The NHS under the Tories.

Lookyhere

the Tories have been in power for over 6 years, and regardless of your political beliefs, its clear that it is in crisis, we ve had no real winter, no flu epidemic etc so why?

Clearly demand is out stripping supply and we all ride bikes, may well need AE, most of us seem to be more than just youths, so our perent might well need adult social care and our kids a GP.

so far, the governments response is to blame GP opening hours, already 30% of practices cant fill vacancies :roll: and say they put in an extra £400m wow! thats about 3 days of extra spending - perhaps they need to look at how care homes are funded?

its probably too late to do anything at all short term, as trusts have limits on recruiting agency staff and are already dipping into capitol budgets, nurse training was cut under austerity and with brexit looming, how many eu med staff want to come here?

they ve had chances to try and improve the nations health, sugar taxes for example and failed yet can tax book makers to fund horse racing, but not McDonalds or the soft drinks industry, why is that then?

the Tories have always been accused of under funding the NHS and it now seems that is exactly what they gone and done and the next time your mum or dad have a stroke etc or you fall off your mtb, it ll be us paying for it.

Stevo_666

Advice in the thread title
http://www.bikeradar.com/forums/viewtopic.php?f=40088&t=13030866

Or even better, post there as it has become the catch all leftie (non-EU) whinge thread.

veronese68

So you don't think the NHS is underfunded and it's all just whinging?

rjsterry

Stevo 666 wrote:

Advice in the thread title
http://www.bikeradar.com/forums/viewtopic.php?f=40088&t=13030866

Or even better, post there as it has become the catch all leftie (non-EU) whinge thread.

Thought you didn't like assumptions. There's nothing specifically leftwing in the OP, just frustration at the government's current handling of the NHS. Lookahead might be a UKIP voter for all I know.

Not sure I follow the OP's last point about us paying for it as the NHS is publicly funded anyway.

secretsam

A significant part of the issue is not the NHS but social care. Health is a system of which hospitals are only one part; with an ageing and increasingly infirm population, social care, at home or in a dedicated facility is a key element.

The majority of hospital beds are not taken up with planned surgical patients; about 90% are medical emergencies. Most of these are older people, many of whom could be cared for outside of hospital, but social care doesn't have sufficient resources. So they block beds. This causes a lot jam that stretches back to A&E.

At the same time, care for people with manageable chronic conditions isn't strong enough, so rather than being managed their condition escalates and they end up in acute crisis. This includes physical and mental health patients.

So it's a big, system issue. No one solution.

Ben6899

OP, you're not allowed to be negative towards the Tories. Not on Stevo's watch.

pblakeney

SecretSam wrote:

A significant part of the issue is not the NHS but social care. Health is a system of which hospitals are only one part; with an ageing and increasingly infirm population, social care, at home or in a dedicated facility is a key element.

The majority of hospital beds are not taken up with planned surgical patients; about 90% are medical emergencies. Most of these are older people, many of whom could be cared for outside of hospital, but social care doesn't have sufficient resources. So they block beds. This causes a lot jam that stretches back to A&E.

At the same time, care for people with manageable chronic conditions isn't strong enough, so rather than being managed their condition escalates and they end up in acute crisis. This includes physical and mental health patients.

So it's a big, system issue. No one solution.

You are correct. I have some perspective being married to a community nurse. Many of those want out due to management and wages.
A perceived assumption maybe, but does the majority of the problems not involve minor level care correlating with people not looking after their family members personally and relying on the State?

coopster_the_1st

Veronese68 wrote:

So you don't think the NHS is underfunded and it's all just whinging?

The NHS is almost a bottomless pit so no matter how much money it is given someone will always be able to argue that it is still not correctly funded. :roll:

The solution from my view is not giving it more money but changing the lifestyles of the people who are a drain on it.

I will pick one disease, type 2 diabetes which costs the NHS between £10-£14bn a year. That's over 10% of its overall budget. This is for the majority a lifestyle disease so rather than bring in a Sugar or Fast food tax, charge patients for their medication. Patients will have 3 choices, change their lifestyle, pay-up or suffer the further complications that the disease brings.

A 'tough love' approach is what is needed now. We need to move to the stick approach as the carrot has not worked.

It's a guess, but I suspect this approach could yield a huge reduction in costs quite quickly which would then give a huge boost to NHS finances. There will also be associated benefits to those patients from the lifestyle changes that will further reduce the costs to the NHS.

This approach will upset many of the 'delicate petal' generation but tough action is needed on the causes not just throwing more money at the NHS.

Once this has been started do the same for other lifestyle choices. There is a lot of low hanging fruit to be picked when it is tackled from a different direction. This is where the political direction needs to go for all parties. Playing party politics with the NHS but trumping each other by increasing how much is paid into it will never solve the issues.

mrfpb

Austerity pay freezes/restrictions (which started under Labour following the financial crash and still continue eight years later) mean that it's less attractive to stay in a job as a front line NHS worker or social care employee and more attractive to work for an agency. Trusts can't get staff with a decent level of experience, due to the terms they are allowed to offer. As they are contracted to provide a certain level of staff, agencies know they can charge over the odds and so can pay their staff more than they would get as an employee. So wage costs rise anyway, but by way more than they would if a decent pay structure was in place.

But staff are less experienced or just less familiar with the local practice as they are employed on shorter term contracts, so more time is spent on training/induction and less on delivering care.

Add in that nurse training has been a disaster as so many take the funding in order to avoid student debt on their degree with little or no intention of working in the NHS when their degree is complete. So their is a lack of graduates with up to date training entering the profession. I thought it was perfectly reasonable to end that funding model for training, but they don't seem to have put in any efficient alternative.

Stevo_666

Veronese68 wrote:

So you don't think the NHS is underfunded and it's all just whinging?

Not sure but no matter how much money gets thrown at it, the NHS is always said to be underfunded. Whether that's true or whether its expectations, don't know,

But I do seem to have created a few knee jerk reactions

Stevo_666

Ben6899 wrote:

OP, you're not allowed to be negative towards the Tories. Not on Stevo's watch.

Oh dear, all I do is give him some advice to join the Labour party (who I presume solve the problem they failed to solve after 13 years in power) and post in a thread ready made for this sort of subject. So you're jumping to conclusions aren't you.

pblakeney

mrfpb wrote:

Add in that nurse training has been a disaster as so many take the funding in order to avoid student debt on their degree with little or no intention of working in the NHS when their degree is complete. So their is a lack of graduates with up to date training entering the profession. I thought it was perfectly reasonable to end that funding model for training, but they don't seem to have put in any efficient alternative.

This will be a major problem for recruiting in the future.
The Government is treating trainee nurses as if they are full time students and want to charge them accordingly.
However, trainee nurses are like apprentices and are effectively working part time for free. Now the Government wants to charge them for the privilege. I can see a drop in future applicants.

964cup

It's nothing to do with the Tories. Or with Labour, for that matter. It's a structural problem.

It's a demographic challenge: more old people, more fat people, more lazy people. So ever-growing demand.

It's also a technological problem - an ever-increasing range of treatments, so ever-growing demand.

It's a social issue. On the one hand we live longer; on the other hand, we care less - so old people need places in care homes rather than being cared for by their families. But we don't fund proper social care, and it's much more expensive than it used to be because (see above) we live much longer and our lifestyle expectations are greater. So more and more hospital beds are blocked by old people with nowhere to go. I always wonder, when I read about these poor unfortunates, whether they are somehow all childless, or whether their children are just selfish. Gran (since grandad had usually had the decency to die shortly after retirement of a smoking-related disease) always used to live with her kids in the twilight of her life, and this was not just some feature of the wealthy. Somewhere along the way we seem to have lost both our caring and our sense of duty - and I think this is specific to the UK, since in other European countries it's still the norm.

It's also a social problem because nursing, the bedrock of all healthcare, was never intended as a career for a single person, never mind a single parent. As currently designed (or, more accurately, as currently paid) it's something for young women to do until they marry a doctor - that's how it worked in the 50s and very little has been done to reflect the complete transformation in gender equality and career expectations since.

We don't help it by having lost all of the stoicism, gumption and common-sense that characterised the population when the NHS was founded after the war. We expect the moon and do nothing to help ourselves, then complain about discrimination when anyone suggests that tar-clogged bloaters might have to give up smoking and eat fewer pies before we treat the diseases they have brought on themselves. If you don't like me picking on the circumferentially-challenged, how about this: there's this horrible viral cough going around in London at the moment. Everyone has it. All of my family have it. But clue in the word "viral" - there's nothing the GP (or A&E) can do about it, so suck up the Lemsip, suck on a Locket, take a couple of days off, and HTFU.

Ultimately, though, if we want a socialised medical system that works, we have to accept that the chain of family responsibility is broken and fund proper care homes for the aged. Which means higher taxes (or cuts elsewhere). We have to radically transform the salary structure and career track for nurses, so that it becomes an attractive choice for a much wider section of the population (and we have to keep the ol' immigration doors wide open, since that's where we get almost all of our nurses these days). Of course that also means higher taxes (or cuts elsewhere). We have to put far more money into health education, and give it some teeth, which means somehow making it acceptable to tell people that smoking, or having a BMI over 30, are *choices* and that those choices will have consequences.

And if you want the honest truth, we probably also have to decide when to let people die. Just because we can, at vast expense, keep someone alive for an extra six months (with whatever compromised level of quality of life) doesn't mean that's the right choice for the country as a whole. Of course this is a desperately hard ethical problem - I'm very glad it's not my call.

lettingthedaysgoby

It is very simple. The tories are deliberately running it into the ground so they can privatise it. A process started by New Labour is being finished now.

mrfpb

The current "Hospital" TV doc. series is all about the hard choices the NHS is making - focussing on the decision makers rather than the front line care.

NICE already makes hard decisions on whether eg a £100,000 drug prescription is worth the money to extend a person's life by 3 months. But if they face a media frenzy every time they block an expensive treatment, then decisions start to become political rather than clinically/medically sound.

It's the same with social care - Gordon Brown's plan for a social care inheritance tax was ridiculed as a death tax by the Tories, but they put up no real solution as an alternative, so action was not taken post 2010 to address a funding issue that has got worse and worse since.

Lots of posters here agree the NHS shouldn't be political but as it matters so much to the electorate parties will always be partly defined by how they view it and manage it and come election time they will always have to show that they are better than the others, as it is one of the issues they will always have to provide answers on on Question Time or Today. Our political system does not allow parties to work in a co-operative way on issues that strongly influence the public vote.

964cup

lettingthedaysgoby wrote:

It is very simple. The tories are deliberately running it into the ground so they can privatise it. A process started by New Labour is being finished now.

And privatising it would work how, exactly, and would fix the various issues in what way?

Bollocks. It's not an ideological problem. It's a much bigger challenge than that. What would *you* do to fix it?

Perhaps the real question is - how much more tax would *you* pay, or what other services would *you* cut, in order to make it work? And do please bear in mind the scale of the problem - just to reach European average expenditure we need to spend an additional 2% of GDP on healthcare (which is the same as the whole of the defence budget) - about £35bn. Total UK tax take last year was £533bn, of which all forms of personal taxation (income tax, NIC, CGT, inheritance tax) contributed 54%, or £287bn. So we either need about a 7% rise across all taxation, or a 12% rise in income tax, to close that funding gap. Bear in mind also that we already run a £20bn budget deficit (excluding capital expenditure), so really we need something like £55bn extra. So a 10.3% tax increase across the board (raising the price of petrol, increasing VAT, etc etc) or a 20% rise in income taxes.

Before you say "tax the rich" remember that £116bn of the income tax take (about 67% of £173bn total) comes from higher rate tax payers already. So if you want to raise just the £35bn from them, you have to increase their taxes by 30%, which will leave them contributing 73% of all (increased) income tax revenues - and paying tax at a rate of 60%. That's 60% on all income over about £45k. That sound fair to you? More importantly, does that sound sustainable to you?

pblakeney

964Cup wrote:

And privatising it would work how, exactly, and would fix the various issues in what way?

Well, it would take the NHS off the Governments books for a start.
In which case taxes could be dropped substantially. Did i really just type that? :roll:

Ben6899

Stevo 666 wrote:

Ben6899 wrote:

OP, you're not allowed to be negative towards the Tories. Not on Stevo's watch.

Oh dear, all I do is give him some advice to join the Labour party (who I presume solve the problem they failed to solve after 13 years in power) and post in a thread ready made for this sort of subject. So you're jumping to conclusions aren't you.

Fish in a barrel, Stevo...

Ben6899

Coopster the 1st wrote:

Veronese68 wrote:

So you don't think the NHS is underfunded and it's all just whinging?

The NHS is almost a bottomless pit so no matter how much money it is given someone will always be able to argue that it is still not correctly funded. :roll:

The solution from my view is not giving it more money but changing the lifestyles of the people who are a drain on it.

I will pick one disease, type 2 diabetes which costs the NHS between £10-£14bn a year. That's over 10% of its overall budget. This is for the majority a lifestyle disease so rather than bring in a Sugar or Fast food tax, charge patients for their medication. Patients will have 3 choices, change their lifestyle, pay-up or suffer the further complications that the disease brings.

A 'tough love' approach is what is needed now. We need to move to the stick approach as the carrot has not worked.

It's a guess, but I suspect this approach could yield a huge reduction in costs quite quickly which would then give a huge boost to NHS finances. There will also be associated benefits to those patients from the lifestyle changes that will further reduce the costs to the NHS.

This approach will upset many of the 'delicate petal' generation but tough action is needed on the causes not just throwing more money at the NHS.

Once this has been started do the same for other lifestyle choices. There is a lot of low hanging fruit to be picked when it is tackled from a different direction. This is where the political direction needs to go for all parties. Playing party politics with the NHS but trumping each other by increasing how much is paid into it will never solve the issues.

Coopster, some chronic illnesses manifest through no 'fault' of the unlucky patient. What about those people?

I don't disagree with educating people into living healthier, btw, but we have to be careful when applying broad brush solutions.

finchy

Making people suffer for their lifestyle choices isn't going to solve the problems. Look at the USA, where illnesses can lead to bankruptcy - they're not exactly a picture of health.

A sugar tax to pay for treatment on the other hand would be a good idea - I'm all in favour of people being made to pay beforehand for any problems their lifestyle may cause, like with smoking and alcohol.

But really, if we want our health service to measure up to those in other nations, we'll need to pay for it.

lettingthedaysgoby

964Cup wrote:

lettingthedaysgoby wrote:

It is very simple. The tories are deliberately running it into the ground so they can privatise it. A process started by New Labour is being finished now.

And privatising it would work how, exactly, and would fix the various issues in what way?

****. It's not an ideological problem. It's a much bigger challenge than that. What would *you* do to fix it?

Perhaps the real question is - how much more tax would *you* pay, or what other services would *you* cut, in order to make it work? And do please bear in mind the scale of the problem - just to reach European average expenditure we need to spend an additional 2% of GDP on healthcare (which is the same as the whole of the defence budget) - about £35bn. Total UK tax take last year was £533bn, of which all forms of personal taxation (income tax, NIC, CGT, inheritance tax) contributed 54%, or £287bn. So we either need about a 7% rise across all taxation, or a 12% rise in income tax, to close that funding gap. Bear in mind also that we already run a £20bn budget deficit (excluding capital expenditure), so really we need something like £55bn extra. So a 10.3% tax increase across the board (raising the price of petrol, increasing VAT, etc etc) or a 20% rise in income taxes.

Before you say "tax the rich" remember that £116bn of the income tax take (about 67% of £173bn total) comes from higher rate tax payers already. So if you want to raise just the £35bn from them, you have to increase their taxes by 30%, which will leave them contributing 73% of all (increased) income tax revenues - and paying tax at a rate of 60%. That's 60% on all income over about £45k. That sound fair to you? More importantly, does that sound sustainable to you?

Leaving aside that I'd consider a 60% top tax rate more than fair if it brought about decent public services, my starting point is far simpler - scrap the trident replacement.

Stevo_666

Ben6899 wrote:

Stevo 666 wrote:

Ben6899 wrote:

OP, you're not allowed to be negative towards the Tories. Not on Stevo's watch.

Oh dear, all I do is give him some advice to join the Labour party (who I presume solve the problem they failed to solve after 13 years in power) and post in a thread ready made for this sort of subject. So you're jumping to conclusions aren't you.

Fish in a barrel, Stevo...

Yawn. Stop back pedalling as well as making assumptions.

Pross

The NHS in Wales is run by Labour out of the assembly, it faces all the same problems. It's too big an animal trying to do too much but it also appears to be massively inefficient. Whilst I certainly don't want it privatised I do think it could do with learning from management of successful, lean businesses so that the money is spent wisely.

secretsam

Most of the stuff above makes sense.

But please stop referring to "the NHS" when you really mean the healthcare system, which starts with the individual and ends...With death.

As for funding: every nation faces the challenge of funding care. The NHS is not a bottomless pit: rather, healthcare has near infinite demand, and the parameters change every day.

blueturtle

How can you possibly run a business with 300,000 new members joining every year! totally overstretched .No matter how much money you throw at it, it will not work.Plain as the nose on your face what the problem is.

coopster_the_1st

Ben6899 wrote:

Coopster the 1st wrote:

Veronese68 wrote:

So you don't think the NHS is underfunded and it's all just whinging?

The NHS is almost a bottomless pit so no matter how much money it is given someone will always be able to argue that it is still not correctly funded. :roll:

The solution from my view is not giving it more money but changing the lifestyles of the people who are a drain on it.

I will pick one disease, type 2 diabetes which costs the NHS between £10-£14bn a year. That's over 10% of its overall budget. This is for the majority a lifestyle disease so rather than bring in a Sugar or Fast food tax, charge patients for their medication. Patients will have 3 choices, change their lifestyle, pay-up or suffer the further complications that the disease brings.

A 'tough love' approach is what is needed now. We need to move to the stick approach as the carrot has not worked.

It's a guess, but I suspect this approach could yield a huge reduction in costs quite quickly which would then give a huge boost to NHS finances. There will also be associated benefits to those patients from the lifestyle changes that will further reduce the costs to the NHS.

This approach will upset many of the 'delicate petal' generation but tough action is needed on the causes not just throwing more money at the NHS.

Once this has been started do the same for other lifestyle choices. There is a lot of low hanging fruit to be picked when it is tackled from a different direction. This is where the political direction needs to go for all parties. Playing party politics with the NHS but trumping each other by increasing how much is paid into it will never solve the issues.

Coopster, some chronic illnesses manifest through no 'fault' of the unlucky patient. What about those people?

I don't disagree with educating people into living healthier, btw, but we have to be careful when applying broad brush solutions.

The current system is failing some with chronic illnesses that manifest through no fault of the unlucky patient. It will never be perfect and will always fail someone so why not concentrate that failure on what has now become a lifestyle disease? Additionally the current system is at risk of failure as it cannot cope with the demand.

There is a huge section of society that are not heeding the lifestyle warnings (by being on here most, if not all of us will be on the right side of this). By pushing the costs onto them it will be their choice. Pay up and continue as they are now or change their lifestyle and it will cost them less.

coopster_the_1st

blueturtle wrote:

How can you possibly run a business with 300,000 new members joining every year! totally overstretched .No matter how much money you throw at it, it will not work.Plain as the nose on your face what the problem is.

The increasing population size is obviously one of the reasons why the health system is struggling although increases in population are greater through births than immigration however it is a negative contribution. For those struggling to see the above effect, view it from the following comparison.

We all are aware of how much better traffic flow is when its the school holidays. It's reported that the number of cars on the road at that time of day is only 5% fewer. That is a small amount but when something is running near capacity reducing it slightly makes a huge difference.

The use of agency staffing is another very good point as is the training of health professionals.

Lookyhere

Stevo 666 wrote:

Ben6899 wrote:

Stevo 666 wrote:

Ben6899 wrote:

OP, you're not allowed to be negative towards the Tories. Not on Stevo's watch.

Oh dear, all I do is give him some advice to join the Labour party (who I presume solve the problem they failed to solve after 13 years in power) and post in a thread ready made for this sort of subject. So you're jumping to conclusions aren't you.

Fish in a barrel, Stevo...

Yawn. Stop back pedalling as well as making assumptions.

Steve0 if you dont like a thread on the NHS, then you know what you can do dont you?

Blair/Brown poured billions into the NHS, satisfaction levels had never been higher, but in real terms the Tories have taken money out of the NHS and more importantly, community care, expert after expert (do we still listen to them????) says its the lack of community/social care that is a main cause of the current issues and as much as you dont like that, it has been done since 2010, couple this with an a total waste of money on agency staff/cutting nurse training and its easy to see why we are at this juncture.
even now the Tories have taken away the bursaries given to trainee nurses, despite that they train on the job, these are all short term cost cutting measures that end up costing far more to put right later on......

We ALL rely on the NHS even those with BUPA etc, private health creams off the treatments that make money, they are not interested when your Dad has a Stroke or you kid/misses develops Cancer and they wont be in the Welsh valleys airlifting you of that DH section you really should nt have attempted.

Longer term, i think we need across the board taxes rises, we also need to look again at taxing unhealthy food products and stop cutting taxes for the more wealthy in society, IHT does not need a £1m TH.

If we can fund Trident, HS2 & numerous wars, then we can also find the money to fund what used to be something we could all be proud of.

Finally Coopster, Life style? interesting that one, i assume you ride a bike? maybe you also go skiing or running, if you injure yourself doing any of these, then you ll be reimbursing the NHS ? no i didnt think you would.

to me, if the government allows 'pop to be sold for pence a bottle, alcohol cheaper than bottled water, doesnt tax fast food, then it is telling society "its ok, eat/drink what you like"
after decades, we ve finally done things about tabacco, so no one has any excuse to smoke, so we can if we want too.

coopster_the_1st

Lookyhere wrote:

Finally Coopster, Life style? interesting that one, i assume you ride a bike? maybe you also go skiing or running, if you injure yourself doing any of these, then you ll be reimbursing the NHS ? no i didnt think you would.

Are you saying exercise does not improve mental and physical health and means that overall those who exercise are more of a drain on the system than those who don't?

I'm guessing you drive a car. If you are in a accident that requires treatment will you be reimbursing the NHS? No, I thought not. See we can keep going on like this but lets not because both are positives to society.

The difference with changing peoples lifestyle through diet and exercise is that it treats the root cause of many health issues and allows moderation of the what is seen as bad stuff. Charging for the treatments of lifestyle diseases like Type 2 diabetes is the same as taxing what you list but only costs those who are affected rather penalising everyone...

coopster_the_1st

Lookyhere wrote:

Blair/Brown poured billions into the NHS

Who was it that created overpriced and off balance PFI contracts?

These also have a huge negative effect on the UK finances

All Blair/Brown did was pass what they were spending onto future governments

mrfpb

The Blair/Brown budgets were affordable right up until the financial crash. I would target the Iraq war as the biggest waste of money (without going into the waste of life) and the financial crash as the most costly mistake of the Blair/Brown years.

Making public sector jobs more attractive and drastically reducing waiting lists was a rebalance of problems caused by chronic underfunding through the Thatcher/Major years.