Radical ideas to revolutionise a broken NHS. Your thoughts?

[Bletchleyite]

Another point is NHS dentist, it's impossible to be taken on as a new patient, it's a postcode lottery whether you need to pay for unaffordable private treatment or not.

Perhaps a way to start down the social insurance route would be setting up a not for profit National Dental Plan?

 

[MattA7]

My votes were

Drunk A&E charge/strongly agree- this could cause people to drink more responsibly and possibly be more careful when they have been drinking. Possibly use of the 0.08 BAC drink drive limit could be used as the definition of being drunk.

Legalized euthanasia/strongly disagree- too controversial and potentially dangerous as vulnerable people may be coerced into such options. Not to mention the ethical issues associated with such practice

Flat bill rate for sporting injuries/ strongly disagree- this could discourage people from taking up physical activities and be counterproductive

Reasonable medical insurance/ don’t know- see idea below

Free degrees for medical students/agree- this could be a good idea however only if the student is required to work a certain amount of years in the NHS after passing their degree

National service based system/strongly disagree- the last people who want to see a reintroduced national service is the army and this could disadvantage those who are unable to serve due to Ill health/disability or who have religious/ethical objections to serving in the armed forces.


The best way forward should be a system based on income such as

Under £12k* - fully paid by NHS
£12k-£50k - you pay 20% NHS pays 80%
£50k-£100k - you pay 40% NHS pays 60%
£100k+ - you pay 50% NHS pays 50%

* those over state pension age, under 16 or with disabilities should be exempt from this requirement.

Introducing a “health card” to prove eligibility and what payment band people are in could also help reduce misuse by ineligible people.

 

[yorkie]

My votes were

Drunk A&E charge/strongly agree- this could cause people to drink more responsibly and possibly be more careful when they have been drinking. Possibly use of the 0.08 BAC drink drive limit could be use as the definition of being drunk.

In theory yes, but I have my doubts this will be practicable.

Legalized euthanasia/strongly disagree- too controversial and potentially dangerous as vulnerable people may be coerced into such options. Not to mention the ethical issues associated with such practice

This just forces people (such as Adrian Shooter) to travel to Switzerland.

Flat bill rate for sporting injuries/ strongly disagree- this could discourage people from taking up physical activities and be counterproductive

Yep I agree with you on that.

Reasonable medical insurance/ don’t know- see idea below

Free degrees for medical students/agree- this could be a good idea however only if the student is required to work a certain amount of years in the NHS after passing their degree

Yes this sounds sensible

National service based system/strongly disagree- the last people who want to see a reintroduced national service is the army and this could disadvantage those who are unable to serve due to Ill health/disability or who have religious/ethical objections to serving in the armed forces.

National service conjures up ideas of being in the army but the original poster did say they were referring to an "entry-level NHS (or any other critical public service)" role. I did a year working for the NHS which was a great experience for me (at the time; I would not be keen more recently!) however I do not think anyone should be forced into such roles. I can understand how it is linked to the other issues but I think this is actually part of a much bigger topic which probably deserves its own thread, so I won't go into further detail here.

 

[The Ham]

There's no point increasing funding with these radical schemes if you don't reform the health service.

The management scheme needs to be completely overhauled because it is grossly inefficient and expensive. The amount of trusts should be reduced, with GPs and Ambulances being managed from the same management as the hospitals.

Another point is NHS dentist, it's impossible to be taken on as a new patient, it's a postcode lottery whether you need to pay for unaffordable private treatment or not.

Do you have any evidence for this, as this report disagrees with you:

Is the NHS overmanaged

www.nhsconfed.org

the NHS Confederation and independent academics from the University of York and London South Bank University are publishing a series of three long reads on NHS management. In the first in the series, Prof. Ian Kirkpatrick and Prof. Becky Malby examine the question of whether the NHS is overmanaged. Key points
- NHS managers make up circa 2 per cent of the workforce compared to 9.5 cent of the UK workforce.
- In recent years the number of managers has been cut, at a time when the NHS is facing its biggest challenge.
- The NHS as a whole is under, not over, managed. However, persistent and misleading media headlines continue to claim that the NHS is overmanaged.

My votes were

Drunk A&E charge/strongly agree- this could cause people to drink more responsibly and possibly be more careful when they have been drinking. Possibly use of the 0.08 BAC drink drive limit could be used as the definition of being drunk.

Legalized euthanasia/strongly disagree- too controversial and potentially dangerous as vulnerable people may be coerced into such options. Not to mention the ethical issues associated with such practice

Flat bill rate for sporting injuries/ strongly disagree- this could discourage people from taking up physical activities and be counterproductive

Reasonable medical insurance/ don’t know- see idea below

Free degrees for medical students/agree- this could be a good idea however only if the student is required to work a certain amount of years in the NHS after passing their degree

National service based system/strongly disagree- the last people who want to see a reintroduced national service is the army and this could disadvantage those who are unable to serve due to Ill health/disability or who have religious/ethical objections to serving in the armed forces.


The best way forward should be a system based on income such as

Under £12k* - fully paid by NHS
£12k-£50k - you pay 20% NHS pays 80%
£50k-£100k - you pay 40% NHS pays 60%
£100k+ - you pay 50% NHS pays 50%

* those over state pension age, under 16 or with disabilities should be exempt from this requirement.

Introducing a “health card” to prove eligibility and what payment band people are in could also help reduce misuse by ineligible people.

I pay 20% of what though?

The full cost, well if that's £1 million that's going to mean remortgaging.

Even £50,000 would be £10,000, who earning (even £50,000 a year) is likely to be able to afford that, let alone a pensioner on a little more than just state pension.

Those sorts of numbers can rack up fairly quickly, with limited other costs it can be nearly £3,000 for a week in hospital (20% of that would be nearly £600).

That's likely to put people off and lead to it being more costly to deal with later.

The issue would be that you'd actually need an army of admin staff to recover those costs, which would mean that in reality the NHS would be paying more than 80%.

Conversely an extra 0.5% on income tax would mean for every £10,000 above the threshold it would be an extra £50, which doesn't sound like much, but someone earning £50,000 that's nearly £200/year more and so would cover their 20% of a week in hospital in 3 years. With no extra admin costs (NHS) and no sudden costs to deal with (personal).

 

[Yew]

Another point is NHS dentist, it's impossible to be taken on as a new patient, it's a postcode lottery whether you need to pay for unaffordable private treatment or not.

Didn't they cut the amount the NHS pays the Dentists for treatments about... 15 years ago, and since then it's been impossible?

 

[DelayRepay]

I would not support any plan to charge for access to GPs or A&E, even if the person's injury is self inflicted, or they are deemed a time waster, and/or the charge is only a nominal £10. I think any charges would put some people with genuine illnesses off seeking help, which could result in treatable conditions becoming fatal and/or costing far more to treat further down the line.

I would however like to see greater use of 'walk in' type services where you can be triaged by a professional such as a nurse or pharmacist (depending on your condition) who can refer you to a GP if necessary, or provide advice or prescriptions, or referral to another service where that's more appropriate. This could also be by telephone or video call for certain conditions where it suited the patient.

 

[chorleyjeff]

Earlier on today, me and my family were having a discussion on possible ideas to improve the NHS, whether small or large. Unsurprisingly, some ideas put forward by my family were quite radical and probably wouldn’t be policies I advocate personally. At a time when the NHS is at breaking point however, it’s not hard to see why one would have that pattern of thought, even if those ideas would never actually work in practice. Some of the ideas suggested were:

• A&E flat rate charge for weekend revellers who have chosen to go out and get drunk then need treatment as a direct result - While this might discourage binge drinking (making people healthier in the long run too) and raise additional revenue for the NHS, the frequency of such events would make it quite a challenge to administer, not to mention that the administration side might even cost more than any income generated from the drunk revellers.
• Legal Euthanasia pathway for terminal/end of life patients who have capacity and wish to die rather than endure longer term deterioration. While it will ease immediate pressure on the NHS by freeing up bed capacity, this is a very controversial topic and such a proposal will cause a lot of uproar from certain groups.
• Flat rate bill for minor sporting injuries. Might be a good short-term measure when hospitals are at capacity but this comes at the cost of penalising healthy physical activity. As people switch to sedentary lifestyles, this will only put more pressure on the NHS through obesity-related conditions in the long term.
• Reasonable private medical insurance. Might lead more people to choose to go privately and reap the benefits of competition, but at what cost to the NHS?
• Make nursing and medical degrees free (tuition fees fully paid by government) under the condition that students must do a minimum amount of service in the NHS, otherwise they will have to pay back cost. While this might incentivise more people to train as doctors and nurses, it doesn’t really solve the deeper issues within the NHS and of course you cannot force people to stay in the profession.
• Introduce a National Service style scheme whereby all fit-to-work adults must complete a set number of years in an entry-level NHS (or any other critical public service) role to be entitled to benefits, student loans etc. It might solve the UK’s skills gap problem but do we really need to be sacrificing non-critical sectors of the economy just for this?

What are your thoughts, and would you suggest any alternative ideas to fix the NHS?

Make the existing system work
eg Doctor said my son was fine for discharge to home on Thursday. Nurses said he had to do discharge process. Said they could not do on Friday then said they wouldhttps://www.railforums.co.uk/threads/radical-ideas-to-revolutionise-a-broken-nhs-your-thoughts.241639/reply?quote=6007970 do discharge on Monday -waste of time and money and hospital bed. He discharged himself.
eg My wife went into A&E of Teaching/District General Hospitalwith Deep Vein Thrombosis on Thursday night. Needed scan. Could not be done until Monday PM due to no available staff - expensive machinery stood idle. I live near said hospital and get road filled with hospital staff parking. Quiet on Monday AM and Friday from noon. Effectively 4 day week.

 

[Bletchleyite]

Under £12k* - fully paid by NHS
£12k-£50k - you pay 20% NHS pays 80%
£50k-£100k - you pay 40% NHS pays 60%
£100k+ - you pay 50% NHS pays 50%

I can't support this. You can't have someone bankrupted because they need to pay £4K due to needing a £20K operation in an emergency with no time to save for it. That's just a slightly softened version of the US system which should just be ignored as it's so badly wrong.

I could be swayed by nominal fees like £20 to see a GP, but not co-pay, it's grossly regressive as generally sicker people are worse off.

== Doublepost prevention - post automatically merged: 6 Jan 2023 ==

eg My wife went into A&E of Teaching/District General Hospitalwith Deep Vein Thrombosis on Thursday night. Needed scan. Could not be done until Monday PM due to no available staff - expensive machinery stood idle. I live near said hospital and get road filled with hospital staff parking. Quiet on Monday AM and Friday from noon. Effectively 4 day week.

To be fair as long as she wasn't admitted that isn't disastrous, because you just start treating as if it was a DVT (heparin injections then onto rivaroxaban or warfarin) and withdraw the treatment if it turns out it wasn't. Slightly inconvenient but not a major capacity nor health issue. If that approach is cheaper than having someone on standby to do an ultrasound late at night then I'm fine with it, and I've had two DVTs.

 

[Howardh]

1. Pay family carers a decent weekly amount, think it's around £70 currently which is peanuts. If they were paid and a guarantee of their job back (OK, that's difficult) I'm sure more would be willing to look after their parents thus freeing up NHS beds, get the needy into wards quicker, ambulences wouldn't be waiting around etc, save in the long run. I was lucky in that when I cared I had savings and my parent's savings to call on and knew that at the end I could retire so no need to job hunt.

2. Re-open the walk-in centres, if staffing is an issue then could we not offer retired staff part-time employment, also use medical students in their final year supervised? Walk-in centres with a pharmacy could take those who can't get an immediate doctor's appointment, and keep them away from A+E.

3. Difficult one this I admit > due to patients not having the money for fines...but those who continually miss appointments should be fined, it might concentrate their minds to turn up or cancel.

4. long term we need more district nurses and professional carers to call on those at home who are in moderate difficulty and have no family carer and would otherwise be in care homes or hospitals.

5. Make the pharmacy the first point of call for non-life threatening emergencies, if the pharmacist can't deal with it then they could (either) give a fast-track ticket to the nearest doctor with the guarantee of a face-to-face appointment within hours (and/or) fast-track to A+E where x-rays, tests etc could be done "ahead" of the queue.

 

[Bletchleyite]

2. Re-open the walk-in centres, if staffing is an issue then could we not offer retired staff part-time employment, also use medical students in their final year supervised? Walk-in centres with a pharmacy could take those who can't get an immediate doctor's appointment, and keep them away from A+E.

They've not closed, have they?

I do think the idea of a "one stop health shop" at A&Es is good, though. One set of triage nurses, and you'd see a pharmacist, a GP, a nurse or a hospital doctor (and be admitted if necessary) from the single visit, depending on your need. As I said, if people turn out to prefer to see GPs this way then build the service further and reduce the number of community GPs. The community GP service, while valuable for some, was created in the days when people were far less mobile generally. For those who genuinely can't get out, you could have some level of home visits reinstated or have a touring local GP service in the back of a van for those who can't travel to a large central service.

You do lose the thing where the GP really knows the patient, but most practices are larger now and that isn't a thing any more.

 

[Howardh]

They've not closed, have they?

Ours in Bolton town centre has, yes!

 

[Jan Mayen]

If people are drunk and fighting lampposts, charge them.
With being drunk and disorderly!

 

[Bletchleyite]

Ours in Bolton town centre has, yes!

Hadn't heard of that model, all the ones I've known of (and used) are on hospital sites, generally near the A&E to deflect minor cases away from it. They differ between England and Scotland - the English ones have skilled prescribing nurses and usually a doctor, the Scottish ones only have basic nurses and can miss stuff. (Direct example: went into Edinburgh walk in centre thinking I had a partial fracture of my leg, got an X ray and was sent away because I didn't, went back to MK in a lot of pain and went into that one that night, and they diagnosed a DVT very quickly)

 

[Howardh]

Hadn't heard of that model, all the ones I've known of (and used) are on hospital sites, generally near the A&E to deflect minor cases away from it. They differ between England and Scotland - the English ones have skilled prescribing nurses and usually a doctor, the Scottish ones only have basic nurses and can miss stuff. (Direct example: went into Edinburgh walk in centre thinking I had a partial fracture of my leg, got an X ray and was sent away because I didn't, went back to MK in a lot of pain and went into that one that night, and they diagnosed a DVT very quickly)

Ours was right in the town centre, miles away from the hospital. Think we have another at Watersmeeting, not sure if that's a bunch of surgeries or that + walk-in. I do know that if you require a night doctor and go through 111 or your local out-of-hours service, that's where they send you.

I've never come across the model you describe, the walk-in centres I remember keep people away from the hospital grounds entirely. Although it makes sense to have a center adjacent to a hospital in case of a genuine emergency I suppose (speed of transfer) but many hospitals are out-of-town and locals have many miles to travel, often uncomfortably.

 

[Broucek]

A lot of ideas to make things "fairer" would cost more in admin than they'd save... And the NHS is not exactly short of admin...

Looking at the bigger picture, there are much, much better mixed (insurance and public funding) models in other European countries (e.g. France). But I don't hold out much hope as any Conservative move in that direction would be immediately weaponised ("selling the NHS to the highest bidder") and I can't see Labour facing down the inevitable producer backlash to proposed change.

BTW, I get very bored of the whole "we can't replace the NHS or we'd end up like the Americans" debate. Even the most right wing people I know I have no affection for the US healthcare system. (And I recently discovered that in the US the NHS is used as a similar bogeyperson as as if it were the only alternative to their own dysfunctional system.)

 

[GusB]

I was about to post my own thoughts on the matter, but you've done a good job of taking the words out of my mouth!

1. Pay family carers a decent weekly amount, think it's around £70 currently which is peanuts. If they were paid and a guarantee of their job back (OK, that's difficult) I'm sure more would be willing to look after their parents thus freeing up NHS beds, get the needy into wards quicker, ambulences wouldn't be waiting around etc, save in the long run. I was lucky in that when I cared I had savings and my parent's savings to call on and knew that at the end I could retire so no need to job hunt.

I agree with this 100%. Carers must save the government an absolute fortune, and the £69.70 Carer's Allowance is a pittance. I didn't actually get around to claiming it when I was looking after my dad (I thought it would only be a temporary situation and I initially had money in the bank), but I wish I had. He was receiving around £80 a month in Attendance Allowance and he made sure that petrol expenses etc. were covered.

Keeping people out of hospital in the first place is one good way to ease the pressure on the NHS and if people were properly remunerated for looking after their elderly relatives, more would be inclined to take on the burden (and it is a burden, no matter how much we assure our relatives that it's not).

3. Difficult one this I admit > due to patients not having the money for fines...but those who continually miss appointments should be fined, it might concentrate their minds to turn up or cancel.

The issue of charging is one that I'm wary of, whether that be an up-front charge to see a GP or a fine for a missed appointment. I think this is a slippery slope and will disproportionately hit the least well-off. It could also end up with people being penalised because they have to rely on public transport and suffer delayed or cancelled journeys.

Regarding my second point, this is another area where there's no joined-up thinking. The main medical practice for here is located 6 miles along the coast in Lossiemouth. There was a satellite surgery here in the village, along with another a few miles away, both of which closed during the pandemic and the premises are no longer deemed to be suitable. There's no direct bus along the coast, and anyone wishing to travel from here has to make a 24-mile round trip via using two buses, one of which only has an hourly frequency (lots of hanging around if appointment times don't match). There seems to have been very little thought given to how people are supposed to get to appointments once they'd closed the satellite premises!

Obviously if you're not going to be able to make an appointment you should cancel at the earliest opportunity, but if you're relying on someone to give you a lift and they don't turn up, either on time or at all, then it's going to be too late to re-allocate your appointment.

4. long term we need more district nurses and professional carers to call on those at home who are in moderate difficulty and have no family carer and would otherwise be in care homes or hospitals.

I also agree with this. There needs to be a joined up approach between local NHS teams, social work and the third sector. There are places where this is being done (I saw a report on a news programme, but cannot for the life of my remember where), but there does seem to be a bit of a postcode lottery.

Simple measures such as installing additional grab rails in someone's house can make a world of difference to their life if it means that person can keep a little bit of their independence.

5. Make the pharmacy the first point of call for non-life threatening emergencies, if the pharmacist can't deal with it then they could (either) give a fast-track ticket to the nearest doctor with the guarantee of a face-to-face appointment within hours (and/or) fast-track to A+E where x-rays, tests etc could be done "ahead" of the queue.

Along with your point about walk-in centres, I think this is definitely the way to go. Have pharmacies that are open for longer - perhaps even combine them with a minor injuries clinic. Have a nurse or a pharmacist in charge and the ability to refer to a GP, A&E, or even a consultant if necessary.

Another thing I'd do is allow people to book a GP appointment wherever there is one free; if your own practice has no appointments left but the one down the road has had a few available, you should be able to go there. I don't see why anyone should still have to attend the practice where they're registered; how many people actually get to see their named GP anyway?

 

[Bletchleyite]

Obviously if you're not going to be able to make an appointment you should cancel at the earliest opportunity, but if you're relying on someone to give you a lift and they don't turn up, either on time or at all, then it's going to be too late to re-allocate your appointment.

In practice it's dealt with by overbooking anyway. When was your GP ever not running 20 minutes or so late? OK, if it's the first appointment then it's a pain, but if someone doesn't show up at say 2pm then it means chance to go to the loo and get a cup of tea, or to complete some notes you hadn't had chance to do. So I'm really not convinced it's the issue some people say it is.

Another thing I'd do is allow people to book a GP appointment wherever there is one free; if your own practice has no appointments left but the one down the road has had a few available, you should be able to go there. I don't see why anyone should still have to attend the practice where they're registered; how many people actually get to see their named GP anyway?

I don't know about Scotland, but in England there seems to be being some consolidation of GP practices into slightly larger businesses, a bit like the way academy schools consolidate into small "chains" in the form of trusts. This does actually create this opportunity - my surgery is a small group of two, and any patient can book an appointment at either. I do agree with it being more widely available though.

 

[Howardh]

Have pharmacies that are open for longer - perhaps even combine them with a minor injuries clinic. Have a nurse or a pharmacist in charge and the ability to refer to a GP, A&E, or even a consultant if necessary.

I think I read a while ago that there was a plan to allow pharmacists to write limited prescriptions, and the ones I have worked with know their "patients" better than doctors at times, and pharmacists often having to either ask for a px to be amended/corrected etc. Anyone know where we are with that? A simple change could save a lot of time r/e doctors appointments.

I have asked my prospective MP (Labour) if, on election, she could get nurses who can write prescriptions into major pharmacies, if the former point isn't carried through.

Top-of-head-thinking.....I wonder if the day will come where a patient scan go into a pharmacy or surgery side room, have some kind of scan, which is then read online by a specialist who can diagnose there and then? Possibly not with x-rays of someone has a fall, but along those lines? I've sent pictures of my health issues to my doctor by email, so this is a step up?

 

[Snow1964]

A&E is currently sweeping up people who shouldn’t be there
1) unable to access quick GP services
2) previously diagnosed problems that haven’t been fixed and got worse, because of treatment backlog
3) Some because they are open 24hours, but night doctors (which used to be your GP) are now scarce

To solve ambulance delays, got to untangle bed blocking, by those not leaving and treating hospital wards as free food and accommodation. I saw on TV local news one hospital with big ambulance queues has 150 people fit to leave, but haven’t

I personally would provide all hospitals with a discharge suite (where there is car and taxi pick up), basically a waiting room whilst awaiting collection. Simple rule if discharged between 7am and 7pm have to be collected within 3 hours or start paying hotel services. It’s not acceptable for some care and social departments to assume NHS will provide free accommodation and food and then can take extra time collecting. Hospital wards are for ill people not those convalescing who just need some intermittent light supervision.

 

[MattA7]

My theory behind the system where those on a higher income pay a certain percentage actually comes from dental costs where most people do have to pay 20% of their dental bill. However as a few have pointed out the cost of non dental healthcare are probably far higher than those of dental care and would likely create the same problems as the US system.


Other thoughts I have were

1) require employers to provide private health insurance for employees- however that could bring its own problems for those who don’t work due to old age, illness or disability and causes the NHS to be viewed as “paupers healthcare” similar to the US Medicare system

2) introducing free annual medicals that screen for the early signs of serious illness possibly results in reduced healthcare costs as the disease will be caught and treated early which would also result in a healthier population overall

3) look into what other countries with effective healthcare systems do and see if we can learn from them.

 

[Bletchleyite]

My theory behind the system where those on a higher income pay a certain percentage actually comes from dental costs where most people do have to pay 20% of their dental bill. However as a few have pointed out the cost of non dental healthcare are probably far higher than those of dental care and would likely create the same problems as the US system.

The UK dental system doesn't work. Generally people in the UK have badly maintained teeth compared to the rest of the world - appointments are rushed if you can even get NHS dental, and old fashioned materials like mercury amalgam remain in use despite being phased out in almost all of the rest of the world. It's just rubbish. The reason private dental just about works, though, is that there are few really swingeing costs until you get onto things like implants, it's just "a bit pricey".

Similar to optical - that's almost entirely private because eye tests aren't expensive and most people prefer to pay privately for fashionable glasses (which are pretty cheap online now anyway).

Though I must admit I'm slightly surprised there isn't a commercial chain of "Toothsavers" or similar - it does seem a similar business to optical where given the rubbishness of NHS dental a "decent but cheap" private chain operation could work reasonably well.

Healthcare rapidly gets far, far more expensive than either of those.

1) require employers to provide private health insurance for employees- however that could bring its own problems for those who don’t work due to old age, illness or disability and causes the NHS to be viewed as “paupers healthcare” similar to the US Medicare system

Yep, we really don't want to go there. It basically IS the US system, which doesn't work. I'd take a failing NHS over that. And of course you can always take private insurance if you *want* it, and many employers do provide it.

2) introducing free annual medicals that screen for the early signs of serious illness possibly results in reduced healthcare costs as the disease will be caught and treated early which would also result in a healthier population overall

Good idea.

3) look into what other countries with effective healthcare systems do and see if we can learn from them.

Absolutely. The ideal is probably a hybrid of the European social insurance systems, though each has strengths and weaknesses of its own.

 

[MattA7]

A bit off topic however I have often wondered why the NHS still continues to use amalgam dental fillings given the health risks associated with mercury are very widely known and it apparently costs more due to the regulations requiring safe disposal of amalgam waste. Especially when we now have safer non toxic alternatives.

 

[Bletchleyite]

A bit off topic however I have often wondered why the NHS still continues to use amalgam dental fillings given the health risks associated with mercury are very widely known and it apparently costs more due to the regulations requiring safe disposal of amalgam waste. Especially when we now have safer non toxic alternatives.

Because it's cheaper at the point of putting it in, and often quicker too (dentists are quite expensive time-wise).

They do have some other advantages, though, if you have a large filling they tend to last better than composites which inevitably come loose and fall out, plus they have a "built in" antibiotic effect. Often it's a case of amalgam or crown, and crowns are quite expensive.

It's also of note that composites have a plastic matrix, and some people have issues with potential chemical leaching from plastics.

 

[DelayRepay]

1) require employers to provide private health insurance for employees- however that could bring its own problems for those who don’t work due to old age, illness or disability and causes the NHS to be viewed as “paupers healthcare” similar to the US Medicare system

I don't see why employers should pick up the tab, and this would probably not be great for small businesses. I thought employer's NI contributions were meant to reflect employers part-funding the NHS care of their workers.

I actually get private medical insurance through my employer - it is not them being nice, it's them trying to minimise disruption to their business caused by me being in need of medical treatment. But even with that, I still need to start with my NHS GP to get a referral for most things, and if I have an accident or emergency I still use the NHS A&E.

I can't support this. You can't have someone bankrupted because they need to pay £4K due to needing a £20K operation in an emergency with no time to save for it. That's just a slightly softened version of the US system which should just be ignored as it's so badly wrong.

I agree. My late father had a heart attack while he was oversees, and required two lots of surgery and a stay in hospital before he was able to return to the UK. The costs were covered by his travel insurance, but if they had not been he would have seen his savings wiped out and probably had to take a loan secured on his house (although how he would have arranged this when he was unconscious, I do not know).

I work in a bank and a few years ago I dealt with a very distressing situation where one of our customers had been involved in a serious accident oversees. He (stupidly) had not taken out travel insurance and the hospital wanted to know how they were going to get paid. His son, who was only young, did not have enough money of his own to cover the bills. The father could not consent to money being withdrawn from his savings account. In the end we found a solution, but it wiped out that poor man's life savings. Would we really want people's relatives to be worrying about things like that in the UK at what is probably already the most desperate time of their lives?

 

[Ediswan]

A bit off topic however I have often wondered why the NHS still continues to use amalgam dental fillings given the health risks associated with mercury are very widely known and it apparently costs more due to the regulations requiring safe disposal of amalgam waste. Especially when we now have safer non toxic alternatives.

Mercury amalgam has been used for centuries. If there were a significant health risk, it would have shown up by now. It hasn't.
https://www.poison.org/articles/do-fillings-cause-mercury-poisoning

Mercury is a naturally occurring substance, found in air, water, and soil. It also is found in dental amalgam fillings. In sufficient quantity, mercury is known to be toxic to humans. Even so, scientific evidence, accumulated over decades, supports the view that there is no clinical evidence of mercury poisoning in people who have amalgam fillings in their mouths.

What you definitely do want to avoid is mercury vapour and organic compounds of mercury.

 

[Bletchleyite]

Arguably it's more of a health risk to dentists. Indeed I do know one of the dentists in Milton Keynes (I'll not name them for risk of libel) is a bit of a "mad hatter" - the term comes from when mercury was used in hat manufacture, so hatmakers were often a bit mad because of the effects of mercury poisoning on the brain!

 

[Jamiescott1]

If you were to design the NHS from scratch would it look like it does now ?

I doubt it. I think a major major once in a generation review and overall of the NHS needs to take place which reviews all aspects and then implement these changes. If its changes to how we access health care, staffing levels etc.

It should always be free at point of use.

 

[Bletchleyite]

If you were to design the NHS from scratch would it look like it does now ?

I think it'd look like the German or Swiss social insurance systems, myself. Most of the European systems are vaguely like that.

It should always be free at point of use.

Absolutely. And paid for (in terms of the "insurance premium") based not on risk but on ability to pay.

 

[TPO]

I do think we should move towards a European style social insurance scheme, but I don't support charges at the point of use because they're regressive, and if you're going to start means testing them then you might as well just put it on the "insurance" cost instead.

However I would want to see a visible cut in income tax to take account of the fact that there was now a separate National Health Insurance payment.

Very much so. The European health system (and indeed wider welfare system) has a lot to recommend it.

And not remotely helped by the government causing 40,000 staff in the care sector to be fired in 2021. Most found easier, better-paying jobs as a result, and so most won't be returning to the care sector, which has caused many more vacancies in an industry already struggling to find people.

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Absolutely this. Everyone I've ever known that has been an inpatient in any hospital, including myself, have been delayed on discharge for hours (or more) due to 'waiting for the pharmacy'. I can't believe this is a tough problem to fix, but it never gets addressed.

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Which would be helpful, but I remain baffled why this is apparently such a major problem. If they *can* get to see the GP - admittedly very difficult nowadays - they will be dealt with in a 10-minute appointment. Why can't A&E do the same?

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On the original questions : definite no to charges for 'lifestyle', definite yes to free degrees (though also reverse the silly policy that nurses are now *required* to have a degree), no to a requirement for National Service - *but* it would be very good to have something voluntrary, rather like the Territorial Army, whereby you have people sufficiently trained to step up if extra capacity is suddenly needed due to a pandemic (or due to it being January).

As for euthanasia I'm very split. I do think people should be allowed to end their life if they are very ill, have no chance of recovery, and don't want to endure days/months/years of pointless pain and misery. But you have to have extremely strong safeguards against it, and I'm particularly nervous about the slippery slope you can start down when you embark on this route - Canada is quite concerning.

Agree on all points. The lack of care places is the elephant in the room not mentioned (along with why so may care staff left....). Also share concerns about what is happengin in Canada with euthanasia, very concerning.

Another isssue is that the NHS strategy coming out of the Blair-Brown era concentrated medical care in swankey new hospitals, constructed on the expensive PFI that NHS is still paying for, and too-often at the cost of local hospitals that had a role in convalescence after severe illness/surgery. When my (now late) father had a severe stroke many years ago, he was initially treated at the main county hospital centre, then at a particular stage moved to the local hospital for next stage of recovery, then to a care place where he was able to live semi-independently until his eventual death. That local hospital has gone now as has much of the local care provision, and if it was now he'd had the stroke, he'd be stuck blocking an acute bed in a main hospital. It's also rather shocking when you see how much an older person can deteriorate mentally in an inappropriate acute bed. And as a spciety, we appear to have sacrificed "convalescence" on the altar of "efficiency."

I think it'd look like the German or Swiss social insurance systems, myself. Most of the European systems are vaguely like that.



Absolutely. And paid for (in terms of the "insurance premium") based not on risk but on ability to pay.

Yes, I wish the debate would move on from one of the other polarised extreme (UK vs USA) and look at examples nearer to home- France, Germany, Spain, Switzerland etc. However the NHS has replaced C of E as the national religion so I am not optimistic this will happen.

As for organisation: maybe look at local Veterinary practices vs GPs to find ways of improving things. It's much easier getting a "GP"-type vet appointment (or for that matter specialised hospital care) for my cat than for a member of my human family so there must be something useful to learn.

TPO

 

[coppercapped]

The model used in some European countries appears to work well. There are no point of service charges and insurance is very reasonable. The automatic assumption that private healthcare will only every be like the horrific USA version is just untue. However....how do those European countries deal with those who don't have insurance? Can you imagine the outcry when the first person in the UK dies because they couldn't afford even moderate insurance? I can't either because I don't think any hospital could afford the bad PR. So those with insurance would then wonder what they are paying for if treatment is being given out anyway. That would have to be addressed.

I published a variation of the following some 2 years ago in another thread on the politicisation of the NHS - I have not updated the numbers but they are not far off. It gives an outline of the German Health Insurance system. I would suggest that as the German health insurance system is the oldest in Europe and still works Britain could well learn from it. There are parallel insurance systems for unemployment, pensions, social care and so on and many people have a private 'Third Party' insurance as the health insurance is not an accident insurance if, for example, your dog bites a passer-by and he/she needs attention at A&E. You are expected to pay the A&E costs.

Firstly a bit of history. In the Middle Ages the craft guilds provided an early form of social insurance: guild members paid into a fund which was then used to help individuals if they got into financial difficulties because of, e.g., an illness. From the beginning of the industrial revolution local insurance funds were organised for industrial workers, a bit like the GWR's health insurance scheme. All these different insurances were then standardised by Otto von Bismarck in the late nineteenth century, the first being health insurance for factory workers in the event of illness in 1883. It rather predates the NHS...

Anyone who was insured was granted the right to free medical treatment and medicine, as well as sickness benefits and a funeral allowance. At that time, about 10% of the population was insured – over the years statutory health insurance was extended to other groups of workers. One of the last to be included were farmers in the early 1950s and seasonal workers in the early 1970s - my late father-in-law, a GP with a practice which was predominantly in the countryside, was often paid in kind which made life difficult for my mother-in-law as at any one time in the year all the farmers paid in kind with the same produce! Apparently nearly 100% of the population is covered by insurance now; there seems to be about 0.1% to 0.3% (depending on the data source) who are not covered but I cannot find out which group of people that includes.

The introduction of health insurance was followed by the introduction of statutory accident insurance (1884) and pension funds (1889). Unemployment insurance was introduced in 1927.

Health insurance is compulsory: everyone must have statutory health insurance (called “gesetzliche Krankenversicherung” – GKV) as soon as a work contract is signed provided that their gross earnings are under a fixed limit (“Versicherungspflichtgrenze“), in 2017 (the latest date for which I have quickly found the numbers) this was €4,800 a month. This covers primary care with registered doctors, hospital care (both in- and out-patient) and basic dental treatment. Non-working dependents living at the same address and registered with the Krankenkasse are covered at no extra cost. It does not cover consultations with private doctors, private rooms in hospitals, alternative or complementary treatments, dental implants or spectacles or contact lenses for adults.

There is a lower limit of income for contributions, people earning less than about €850 per month have their contributions paid by the state.

The insurance is run by the Krankenkassen, non-profit making associations which must all charge the same basic rate of 14.6% of the individual’s eligible gross salary, up to a maximum of, in 2017, €4,350 a month. The premium is shared equally between the employee and the employer. Even if one’s income is higher than the Versicherungspflichtgrenze this is the upper limit to the premiums. Once signed up with one of the Krankenkassen one has to stay with it for (IIRC) 18 months or 2 years after which time one can change to another. There are over 100, many tuned to the needs of certain types of employment or social situation.

No cash changes hand if one visits a doctor or goes to hospital - health care is free at the point of use. The user experience is exactly the same as here except that waiting times are in general shorter and the buildings less shabby.

Some parts of medical insurance premiums are tax-deductible.

The health system is self-governing - the Federal Government plays no part in the operational details of the health system although it sets the framework for medical care such as benefits; eligibility; compulsory membership; the physical, emotional, mental, curative, and preventive risks to be covered; income maintenance during temporary illness; the split between employer and employee contributions to the statutory insurance; and other central issues. Below this level health and social care generally is a matter devolved to the individual Länder and each Land makes its own arrangements.

This is not to say that there are not problems - one of the biggest ones at the moment is the shortage of personnel leading to all sorts of delays, but this is generally localised. I'm in Berlin at the moment and local difficulties here cover a large area...