Sorry I misunderstood, I thought you were saying people should be able to not have insurance/coverage at all. My bad, too much arguing with Americans about healthcare over the years..
NHS faces biggest financial crisis 'in a generation'
- Thread starter Nick 0208 Ldn
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Hahaha
We are leaving
Its not an eu initiative thats why the card can be used in non eu European countries
Where the UK stands, with regard to both private and public expenditure: https://www.oecd.org/unitedkingdom/Country-Note-UNITED KINGDOM-OECD-Health-Statistics-2015.pdf
I have a question for those presently living abroad, or posters with direct experience of their health systems. Is there an ongoing policy of centralising the provision of services in countries comparable to Britain?
There are two reasons why i ask: firstly, my local area has suffered severe cuts, mostly under Labour but also the Tories; secondly, the concept seems to necessitate us building facilities which bear a closer resemblance to Terminal 5 at Heathrow.
On the anecdote front, my uncle was rather lucky this week. He had been admitted for surgery on his gall bladder, and was laying there waiting to be taken to the operation, only for someone to step in and cancel the procedure due to it being unsafe. He's had some trouble with his heart in the past you see. The day before he was sent home on account of there being no bed for him (this was at the Royal London where there can be a sudden spike in trauma cases).
Saying that, St Thomas' has served me well over the years, and UCH has done well by my father.
I have a question for those presently living abroad, or posters with direct experience of their health systems. Is there an ongoing policy of centralising the provision of services in countries comparable to Britain?
There are two reasons why i ask: firstly, my local area has suffered severe cuts, mostly under Labour but also the Tories; secondly, the concept seems to necessitate us building facilities which bear a closer resemblance to Terminal 5 at Heathrow.
On the anecdote front, my uncle was rather lucky this week. He had been admitted for surgery on his gall bladder, and was laying there waiting to be taken to the operation, only for someone to step in and cancel the procedure due to it being unsafe. He's had some trouble with his heart in the past you see. The day before he was sent home on account of there being no bed for him (this was at the Royal London where there can be a sudden spike in trauma cases).
Saying that, St Thomas' has served me well over the years, and UCH has done well by my father.
What do you mean by this?
There is a tendency toward creating these hospital hubs, and either scaling back or withdrawing local services altogether. This can range from maternity care to A&E units.
Assuming we stay in the EEA
Its your positivity that makes me feel so warm
It's happening in Germany too but it is difficult to compare to the UK. The health systems are so different that there has been and still is per se a big difference in number of physicians, nurses or hospital beds per citizens. Some years back, Germany had for example more than twice as many hospital beds as the UK per 10,000 citizens and 75% more physicians per 10,000 citizens.
Junior doctors spend most of their time doing admin to be fair, it's part of the job description.
The NHS is failing but we cannot do any more than pour more money into the leaking bucket.
Admin includes walking round wards instead of operating? Not in other countries
Junior docs don't operate.
Well then thats not who I'm talking about
I don't understand? What kind of jobs do you think 23 year old medical school graduates do? Heart transplants?
@Cassidy
Means testing and restricting a universal program is usually the 1st step to demolishing it - remember, rich people's opinion counts many times more, and the moment they lose all connection to some program they will have no incentive to keep it funded.
Means testing and restricting a universal program is usually the 1st step to demolishing it - remember, rich people's opinion counts many times more, and the moment they lose all connection to some program they will have no incentive to keep it funded.
The will of the people was and is clearly to leave the EEA. Show me any evidence to the contrary.
We are heading for a hard exit. We will be treated the same a citizen of any other nation outside the EEA.
That's daft. The NHS isn't there to generate a profit. It's success is making people better. We have an ageing population that needs more care so the amount of money going into the service should increase.
Or brain surgery. 
Yet the UK has a longer life expectancy than Garmany. What's killing you guys?
At least watch surgey being performed like my mrs had to, she never went round wards looking for beds.
Junior doctors 100% do operate, seeing as the terms refers to everyone from a fresh faced 23 year old medical school graduate to a 40 year old ST7 registrar a few months away from being a consultant.
Registrars will operate. Depending on seniority, sometimes by themselves. Core trainees should be operating too, to further their own learning in the specialty they want to do (obviously as the assistant to the consultant). And Foundation doctors should be in theatre to actually learn, rather than just be there for service provision. After all, they are tomorrow's registrars and consultants.
Instead, doctors all the way up to consultant are weighed down in ridiculous amounts of admin from all sides and are having training opportunities cut away from lack of theatre time, because of situations like this. My surgical colleagues are not even sure if they'll be able to hit their minimum required number of ops this year.
I'm not sure about abroad but I understand the rationale behind it actually comes from the military. They found that soldiers had better outcomes if they provided simple care for problems locally and then transported them to a centre for excellence, where they could have their various operations. Apparently waiting for a bit to do the operation (for a blast injury for example) in a centre of excellence where the specialists in both medicine and nursing were concentrated had better outcomes than if they attempted to do ops in more isolayted places where their support and expertise was not as substantial.
It apparently works quite well for things like stroke as well, which London is very well covered by.
I guess the problem for me is...how well does this work outside of London (or perhaps other big cities too, I don't have experience of working in Manchester, Leeds etc). Its quite easy to get from one hospital to the other. For patients and for families. There is great public transport. There are just more services. And a few of the trusts (Guys & St Thomas especially) are absolutely rolling in money.
But does this work quite so well when you have to go not to your local DGH but the one an hour drive away? How regularly can your family visit there? Is it easy for them to do so? What happens in that delay to you getting to the hospital?
I'd be interested like you to know how things work in other countries.
I was talking about foundation docs as opposed to junior ones to be honest. I've been on an orthopaedic placement, and my exposure to actual theatre time has been absolutely minimal. Most of my mates are in similar situations, it seems our jobs consists mainly of paperwork/fluids and clerking patients. It's exactly what we expected though, and it's hard to imagine that things were ever different.
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Another one for Jeremy Hunt's wankbank.
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The NHS problem is not a funding one. It has been adequately funded for 20 years, and overall funding is above the OECD average. As shown in the chart below, state funding per capita is similar to that of similarly developed countries.
The big problem is obviously demand. The increase in demand has by far outpaced any feasible funding increases, and will continue to do so. As a nation we are too old, too fat, too drunk and too stationary - based on our current physical state, an increase in funding sufficient enough to solve the crisis would result in our health spending being so high that an impartial observer watching from outer space would have to conclude that our labour force is nothing more than a slave unit whose primary purpose is to serve an ageing/sick population. Once we start being honest and admit to ourselves that the bulk of the NHS crisis can be attributed to demand and not funding, we can start to seriously look at solutions. For example:
- We need to end the madness of our medical research being focused so strongly on extending the life of the elderly rather than improving the health of the young. In fact, the extension of life past current life expectancies should start to be looked upon as a moral wrong. This is obviously a global issue and not a domestic one.
- Leading healthy lifestyles should be looked upon not just as a service to the individual, but a duty to the wider nation. Likewise, unhealthy lifestyles should merit greater social disgust.
Away from demand, the next big issue that I can see is management. We need to look at re-centralising the NHS. Scrap healthcare devolution to the Welsh/Scottish/NI assemblies and return them to the management of competent civil servants and ministers who are properly accountable. I'm not very clued up on the NHS in Scotland and NI, but in Wales the NHS is in such a bad state that the UK government should have intervened years ago. As for England, re-centralisation will put an end to the corruption and incompetence of overpaid local trust CEOs and directors. Also, re-negotiate GP contracts - have GP surgeries be run fully as public institutions rather than as quasi-private companies where surgeries act for their own benefit rather than for the benefit of the wider NHS.
The big problem is obviously demand. The increase in demand has by far outpaced any feasible funding increases, and will continue to do so. As a nation we are too old, too fat, too drunk and too stationary - based on our current physical state, an increase in funding sufficient enough to solve the crisis would result in our health spending being so high that an impartial observer watching from outer space would have to conclude that our labour force is nothing more than a slave unit whose primary purpose is to serve an ageing/sick population. Once we start being honest and admit to ourselves that the bulk of the NHS crisis can be attributed to demand and not funding, we can start to seriously look at solutions. For example:
- We need to end the madness of our medical research being focused so strongly on extending the life of the elderly rather than improving the health of the young. In fact, the extension of life past current life expectancies should start to be looked upon as a moral wrong. This is obviously a global issue and not a domestic one.
- Leading healthy lifestyles should be looked upon not just as a service to the individual, but a duty to the wider nation. Likewise, unhealthy lifestyles should merit greater social disgust.
Away from demand, the next big issue that I can see is management. We need to look at re-centralising the NHS. Scrap healthcare devolution to the Welsh/Scottish/NI assemblies and return them to the management of competent civil servants and ministers who are properly accountable. I'm not very clued up on the NHS in Scotland and NI, but in Wales the NHS is in such a bad state that the UK government should have intervened years ago. As for England, re-centralisation will put an end to the corruption and incompetence of overpaid local trust CEOs and directors. Also, re-negotiate GP contracts - have GP surgeries be run fully as public institutions rather than as quasi-private companies where surgeries act for their own benefit rather than for the benefit of the wider NHS.
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How much more funding do people want? £40 billion? £80 billion? And where is this money going to come from? The magic money tree? All departmental budgets are stretched and it is not feasible to place further tax burdens on the economy at this point. You can't just call for greater funding unless you can account for where is will come from and how it will be sustainable. And even if the money can be found? Then what? It's not going to solve the demand problem, it's only going to make it worse as we will become more complacent as a nation as far as out health is concerned.
I want to slap Labour politicians around their stupid fecking faces whenever I hear them harp on about NHS funding.
I want to slap Labour politicians around their stupid fecking faces whenever I hear them harp on about NHS funding.
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Fair point but this just isn't going to happen while we've got a Tory government who are reliant upon old people for votes, and find themselves lagging in regards to getting younger vote.
You wouldn't realistically be able to scrap the NHS in Scotland without losing Scotland itself, which would make the whole process pointless. At most, you'd maybe get away with it under an immensely popular governing party (and even then that's a stretch) but there's absolutely no way it'd work with a Tory government in charge.
I'd say a significant portion of the NHS being competently run under a devolved administration relates to the competence of that administration - as it is Wales keep on voting for the same party to be the biggest member of any government.
Yes, Scotland's control of NHS Scotland is unlikely to be challenged any time soon - I was thinking of an ideal more than a practical reality in that sentence. However, the state of the NHS in Wales is so bad that I think an end to healthcare devolution in Wales could be on the cards. The problem is, the people in Wales are fecking clueless on this issue - and I say that as a Welshman. The average person doesn't understand that healthcare is a devolved matter and that Westminster has very little say in it. The people who should be held to account (namely Plaid and the Welsh Labour Party) are being allowed to ruin the NHS without any scrutiny because nobody gives a shit about Assembly politics. In fact, while I'm at it, scrap the Welsh Assembly altogether....the Welsh people never really wanted it in the first place.
I'm not sure this graph shows what you want to show. This is total health expenditure per capita so if the UK is in a good position by being "above average" in terms of funding, the US must be the best in the world at healthcare. The US is "first" but is terrible. Switzerland is second but is good. Israel is miles down the list but is pretty good.The NHS problem is not a funding one. It has been adequately funded for 20 years, and overall funding is above the OECD average. As shown in the chart below, state funding per capita is similar to that of similarly developed countries.
What matters is how it is funded from both a private and public sector perspective.
Actually, in terms of trends, the biggest one is age, and unfortunately, unlike health, you can't reverse it. The UK is aging and the dependency ratio (ratio of retirees to working age people) has increased - because Baby Boomers are now retiring. Two-fifths of the NHS budget is spent on over-65s and it's going to get worse.
We haven't become that much unhealthier - we're living longer than ever - but unfortunately, this contributes to the problem.
There are only morbid solutions to the demand in this area, unfortunately.
NHS Scotland does pretty well, though. NHS England and NHS Wales are the terrible ones. I think devolution, if anything, is the better solution, and it needs to go further by integrating the NHS and hospitals into councils for social care, which of course has a fat chance of happening under this government.
A 1% rise in NI has been mooted and has majority support according to some polls.
It's still not enough, but I don't think tax rises can be ruled out. In fact, I don't really see any other solution in the short-term.
I wasn't trying to illustrate a link between expenditure and outcomes, but to instead put into perspective UK spending to show that the NHS is not underfunded compared to other nations. In the face of the chart, the argument to increase funding would have to acknowledge that the UK would need to increase spending to relatively exceptional levels if it is correct in saying that an increase in funding is necessary for the desired outcome.
Indeed, but some morbid realities are better than others and the future is going to be a morbid one if trends continue. It's a question of how we manage it - do we allow the working age population to be worked into the ground to fund an increasingly elderly and unfit population, or do we face up to the fact that we need to look at putting a halt to life expectancy?
More taxation on the work force? No thanks. The regressive NI taxation system is already too high. A 1% increase in NI contributions will do nothing to help the NHS, but could be the straw on the camel's back as far as our fragile economy is concerned.
That's the bottomline IMO. I am a doctor in USA and so I see it everyday. When you live longer odds are you are going to get sicker and need more care and so that takes up more of the healthcare dollars. We, as in the productive members of the society who are working have to contribute more now and hope that when we get there, we will get similar care. I have my doubts about the care we will get when we are in 70s and 80s. I just cannot imagine how this can continue.
As he said there are only morbid solutions to this demand.
I'd argue that pretty much all Western nations have a healthcare issue. The UK is facing a £30b deficit on the NHS by 2020/21. France's is struggling.. We all know the US is shafted. In fact, healthcare spending across the OECD has lagged economic growth.
Personally, I have no problems acknowledging we'd need to increase spending to relatively exceptional levels, and we won't be alone. Our society is aging and with that comes parallels to Japan - mass urbanisation, retirees taking care of older retirees, a ridiculous burden on workers...
I agree NI is regressive but I don't think a tax increase is necessarily that bad as such. Remember, the health system isn't just for the old, but for the healthy too. The healther the population, the more they spend, and the economy benefits as well. Obviously, it's not as simple as "quadruple spending and quadruple the economy" but taxation is more subtle than that. A small increase but focusing on things that help middle-class workers may end up with reasonable returns. It's arguably partly why the US's system is so messed-up - they spend more per capita than the rest of the Western world, but they get amongst the worst bang for buck. Hence the healthcare debate there.
Apparently, the triple lock costs us about £6b a year. If it's too much to get workers to pay, and it's not ethical to just kick the can and get the next generation to pay (oh, but they will try - it's already happening in the US - Google "filial responsibility laws") then there is no choice but to get the pensioners to pay. And in some cases I think that's kind of fair - that the NHS has a deficit is largely due to a consequence of their actions (it's not like millennials could have stopped the financial crisis nor got our grandparents to have more kids) so they will have to share the burden as well.
Personally, I think the solution is along the lines of - legalize euthanasia (the morbid bit), and increase taxes/reduce spending elsewhere - including a raise in income tax and abolishing the triple lock. This is about as likely to happen as me marrying Scarlett Johansson.
I think dying with dignity sadly needs to become a thing, short of massive technological breakthroughs and the societal changes that come from it actually work.
Tax is not a burden, so the solution is to increase them
No, I think you have lost your bearings on these points.The NHS problem is not a funding one. It has been adequately funded for 20 years, and overall funding is above the OECD average. As shown in the chart below, state funding per capita is similar to that of similarly developed countries.
The big problem is obviously demand. The increase in demand has by far outpaced any feasible funding increases, and will continue to do so. As a nation we are too old, too fat, too drunk and too stationary - based on our current physical state, an increase in funding sufficient enough to solve the crisis would result in our health spending being so high that an impartial observer watching from outer space would have to conclude that our labour force is nothing more than a slave unit whose primary purpose is to serve an ageing/sick population. Once we start being honest and admit to ourselves that the bulk of the NHS crisis can be attributed to demand and not funding, we can start to seriously look at solutions. For example:
- We need to end the madness of our medical research being focused so strongly on extending the life of the elderly rather than improving the health of the young. In fact, the extension of life past current life expectancies should start to be looked upon as a moral wrong. This is obviously a global issue and not a domestic one.
- Leading healthy lifestyles should be looked upon not just as a service to the individual, but a duty to the wider nation. Likewise, unhealthy lifestyles should merit greater social disgust.
Away from demand, the next big issue that I can see is management. We need to look at re-centralising the NHS. Scrap healthcare devolution to the Welsh/Scottish/NI assemblies and return them to the management of competent civil servants and ministers who are properly accountable. I'm not very clued up on the NHS in Scotland and NI, but in Wales the NHS is in such a bad state that the UK government should have intervened years ago. As for England, re-centralisation will put an end to the corruption and incompetence of overpaid local trust CEOs and directors. Also, re-negotiate GP contracts - have GP surgeries be run fully as public institutions rather than as quasi-private companies where surgeries act for their own benefit rather than for the benefit of the wider NHS.
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