Split Thread The future direction of the NHS

Henri McPhee

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This is a split thread from the Brexit-focused Now What? thread.
Posted By: Agatha


I don't like the way the junior doctors are new being provoked into going private, or encouraged to emigrate, by the government causing NHS strikes. It's not good human relations. The same sort of thing happened a few years ago with regard to NHS dentistry. Long queues started forming in some parts of the country as people desperately searched for an NHS dentist.

It's all very well for pundits on TV to whinge about the doctors. Most of those journalist pundits are on private health care schemes, as are most bankers and politicians. It's people who are not on private health insurance, and who need hip replacements, or have brain tumours, or heart attacks and strokes who are the people who suffer. It's like politicians advocate comprehensive schools and then have their own children privately educated.

Most people now have no idea what it was like before the NHS. You had to pay to have a baby born. The BMA was opposed to the NHS at first and they had to be persuaded to join by the then Labour government.

It's typical lack of strategic vision by the government. A capitalist government consists of a private sector and a public sector, not just a few prospering billionaires.
 
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Henri McPhee said:
I don't like the way the junior doctors are new being provoked into going private, or encouraged to emigrate, by the government causing NHS strikes. It's not good human relations. The same sort of thing happened a few years ago with regard to NHS dentistry. Long queues started forming in some parts of the country as people desperately searched for an NHS dentist.

It's all very well for pundits on TV to whinge about the doctors. Most of those journalist pundits are on private health care schemes, as are most bankers and politicians. It's people who are not on private health insurance, and who need hip replacements, or have brain tumours, or heart attacks and strokes who are the people who suffer. It's like politicians advocate comprehensive schools and then have their own children privately educated.

Most people now have no idea what it was like before the NHS. You had to pay to have a baby born. The BMA was opposed to the NHS at first and they had to be persuaded to join by the then Labour government.

It's typical lack of strategic vision by the government. A capitalist government consists of a private sector and a public sector, not just a few prospering billionaires.
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....and how does all of this relate to Brexit as opposed to a more generic "Ills of the NHS" or "Remoteness of the political classes" subject ?
 
The Don said:
....and how does all of this relate to Brexit as opposed to a more generic "Ills of the NHS" or "Remoteness of the political classes" subject ?
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The point I was trying to make is that Brexit affects the healthcare of British people, unless perhaps you are in the Royal family where every health problem is covered privately. I don't know the full details, but I believe the Spanish healthcare system now covers the health costs of British people living in Spain. I don't know how much longer that arrangement will continue with Brexit.

I remember once being told a story of a young boy in America who needed a brain operation. His family was asked for $30000 which they could not raise. Not all those kinds of operation can be funded by public appeals.

A few years ago I was rather surprisingly told for some reason by mail that I was on a committee of my local NHS Trust. I was bombarded with surveys about my opinions of the local NHS Trust. I was full and frank with them about matters, like the lack of parking at local hospitals, and the closure of local hospitals, and various other matters.

The other point I was making on this forum is that before the second world war, if you had a serious illness, or an accident, or TB, then that could cause financial anxiety to some people. That doesn't seem to bother the posters on this forum, or Victorian workhouse discipline which could easily happen again if the government has its way.

The other point I was trying to make is that these private healthcare schemes which are so popular with the elite, and trade union officials, do not cover chronic illness, like multiple sclerosis, or things like genetic disorders, or if you think you are being bugged, or even problems which affect the elderly, like cataract operations.

There is a bit about all this in a Guardian UK newspaper article in 2013, or 2014 which I can't link to this forum. It seems to be funded by the private healthcare industry, but it makes some interesting points.

This is part of that article:

"Dr Jacky Davis, a consultant radiologist in north London and co-chair of the NHS Consultants' Association, who took part in the discussion, says she has never been convinced about the superiority of the private sector. She argues that despite a lot of talk about private sector innovation, what it actually does is to save money and increase profit. Wages and salaries are expensive, so private providers often cut staff numbers, downgrade terms and conditions and employ people on zero-hours contracts, she says.

The private sector, Davis adds, tends to take on more straightforward elective procedures and leaves more difficult and expensive work to the NHS."
 
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Henri McPhee said:
The point I was trying to make is that Brexit affects the healthcare of British people, unless perhaps you are in the Royal family where every health problem is covered privately. I don't know the full details, but I believe the Spanish healthcare system now covers the health costs of British people living in Spain. I don't know how much longer that arrangement will continue with Brexit.

I remember once being told a story of a young boy in America who needed a brain operation. His family was asked for $30000 which they could not raise. Not all those kinds of operation can be funded by public appeals.

A few years ago I was rather surprisingly told for some reason by mail that I was on a committee of my local NHS Trust. I was bombarded with surveys about my opinions of the local NHS Trust. I was full and frank with them about matters, like the lack of parking at local hospitals, and the closure of local hospitals, and various other matters.

The other point I was making on this forum is that before the second world war, if you had a serious illness, or an accident, or TB, then that could cause financial anxiety to some people. That doesn't seem to bother the posters on this forum, or Victorian workhouse discipline which could easily happen again if the government has its way.

The other point I was trying to make is that these private healthcare schemes which are so popular with the elite, and trade union officials, do not cover chronic illness, like multiple sclerosis, or things like genetic disorders, or if you think you are being bugged, or even problems which affect the elderly, like cataract operations.

There is a bit about all this in a Guardian UK newspaper article in 2013, or 2014 which I can't link to this forum. It seems to be funded by the private healthcare industry, but it makes some interesting points.

This is part of that article:

"Dr Jacky Davis, a consultant radiologist in north London and co-chair of the NHS Consultants' Association, who took part in the discussion, says she has never been convinced about the superiority of the private sector. She argues that despite a lot of talk about private sector innovation, what it actually does is to save money and increase profit. Wages and salaries are expensive, so private providers often cut staff numbers, downgrade terms and conditions and employ people on zero-hours contracts, she says.

The private sector, Davis adds, tends to take on more straightforward elective procedures and leaves more difficult and expensive work to the NHS."
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Again, it seems to me that you have a more generic issue with the provision of private services into the NHS than anything specifically pertaining to Brexit.

Personally I think that the privatisation of those services has generally been done poorly with politcal dogma being the prime driver in many cases. As a consequence the health authorities have often ended up with very expensive contracts with very poor service levels.

I'm sure that there are exceptions but from what I've seen the drive to privatisation of everything from cleaning and portering through to surgery has typically resulted in greater expense and/or poorer service.

That's not to say that the NHS is perfect and that there aren't huge inefficiencies in the system but in some cases those inefficiencies are in response to public demand. It may be more efficient to have a few centres of excellence running at close to 100% capacity for certain treatments but often people don't want to or cannot travel and so there is duplication which is not strictly necessary from a clinical standpoint.

Another issue the NHS will always face is that demand for services is elastic. As new treatments become available they become a necessity. Fertility services which were unheard of a generation or two ago are now a hotly-contested right. Should a couple be entitled to in-vitro fertilisation ? If so how many rounds until they lose funding ?

It's worse when high profile cases like test-tube babies or some poor child who requires costly, ground-braking but unproven treatment grabs the headlines. It often means that other vital but un-sexy services like mental health and elderly care slip down the pecking order but that's the price of having the public influence choice.
 
P.J. Denyer said:
IIRC dentistry was privatised under Thatcher. That's when the sports cars appeared outside their surgerys.
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No :)

Family doctors, dentists, opticians and pharmacists were self-employed under a contract for services from an Executive Council. The family doctor acted as gate-keeper to the rest of the NHS, referring patients where appropriate to hospitals or specialist treatment and prescribing medicines and drugs. However the GPs had been stretched by the war, as younger doctors were away, and their pay, status and morale was low. In 1955 some money was made available to GPs to develop group practices, the beginning of a major development. Dental services consisted of check-ups and all necessary fillings and dentures. Eye tests were provided by ophthalmic opticians on production of a GP referral note. Pharmacists provided over the counter remedies and dispensed the GP’s prescriptions
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http://www.nhshistory.net/shorthistory.htm
 
In the Tory party manifesto in 2010 it said the NHS was to be safe in Cameron's hands and that there were no plans for a top down reorganisation of the NHS. As soon as they got into power the same year they promptly made the biggest top down reorganisation of the NHS in history. The Health Secretary was to be absolved from responsibility, and the NHS Trusts were to be put on the verge of bankruptcy. Cuts and closures were to be made to social care, and redundancies made to public health in local authorities, which also added to problems.

It's no wonder the junior doctors have grievances. They need more staff.There are not the beds or resources. The disastrous result is that if you have complications from broken ribs your only option now is to die at home, unless perhaps you can get into a private hospital.

I remember years ago my mother was treated for a broken ankle at Newquay hospital in Cornwall. I think that hospital in Newquay is now no more, which is the story of all these cuts and closures.

It's just the same with this past policy of mixed ability schools. The elite are not affected by it, or by the cuts to public spending, which are so popular with economists.
 
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Henri McPhee said:
In the Tory party manifesto in 2010 it said the NHS was to be safe in Cameron's hands and that there were no plans for a top down reorganisation of the NHS. As soon as they got into power the same year they promptly made the biggest top down reorganisation of the NHS in history. The Health Secretary was to be absolved from responsibility, and the NHS Trusts were to be put on the verge of bankruptcy. Cuts and closures were to be made to social care, and redundancies made to public health in local authorities, which also added to problems.
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While I have no love for the coalition and in particular the Conservative Party the highlighted seems rather Machiavellian. Instead funding of the NHS continued to grow (albeit not quickly enough to cope with the growth in population and medical inflation).

You're right about the strain being placed on social care and public health but IMO that's down to priorities. Funding is increasingly being directed towards "sexy" things like cancer care while mental healthcare, social care and so on are not getting a fair shake. That would change it there was a public outcr.

Henri McPhee said:
It's no wonder the junior doctors have grievances. They need more staff.There are not the beds or resources. The disastrous result is that if you have complications from broken ribs your only option now is to die at home, unless perhaps you can get into a private hospital.
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Unfortunately over the last few years I've had more second hand experience of NHS end-of-life care than I'd ever want and I find your characterisation both inaccurate and insulting to those who work so hard in the NHS both from the clinical AND the administrative side.

Henri McPhee said:
I remember years ago my mother was treated for a broken ankle at Newquay hospital in Cornwall. I think that hospital in Newquay is now no more, which is the story of all these cuts and closures.
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This is an example of the planned inefficiency that I mentioned a few posts ago. People would like to have hospitals with a full range of services within easy reach of their homes no matter where they live in the country. This issue is that it is very expensive to do this because the consequence is that expensive equipment and skilled medical personnel are not being used to full capacity.

The NHS can never have an infinite budget and one of the ways in which more can be delivered for less is to consolidate services into a smaller number of larger hospitals with GPs and local surgeries picking up some routine procedures.

Henri McPhee said:
It's just the same with this past policy of mixed ability schools. The elite are not affected by it, or by the cuts to public spending, which are so popular with economists.
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I'm not sure whether you're advocating in favour of mixed-ability schools - where in my experience those who do less well under a selective system have a chance to thrive - or against them.

In a selective system a smaller number of people who happen to peak at the right time and/or who have the family resources to coach them do perform better but overall the picture is less clear.
 
The Don said:
I'm not sure whether you're advocating in favour of mixed-ability schools - where in my experience those who do less well under a selective system have a chance to thrive - or against them.

In a selective system a smaller number of people who happen to peak at the right time and/or who have the family resources to coach them do perform better but overall the picture is less clear.
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What happens in practice is that parents attempt to send their children to the best comprehensive schools where there is streaming, by buying houses in the catchment areas of those best schools. Bright children from working class council estates are then held back by being put into mixed ability classes in other schools. Comprehensive school pupils later in life tend to attempt to have their children privately educated, and to have private health care. None of this affects the elite who almost invariably have their children privately educated and have private healthcare.

I don't like this recent proposal by the government for consultants to have to disclose their private work. It will force them to go private and then affect patient care. It's like the fire brigades are being reduced to a skeleton, and libraries closing. Economists only understand straight lines. The staff at Sky TV or the Daily Express, or economists, don't disclose their salaries.

It's like that lawsuit the comedy actor Gorden Kaye once had over privacy issues. From a wikiipedia:

"While recovering in hospital from emergency brain surgery to treat injuries sustained in the accident, Kaye was photographed and interviewed by Sunday Sport journalist Roger Ordish. He sued the Sunday Sport, but the Court of Appeal held that there was no remedy in English law for an invasion of privacy."
 
Henri McPhee said:
What happens in practice is that parents attempt to send their children to the best comprehensive schools where there is streaming, by buying houses in the catchment areas of those best schools. Bright children from working class council estates are then held back by being put into mixed ability classes in other schools. Comprehensive school pupils later in life tend to attempt to have their children privately educated, and to have private health care. None of this affects the elite who almost invariably have their children privately educated and have private healthcare.
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Evidence for the highlighted....

The reason that I ask is that many of my cohort at comprehensive school have turned out to be successful enough to afford both of the above but AFAIK all of their children have been educated in the state sector - several in the same school we went to.

I'm less aware of their healthcare arrangements but most people I know with private healthcare get it through their jobs rather than sourcing it themselves. Whether or not private healthcare is a key differentiator is another matter but again, as far as I'm aware it's down the list behind salary, job satisfaction, holiday entitlement and so on.
 
Lothian said:
A use of the term journalist that I haven't seen before.
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How can you denigrate the highly skilled professionals who broke the story of the Hitler Clones' Secret Moonbase (located close to the double decker bus, convenient). Woodward and Bernstien missed that one!
 
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