NHS breaking point?

Discussions about serious topics, for serious people
Post Reply
User avatar
jimbob
Stummy Beige
Posts: 4023
Joined: Mon Nov 11, 2019 4:04 pm
Location: High Peak/Manchester

NHS breaking point?

Post by jimbob » Tue Apr 05, 2022 8:11 am

My girlfriend has just phoned her friend's GP for her, as she's not doing well after Covid (triple vaccinated but autoimmune illness, and was recommended to suspend her usual medication during Covid).

187 phone calls to get through.
Have you considered stupidity as an explanation

User avatar
Little waster
After Pie
Posts: 2113
Joined: Tue Nov 12, 2019 12:35 am
Location: About 1 inch behind my eyes

Re: NHS breaking point?

Post by Little waster » Tue Apr 05, 2022 9:09 am

My partner works in early-stage dementia care. (All mistakes in the following are my own).

They call it the Memory Protection Service (MPS) and the idea is if they can identify the dementia as soon as it presents then early intervention can slow the progression for years which both saves money and adds immensely to the QALYs the patient and their families enjoy.

The flipside is once the dementia has progressed a bit further then treatment becomes a lot less effective and the regime switches to a purely palliative one and the patient is transferred to the next unit which deals with moderate-to-severe dementia. Once the patient reaches that stage the disease tragically runs its course all too quickly and the patient is rapidly "lost" even if the physical body remains a while longer.

The key then is early identification and intervention and can be the difference between a few more years with your loved ones watching your grandkids grow and get married and a rapid descent into the fog.

Staff shortages, delays in referrals, issues with GPs etc. are now seeing them regularly breaching their contracted waiting times*, which can now run into 8 months or more so by the time the patient presents to Mrs Waster they are already too far gone and she can do no more then pass them along to the moderate-to-severe unit. These are patients she could have genuinely helped had she just seen them quick enough, which she finds heart-breaking.

*The idiocy of the Coalition's NHS deforms means it appears to be only a matter of time before the MPS has its contract removed by the CCGs due to issues outside their control (but often ironically down to the CCGs), the service then gets dissolved and the nurses and doctors are "fired" as its "business model" (which is the term they use) will no longer be considered viable. What happens next is Kafkaesque as there is no alternative provider available and even if there was their only option would be to re-hire the exact same staff facing the exact same issues of absent GPs, shortage of qualified nurses, lengthy referral times etc. The more likely option then is the MPS team will be broken up and the "fired" staff will simply be rolled into the existing general dementia care units and you'll dilute that expertise in early-intervention and hence lose that benefit. Ultimately that translates into higher costs and worse patient outcomes so everyone's a loser.

Thanks Clegg, Thlegg.
This place is not a place of honor, no highly esteemed deed is commemorated here, nothing valued is here.
What is here was dangerous and repulsive to us.
This place is best shunned and left uninhabited.

User avatar
Fishnut
After Pie
Posts: 1977
Joined: Mon Nov 11, 2019 1:15 pm
Location: UK

Re: NHS breaking point?

Post by Fishnut » Tue Apr 05, 2022 11:35 am

The weekend-before-last, my mum's partner was taken to hospital three times by ambulance after feeling faint, having low blood pressure and tightness in his upper chest/lower throat. The first time was friday evening and he was stuck in the ambulance outside the hospital for about 6 hours (putting that ambulance out of action for the duration of their wait). In A&E they did basic tests, couldn't find anything and discharged hin. Same thing on the saturday, though he got into A&E much quicker as it was the morning. Same thing on sunday, with us all hoping he'd be kept in to do proper tests and find out what was actually wrong. They were about to discharge him when he had another incident so they kept him in for a few more hours, then as soon as he was stable they discharged him.

He died on Friday. It's going to be 3 weeks before the post mortem can be done due to a backlog and Easter. We are pushing for them to see if the problems he had caused his death and whether proper investigation/treatment could have prevented it - I think we want a coroner's inquest but I'm no sure if that's the right terminology and, if it is, how we get one. I don't think that anyone was personally negligent, I'm sure everyone he saw did the best they could. But the hospitals are understaffed and overworked and they just don't have the capacity to keep people with weird stuff that comes and goes.

My next-door neighbour has multiple health problems and has been bedbound for the last year or so. He has two carers coming in four times a day to look after him. His wife was told about a week ago that they have two weeks of support and then it will be withdrawn as they don't have enough staff. They were just one of 23 families being given the news that the care they rely on was being withdrawn. The only option for him was going to be to go into a nursing home, which we knew he would hate (he spent most of the first year of the pandemic in one due to circumstances I won't bore you with) and would probably refuse. 'Fortunately' his health has rapidly declined, he caught covid, and he's unlikely to last much longer (tbh I'm surprised he made it through the weekend), so hopefully he can die at home like he wants.

Everything is breaking. We are a rich country yet we have people living in desperate poverty and essential services falling apart at the seams. It's despicable.
it's okay to say "I don't know"

User avatar
bjn
After Pie
Posts: 2030
Joined: Wed Sep 25, 2019 4:58 pm
Location: London

Re: NHS breaking point?

Post by bjn » Tue Apr 05, 2022 12:27 pm

My recent experiences are with child mental health services. To be blunt, they effectively don’t exist for practical purposes. Unless you are at the extremes of psychosis or self harm they don’t have time to see you.

User avatar
jimbob
Stummy Beige
Posts: 4023
Joined: Mon Nov 11, 2019 4:04 pm
Location: High Peak/Manchester

Re: NHS breaking point?

Post by jimbob » Tue Apr 05, 2022 12:34 pm

Little waster wrote:
Tue Apr 05, 2022 9:09 am
My partner works in early-stage dementia care. (All mistakes in the following are my own).

They call it the Memory Protection Service (MPS) and the idea is if they can identify the dementia as soon as it presents then early intervention can slow the progression for years which both saves money and adds immensely to the QALYs the patient and their families enjoy.

The flipside is once the dementia has progressed a bit further then treatment becomes a lot less effective and the regime switches to a purely palliative one and the patient is transferred to the next unit which deals with moderate-to-severe dementia. Once the patient reaches that stage the disease tragically runs its course all too quickly and the patient is rapidly "lost" even if the physical body remains a while longer.

The key then is early identification and intervention and can be the difference between a few more years with your loved ones watching your grandkids grow and get married and a rapid descent into the fog.

Staff shortages, delays in referrals, issues with GPs etc. are now seeing them regularly breaching their contracted waiting times*, which can now run into 8 months or more so by the time the patient presents to Mrs Waster they are already too far gone and she can do no more then pass them along to the moderate-to-severe unit. These are patients she could have genuinely helped had she just seen them quick enough, which she finds heart-breaking.

*The idiocy of the Coalition's NHS deforms means it appears to be only a matter of time before the MPS has its contract removed by the CCGs due to issues outside their control (but often ironically down to the CCGs), the service then gets dissolved and the nurses and doctors are "fired" as its "business model" (which is the term they use) will no longer be considered viable. What happens next is Kafkaesque as there is no alternative provider available and even if there was their only option would be to re-hire the exact same staff facing the exact same issues of absent GPs, shortage of qualified nurses, lengthy referral times etc. The more likely option then is the MPS team will be broken up and the "fired" staff will simply be rolled into the existing general dementia care units and you'll dilute that expertise in early-intervention and hence lose that benefit. Ultimately that translates into higher costs and worse patient outcomes so everyone's a loser.

Thanks Clegg, Thlegg.
My girlfriend works in a related area. Best interests assessments and deprivations of liberty for those who lack mental capacity within social services.
Have you considered stupidity as an explanation

User avatar
discovolante
Stummy Beige
Posts: 3415
Joined: Fri Oct 11, 2019 5:10 pm

Re: NHS breaking point?

Post by discovolante » Tue Apr 05, 2022 12:46 pm

My sister called 111 a few weeks ago with severe abdominal pain and was advised to go to A and E. She did and they sent her home and told her to see her GP. So she did and then waited 2 weeks for a phone appointment and got booked in for some tests. Then the tests got pushed back a further 2 weeks so she still hasn't had them yet. She says she's feeling a bit better (well clearly not in as much pain as she was, but she can't eat properly - and on that note I'd be really grateful if people could avoid speculation as to the cause! Believe me there isn't much I haven't already imagined) but she is clearly not actually better. Maybe not the worst war story/anecdote on this thread so far but I am quite worried and also upset for her that she keeps having to wait even longer when she's not feeling well and doesn't know what the cause is.
I'M HEATING STREAKY BACON IN A TROUSER PRESS

IvanV
Dorkwood
Posts: 1298
Joined: Mon May 17, 2021 11:12 am

Re: NHS breaking point?

Post by IvanV » Tue Apr 05, 2022 1:35 pm

It has long been predicted that the NHS would reach breaking point (though it's really a breaking broad-fuzzy edge):

On the demand side:
Demand growth from aging population
Technical change producing better, but more expensive, therapies
Technical change increasing the number of things you can do, if you have the money
Demand for better trained staff, as things get ever more complicated, and the basic is ever less acceptable; so, eg, now nurses have to have a degree, unlike my mother who entered nursing with 3 O-levels (predecessor of GCSEs) which makes staff cost more

On the funding/supply side:
A markedly lower proportion of gdp spend on health services than our peer nations.
With a lot of labour-intensive services, costs grow with wage costs, which is mostly higher than inflation
Unwillingness to create the training capacity for the number of staff we need to have the kind of doctor per pop ratio of our peer nations100% funded from taxes, it's difficult to grow the funding to benchmark rates, without some major change to tax policy more like France, that seem unlikely here

We were ambling towards and maybe already well into that breaking broad-fuzzy-edge. But Covid suddenly pushed us well past that broad-fuzzy-edge, well into broken territory. Now no one can see waiting lists being reduced to manageable levels within less than about a decade. Waiting lists will continue to grow, as it takes time to expand output even to stop them growing. There's no plan to put in the resources required to get them down to sensible lengths in the near future, or even put in place that sensible spare capacity the health service needs to deal with fluctuations in demand, and avoid being on the edge of crisis most of the time.

Where do we go from here? My personal view is that the old funding model is now broken and unsustainable. But there will be a huge political impediment to doing anything about it, as the electorate just don't get the huge amounts of money needed and how it can plausibly be funded. The consequences it would have for tax rates if it remained 100% taxpayer funded would probably also be unacceptable to them.

Our peer nations put a higher proportion of gdp into health services, but they generally only achieve that because they use a co-funding model (eg France). Even France has pretty eye-watering tax rates by British standards, and they co-fund their health service. Clearly there are some exceptions like Norway whose public sector has so much money they can continue to fully fund the health service from tax. But few places can do that.

I don't know how this is done politically. The British people will find it very hard to believe that what mostly worked for over 70 years is now irreparably broken. They will think it a Tory plot to "privatise" the health service, the usual pejorative term applied to any attempt to make money go further, or increase the funding other than through taxation. And I rather suspect that any attempt by the present administration to try to "repair" it could well be a plot of that nature.

A couple of parables on Not Enough Money. When François Hollande was president of France, he had lots of high cost ambitions he was voted in on. Then he quickly discovered that even at French tax rates, it was unfundable. He tried putting tax rates up, but that was so clumsily done that Gérard Depardieu became Belgian. It didn't work, and Hollande had to scale back his plans. Ambitious public sector plans do need funding, and funding doesn't come from the air. I think Keir Starmer would discover a similar issue here, if he tried to find the money.

Maybe it needs something like the month of 5 presidents in Argentina. In less than 30 days in Dec 2001 to Jan 2002, there were 5 different presidents. They were repeatedly overthrown because the people would not accept the austerity of spending to the available amount of money. No one would lend Argentina any money any more after its default, so short of Weimar-style money-printing, which would only make things worse, they had to budget within the actual quantity of money available. Eventually the people accepted that there just wasn't the money to meet their demands, once told it for the 5th time. And the 5th president of that month, Eduardo Duhalde could get on with the job of begining Argentina's reconstruction, subject to a promise of early elections.

User avatar
Opti
Dorkwood
Posts: 1201
Joined: Mon Nov 11, 2019 11:21 pm
Location: On the beach

Re: NHS breaking point?

Post by Opti » Tue Apr 05, 2022 1:46 pm

I have, unfortunately, had to very recently make use of emergency medical care in Austria and Spain. I've had amazingly good care in both systems.
From here it really does look like the NHS has gone past breaking point. :(
Time for a big fat one.

User avatar
Woodchopper
Light of Blast
Posts: 5416
Joined: Sat Oct 12, 2019 9:05 am

Re: NHS breaking point?

Post by Woodchopper » Tue Apr 05, 2022 2:18 pm

IvanV wrote:
Tue Apr 05, 2022 1:35 pm
Clearly there are some exceptions like Norway whose public sector has so much money they can continue to fully fund the health service from tax. But few places can do that.
Norway doesn't do that. Adults have to pay for each visit to the doctor, clinic etc. A visit to the GP costs about £16, a specialist about £37, a psychologist £37, a visit to A&E is about £21, an xray is about £26 and bandages about £10. That's far less than someone would pay in the US, and it is still heavily subsidized. But an accident resulting in a fracture is going to cost someone circa £50.

There is though a personal limit of circa £300 per year, and once someone exceeds that everything is free.

In effect adults who need regular medical attention pay £300 more per year than those that don't.

monkey
Dorkwood
Posts: 1341
Joined: Wed Nov 13, 2019 5:10 pm

Re: NHS breaking point?

Post by monkey » Tue Apr 05, 2022 2:51 pm

Woodchopper wrote:
Tue Apr 05, 2022 2:18 pm
IvanV wrote:
Tue Apr 05, 2022 1:35 pm
Clearly there are some exceptions like Norway whose public sector has so much money they can continue to fully fund the health service from tax. But few places can do that.
Norway doesn't do that. Adults have to pay for each visit to the doctor, clinic etc. A visit to the GP costs about £16, a specialist about £37, a psychologist £37, a visit to A&E is about £21, an xray is about £26 and bandages about £10. That's far less than someone would pay in the US, and it is still heavily subsidized. But an accident resulting in a fracture is going to cost someone circa £50.

There is though a personal limit of circa £300 per year, and once someone exceeds that everything is free.

In effect adults who need regular medical attention pay £300 more per year than those that don't.
That seems about the same that it would cost me in the US... if you ignore the amount I (and my employer) spend on me having insurance in the first place.

IvanV
Dorkwood
Posts: 1298
Joined: Mon May 17, 2021 11:12 am

Re: NHS breaking point?

Post by IvanV » Tue Apr 05, 2022 3:40 pm

Woodchopper wrote:
Tue Apr 05, 2022 2:18 pm
IvanV wrote:
Tue Apr 05, 2022 1:35 pm
Clearly there are some exceptions like Norway whose public sector has so much money they can continue to fully fund the health service from tax. But few places can do that.
Norway doesn't do that. Adults have to pay for each visit to the doctor, clinic etc. A visit to the GP costs about £16, a specialist about £37, a psychologist £37, a visit to A&E is about £21, an xray is about £26 and bandages about £10. That's far less than someone would pay in the US, and it is still heavily subsidized. But an accident resulting in a fracture is going to cost someone circa £50.

There is though a personal limit of circa £300 per year, and once someone exceeds that everything is free.

In effect adults who need regular medical attention pay £300 more per year than those that don't.
Thanks for that. So even Norway co-funds their health service, and they have the best funded public sector in Europe. Though these are fairly small payments, especially for Norwegians, where everything is sodding expensive. It won't contribute much to the overal financial needs of their system

According to the ONS (2017) - see Figure 1 - Norway spent about £4,600 per person on health care, so £300 doesn't go very far towards that, especially with not everyone paying it. I suspect it is more about avoiding frivolous taking up of time, than raising a reasonable amount of money. Figure 2 of that link shows % of GDP for a smaller selection of countries. France, in 2017, was at 11.3% of GDP compared to our 9.6%, which is 18% more. The US figure reminds us how it is possible to be wasteful with health expenditure.

User avatar
EACLucifer
After Pie
Posts: 2080
Joined: Fri Dec 13, 2019 7:49 am
Location: Behind you

Re: NHS breaking point?

Post by EACLucifer » Tue Apr 05, 2022 4:28 pm

IvanV wrote:
Tue Apr 05, 2022 3:40 pm
I suspect it is more about avoiding frivolous taking up of time...
Worth remembering that £16 for a visit to the GP does virtually nothing to deter the middle class worried well, but an awful lot to restrict access for poor people.

User avatar
dyqik
Light of Blast
Posts: 5543
Joined: Wed Sep 25, 2019 4:19 pm
Location: Masshole
Contact:

Re: NHS breaking point?

Post by dyqik » Tue Apr 05, 2022 4:58 pm

EACLucifer wrote:
Tue Apr 05, 2022 4:28 pm
IvanV wrote:
Tue Apr 05, 2022 3:40 pm
I suspect it is more about avoiding frivolous taking up of time...
Worth remembering that £16 for a visit to the GP does virtually nothing to deter the middle class worried well, but an awful lot to restrict access for poor people.
Yeah, the idea of co-pays is ludicrously unequal, and promotes ever higher inequality, and can easily cost more than it brings in (much like means testing). Restricting access to healthcare restricts access to jobs, and restricts the ability to be an economically useful member of society.

monkey
Dorkwood
Posts: 1341
Joined: Wed Nov 13, 2019 5:10 pm

Re: NHS breaking point?

Post by monkey » Tue Apr 05, 2022 6:06 pm

EACLucifer wrote:
Tue Apr 05, 2022 4:28 pm
IvanV wrote:
Tue Apr 05, 2022 3:40 pm
I suspect it is more about avoiding frivolous taking up of time...
Worth remembering that £16 for a visit to the GP does virtually nothing to deter the middle class worried well, but an awful lot to restrict access for poor people.
Yep.

And even so, while I am not poor, co-pays still have me guessing whether I need to have something checked up. Generally, it's "Am I going to spend $20 and a bunch of time off work* to be told 'rest it up, take some OTC painkillers, and come back next week** if it still hurts.', or do I reckon it's something more serious". I am not qualified to do that sort of reckoning - that's the whole point of doctors. I can't properly imagine what's it's like for those worse off than me, especially the parents among them.

Co-pays could be waived for those who might need it in any system where they exist - much like the prescription charge in the UK is. But I'd prefer a universally free-at-the-point-of-use system.



*The size of this problem is employer dependent, my boss has always been cool with me taking time off for medical stuff, but in an "At Will" state like mine, you have no right to paid sick leave and you could even loose your job. Nearly all employers aren't that c.ntish, but it does happen. This is a separate issue to the funding of healthcare, and would not happen in the UK, or any other Global North nation, as far as I'm aware.

**If you can get an appointment that soon.

IvanV
Dorkwood
Posts: 1298
Joined: Mon May 17, 2021 11:12 am

Re: NHS breaking point?

Post by IvanV » Tue Apr 05, 2022 10:24 pm

EACLucifer wrote:
Tue Apr 05, 2022 4:28 pm
IvanV wrote:
Tue Apr 05, 2022 3:40 pm
I suspect it is more about avoiding frivolous taking up of time...
Worth remembering that £16 for a visit to the GP does virtually nothing to deter the middle class worried well, but an awful lot to restrict access for poor people.
I'm certainly not recommending the general method of the Norway system for this country, as it is very regressive. But Norway has much lower poverty in both an absolute and relative sense than this country, and it probably makes much less difference there.

The challenge for Britain is to devise a fair and proportionate method of better funding our health service, which does take a bit more from the pockets of those desiring service, according to their ability to afford it.

Let's not dis the "worried well", be they middle class or otherwise. A large role of doctors is to examine the worried and show that there is nothing wrong with them, or at least nothing much wrong with them. The genuinely worried do often need a medical service to find that out. That's the very best outcome - there's nothing wrong with you. I have been very pleased when doctors have told me that I wasn't having a heart attack or stroke, and I didn't have colon cancer, and my eye didn't need an immediate emergency operation, despite in each case presenting as someone who might well do. It required some considerable investigation in each case to track down the true explanation of what was happening. I certainly couldn't have worked it out myself, for all the internet these days. I was well, it turned out, but worried for good cause. More broadly, when such things happen, the worst thing to do is not be worried and so delay finding out, by which time it might be too late.

User avatar
Fishnut
After Pie
Posts: 1977
Joined: Mon Nov 11, 2019 1:15 pm
Location: UK

Re: NHS breaking point?

Post by Fishnut » Wed Apr 06, 2022 9:20 am

it's okay to say "I don't know"

Herainestold
After Pie
Posts: 1821
Joined: Mon Nov 25, 2019 1:23 pm

Re: NHS breaking point?

Post by Herainestold » Wed Apr 06, 2022 3:09 pm

I just wonder if all this is a prelude to Johnson's plan to sell/privatize the NHS, as predicted by Corbyn.
Like they are doing with Channel 4.
Masking forever
Putin is a monster, Russian people are not.

User avatar
Fishnut
After Pie
Posts: 1977
Joined: Mon Nov 11, 2019 1:15 pm
Location: UK

Re: NHS breaking point?

Post by Fishnut » Wed Apr 06, 2022 3:24 pm

NHS under ‘enormous strain’ in England as trusts declare critical incidents
Dr Layla McCay, director of policy at the NHS Confederation, which represents the whole healthcare system, said the situation had become so serious that “all parts” of the health service were now becoming “weighed down”. This will have a “direct knock-on effect” on the ability of staff to tackle the care backlog, she added, as well as the current provision of urgent and emergency care.

She sounded the alarm after a major ambulance trust, South Central Ambulance Service (SCAS), which covers 7 million people across Berkshire, Buckinghamshire, Hampshire, Oxfordshire, Sussex and Surrey, declared a critical incident after “extreme pressures” forced it to prioritise patients with life-threatening illnesses.

At the same time, six hospitals across Yorkshire issued a joint warning for people to stay away from emergency departments except for in “genuine, life-threatening situations” after a surge in numbers left some patients waiting for up to 12 hours.

With nearly 20,000 people in hospital with coronavirus in England, these latest critical incidents highlight how once again the pressure on our health service is mounting,” McCay said. “Ambulances, A&E departments and frontline providers of care across all parts of the NHS are weighed down by heavy demand. [my emphasis]
But the pandemic is over /s
it's okay to say "I don't know"

User avatar
Ben B
Stargoon
Posts: 138
Joined: Mon Nov 11, 2019 3:28 pm
Location: Uranus

Re: NHS breaking point?

Post by Ben B » Wed Apr 06, 2022 4:05 pm

This is deliberate Tory policy
  1. Underfund the NHS for decades
  2. Talk up its failings and downplay the pressure it is under
  3. Present privatisation as a solution to "fix" it
  4. Profit
The first ten million years were the worst.
And the second ten million, they were the worst too.

IvanV
Dorkwood
Posts: 1298
Joined: Mon May 17, 2021 11:12 am

Re: NHS breaking point?

Post by IvanV » Wed Apr 06, 2022 4:33 pm

Ben B wrote:
Wed Apr 06, 2022 4:05 pm
This is deliberate Tory policy
  1. Underfund the NHS for decades
  2. Talk up its failings and downplay the pressure it is under
  3. Present privatisation as a solution to "fix" it
  4. Profit
Someone else wrote:I just wonder if all this is a prelude to Johnson's plan to sell/privatize the NHS, as predicted by Corbyn.
As I mentioned upthread, there are many - especially on the left - who use "privatisation" as a generic insult for many kinds of potential NHS reform they wish to disparage, whether they are reasonably described as such or not. And it is an effective form of insult, that appeals to the voter, fake news that it often is. It tends to result in preventing any kind of effective reform that might result in something nearer to the better health services of our peer nations on the continent.

I don't really see how we get past that taboo until the NHS is in such a mess that a consensus around the need to do something sensible arises. So I think it happens deliberately or otherwise.

I think even the Tories understand that true privatisation - as they have in the US - is non-runner. Everyone can see how disastrous the US health service is. Anyone going that way will be out of office before they finish it. I think the Tories' real instinct is for increased contracting out. That can be abused to dob money the way of their friends, and we have seen recently how it has been abused in that way. But it doesn't have to be abused. The GP service has always been contracted out, and no one says that is what is wrong with it.

But actually contracting out is beside the point. It is incapable of addressing the main point, which is that funding is grossly insufficient for the demand placed on the service. It is the funding of the health service that needs addressing, not details in the way the service is delivered. There is no reason to believe there is so much inefficiency in it that if that could somehow be rooted out the money would now go far enough.

User avatar
nekomatic
Dorkwood
Posts: 994
Joined: Mon Nov 11, 2019 3:04 pm

Re: NHS breaking point?

Post by nekomatic » Wed Apr 06, 2022 10:47 pm

That being the case, if we accept the premise that the current funding model is irreparably broken, then any alternative model needs to either a) convince people to accept less from the NHS for the same or less money, or b) persuade people that paying more than they currently do is worth it in order to get the level of healthcare they consider adequate.

Is there a viable model of (a)? I can, sadly, believe that enough voters might accept being screwed over by a private insurance system on the basis that well, we couldn’t afford the NHS any more could we, it’s only right that we have to pay our way now, and so on, but it’s still got to be a risk for any government to bet the farm on that. On the other hand it seems to me that general taxation is the most progressive way of funding healthcare, so any (b) alternative needs to convince those on higher incomes that they need to pay an even bigger share if it’s not to disadvantage those lower down. So are voters really that thick that they can’t deal with the simple premise that yes, your income tax needs to go up by four percent* because that’s what will pay for a decent NHS? Would they wear it if it were hypothecated, and came out as a separate ‘National Health Insurance’ line on their payslip, even if functionally identical to a plain old tax rise?
Move-a… side, and let the mango through… let the mango through

User avatar
lpm
Junior Mod
Posts: 4787
Joined: Mon Nov 11, 2019 1:05 pm

Re: NHS breaking point?

Post by lpm » Wed Apr 06, 2022 10:56 pm

Two tier healthcare

- Basic survival NHS
- Paid for healthcare, with people/employers taking out insurance

In other words, a reversal of the current NHS/BUPA ratio.
⭐ Awarded gold star 4 November 2021

monkey
Dorkwood
Posts: 1341
Joined: Wed Nov 13, 2019 5:10 pm

Re: NHS breaking point?

Post by monkey » Wed Apr 06, 2022 11:14 pm

lpm wrote:
Wed Apr 06, 2022 10:56 pm
Two tier healthcare

- Basic survival NHS
- Paid for healthcare, with people/employers taking out insurance

In other words, a reversal of the current NHS/BUPA ratio.
So a bit like the US then? It works really well and it's not at all expensive.

I also really hate that my healthcare is decided by who I work for.


(The US has Medicare for the poor, Medicaid for the old, and the VA system for veterans. Everyone else gets insurance through their employer, by themselves, or through charity.)

User avatar
dyqik
Light of Blast
Posts: 5543
Joined: Wed Sep 25, 2019 4:19 pm
Location: Masshole
Contact:

Re: NHS breaking point?

Post by dyqik » Wed Apr 06, 2022 11:50 pm

monkey wrote:
Wed Apr 06, 2022 11:14 pm
lpm wrote:
Wed Apr 06, 2022 10:56 pm
Two tier healthcare

- Basic survival NHS
- Paid for healthcare, with people/employers taking out insurance

In other words, a reversal of the current NHS/BUPA ratio.
So a bit like the US then? It works really well and it's not at all expensive.

I also really hate that my healthcare is decided by who I work for.


(The US has Medicare for the poor, Medicaid for the old, and the VA system for veterans. Everyone else gets insurance through their employer, by themselves, or through charity.)
And it costs the US government more per capita than the UK government spends on the NHS.

And requires far more labour to administer and to deliver healthcare.

Millennie Al
Dorkwood
Posts: 1410
Joined: Mon Mar 16, 2020 4:02 am

Re: NHS breaking point?

Post by Millennie Al » Thu Apr 07, 2022 1:37 am

nekomatic wrote:
Wed Apr 06, 2022 10:47 pm
That being the case, if we accept the premise that the current funding model is irreparably broken, then any alternative model needs to either a) convince people to accept less from the NHS for the same or less money, or b) persuade people that paying more than they currently do is worth it in order to get the level of healthcare they consider adequate.
Persuade rich people that using the NHS shows that you're poor so many will pay for private treatment that they could have received on the NHS. Private hospitals could provide better food (emplying skilled chefs etc), nicer decor, and other things that make no difference ot the treatment but attact business. Just like happens in other parts of life - people spend more on clothes, cars, flights etc than actually necessary - that's why we have first class seats on planes and trains. Make it socially unacceptable for someone to use the NHS when they could have easily afforded to pay for private treatment. It's no different to people running their own car or taking a taxi when there's a bus service.

Post Reply