for it].

Would you be willing to see a not insignificant rise in income tax rates (as is the case in Scandinavia) or compulsory private medical insurance (as explained by [MENTION=409]Herr Tubthumper[/MENTION] in the past) to go to frontline NHS services? Now!

To me, a no-brainer yes.

We have a bit of an emergency with one of our teenage kids. We were told over the phone to head to Brighton A&E immediately.

The queue’s out of the door, people on plastic chairs or crutches outside, thank God it’s not raining.

We were allowed to walk through the Major Trauma centre to get here. As I experienced myself in 2019 there are dozens and dozens of poor souls on beds and wheelchairs in the corridors.

An astonishing eye-opener, it’s shocking, but preventable with huge investment. Not just in buildings (the new £480m towers will be great), but with a recruitment drive, better working conditions.

In fairness it’s always been too busy here, I came as a kid in 1980 and remember 6 hour queues to be seen and get an x-ray.

It’s broken.

Would I pay more? Yes.

Would I subscribe to an insurance system? Yes.

When I lived in Canada as a foreigner (student) I was required to pay for health insurance. As a student the cost was trivial (about ten dollars a year if I recall correctly, at a time when I was paid around ten thousand dollars a year). Everyone can afford that. I am not sure how they dealt with rough sleepers but there was some sort of safety net.

The health system there was fantastic. After 3 years I did my meniscus and got it fixed with keyhole surgery. One of my colleagues did the anaesthesia. I hope it is still as brilliant there as it was (calling @stoneham park).

When I came back to the UK in 86 I worked in a big London teaching hospital (doing research) and it was tatty and a lot of the support staff were clearly workshy, heavy smokers and drinkers, but it seemed to work.

Since then we have had a massive marketization of the NHS, a massive expansion of administration, administrators, rules and regulation, 'standardization' of treatment protocols, the separation of patients from a 'family GP' by the creation of large 'GP practices'.......and of course the introduction of tendering, a business model, 'successful' hospitals 'taking over' 'failing' hospitals....health care 'Trusts' . . . 'deliverance targets' . . .'league tables'...competition....language like 'across the piece' (I am on various madcap committees and this is how they talk).

Yes, it looks to me like it has been systematically ****ed and burned. It needs a proper fix and this will be a test of the tories' true intentions. Were I a conservative I would destroy the NHS and make people pay for it all via insurance, like in America. I am, I hastily add, not a conservative.

I would like to see the market model removed. More than half our (uni) staff are administrators. It will be the same in the NHS. If there are fewer things to administrate, then . . .(you do the sums). BUT making people pay (even a token amount) may focus minds a bit.

I would also do something about serial malingerers. Back in the 70s I worked in a pharmacy and delivered meds to local GPs. The same people were always there (kid has a cough; 'I want antibiotics') and the attitude was 'it's free so I want my share'. :facepalm:

What an absolute shower we are, we Brits. Some of us, anyway. Some of them.

I suspect however, like with governments, we have the health service we deserve. :nono:

Harry Wilson's tackle · Oct 7, 2021

Butch Willykins said:
It's the biggest employer in Europe, but something like 90% work in non-medical roles? Isn't that the problem?

Yes. Absolutely.

I ran that question past our head of deliverance and he emailed the question to his team and one of them found a contractor who tendered with a rather high overhead but was nevetheless selected to respond, and their report said "Yes. No it isn't the problem. Yes".

drew · Oct 7, 2021

Butch Willykins said:
It's the biggest employer in Europe, but something like 90% work in non-medical roles? Isn't that the problem?

You need to back that up with some links!

Also, what do you define as medical? Is it a qualified nurse, a doctor? Does it include HCAs, physios, pharmacy staff, pathology.

There are plenty of myths about there being too many managers.

https://www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-managers

We have, compared to most other countries, underfunded our healthcare system, spending less of our GDP on it. The NHS has just about coped with the pandemic and now all they get from this government are threats about jobs if they don't clear the backlog.

The answer is not compulsory medical insurance as that will lead to a two tier system. Higher taxes, and fund it properly.

Weststander · Oct 7, 2021

The Clamp said:
You’ll be seen far quicker heading to Worthing hospital. I hope your kid is okay now.

My wife said that, but this was specific referral from an over the phone expert.

Didn't want to drive to Worthing and a jobsworth turn us away as Brightonians.

rippleman · Oct 7, 2021

Swansman said:
Do something about the richest 0,1% putting all their money in tax havens and a significant part of the problem is solved.

Unfortunately, throughout history - regardless of nation and regardless of ruler - no one has seemed to be willing to solve this.

If the government taxed the dodgepots like Amazon, Google etc and they paid their fair whack, and went after the foreign billionaires money laundering in the UK, then poor old Peter Bottomley wouldn't have to scrape by on just £82K a year - and we could invest the tax yield in the NHS.

Unfortunately, the OP has overlooked the fact that with ever-increasing prices, the UC cut, the NI rise etc etc many people are not in a position to bear the burden of increased taxes and therefore less take home pay.

I agree a tax hike is the way to fund the NHS - but from those corporations and individuals who are best placed to afford it. But a Tory government putting up taxes for the wealthiest individuals and big business is never going to happen; they have their own vested interests to protect.

How about recovering all the money paid out to Hancocks friends and family to provide PPE that never happened. There's a good few millions to start us off

Thunder Bolt · Oct 7, 2021

Harry Wilson's tackle said:
Yes, it looks to me like it has been systematically ****ed and burned. It needs a proper fix and this will be a test of the tories' true intentions. Were I a conservative I would destroy the NHS and make people pay for it all via insurance, like in America. I am, I hastily add, not a conservative.

Sorry to pick up on just one small part of your post, but I must make the point that insurance companies look to find get-out clauses. My cousin's daughter died in her 40s from liver cancer, because her insurance wouldn't pay out. She was refused treatment.

I am extremely wary of this government's motives (to put it mildly) A lot of their backers own insurance companies ie Aaron Banks.
When they boast of 40 odd new hospitals, when it is 40 odd refurbished hospitals (have they all been refurbished yet?) then their motives are extremely suspect.

the slow norris · Oct 7, 2021

Obviously I don't know your background, and yours is a perception shared by many. I wonder if that's because of how exposed we all are relatively to each i.e. RAF vs NHS? Could there be some skewing here because we as a society deal with the NHS a lot over our life, therefore can see it's flaws up close, rather than the RAF which most of us will have no insight of. Do we have any idea how inefficient the RAF are really? I would wager that those working in the RAF could probably tell similar stories, yet that doesn't get the same press or indeed carry the same emotional impact that the NHS does because day in/day out it doesn't affect us as much and is a lot less "visible".

Just debating here, not castigating.

Southern Scouse · Oct 7, 2021

Weststander said:
[I posted something similar in 2019 after I’d witnessed NHS semi-chaos and substandard infrastructure. Not inclined to look for it].

Would you be willing to see a not insignificant rise in income tax rates (as is the case in Scandinavia) or compulsory private medical insurance (as explained by [MENTION=409]Herr Tubthumper[/MENTION] in the past) to go to frontline NHS services? Now!

To me, a no-brainer yes.

We have a bit of an emergency with one of our teenage kids. We were told over the phone to head to Brighton A&E immediately.

The queue’s out of the door, people on plastic chairs or crutches outside, thank God it’s not raining.

We were allowed to walk through the Major Trauma centre to get here. As I experienced myself in 2019 there are dozens and dozens of poor souls on beds and wheelchairs in the corridors.

An astonishing eye-opener, it’s shocking, but preventable with huge investment. Not just in buildings (the new £480m towers will be great), but with a recruitment drive, better working conditions.

In fairness it’s always been too busy here, I came as a kid in 1980 and remember 6 hour queues to be seen and get an x-ray.

It’s broken.

Most importantly I hope your son got the treatment he needed.
I work frontline and at my station we have a ratio of 6:4.
So, we have four, office bound managers to every six frontline staff. I’m not a manager and yet I receive on average 40 emails ever day which are completely irrelevant.
I myself have been waiting for an MRI scan and a CT scan for over 4 months even though I’m considered a priority.
For 9 months continuous service during the first wave of covid I received a Thank You badge. My managers, manager got a large bonus for working in comfort, covid free at hone.
The NHS is not broken, it is just run by a massive workforce of over paid incompetents who want nothing more than to continue with the status quo, leaving others to literally kill themselves helping others.

Neville's Breakfast · Oct 7, 2021

Weststander said:
[I posted something similar in 2019 after I’d witnessed NHS semi-chaos and substandard infrastructure. Not inclined to look for it].

Would you be willing to see a not insignificant rise in income tax rates (as is the case in Scandinavia) or compulsory private medical insurance (as explained by [MENTION=409]Herr Tubthumper[/MENTION] in the past) to go to frontline NHS services? Now!

To me, a no-brainer yes.

We have a bit of an emergency with one of our teenage kids. We were told over the phone to head to Brighton A&E immediately.

The queue’s out of the door, people on plastic chairs or crutches outside, thank God it’s not raining.

We were allowed to walk through the Major Trauma centre to get here. As I experienced myself in 2019 there are dozens and dozens of poor souls on beds and wheelchairs in the corridors.

An astonishing eye-opener, it’s shocking, but preventable with huge investment. Not just in buildings (the new £480m towers will be great), but with a recruitment drive, better working conditions.

In fairness it’s always been too busy here, I came as a kid in 1980 and remember 6 hour queues to be seen and get an x-ray.

It’s broken.

I’m not sure there is consensus on what we want from the NHS. The demands on the service and its provision certainly bears little resemblance to the service set up in the 1940s. It has become bigger and bigger because of the mantra of free at the point of delivery and because of advances in medical science. We seem trapped in a perpetual systematic underfunding as defined by these two factors. We can never catch up. Personally I would go for both of your options. Higher taxes to pay for a better basic service more in line with the vision of the Beveridge Report and compulsory insurance for the rest. Can’t see either happening though as the Right is against higher taxes and the left is against medical insurance.

beorhthelm · Oct 7, 2021

across europe healthcare is provided as a mix of public and private, usually with additional insurance for most employed. for some reason we are horrified by the notion of private healthcare, despite most being not for profits, and ignoring GPs are private.

until we want to accept new models of funding and delivery of healthcare, its not going to change substantially.

PeterOut · Oct 7, 2021

southstandandy said:
Problem is money is not the sole answer.

It's not like there are thousands of doctors and nurses sitting at home unemployed with nothing to do and just waiting for a job opportunity to come along in this sector. If you're qualified you could pretty much bag a job tomorrow.

It's the shortage of staff that's the main problem with insufficient numbers to meet the ongoing demand. Undoubtedly more money would help but we need to attract future doctor's and nurses to enter this sector. If you gave the NHS £1billion every day of the week, there are only so many operations that the exisiting staff could do. Infrastructure and recruitment (along with finance) are required to sort out the current state of affairs. And thats a major long term problem.

The particular issue identified by the OP is recently exaggerated by one of the many examples of the overall pressure on the NHS. Previously, ambulances would keep patients on their vehicles in the car park until they could be seen by the medics, within reason. However, they are now getting hammered (again) for failing to hit their attendance time targets, so they now turn up, offload their patients and say cheerio and go on to their next call (it's a lot more professional than that, but hopefully you get the point). As a consequence, patients are now stored inside, with a consequent stacking of patients in corridors within A&E.

Meanwhile, to maintain a modicum of social distancing, people who self-present at A&E and are waiting for (hopefully minor) treatment no longer can be fitted into the previously-small waiting area, so now need to be stacked outside.

Work has already started to erect a porta-kabin style building in the current car park area outside A&E to accomodate the self-presenters to A&E, which is planned to be open at about Xmas. This may help to manage the current over-flow of such people, and reduce / eliminate the need for them to wait outside. Time will tell.

So, staffing? Well, without a doubt, the serious over-crowding and poor physical facilities make that department a less attractive department to attract new staff to from elsewhere, and the over-crowding undoubtably increases stress on hard-working staff, leading to more sickness-related absences.

Undoubtedly the NHS is under-staffed at so many levels. Improved pay is one issue that may help, but improved conditions will also help to attract and retain staff, many of whom I know from personal contact are hanging on by a thread.

We as a community can also help, of course, by reducing the incidence of Covid (get vaccinated, do not infect an NHS worker or member of their family), not self-harming and thereby needing to present at A&E (I am still amazed at the number of people, particularly in late teens and early 20s, who end up in A&E after a night's drinking / drug taking) and using the facilities at places such as the walk-in minor treatment centre at Lewes, or finally being content to wait and see their GP (either in person or via a video call - and yes, I do understand the waits involved with that at times).

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