NHS

Govt should admit that there is not enough money to provide a full range of healthcare for everyone.

Reduce reliance on target setting

Allow additional funding to reach the front line services without it being hijacked in additional "administration"

Allow patients free access to services independent of geography (or postcode) - if a service is available in one location it should be available nationally.

Trust people with healthcare training to make decisons about the delivery of healthcare and then trust people with financial training  to provide the finance.


Listen to what patients want and prioritise on what improves quality of life first.  Urgent treatments need to be delivered quickly but not at the same speed as non-urgent procedures that are not interfering with quality of life.  Recognise this and don't force everything to be done within the same timescale.

Should I go on ...?

The main reason that most Health Plans in most countries fail, is that the person receiving the services, is not the person paying for the services.

For example, if you need an operation to correct a small wart on your butt, that is not visible, and does not hurt, but is cover by insurance, for little or no expense to you, then there is no motivation for you to worry about the cost, you would probably have it done.

A perfect example of cost reduction because of consumers (in the USA) is Lasik surgery (where they correct your vision so that you don't need glasses) it is not covered by most insurance, but is covered under most medical savings plans.

Because the person getting the surgery is actually paying the bill, they shop around for the best bargain, which has caused the surgery to drop drastically in price to less than $500 an eye in many markets.

The (USA) medical savings plan is a good example of something that (sort of) works.  You put away part of your income to pay for medical expenses, and you don't pay taxes on that money.  The bad part is that if you over fund the account you loose any money that is not spent by the end of the year.  (This is the part that could be fixed but I am not sure how, yet.)  Since the owner of the account can get more services if they monitor their costs, they tend to choose the providers with more reasonable costs.

Anyway, it is natural economics, if something is "Free" (to you) or already paid for, then you don't really care about the cost.  

The other side of the coin is that in most medical plans (either insurance or government) there is no motivation for the providers to control costs, especially if they are funded by a percentage of the costs.  

The assumption is wrong, NHS is working and well too. It is the media hype and expectations of the public. Where else can you get such a quality service which is free? The waiting lists are coming down and the hospitals are much cleaner.   There are enough doctors and nurses in my opinion.

 The consultants are interested only private practive, each working probably three days a week. Make them work for their salary to imporve the efficiency of the system and to improve waiting times. Cut out the managers from the system. Remove the free for all treatment- make a partial fee system: every one needing to pay a certain sum for consultation  or use the insurance system for payments. Penalise the patients who do not attend appointments causing massive waste. Remove the health tourism from the system. If a visitor to Britain needs treatment (except emergency), they need to pay. Reduce government targets- allow the doctors and patients to choose the targets, dates for admission/operation being set in the clinic during consultation. Educate the staff on cleanliness and make sure it is practised. Ask doctors to remove overcoats, ties and long sleeved shirts which are cause of contamination, make nurses wash their ward uniforms daily to reduce infection.Do  less paperwork.  Invest in research to find newer effective treatments. Improve health of population.

neopolitan, please don't take this personally, your post raises a lot of salient points that I want to address.

>>The assumption is wrong, NHS is working and well too.
But it could be working better, particularly given the amount of extra funding directed at it over the last few years.

>>The waiting lists are coming down and the hospitals are much cleaner.  
According to whose figures?

>>There are enough doctors and nurses in my opinion.
But there are not enough posts for them to work in the NHS (see the MTAS fiasco)

>>The consultants are interested only private practive, each working probably three days a week.

There are very few NHS consultants who do not rely on their NHS income
Most are actually committed to delivering care for patients who could not obtain it privately & many who whould be appalled to discover that this is the perception

>>Make them work for their salary
This is a condition of the new NHS contract that ties consultants into limited private work

>>to improve the efficiency of the system and to improve waiting times. Cut out the managers from the system.
Which do you want?  Consultants should be providing the front-line care for patients, this is what they are trained to do, although some also make excellent managers if you have GOOD managers they should be managing - that's what they're trained to do, then you have a well managed service whare the people who can provide care for patients are doing it and not taking time away from treatment so they can sort out the managing.  Managers also cost less to use for management than well meaning medical, surgical and nursing experts.

>> Remove the free for all treatment- make a partial fee system: every one needing to pay a certain sum for consultation  or use the insurance system for payments.
No argument but this is political suicide for whichever party decides to try, the opposition will seize of the "destruction of the NHS" .

>>Penalise the patients who do not attend appointments causing massive waste.
Again agree, the suggestion of £5 to see your GP was suggested but again politically it is "privatisation" and discriminates against those in a poverty trap who neither get state benefit nor can afford care.

>>Remove the health tourism from the system.
Why?  It is adding millions to the economies of eastern European states who are providing care to UK patients who cannot get timely care in their own country ;)

>>If a visitor to Britain needs treatment (except emergency), they need to pay.
Not going to happen while we are part of the bigger European health economy (although in France it is already a requirement to pay a fixed fee when you use state healthcare for their residents - see £5 above)

>>Reduce government targets- allow the doctors and patients to choose the targets, dates for admission/operation being set in the clinic during consultation.   YES!!!!!!!

>>Educate the staff on cleanliness and make sure it is practised. Ask doctors to remove overcoats, ties and long sleeved shirts which are cause of contamination, make nurses wash their ward uniforms daily to reduce infection.
Yes but better handwashing would make a more substantial difference.  In 1997 10% of patients had their discharges delayed because of hospital acquired infection.  Ten years later the proportion is roughly the same.

>>Do  less paperwork.  
Too nebulous - perhaps getting the right people to do the right paperwork would be better.

>>Invest in research to find newer effective treatments.
And then send it to NICE if it is too expensive and needs rationing

>>Improve health of population.
Empower them to look after their own healthcare, after all you are more likely to die if you go to hospital!

Since the Bristol heart surgery and Shipman cases the medical profession has taken a huge dent but another thing worth consideration is trusting a profession to make the right choices.


I will now hide while the bricks are thrown ;)

The whole way in which the NHS funds are managed introduces extra levels of bureaucracy and so inefficiency. Unfortunately the medical profession proved themselves incapable of managing and improving the hospitals within which they worked. The result has been the introduction of managers who have by comparison to the medical staff, few qualifications. It is all too common now for medical staff to have 3, 4 or 5 degrees and their managers just 1. That doesn't make the managers unintelligent but it does mean they are not as well qualified as the staff they are supposed to be managing.

One of the fundamental problems is that we don't actually have a National Health Service. We have a National Sickness Service. By that I mean we spend a fortune on treating illnesses and little on preventing diseases through education and preventative actions. The whole medical profession is wedded to the concept that diseases and health can be dispensed at the pharmacy. You don't believe me, well consider for a moment Cuba. The stupid Americans have had an embargo on selling Cuba a whole range of anything and everything including medicines. Yet despite that Cuba has the second best record for births in the world - after Canada. They don't have that by default but only because they make a great deal of effort in preventive medical care for pregnant women.

We haven't even started to think about improving the health of the nation, instead we only attempt to treat the failures.

I agree that this waiting list scam is a ridiculous attempt to pull the wool over our eyes; no longer are you able to book an appointment for a weeks time since these stupid stats say you waited for a week. It's a bit like like my local Kwik-Fit while you wait tyre shop, drop your car off in in the morning and come back in the evening and they haven't done the job because you weren't waiting!

NHS costs about £1400 per annum per capita, you would get a far better deal through the government giving you the money and buying health care with it. Even private medicine is overpriced here, it's cheaper to fly to France to get a hip replacement than have one here privately and to go to Poland to the dentist!

>How about some personal accounts of experiences in English hospitals?

I had my nose re-bored about 15 years ago and there were several other patients in the ENT ward; in the morning after the op' waking up quite groggily I could hear the bloke in the next bed feebly crying "nurse, nurse..." so I started calling "nurse, nurse..." and then a fountain of bloody puke erupted from the guy's mouth! It was funny at the time and Matron got it cleaned up fairly quick but it goes to show how dificult it is to keep a hospital clean, splashes went at least 6 feet.

Next time I have surgery I want to have it at home, hospitals are full of people with diseases - last place I want to be opperated on.

Synthetics,

Many countries people such as the U.S. equate the Social Canadian Health Care with NHS in the U.K., they are close in many ways, but NHS is better than Canada's Health Care, that is why it is so easy for the thousands upon thousands of Canadians to come to the U.S. for surgeries, where in Canada you may die waiting for care. There are a large group in Canada who pay the U.S. Insurance companies monthly premiums to have access to our Health Care.

All large corporations must offer very affordable Health Care to all of it's employees, and about 80% of smaller Companies. I can get a medication which costs $1,500.00 or more for $5.00 per script.

On my way into work on March 04, 2000 at 4:00am a drunk driver ran me off the road at 85mph (136kph) directly into a concrete column supporting an overpass. I was taken to the nearest Trauma Center by Medical Helicopter, I was later told they didn't think I would make it...

The first surgery took over seven hours to stop all the internal bleeding, four broken ribs had pierced my Heart (Had to replace a valve in my heart) and Left lung, also lost part of my Liver, one Kidney, and my Spleen. After eight days in the Intensive Care Unit, I was moved to my private room where I was told I had Leukemia and an unknown Bone Marrow disorder, plus they found I had Type II Diabetes. I spent six weeks and four days in the Hospital.

During an MRI, they found swelling in my brain and had to drill a hole in my skull to relieve the pressure, all charges including tests; the MRI, four Cat-Scans, Nuclear medicine, eight X-Rays, repaired a compound fracture on my left leg, a complete replacement of my right knee, two breaks in my right arm, and all medications while there, including Chemo Therapy, the final charges were well over $400,000.00, all I had to pay was $130.00 out of pocket.

Under Hillary Care II, I would have to paid 10% (42,000.00), on average I have to see four Specialists 40 to five times per month, my cost for each visit is $5.00 Co-Pay. Had I been a Canadian Resident, I would still be here writing this.

I am completely against any Government Health Care system.

But what good is "full range" healthcare that makes you wait months to get treatment? You could be dead by then. Delaying treatment until its no longer necessary because the patient is dead is no way to cut costs.

Even the simplest of medical equipment is tremendously expensive. What motivation does a hospital have to invest large amounts of money in new equipment if the payback period exceeds the equipments useful life? A shortage of MRI machines is the reason waiting lists for an MRI scan can take as long as four months in Canada.

Can you imagine what it must be like having to wait that long to be diagnosed (let alone treated) for a life threatening condition, all the while knowing your life could be in jeopardy?

Even worse, the system is structured in such a way as to make it illegal to obtain healthcare services at your own cost, which is an untenable situation.

ahh.. Well I think NHS is still a better system then we have here..

We had a to have a few cuts in Doctors and Nurses, even though we are short.
But we have to look at bright side of things due to these cuts and the money made from them, we had to 'Increase the Salary' of the Health Minster and Some Top Doctors running the health care system, that would solve the problem.. Ahh maybe not, coz we need more cuts nows because some bureaucrat managers didn't get their cut..

--
From My Point of view, any system is like the question 'which came first the chicken or the egg'..

More like trying to solve it.. The Problem is that you put money into health care at then it is mis-management, so what do you? Simple, put more people to manage the system that will solve the problem right?

Yeah.. but for a few year, now you need more doctors/nurse/ beds etc..
Make a few cuts, increase the number of doctor/nurses/bed...  That will fix all the problems right?

Not quite.. you now are back to the same problem.. mis-management..

Other things happen as well, doctors/nurses/managers demanding more pay..
Or the Government put out a new plan system which cost the tax payers billions of pounds and its a totally waste. Or they could do something like the Irish Government did and Pay for Computer software which was suppose to cost 8 Million Euros to build but actually cost 150 million instead and need another 100 million to finish it.

Sometime we think too many people managing the system will fix it, but they don't. But if we have too few managing we normal end up with the same problem..

-Muj ;-(

There isn't a British NHS, there's a Scottish, Welsh, Northern Irish and English NHS.

Which one do you want to fix?  The English NHS is chronically underfunded, we still pay for most of our prescriptions and when our elderly get old and infirm they have to sell their homes and posessions to pay for their care.  In Wales they don't pay for prescriptions and they don't pay for elderly care.  In Scotland 96% of their prescriptions are free and they don't pay for elderly care.  In Northern Ireland most of their prescriptions are free and they don't pay for elderly care.  The English taxpayer pays for this superior service via the annual subsidy the Scottish Chancellor gives to Scotland, Wales and Northern Ireland.