Let's NOT give £350m extra each week to the NHS! A better idea....

[blightymam]

That's exactly my point. Those who can't afford to pay extra will have to accept the bare minimum standard provided by the NHS.
The people who demand more and more money for the NHS usually argue from the perspective that the NHS should be the gold standard and not merely the safety-net standard, oblivious to the alternative perspective. Just like demanding more and more tax money for schools with the vision that they 'ought' to be as good as Harrow.

So those who cannot afford private should only get basic standard of care.
Who decides what that is?

Cancer patients only given pain meds rather than expensive chemo?
Old people should be left to die in their homes in great pain because they're on a pension (which was cut by government along the line) and can't afford private insurance to help them with their elderly illnesses?
Do small children who develop illnesses get little help other than basic because they happen to be born into a poor family?

Tho exactly gets to play god here with the lives of the UK?

It's totally against what the NHS stood for. The state of the health of the UK was utterly appalling before the NHS, only the wealthy could call a doctor. You really think it's ok to go back to that? Scary.

I don't believe in wasting money in the NHS. All those things should be improved before the lives of many are made worse because they happen to be poor. Not everyone can have jobs in banking etc, someone has to sweep the streets.

 

[Gerrydelasel]

So those who cannot afford private should only get basic standard of care.
Who decides what that is?

Partly the electorate, partly politicians, partly the market, same as for anything else. Who decides what the minimum wage is? Or the national curriculum?

Tho exactly gets to play god here with the lives of the UK?

Only letting people recover or die naturally is not 'playing god'. Saying we should have free healthcare at all is ultimately 'playing god'. Anything above 'nothing at all' could be abitrarily set as the minimum, right up to the standard currently acheived. There are lots of compromises and hard decisions about how to spend money in the NHS as it is. You can't just buy whatever you want regardless of the cost, even if you taxed 100% the money eventually runs out. You have to 'play god'.

You really think it's ok to go back to that? Scary.

No, you still seem to be reading my posts and interpreting them as "abolish the NHS".

Not everyone can have jobs in banking etc,

Absurd extreme. You don't have to be a banker to afford private healthcare. A full time minimum wage earner could do so, if it happened to be their priority. That's a free choice.

 

[blightymam]

Partly the electorate, partly politicians, partly the market, same as for anything else. Who decides what the minimum wage is? Or the national curriculum?


I think you'll find letting people die naturally is in fact the opposite of playing god!


No, you still seem to be reading my posts and interpreting them as "abolish the NHS". Anything above 'nothing at all' could be abitrarily set as the minimum, right up to the standard currently acheived.


Absurd extreme. You don't have to be a banker to afford private healthcare. A full time minimum wage earner could do so, if it happened to be their priority. That's a free choice.

It's not free choice for some.
So how does a minimum wage earner do it? What happens if they have children? Or should their choice of having children be taken away too? Or a disabled partner or one who has just lost a job? They pay all the rent (too poor for mortgage because they are supposed to pay £100 to bupa) bills, food, travel to work. Do you really think there's much change from their £1,200 a month salary? What about those rents in cities are much more expensive, but that's where the work is?

15 years ago I rented a tiny flat in Hertsmere, nothing special nor in a special posh town. I needed to be in or near London for my job and ideally live alone because I was up at 4.30am for work and needed my sleep, unlike when I flat shared with normal working hours people.
The cost of my rent, council tax and heating/electric/water bills it worked out at £1k a month. That's before my petrol, car costs, food, clothes, insurance costs and my work gear had to be paid. I could afford it, just, because I was on a decent wage but I didn't have much left to save up for a rainy day or a cushion. Why should I, despite paying national insurance, have to pay further for good treatment?

I mean this with the greatest respect, but it's just not reality to think that everyone can afford it nor to punish those who are poorer with money with a poorer NHS service. In fact, I would go so far as to say those are the people who need it most. If that minimum wage earner who cannot afford private insurance gets sick, it won't be long before they and their dependents are on the streets. Then eventually costing the tax payer even more in social housing.

 

[Doggit]

The simple solution is instead to accept the current standard of public service as the defult, and use private alternatives if you want better service

A better "simple" solution, would be to get rid of most of the managers that just shift paper, and record targets - which is where most of the waste comes from, chasing them unecessarily. Then you get rid of the managers at the top who are useless at their jobs, but will quitely move any one of their innept coleauges into another job because they are all on the gravy train. And finally, you decide which procedures are necessary - operations to save someones life - and those that aren't, such as cosmetic surgery to make someone feel better about themselves, and IVF treatment where people could adopt instead.

Oh, and make sure that someone is entitled to free care first, rather than just take in freeloaders from abroad.

 

[Gerrydelasel]

It's not free choice for some.

No, and it never will be. You're stating the obvious: "people can't afford things that cost more than they can afford".
You're still missing my point. In any practical universe you will always have people who ultimately have more money that others to spend on X. Those people with more money to spend on X will always be able to buy a better version of X than the people who can't afford to do so. Those poorer people have no choice but to accept the minimum standard of X, and it would be foolish to suggest the minimum standard should or even could be the same as that avialble to those who can spend more money on X. All you could practically do is place a maximum limit on the standard of X. But that would of course be silly in the case of healthcare.

Why should I, despite paying national insurance, have to pay further for good treatment?

Simple: because your concept of what constitutes 'good treatment' is more expensive than what the working populace is willing to pay in the form of tax.
Conversely, if your concept of what is 'good treatment' is within the available budget, then there is no problem.
So, do you want your broken leg to be fixed with uncomfortable plaster after a 5 hour wait, which may be well within budget, or with a space-age comfortable support within 30 minutes, which requires either more tax from everyone, or a further payment from you? Either way your leg gets fixed but the service levels are very different.

it's just not reality to think that everyone can afford it

No one would disagree with you there. Likewise most people are too poor to afford a Rolls Royce, or lobster thermidor, however much they may want it.

poorer NHS service.

Poorer service than what? Than a service which was formerly supplied but which has become unaffordable? If you increase tax to continue to provide that level of service, then what is to stop that also become unaffordable, for the same reason as last time, meaning you need even more tax, ad infinitum? You have to place a limit somewhere.

Then eventually costing the tax payer even more in social housing.

Then abolish social housing and it will cost the tax payer nothing. There is a 'solution' to everything, but 'solutions' invariably come at a cost somewhere else, so more often than not we must settle for a compromise, not a solution.

 

[blightymam]

No one woudl disagree with you there. But likewise most people are too poor to afford a Rolls Royce, but not buying a Rolls Royce for everyone is not "punishing" them.


Poorer service than what? Than the service which was formerly supplied but which has become unaffordable?


Then abolish social housing and it will cost the tax payer nothing. There is a 'solution' to eveverything, but 'solutions' invariably come at a cost somewhere else, so more often than not we must settle for a compromise, not a solution.

But you said people can afford it and now you're saying they can't? You said everyone on minimum wage could afford it. I disagree. Rolls Royce is a JohnD type comparison, please don't go there, one JohnD is enough.

Poorer service on the NHS is something you started - you said they can't expect gold standard or whatever. I asked what that entailed. I think everyone is entitled to be helped and I do not want different levels, whatever you think they are. The basics are the same - get the best help, the best cures and try and save lives or make them as good as they can be. If someone wants a room on their own in a hospital with flowers and smiling docs, to jump long waiting lists, have a nosejob, then they can pay. Everyone else should be entitled to a good, caring NHS service and most deffo not dependent on how much you earn or if can afford private.

And I thought you may say get rid of social housing. I just had this feeling, lol.

 

[Gerrydelasel]

But you said people can afford it and now you're saying they can't? You said everyone on minimum wage could afford it.

No, I said a full time minimum wage earner could do so, if it happened to be their priority.
That might require choosing not to save money, or not living in a certain house, or not owning a car, or not buying brand name goods, or not having children, or not doing a million other things that would divert that potential money somewhere else. Or they may choose to settle for the standard provided by the NHS. That's what it is to prioritise. Heck, if they chose to live on bread and water they could afford a Rolls Royce eventually! I'm just pointing out that the idle claim that you have to be 'rich' to afford private healthcare or schooling is not actually true; they're nowhere near as expensive as political rhetoric sometimes implies.

I disagree. Rolls Royce is a JohnD type comparison, please don't go there, one JohnD is enough.

Ok fair enough, how about food instead? If healthcare is essential, then presumably food is even more essential. So should the state provide free food? If yes, what kind? It can be anywhere from bare nutrition to haute cuisine...

I think everyone is entitled to be helped and I do not want different levels, whatever you think they are.

Ah, but there you are saying that people who can pay extra should not be allowed to do so; everyone should be forced to accept the same thing. (I wasn't ever saying that there should be different service levels within the NHS).

The basics are the same - get the best help,

What is best? As long as there are people who can afford private, they will always have access to something that bit better than the NHS (unless you ban private healthcare or something). So you will never be getting the 'best' on the NHS. All you can ever get from it is a compromise.

If someone wants a room on their own in a hospital with flowers and smiling docs, to jump long waiting lists, have a nosejob, then they can pay. Everyone else should be entitled to a good, caring NHS service

Which is precisely what I said all along. We're just arguing over what constitutes 'good'.

And I thought you may say get rid of social housing. I just had this feeling, lol.

Get rid of social housing, schools, the military, benefits, pensions etc, and there would be much more money available for the NHS. But I don't think you would argue for that to happen, and neither would I. Obviously you think those things should exist, but that the standard must be limited to some minimum for practical reasons.

 

[Doggit]

What this debate shows, is that we are in desperate need of defining what sort of NHS we want for the future, as we can't continue to throw money at it endlessly, as it'll just get wasted ad infinitum.

I think part of the problem is that because it's free, it's not treated with respect. Very few people self medicate; "can I take something over the counter before I really need to go to the doctor". Mothers panic and take the baby to the doctor rather than switch their brains on first, and maybe just give the kid some calpol first rather than demanding the child gets antibiotics for a sniffle. If there wasn't an automatic rush to the doctor at the first sign of trouble, then there would be a little more capacity for those that need it. Drugs reps shouldn't be allowed to push their new expensive drugs, nor give incentives for them to be used, and the NHS should have a central procurement policy, not a regional one.

I suspect if you just charged a fiver to see the doctor, it would cut the queues. Not too much that you couldn't afford it, but it'd make you look for a cheaper medicine first.

And if you made motability users pass a lie detector test, you could put all that money into the NHS as well.

 

[Gerrydelasel]

What this debate shows, is that we are in desperate need of defining what sort of NHS we want for the future, as we can't continue to throw money at it endlessly, as it'll just get wasted ad infinitum.

Precisely. If we observe that the current service is unsustainable then we need to decide what sustainable version is acceptable, or we'll forever be chasing impossible targets.

the NHS should have a central procurement policy, not a regional one.

Hmm, not sure I agree with that. Health demands do vary by region.

I suspect if you just charged a fiver to see the doctor, it would cut the queues. Not too much that you couldn't afford it, but it'd make you look for a cheaper medicine first.

Exactly, much like the dentists. I don't see any angry protests in the streets about the small surcharge for NHS dental treatment (which you don't have to pay if you're on welfare).

 

[blightymam]

There's so much wrong with the NHS which is just not the patients fault. I do think folk look at the wrong cause for a lot of the troubles.

There is wasted money, across the board. A company will sell equipment at a very high mark up, more than it's worth - and this isn't machinery I am talking about, it's things like plastic gloves, pee bottles etc. Even stop buying the most expensive medicines would help the budget and use generic ones where possible. Then there's the wasted money on management, people who've never worked in a hospital, no real understanding how it's run who make really important decisions, as well as utterly time wasting and expensive ones. The amount of time my brother (who works in the NHS) has told me how soul-destroyingly pointless these targets/changes are isn't funny and also the amount of needless paperwork he has to fill in for each patient, this has increased over the years and that time would be better off treating patients.

Then there's the fact the NHS rarely sack staff, even the really rubbish ones. They get moved on.
Oh, then there's the staff jollies. I remember photographing some pen pusher leaving work (at her hospital in London) who put together a jolly for the admin staff - not a night down the pub or a staff day running around a field with a paintball gun but tens of thousands spent on a holiday abroad for the whole admin team, 1st class travel and hotel.. Put under 'staff training' I think. That's you and I who paid for that. Oh and of course, there's the £10bn abandoned computerised central system the NHS paid for with nothing to show for it. Owning a lot of empty buildings that sit there and go to ruin.. ambulance chasers.. Add all these things up and that's a lot of money, down the drain.

But then there's the biggy. The fact that the NHS has systematically had it's funding cut for many years and at the same time as demand growing. Something has to give and it's not a shocker that it's not the NHS we once knew.

But sure, charge them to go so see the quack. Ask for everyone to get insurance. Do that and nothing will change for the better. It needs to stop being an old boys club, be held accountable how our money is spent and those sticky fingers in the NHS pie need to be chopped off

 

[Judy in the sky]

There's so much wrong with the NHS which is just not the patients fault. I do think folk look at the wrong cause for a lot of the troubles.

There is wasted money, across the board. A company will sell equipment at a very high mark up, more than it's worth - and this isn't machinery I am talking about, it's things like plastic gloves, pee bottles etc. Even stop buying the most expensive medicines would help the budget and use generic ones where possible. Then there's the wasted money on management, people who've never worked in a hospital, no real understanding how it's run who make really important decisions, as well as utterly time wasting and expensive ones. The amount of time my brother (who works in the NHS) has told me how soul-destroyingly pointless these targets/changes are isn't funny and also the amount of needless paperwork he has to fill in for each patient, this has increased over the years and that time would be better off treating patients.

A lot of equipment is actually on hire. Ranging from beds , pressure mattresses through to kitchen equipment and even some theatre equipment.
Use generic medicine instead of expensive ones? You've got to be kidding. You or I, can buy paracetamol tablets (generic) cheaper from Tesco's than the NHS can buy them for, and believe me, we must use thousands per day (just in our hospital) Wasted money on management? Yep another joke. I'm sure if you needed a life saving operation, the decision as to whether you get that operation is made by a chap in a suit and tie, who has a degree in accountancy, not medicine.
Paperwork?? It's a bloody joke. We have computers where everything could be recorded (and stored) at a fraction of the cost of the paperwork. But of course this would mean spending even more time sitting at the damn computer . If everything were to be computerised, I'm sure us nurses would have secretaries to type up care plans, wound management plans EOL plans, pain relief plans and the myriad of plans there are involved in patient care.
Paperwork too, has to be kept for a certain time (up to five years) after each patient has been discharged or has died, moved abroad or whatever.

 

[Gerrydelasel]

I feel like the NHS also needs more protection from frivolous litigation. This forces the NHS's hand to be overcautious and do things like buying brand new tools for each and every patient, and throw them away afterwards when they could be used multiple times.

 

[blightymam]

I feel like the NHS also needs more protection from frivolous litigation. This forces the NHS's hand to be overcautious and do things like buying brand new tools for each and every patient, and throw them away afterwards when they could be used multiple times.

Do they do that? Which tools? My uncle used to service the machines that sterilised a lot of surgery tools - scalpels etc.

 

[Gerrydelasel]

Do they do that? Which tools? My uncle used to service the machines that sterilised a lot of surgery tools - scalpels etc.

I'm thinking of Henry Marsh's disappointed comments on NHS waste and bureaucracy (he's not allowed to reuse his drill bits in the UK but he re-uses them in the Ukraine instead)
https://www.amazon.co.uk/Do-No-Harm-Stories-Surgery/dp/0297869876

 

[wobs]

With Brexit, the cost of medicine will go up, as we will have an extra step in drug development in addition to the EMA. You may recall we will lose EMA offices in the UK (and the loss in revenue that that brought to the area)? Well, we'll have to set up a new department. But drug companies will still have to pass any news drugs through the EMA, and our new department to get them to market in the UK, and they won't just make them for us.

There are other steps they have to go through, but this would be the main change.

Go team!