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alanpo68

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My problem with the NHS isn't the staff, it's the management and the way it's run, it's wholly unfit for purpose, I have said it many times it is in need for reform but until we stop treating it like the national religion and have a proper discussion it will never happen.
The NHS, so great that everyone in the world wants to copy it........... oh wait.
You are right we should sell the NHS to the USA.

They will run it so much better. The ambulance may well drive past you if you cannot afford to pay and you might spend a huge amount on healthcare but at least you won't have to worry about false stories from the Mail and Express about immigrants exploiting the system.
 

selectortone

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I'm married to a doctor. I've seen the affect of the worsening conditions in the NHS for the last decade. I've watched it break some of her friends and colleagues; both from the same hospital, and others within the UK.

So, no, you don't know what you're talking about. Sorry to be so blunt, but the assertion that the NHS isn't overloaded in the winter is counter to any good evidence, and not least a bit insulting to the staff having to deal with it.
Rorschach knows best. Actual first-hand experience counts for nothing. Best not bother, you're wasting your time.
 

Cheshirechappie

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Don't want to get involved in any arguments, but just out of interest I looked up the NHS England budget for 2020/21 - £129.9bn. (that's just the operating budget - doesn't include capital exdpenditure or Whitehall administrative costs ).The population of England is 54 million, so that means expenditure of £2,405 for each man, woman and child in England on health care in 2020/21.

In all honesty, if I was paying £2,400 health insurance per year for each member of my family, I think I'd regard NHS service as patchy at best, and less than satisfactory if I was forced to wait over 12 months for - say - a hip replacement. There's certainly scope for improvement.

That is emphatically NOT criticism of front line staff, the majority of whom are decent people doing their best in sometimes very difficult circumstances. It's a comment on the system. Monopolies, whether public or private sector, usually end up serving themselves, not their customers, because where else are their customers going to go? Captive markets serve suppliers, not customers.

Successive governments have fiddled about with NHS organisation, but none have really grasped the nettle of trying to break the monopoly and give consumers some leverage. Until one does, we'll have a service that is sometimes excellent, but often indifferent, and occasionally dreadful (South Staffs, Shrewsbury and Telford, etc etc).

(Source of budget figures - nhs-providers-briefing-march-2020-budget.pdf )
 

alanpo68

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Don't want to get involved in any arguments, but just out of interest I looked up the NHS England budget for 2020/21 - £129.9bn. (that's just the operating budget - doesn't include capital exdpenditure or Whitehall administrative costs ).The population of England is 54 million, so that means expenditure of £2,405 for each man, woman and child in England on health care in 2020/21.

In all honesty, if I was paying £2,400 health insurance per year for each member of my family, I think I'd regard NHS service as patchy at best, and less than satisfactory if I was forced to wait over 12 months for - say - a hip replacement. There's certainly scope for improvement.

That is emphatically NOT criticism of front line staff, the majority of whom are decent people doing their best in sometimes very difficult circumstances. It's a comment on the system. Monopolies, whether public or private sector, usually end up serving themselves, not their customers, because where else are their customers going to go? Captive markets serve suppliers, not customers.

Successive governments have fiddled about with NHS organisation, but none have really grasped the nettle of trying to break the monopoly and give consumers some leverage. Until one does, we'll have a service that is sometimes excellent, but often indifferent, and occasionally dreadful (South Staffs, Shrewsbury and Telford, etc etc).

(Source of budget figures - nhs-providers-briefing-march-2020-budget.pdf )
The budget for 20/21 has been increased by £50bn because of COVID so isn't a true representation.

Funny you should say hip replacement in the UK it costs $16k in the USA it costs $29k. Or how about a typical cancer drug $3930 in the USA or $470 in the UK.

 

sploo

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In all honesty, if I was paying £2,400 health insurance per year for each member of my family, I think I'd regard NHS service as patchy at best, and less than satisfactory if I was forced to wait over 12 months for - say - a hip replacement. There's certainly scope for improvement.
Take a look at average yearly health insurance premiums in the USA, and suddenly £2400 doesn't seem so bad.

Also (and I accept there's an economic right wing argument in favour of this, but) with a health insurance model the poor pay as much as the wealthy (maybe even more, if their health is poor due to poverty). In the UK the poor in theory get their health care at much less than a £2400 yearly cost, with the balance being covered by those on high incomes (at least, ignoring tax avoidance).
 

Cheshirechappie

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I don't think the US healthcare system is perfect, either. Obama's attempts to provide care for the less well off seem to have caused sufficient financial pain to some in the lower middle classes to have resulted in significant push-back. Also, a nation that spends 17% of GDP on healthcare (compared to about 7% typically in many other countries) suggests a system with a fair amount of profiteering somewhere along the line, and as little seems to be done legislatively about that, one wonders about links between legislators and some in the health business. However, I don't really know enough about US health care to comment in too much detail, except to say that I don't think it's a system to copy.

Other countries do seem to deliver better care - Taiwan* and Germany have been mentioned, but I suspect both of those have their problems, too. I think if there were any simple solutions to the problem of delivering universal health care, they would have been identified and implemented by now. That we struggle on with a less than perfect system just emphasises the complexities.

Edit to add;

* Or it may have been Singapore - I do recall a S.E.Asian country with a hybrid public/private healthcare system being mentioned somewhere as being sufficiently effective and efficient as to be worth examining to see what could be learned.
 
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alanpo68

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Take a look at average yearly health insurance premiums in the USA, and suddenly £2400 doesn't seem so bad.

Also (and I accept there's an economic right wing argument in favour of this, but) with a health insurance model the poor pay as much as the wealthy (maybe even more, if their health is poor due to poverty). In the UK the poor in theory get their health care at much less than a £2400 yearly cost, with the balance being covered by those on high incomes (at least, ignoring tax avoidance).
It isn't even that just look at what happens to people who have paid their healthcare premiums and then they get a serious illness.
 

RobinBHM

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Healthcare provision around the world....the NHS performs pretty well. It is very good value for money.

But on many metrics, such as early cancer treatment, waiting lists etc etc it's not great....but that's because it's underfunded.

Americas healthcare system is way down the table.


Having a healthcare system free at the point of service is an amazing thing for a society to have.

the leading cause of bankruptcy in USA is healthcare bills.
 

alanpo68

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Healthcare provision around the world....the NHS performs pretty well. It is very good value for money.

But on many metrics, such as early cancer treatment, waiting lists etc etc it's not great....but that's because it's underfunded.

Americas healthcare system is way down the table.


Having a healthcare system free at the point of service is an amazing thing for a society to have.

the leading cause of bankruptcy in USA is healthcare bills.
Having a healthcare system free at the point of service should be the basic tenet of a civilised society. It should be a basic human reaction to help those in need. Would anyone really go to someone in a medical emergency and start quibbling about a price.

It is the same as the vaccine passport, people doing things for the greater good.
 

sploo

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I don't think the US healthcare system is perfect, either. Obama's attempts to provide care for the less well off seem to have caused sufficient financial pain to some in the lower middle classes to have resulted in significant push-back.
I can quite believe - though just imagine how much that burden would be reduced if large corporations we're paying their fair share; rather than avoiding (literally) billions in legal tax avoidance schemes.

Also, a nation that spends 17% of GDP on healthcare (compared to about 7% typically in many other countries) suggests a system with a fair amount of profiteering somewhere along the line, and as little seems to be done legislatively about that, one wonders about links between legislators and some in the health business. However, I don't really know enough about US health care to comment in too much detail, except to say that I don't think it's a system to copy.
There's definitely a lot of price gouging in the US medical and pharma industries (one of the reasons Americans who can skip across the border to Canada to get prescriptions). One other issue is the high levels of litigation; my wife's worked in the US and tells me that US hospitals tend to be very cautious with testing - in the sense that they'll throw pretty much every applicable test at a patient (even at high cost and potential discomfort for the patient) because it's considered less risky than the chance of being sued because you missed some statistically insignificant illness and the patient later took you to court. All these things (high drug costs, lots of expensive testing due to risk of litigation, and litigation itself) make the US system very costly.
 

Rorschach

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You are right we should sell the NHS to the USA.

They will run it so much better. The ambulance may well drive past you if you cannot afford to pay and you might spend a huge amount on healthcare but at least you won't have to worry about false stories from the Mail and Express about immigrants exploiting the system.
Did I say sell it to the US? Did I even mention wanting a US style system? No. Just because I think the NHS is in need of serious reform doesn't mean I want to go to a fully private model, wouldn't exactly benefit me since I couldn't afford it! This why I say it's become a religion, we can't have a proper discussion about it.
 

Chris152

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Trainee neophyte

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The last system to be held up as free market is the USA. It's a very cozy cartel with corrupt politicians siphoning off enough of the profit to keep all the top players very comfortable indeed. Lobbying is a Lucrative Investment, Researchers Find Using CRP Data - OpenSecrets News

Somewhere in the world there is the best healthcare system with the lowest cost to the country. How hard would it be to find out which one works best, and copy it?

Edit: this list says France is number one, and Italy number two. I seem to remember some kind of Italian crisis, so perhaps take it with with a pinch of salt (either the list or the crisis - your choice). Anyway: Best Healthcare In The World 2021
 
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alanpo68

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Did I say sell it to the US? Did I even mention wanting a US style system? No. Just because I think the NHS is in need of serious reform doesn't mean I want to go to a fully private model, wouldn't exactly benefit me since I couldn't afford it! This why I say it's become a religion, we can't have a proper discussion about it.
The NHS has been continually reformed though. We had a Royal commission under Thatcher in 1979, we then had a review 1988, followed by new GP contracts in 1990, then in 1991 we had the patients charter, in the mid 90's the number of regional health authorities was cut to 8, NHS direct was introduced in 98, then in 2000 we had the NHS 10 year plan, then in 2004 we had the creation of foundation trusts, In 2009 we had the NHS constitution. Then in 2012 we had the Health and social care act.
 

Rorschach

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The NHS has been continually reformed though. We had a Royal commission under Thatcher in 1979, we then had a review 1988, followed by new GP contracts in 1990, then in 1991 we had the patients charter, in the mid 90's the number of regional health authorities was cut to 8, NHS direct was introduced in 98, then in 2000 we had the NHS 10 year plan, then in 2004 we had the creation of foundation trusts, In 2009 we had the NHS constitution. Then in 2012 we had the Health and social care act.
All that and it still needs a lot of work! lol
I don't think we will ever get things right until we accept that the basic premise is flawed. That being said, Brexit may well help in that regard, we'll see.
 

Fergie 307

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At the end of the day I am sure there will be many venues that will adopt a policy of refusing admission to anyone who cannot prove they have been vaccinated. It is the proprietors choice, in much the same way as a nightclub might refuse to let you in because you are wearing trainers. If this is the case then some recognised official document would seem an entirely sensible way to demonstrate your vaccination status. Now if there is a good medical reason for you not to have been vaccinated, I am sure there will be exemptions, just as there are for masks. If you have simply decided not to have it as a personal choice, then I think you have to accept that some people will make it their, equally valid, choice not to let you enter their shop or whatever. To suggest that this is the first step towards a police state is frankly ludicrous.
 

Jameshow

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Why is the basic premise flawed?

I would suggest the management of that service us flawed in areas, the obvious Stafford case comes to mind.

Problem the better we are at staying alive the more it costs. My grandparents died weeks after retirement. Thankfully that isn't the case these days, but it costs money.

Cheers James
 

alanpo68

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All that and it still needs a lot of work! lol
I don't think we will ever get things right until we accept that the basic premise is flawed. That being said, Brexit may well help in that regard, we'll see.
Which premise is flawed ?
 

Rorschach

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Which premise is flawed ?
Free healthcare, no questions asked, no contribution needed, no incentive to live a healthy lifestyle/take care of yourself. It's treated as some kind of magic service that appears as if out of nowhere and for free and we keep getting told it's free. It isn't free, we all (mostly) pay for it and yet we allow ourselves and visitors to the country to abuse it.
 

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