Anyone want a sensible debate on....

[Norman Verona]

Back later, off to pick the tranny up and start loading for the return to France.

I may not get back for a few days as this computer is goin.....

[lippydave]

Interesting debate.......

Point is, if you do every expierence life threatning situations, it does tend to put a different perspective on the NHS........I can't praise them enough.

I don't think anyone is maligning the medical and care capabilities of the NHS....

It does however appear that the NHS is still a wonderful organisation in spite of p*ss-poor mismanagement rather than as good as it could be with proper management....

IME the nurses and doctors at the coal face do a sterling job, but they are hamstrung by ridiculous bureaucracy and stupid working conditions...

[Blatman]

those that work the least take the most.

Surely the ultimate expression of "welfare state", an invention of the left of centre parties who envisaged a utopia of "shared wealth" through taxation and the redistribution of that taxed income where the privileged are happy to support the less well off for the good of the country. The unfortunate side effect of this is that when you strip it back it simply means that those who earn enough (that's enough, NOT a lot) end up feeling resentful in the way many demonstrate here. But I don't think there is a "welfare state" system anywhere else in the world where this isn't so.

BUT, any call to reform the welfare state and place sensible restrictions on access to services is met with rabid objections and the oft repeated "dismantling of the welfare state" nonsense. I think we all agree that it's more or less broken. Unfortunately, "we" aren't brave enough to let the powers that be take it apart so that "the problem" can at least be adequately quantified, let alone fix it...

[Dibby]

Hopefully after 10 years of Labour tyring to please everyone all the time, spending our way out of misery (kind of like w**king your way out of loneliness) and achieving nothing there are reforms in the welfare system.

It's going to be a lot harder to prove you are incapable of doing anything useful at all for the country and hopefully get a lot more people back into work

... well, that's the theory anyway. I reality I bet we'll still have thousands (millions possibly?) who know how to scam the system, claim an alcoholic allowance, claim for a dog, claim for kids that aren't living with you any more ...

[Carl]

QUOTE

Carl, one of the points about the FRench system, is that by having to pay, even though you get it back, you do not run to the doctor with every little sniffle.

However, if you put into practice what you suggest we would have empty hospitals and full morgues.

People shouldn't pay up front.

However if you have to have treatment for smoking / Obesety, drink, drugs, etc that needs over a week in hospital your NI increase by 1% for every treatment.

People regularly spend £150+ getting their car serviced every year. However, how many people spend this getting a health check on there body  

[Norman Verona]

Blatters, I sort of agree. However the Tories were in power from 1989 to 1996 and did nothing constructive.

The welfare state should look after those in need. It doesn't it looks after those who know how to get money out of it.

We vote for politicians and it's there job to stop the abuse.

Right a van to load.

[jeff oakley]

I have tried to keep out of this as my wife works as a finance director for the NHS and sees many sides of arguments about what is wrong.

There are so many reasons but we cannot afford the system we have with no restrictions, but put a restriction in place and you get the "post code lottery" headline. The NHS should be there to make people who are ill better but over the years it has become something that is dictated by choice in many areas. Cosmetic surgery for example, endless ivf sessions, gender reasignment. there can be cases made for all of these but in reality can we justify making a women with little breasts feel good by having an enlargment? no we cannot but if they say they are menatally disturbed by it they can have it.

Now the fundemental differance bewteen the French and the UK is that the French value it because they have to top up to get the best cover, we do not, so look into any A&E on a saturday night to witness what you are paying for and how much they value it. I would make these people who are there through drink pay on the door.

The goverments of the day have squander money on reorganisation after reorganisation, billions wasted on the IT system that does not work and is being scrapped, if they left it alone for say 20 years without interferring for one reason or another it would work better. At present there is so much effort into getting the new Doctor led groups together and working, but ask this question, just because a Doctor is clever does it make a good person to run a multi million pound business, the short answer is no but some will make a good job of it others will fail miserabley. And this latest change is a good example of why they should leave it alone, the basic idea of a PCT was good however the constant inteferring from target setting and reporting, took effort and expense away from the job in hand. so the answer is to change everything not just put the bit that was wrong right.

Money was thrown at certain things and ring fenced, so even if a hospital had a need for say an extra nurse, if there was no money for one they cannot have one. Which is stupid as there may well be money in another pot that cannot be touched because some mandarin says so. Perversly that is why you will have heard of new wards built as part of the PFI and yet not opened as they have no money to staff them.

There needs a balance between clinicians, unions and back office managers to arrive at a sensible soultion as they all need to pull in the same direction. the skills in the NHS are second to none in many areas, emergancy treatment and cancer being those that shine yet for basic day to day stuff the system gets in the way.

The question was can we have a sensible discussion? It is very difficult to do that without all the facts and no one has them, not even those charged with making the changes.

When you hear tales from my Dad about when the NHS was formed you can understand why it is a sacred cow to many, women who were suffering with prolapsed uterus walking around with it tied in a bag between their legs as they could not afford the care queing on the first day to get seen. We are a world away from that now but the fear of going back to that is what drives the decisions that are being made. I could go on but the truth is there is no one thing you can change that will make a differance, it is a thousand small things if they would only be allowed.

[tabs23]

Coming at this little discussion a bit late, I'd like to add my 2p-worth:

1) My personal experience of the NHS has been, as with many others, that the front-line people are doing a good job with what they're given.

2) One of my favourite ever quotes comes from PJ O'Rourke, who said something like "If you think health care in America is expensive now, you should see how much it costs when it's free".

3) Even the 'inventors' of the NHS in the 40s didn't expect it to have to last long. They expected to improve the general health of the population through education and sanitation, and then shut it down...

Stirs the pot a bit...  

[s2k7]

"If you think health care in America is expensive now, you should see how much it costs when it's free".

Here is the fix in the state, first stop this nonsense free ride healthcare.

The individual health insurance market is dominated in many states by just a handful of companies, so this provision would allow consumers to shop broadly for cheaper policies. You want to have greater competition in the insurance market.

The consumers should be able to buy less expensive policies in other states because of variations in laws and regulations.

This is absolutely a way to get lower down the cost of health insurance.

By the way, why compare a hard core socialist country like France vs UK in term of social programs?

Not even close.

[Norman Verona]

Jeff, I've eluded to a basic difference.

We spend about 1/3ed of the NHS budget on admin. We employ people to meet targets set by non-medical people.

The French spend that money on the medical side and therefore don't need targets set as they can afford to do it all.

This has nothing to do with political parties, it's peoples health. The politicians job is to provide an environment where the medics can do there job without interference  from accountants.

[Norman Verona]

Carl, sorry miised yours. So you think people shouldn't have to pay a small amount at the point of delivery.

But it's OK to pay a lot each week.

There is no NIC in France, just income tax. For the vast majority they are paying less over their lifetime than you.

[perksy]

Interesting thread this

Like Scott i work in the NHS so its interesting to see other folks take on the NHS and what we do

I spent years in Manufacturing before moving to the NHS and to say its been an eye opener, would be an understatement        

[Carl]

QUOTE

But it's OK to pay a lot each week.

There is no NIC in France, just income tax. For the vast majority they are paying less over their lifetime than you

Norm,

my point is, if the individual doesn't have any personal responsibility towards their own health, the NHS shouldn't be an open cheque book to help them. There should be some sort of penalty to encourage "healthly living"

Interestingly the obesity rate in France is 9.4% compared to 23% in the UK. Maybe this is part of the reaosn the French system costs less.

[Man On The Clapham Omnibus]

It all started to go properly wrong, IMHO, when 'they' tried to treat the NHS as a business. It is nothing like a business, it's a public service, but those whose idea it was have no idea because they have no idea about business either. What business could exist where its prime activity should be educating its customers to avoid patronising that very business? Prevention is cheaper than cure...

I agree with the poster who said that there are some treatments that should fall outside the 'free' NHS ambit: e.g. tattoo removal, breast augmentation, other cosmetic procedures... unless there is a special circumstance. I'm not too sure abortion should a free NHS procedure either (perhaps it's not, I don't know) but that's a can of worms too far.

As for paying a bit up front, I would go further and ask for the (refundable) money at the time of making the appointment and confiscate it if the patient fails to turn up.

[Dibby]

I pulled out of the company BUPA scheme a couple of years ago, they're run very much like an insurance business who wriggle their way out of claims.

Wife did a disc in her back, the MRI scan was quite impressive to a non-medically trained person. She's 30 and I had to dress her, help her up and down the stairs, she was in agony for months. Great, we'll get it sorted on BUPA, they wriggled out of anything to do with it. She also had a blood clot in her lung after the GP told her it was a muscle strain, go home with some ibuprofen, she ended up in spending days in hospital getting it sorted. Again, BUPA didn't want to know.

So with 2 out of 2 illnesses successfuly wriggled out of, what am I paying £200 a year in extra tax for? Paying extra to top up is a nice theory but in practise, if they run it like an insurance company, you pay extra for nothing.