NHS And Funding

I have been following the board for a while and I know there have been a lot of questions about why it takes months to get an appointment with the rheumatologist. My hubby found this article in Reuters this morning and I thought it was interesting:

Britain's health service in a 'humanitarian crisis': Red Cross

By Kate Holton

LONDON (Reuters) -

Britain's health service is engulfed in a "humanitarian crisis" that requires the support of the Red Cross to use Land Rovers to transport patients, the charity said on Saturday.

Founded in 1948, the National Health Service (NHS) is a source of huge pride for many Britons who are able to access free care from the cradle to the grave.

But tight budgets, an ageing population and increasingly complex medical needs have left many hospitals struggling during the winter season in recent years, prompting headlines about patients being left to wait on trolleys for hours or even days.

The NHS rejected the Red Cross' description and the Department of Health said it had injected an additional 400 million pounds ($490 million) to help with the demand, but the opposition Labour Party called on Prime Minister Theresa May to do more to tackle the overcrowding.

"This is a national scandal," Labour leader Jeremy Corbyn said in a statement.

"We should not have to rely on the Red Cross to provide the basic care the people of this country need. I am demanding that the prime minister comes to the House of Commons on Monday and sets out to the British people how she plans to fix her failure on the NHS."

May's office declined to comment.

The row was triggered by a statement on the British Red Cross website, next to appeals for help in Yemen and Syria, which said it was now "on the front line, responding to the humanitarian crisis in our hospital and ambulance services across the country".

Chief Executive Mike Adamson said the charity was deploying emergency volunteers and having to call on partner Land Rover to lend vehicles to transport patients.

The NHS has always been an emotive issue in Britain - one of the richest countries in the world - and was once described by a former finance minister as the "closest thing the English have to a religion".

In recent years, charities and opposition politicians have warned that government cuts to social care have resulted in more elderly and vulnerable patients being treated in hospital rather than at home, putting a huge burden on the service.

Keith Willett, a director at NHS England, said the service was not on a par with a humanitarian crisis but said demand was at its higher level ever and staff were under pressure.

"Winter is always a very busy time for the NHS," the Department of Health said. "To support staff working hard on the frontline we have put in place comprehensive plans earlier than ever."

(Reporting by Kate Holton; Editing by Alison Williams)

70 Replies

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  • Not to be political or anything, but let's face it. Government Run anything is less than efficient. It's a TOP DOWN system with the leadership looking to benefit themselves.

    God help us in the USA if a true government run healthcare system ever gets into place.

    Alice

  • Yeah - I guess free is good, but we do pretty well most of the time...

  • I just worry about the future. What will be left for my grandchild. Free stuf isn't really free.

  • yes - As the saying goes: We Do Not Inherit the Earth from Our Ancestors; We Borrow It from Our Children

  • It's not FREE Caeryl......it's free at point of access. As soon as you earn money over quite a low amount National Insurance is deducted from your salary ....that plus money from other Government funds is what pays for the NHS.

    We pay that every year until we receive the state retirement pension at around 65......so you pay roughly 12% of life time earnings to get they" free" care!

    IT is supposed to be a NATIONAL Service but for some reason the BMA will not support moves to charge people from abroad , who do not qualify to receive free care, to be charged.

    Hence we have pregnant women arriving from abroad giving birth to sometimes quads getting free delivery & premature baby care .....then toddling off home having paid not a cent!

    At the moment under EU law we even have to allow people with diseases like TB & AIDS to enter the UK & receive free treatment!

    Crazy or What?

  • You are so right...I recently attended a meeting to discuss how more services could be provided to look after the sick & elderly who did not need to be in hospital, but did need help in their own homes.

    Every thing was slanted to benefit the NHS staff hierachy....not the carers & not those who need the caring.

    It was a real eye opener.

    Money isn't what the NHS needs....it needs an overview from non politicians who will listen to clinicians not accountants who think 6 minor operations look better on a spreadsheet than one hip replacement!

  • Yep. Our USA non-politician is Donald Trump. I hope he has the guts to do what the professional politicians will not.

    Alice

  • Absolutely.... I sure as heck hope so!

  • I disagree. Government should support healthcare. I do not care for the American system of healthcare for whoever can afford it. Healthcare is a human right, not a private business.

    I believe the American people have been brainwashed into believing government healthcare would be communism if in the USA.

    Anyone should be able to walk into a clinic or hospital of their choosing and not have to worry about how much money is in their pocket if they don't have insurance.

    I think it is awful that Obamacare is mostly paid for by the middle class.and I think it was set up this way purposely. It was set up this way to prove to the American citizens that government healthcare wont work. Why can't the republicans and democrats work together for the human right of healthcare for everyone?

    Take care

    Sue

    PS..I reread what I wrote and I want you to know that I'm not anti American,, I just do not like the US medical system. I love visiting the USA and I think Americans are a friendly people.

  • I agree to a certain extent. BUT, what we have in this country is not just someone walking into a clinic and getting the treatment they need. What people here want, and expect, is walking immediately into a clinic, getting the best treatment there is available immediately and never getting a bill. And preferably without having to pay any taxes either. But again, someone has to pay for it... We are so used to immediate and top of line everything in the US that transition to a more monitored system will be difficult.

    One other thing: I worked for almost 50 years of my life, paying taxes the whole time. AND I worked 60 hours a week (salaried - i. e, management) for the majority of those years, along with paying hundreds of dollars for health insurance. So, yes I had insurance (as does my DH - dear hubby), but we worked our @$$es off for the "privilege" of having insurance.

    At least the NHS system has gotten it down to something that makes sense. People are screened and (hopefully) appropriately directed to the correct level and type of treatment for them.

  • I do believe your countries healthcare system is between a rock and a hard place. People like you and your husband working your behinds off for the privilege of having health insurance. Then you see people (like a few relatives of mine) who never worked a day in their lives expect everything to be handed to them. It's understandable why you feel this way. I get upset that these family members of mine take advantage of the welfare system, have 4-6 children with different men and expect more. But I am not upset with them getting healthcare, as maybe one of their 4-6 kids might become an upstanding citizens.

    To overhaul a healthcare system that you've known and worked for health insurance all your life must be very frusterating and scary. The only hope I wish for the USA is that they improve the ACA faults by looking at how other countries do it. Your future generations will thank you.

  • Yes -

  • Mr. Obama set up this system and in a speech years prior to his candidacy actually stated that his plan was a starting point that would eventually lead to a "single payer system" i.e. Government-Run Insurance.-Socialism.

    It has gone as he planned, but unfortunately it is unsustainable.

    I am a Republican and I wish affordable healthcare for ALL. This administration will work with Democrats to mesh the best of the best, utilizing a system of competition that will allow purchases nationwide instead of within States and allow younger buyers cheaper catastrophic policies rather than "1 size fits all"ones.

    Americans will find a better way. We fight very hard to avoid Socialist Policies. Eventually they all fail.

    Alice

  • Hi Alive - I agree with a lot of what you said. We need to find the right path and mix to make it work...

  • Hi

    Yes I heard this. I think the health service has been struggling for quite some time. In our village a ninety year old lady was discharged from hospital, with no follow up care! She lives alone. Fortunately she was looked after by the village. This was over a year ago.

    I used to volunteer for the Red Cross. I used to specifically visit older folks when they were discharged from hospital. Making sure they were OK, and doing shopping, housework and talking to them. I wonder if this service still exits at my local hospital? I might apply again. It's an invaluable service. The NHS is so overstretched.

    Knowing this still doesn't help when folks are in agony and desperate.

  • Nevertheless, I'm pretty grateful we have the NHS.

    I had amazing, fast treatment when I visited emergency recently. It was a Friday night and they were inundated with people who'd drank too much. I felt for them.

  • That is awesome Hector! You are a nice person

  • No, not really, but it's nice to be useful sometimes I reckon.

    What goes around comes around, and all that!

  • We unfortunately have a government that is underfunding our NHS in order to sell it off to there wealthy pals. God help us if it goes like the USA, as the great Nye Bevan said

    Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community” Aneurin Bevan-founder of the NHS.

  • As much as possible. But the money has to come from somewhere, and for us right now in the US it is coming primarily from the middle class...

  • Yes, your Obama care has to be reworked. Everyone should have equal healthcare. I often wonder why Obamacare is paid off the back of the middle class? I believe Obamacare was set up this way to prove to its citizens that government healthcare is wrong. So sad really. Why can't both political parties get together for the good of the nation?

  • Well, originally it sounded like it might make sense for everyone to pay into the ACA, and the young people would hardly ever need the care. So the older people would be treated on the backs of the young people. But astronomically high premiums and deductibles, with most young people not buying insurance if they don't get caught, more and more doctors refusing to take the coverage because their payments don't cover the cost to render the service, older people needing more and more care, and insurance companies that were supposed to manage it dropping in droves out of the market all combine to set up a giant house of cards.

    I'm not sure what Trump has in mind, but it has to be something that does not give 1/2 of the country a free pass on everything , whether they are legal residents or not.

  • It's just so sad that the ACA was set up to fail. Big businesses don't want to give up their "cash cow" insurance healthcare programs.

    I grew up poor and my hubby and I began out lives together poor. We worked hard and struggled to become "middle class". Never did we fear the cost of healthcare or even think of needing health insurance as I always knew it was available to us, rich or poor. But I know I would never be able to afford Obamacare if I just lived 16 blocks to the south.

  • Yes, a very different and unfair system in my humble opinion. The NHS is one of the UK's most loved and amazing service that people will go on the streets to defend from greed and corporations, I'm definitely one of those!! My grandfather told me how he had to share a bed with his brother who died of whooping cough as his parents couldn't afford to go to the Drs, it was a disgrace then and is still one now. The principles of the NHS are alive and well, long may it continue.

  • That is sad... My grandparents had 17 children! and of those 12 lived to adult hood. I wish you could see the three (tiny) bedroom(s) house they raised their kids in. It is amazing. They had to have 2-3 kids in each twin bed. And I complain that my garage is full of stuff and I need more storage space - ha ha

  • My father was raised with his grandparents that lived in a 2 bedroom basement suite that they rented for their family of 11. My great grandfather had a hardtime finding work as he was an Irish immigrant and the hatred for the Irish ran rampant back in the 1930's. He would claim that he was Scottish in order to work, but he would be fired once someone recognized his accent.

    When I look at my father's side of the family now, I see 4 generations of hardworking people who have become lawyers, RCMP and basicly upstanding citizens, etc. I also see 4 generations of thieves & prisoners, welfare recipients, elementry school dropouts, drug addicts, etc. I have so much respect for people that have overcome their "station" at birth.

  • Hi Caeryl. I for one am grateful for the NHS, but having worked and paid in my dues. It is a postcode lottery, I live in Essex, but my rheumatology hospital is in a London borough, I am lucky they have a clinic in my local hospital. I do have to wait about 8 months between appointments, but the service for the-rheumy nurse is very good. I have had 3 telephone calls from my Rheu/ consultant, if she is worried about anything, in the last year. I am under other hospitals for different medical problems and on the whole has not been too bad for me. Not perfect of course. It does take a while to see my own GP, but could see others in the practice. We are a small island, with a lot of people and far too much bad top management and not enough people that matter. X

  • Nice note Gigi - And honestly there are times I have to wait to see my GP for several months if I don't have an appointment. She is incredibly busy..

    And you are right of course, everyone that pays taxes pays for everything that is "free".

  • I have been to the states 4 times, with of course the appropriate travel insurance. It's very expensive with all my health conditions. Luckily never had to use it. My cousin lives in New Jersey, their medical insurance is very expensive, her husband age 79 still has a part time job. What does amazes me is if she goes to ER she has to give her credit card before they will treat her. I think we would be up in arms if that happened here. I'm not sure if this applies if you have different levels of cover. My eldest son had excellent treatment when he had a heart attack 6 years ago, he didn't need to use his private insurance for further treatment as we have an excellent NHS heart hospital not too far away. I am forever greatful for the wonderful treatment he received. Xx

  • It's not like that everywhere in the states Gigi. I had a Nasy car accident inFlorida & nobody asked for my credit card.....when I left the hospital after 5 days I gave them my insurance details & I never heard any more until I got copy bill from my Insco ...+ a bill,forabout £25.,,,,the excess for the ambulance charge!

  • I'm pleased to hear it. I cant't speak from first hand experience, as never used mine. My cousin doesn't have very good health, apart from that she gets good treatment. X

  • Actually what you are describing is illegal here in the states, unless the medical staff has evaluated the patient / situation and determined that it is not an emergency. If the patient is considered stable, they can determine insurance and payment coverage options before treatment. Do I agree with it? Yes and no. If someone needs treatment, they should not be hit up for payment in advance, but if there is abuse going on. This happens much more than you would believe - most of the abuse is based on drug addiction and the need for more drugs.

    I had this happen with my mother in law several times, where she would take her oxycodone 2 - 3 times as fast as she was supposed to, then go without for three days and have to call an ambulance... In her case, however, she was covered by two full insurances so everyone looked the other way.. Sheesh

  • Thx for the info Caeryl. She looks like a lovely cuddly grandmother, she fell off a foot stool, her ankle was swollen, but not broken. So not an emergency. I will see if she has cover for ER. This happened last year. I think it's hard for us to understand how your systems work we take so much for granted. We met a lovely couple on a tour of North California 4 years ago, they live in Florida, we email each other regularly. The husband has recently had a severe stroke. She emailed me last night, he is in rehab and it is paid by Medicare, but runs out after 3 weeks they would fund some care at home, but he is still very immobile and she has said they have to find another rehab. I don't like to quiz her at this sensitive time. So hoping you can explain. Thx.

  • Sorry this is long, but it is a complex subject. Medicare is an age based coverage, and only requires the person to have paid taxes for something like 1 year total in their life. Or, it can be from your significant other. There is no premium for Medicare A (Inpatient) if you qualify, but for Medicare B (outpatient) there is a fairly chunky one.

    Here is the schedule of payments from Medicare - As you can see, full coverage after the deductible runs for 60 days as an inpatient, and if you are out of the hospital for 60 days, the benefit period starts over. The next 30 days inpatient have a co-pay (daily charge) . The patient is given 60 of what are called Life Time Reserve Days - they are given once in the patients life. Once they use them, they are gone.

    $1,316 deductible for each benefit period

    Days 1-60: $0 coinsurance for each benefit period

    Days 61-90: $329 coinsurance per day of each benefit period

    Days 91 and beyond: $658 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)

    Beyond lifetime reserve days: all costs

    Once the patient has been in the hospital proper for a certain period of time, if they still need care, they can go to a SNF (Skilled Nursing Facility). The coverage is:

    Your costs in Original Medicare

    You pay:

    Days 1–20: $0 for each benefit period.

    Days 21–100: $164.50 coinsurance per day of each benefit period.

    Days 101 and beyond: all costs

    If you stay beyond 100 days, it is considered self pay at that point. This is probably where your friends are right now.. I don't think finding another rehab will do anything unless she is talking about Assisted Living, which is what we did with my mother in law. She was not able to go home, and no longer qualified for Rehab under Medicare or Tricare, but Assisted Living had to come out of her pocket. It was $2800.00 a month, and that was one of the lowest cost ones. Fortunately for us it was also close to our house, excellent care and wonderful staff.

    Looking at the high costs the patient bears, you can see that most people have to have a secondary policy. But even that is not a guarantee. It used to be that if you had two coverages, the second paid what the first didn't, like the deductible and co-pays. Then about 20 years ago, the insurance companies started adding their own deductibles, so that cost could sort through to the patient even with two policies. Sheesh.

    I hope that answers your question. So:

    1 - 150 days in inpatient hospital if the patient qualifies medically, then

    1 - 120 additional days (this is now up to 270 days...) for rehab.

    Holler if questions

  • Thanks Caeryl for taking so much trouble to explain. That's what I thought, why can he not stay where he is, they are quite comfortabley off, certainly not rich by any means. I assume they will have to pay extra anywhere he goes next. He is still not on solid food, or able to do much for himself, he is having therapy to teach him to speak again, this will be ongoing for sometime. They are both in their middle seventies. Their family are spread all over the states, with one daughter an hour away, they all work of course. She cannot manage him at home just yet. I do worry for them. They have been on lots of cruises last year, so where having a lovely life. You just never know. Sorry if I haven't understood is your mother in law still in assisted living. X

  • All of it is really confusing. That's so much of why I keep trying to understand your health system too.. (My nature unfortunately - very curious)

    I really hope your friend can find a suitable place. As hard as it is to put someone there, it is easier than trying to care for the person full time. You just wear out, no matter how much you love them.

    Actually, my MIL passed last June. It was so strange. Last February we came into see her one day and the first thing she said was "I've decided I'm not going to eat any more." And she really didn't... The doc says her body was shutting down and that is what prompted her to do that. It was a really hard 5 months...

  • Oh dear Caeryl, I am sorry to hear about your MIL, that was very hard to take. Bless you both. XX my friend does know her limitations, she is there everyday helping with his therapy, but home by 6.30 for her own sanity. We all wish the best for our loved ones. Keep asking questions xxx

  • Thanks - It was much harder to watch her stop eating than anything else - Even things she has always loved. She was far overweight, but that dropped down of course. We're relieved that it is over for all of us... Thanks for your kind thought.

  • I'd just like to add the NHS is not free and never has been ! we pay for it. I've seen this on the news its not reflecting other issues. I'd add I have private insurance but when seriously ill its NHS all the way. Its saved my life twice and whilst not perfect and the UK has a lot of issues in care matters it is still a facility that a lot of other countries envy. You will never be turned away if your seriously ill.

  • I agree Medway Lady...I broke my arm on a Saturday & couldn't contact my private orthopaedic surgeon & had to go the A&E.

    I got an .Xray & the arm plastered...but no examination ...as an "older" lady having had a fall & banging my head they should have carried out neuro observations ...how did they know I hadn't had some sort of blackout...even a mini stroke that caused my fall? No one asked how I fell.

    I think A&E staff are so overworked the service is seriously slipping. It is worrying.

  • It's interesting. I belong to a membership for Zoe Harcombe. She is a PhD and food researcher and statistician. I found her about 2 /12 years ago, and it was her logic that convinced me to give up being a vegetarian. She sends out a news article every week, and this weeks was actually on the NHS (she is from the UK). I am copying it below - Sorry it is a little long:

    The NHS – What's The Future

    In 2011 I presented at the Brighton Science Festival. A fellow presenter was Professor Klim McPherson – an esteemed epidemiologist. Professor McPherson was asked a question about the future of the UK National Health Service (NHS) and he answered that he thought Type 2 Diabetes (T2D) would ‘break’ the NHS by 2020. How prophetic his reply is proving to be. With three years to go, the NHS is currently showing signs of breaking point. T2D alone may not be responsible, but it could well be the avoidable burden that has just tipped the balance from manageable to unmanageable.

    This week I did a radio interview for BBC Cymru (the Welsh speaking BBC Wales). This year, BBC Cymru is celebrating 40 years since it was formed in 1977. As part of the celebrations, they are looking at what the future might hold for major Welsh institutions and issues for the next 40 years. They wanted to talk to me (in English!) about what the future might be for the NHS and health generally in Wales...

    Even though this is a Welsh/UK story, it has global applicability and interest. What were the principles underpinning the first National Health Service? What are the challenges facing free health services in our increasingly sick societies? Can the laudable aims of one Welsh man – Aneurin Bevan – in setting up a national health system, prevail for much longer?

    The founding principles

    The first free National Health Service was set up in July 1948 in the UK. It was established by the then minister of health, Aneurin Bevan. It was based on three core principles:

    i) that it meet the needs of everyone;

    ii) that it be free at the point of delivery;

    iii) that it be based on clinical need, not ability to pay.

    These three principles have guided the development of the NHS for almost 70 years and they remain at its core. (It is worth remembering from the outset that nothing is free – the NHS is paid for primarily from tax contributions. The England NHS budget is approximately £120 billion, which amounts to almost £2,000 cost and expenditure per citizen.

    The principles under threat

    I argued in my radio interview that the three principles of the NHS are already under threat, if not compromised, today:

    i) It is difficult to argue that the NHS met the needs of this woman who died, in a hospital cubicle, after waiting 35 hours to be treated. It is difficult to argue that the NHW in Wales is meeting the needs of people waiting 200 days for a hip operation (I don’t believe this figure, by the way, as everyone I know waiting for a hip operation in Wales is waiting 18 months). It is difficult to argue that the NHS is meeting mental health needs anywhere in the UK with dangerously long waits to see a therapist and eating disorder facilities woefully inadequate nationwide.

    ii) Free at the point of delivery is the principle most protected today, but interestingly this principle didn’t survive the first 18 months, as the NHS amendment act was passed in December 1949 giving the power to introduce prescription charges. This was a factor in the resignation of Aneurin Bevan in 1951 and charges were introduced in 1952 at the sum of one shilling per prescription.

    Prescription charges were abolished by Harold Wilson’s government in 1965, but then re-introduced in 1968 at a higher charge of two shillings and six pence, but with a wider range of people being exempt from charges.

    Wales introduced free prescriptions for all residents in 2007. The English charge is currently £8.40 per prescription for those not exempt. There are ongoing calls for people in Wales who can afford to pay, to pay. However, there is also an argument that 93% of prescriptions in Wales were already free of charge and therefore it costs more to administer payment for the 7% than it does to make all prescriptions free.

    iii) Decisions being based on clinical need, rather than ability to pay, is a principle that has also already fallen.

    As Dr Malcolm Kendrick explains in the brilliant book Doctoring Data: “The measurement used by NICE to establish cost-effectiveness is the cost per Quality Adjusted Life Year (QALY). One Quality Adjusted Life Year is assumed to be one extra year of perfect quality life, or two years of fifty per cent quality life, or four years of twenty five per cent quality etc. Quite how well quality of life can be measured is a complex question... It has been decreed by NICE that one QALY should cost the NHS no more than around £20,000 or £30,000. Any more than this and the intervention will be deemed too expensive. Sorry about the vagueness of this cost per QALY number. But trying to pin NICE down to an exact figure is, frankly, impossible. This ever-moving range of £20-30,000 was simply plucked out of thin air anyway.”

    This is why many expensive cancer drugs are not funded, which may prolong life for an individual for a few months. I’m not going to debate the rights and wrongs of this – merely to point out that it destroys the third principle upon which the NHS was founded.

    The future

    I said in the radio interview that I can only see the NHS moving further away from these founding principles – not taking steps to recover them. Should we continue to send ambulances free of charge to treat people who have chosen to drink so much that they collapse in our streets? Is this different to treating an athlete with a ‘self-inflicted’ sports injury? Hospitals have already started to deny or delay treatment to obese people. Is this sensible because weight can cause serious surgical complications; or is it an unacceptable way of managing demand because supply is limited? Certain media publications have called for non-UK residents to be charged at the point of treatment. Is this a way of protecting free services for UK residents or a fundamental affront to a doctor’s duty to treat someone needing care (first do no harm)?

    The debates around free healthcare are highly emotive and contentious. What I hadn’t realised, until doing the research for the interview, was that all the founding principles of the NHS have been undermined already. I didn’t have to forecast 40 years ahead – the changes are already apparent.

    The two fundamental issues driving change in the NHS (and therefore the challenge to any attempt to provide free national healthcare anywhere else in the world) is that 1) demand already outstrips supply and 2) demand is continuing to grow whereas supply is not keeping pace (arguably supply cannot keep pace).

    The NHS was set up in a time when we all knew one ‘fat’ person. The 1948, post-war, Britain naturally ate real food. Statins had not been invented. Cholesterol tests and blood pressure tablets were not routinely administered. We didn’t have national screening programmes, dietary guidelines and the mass-medication and intervention that we have today. The average British citizen is arguably less healthy today than when the NHS was established. With pharmaceutical companies driving interventions to maximise profits, can we continue to make drug companies rich by dishing out their never-ending pills and potions freely?

    In my opinion, the only way in which we can retain the gem that is the NHS is to reduce demand. We need to change dietary guidelines so that people are not advised to consume 55% of their food intake in the form of carbohydrate (essentially sugar), which drives the two big lifestyle expenses of obesity and type 2 diabetes. We need to stop pandering to the mass-medication scare mongering tactics of pharmaceutical companies and stop the non-evidence based making up of targets for things that don’t even matter (cholesterol) or things that do matter, but should have the cause not symptom treated (blood pressure). We need to stop interventions that have been shown not to work. However, we also desperately need individuals to do their bit...

    Costs and benefits

    I was on the board of the NHS in Wales between 2009 and 2012. I didn’t seek a second term in office when I started my PhD in 2012. Three years was more than long enough to get an incredible insight into the challenges facing the NHS. Three other facts were of great help in my preparation for the interview:

    1) Two thirds of the NHS budget goes on staff costs. With national pay agreements and an ever increasing need for more (not fewer) staff, let alone the pensions time bomb that is not being addressed, there is virtually no opportunity to reduce costs in the NHS. We should get rid of as much management as possible and prioritise doctors and nurses and front line staff. However, management costs overall are just a couple of percent of the total.

    2) A second crucial fact to be aware of is the difference between life expectancy and the number of healthy years enjoyed by the average person. UK life expectancy is approximately 78 for men and 82 for women, but just 62 of these years are expected to be healthy for men and 64 for women. This leaves an average 16 years for men and 18 years for women where demands on the NHS are likely to be substantial. With an ageing population, the strain on free services is clear. This is where the individual responsibility becomes paramount...

    3) From the great work of Professor Peter Elwood and colleagues, we know that there are five healthy behaviours, which can make a significant difference to both life expectancy and healthy years of life: not smoking; not being sedentary; eating healthily; being a healthy weight; and drinking moderately. We also know that fewer than 1% of people follow all 5 healthy behaviours and just 5% follow 4 or more and that this has not changed between 1979 and 2009. One could argue for public health prevention to be scrapped on this fact alone. I think public health prevention can play a vital role, but its efficacy is currently questionable.

    Being blunt

    People in the UK have come to expect free health care as a right. We expect it. We demand it. We complain about the service. We sue the service when it doesn’t deliver what we want. Insurance costs for doctors are getting out of control. Staff are stretched to their limit. Morale has never been lower, risking the supply of services falling even further away from the demand for them.

    There are 2,000 General Practitioners (GPs) in Wales for 3 million people. Since not all GPs work full time, that’s fewer than 1 GP per 1,500 people. NHS England deals with over 1 million patients every 36 hours. This is simply, sadly, not sustainable.

    Notwithstanding that the founding principles of the NHS were under attack from the start, we can only continue to move away from them unless game changing events occur. I do believe that we need to change dietary guidelines and stop mass medication. However, the Professor Elwood findings teach us that, as individuals, we need to do our bit too. We can no longer expect to be picked up in the street when we fall down incapacitated – either literally or metaphorically.

    If we want our precious NHS preserved for the next 40 years, we all need to play our part.

    Until next time

    All the best - Zoë

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    Copyright © 2017 Zoe Harcombe

  • I basically follow the Zoe Harcombe diet and much of her teaching, so much of what she says makes sense. NHS eat well plate is very different to her diet, but there are signs that it's getting the message, we have a lot of diet programs on our TVs now changing people's idea we should all be on a low fat high carb diet. Good fats and low carbs are the way forward. Even my dear sister still can't understand why she is big, she has a sweet tooth and low calorie diet with so many additives in. More and more people are being dx with weight related problems. So yes the the NHS is under enormous pressure. X

  • Yeah - I love Dr. Harcombe too, and her analysis for the best way to lose weight made/makes perfect sense to me and my hubby too.

    The "food pyramid" we have here in the States is totally off base too in my humble opinion. Way too high in carbs, too low in fats... Probably too high in protein too.. No differentiation between veggies like potatoes and spinach... I was a terrible vegetarian. For almost 30 years I ate too high in carbs and combined them with fats and proteins. My lab work was okay but my weight was way too high. It still is, but I am steadily losing just by changing how I eat. Actually I am more of a keto type now, but still enjoy Dr. Harcombe...

  • Yes I followed her to the T for 2 years, but lost to much weight. I think if you understand the basics of her teaching you will adapt it to your taste. It's lucky I love veg, salads and home made soups. Fish, chicken and meat in moderation. All the best and keep as well as you can. X

  • Zoe has just about got it taped. She is too polite to say until a system is devised where young people ....& a lot if oldies...get this unto their heads. & the grey suits..both NHS Managers & politicians grasp the nettle the NHS will wither away. I am assuming they all have private medical insurance.

    Most people working today have never known anything else but free health care. I am old enough to remember my mother paying one shilling (5 pence) to take me to the GP as a child. In those days you could buy a loaf of bread for less than that, so altho it sounds a pittance now it wasn't then.

    A sense of entitlement has been bred & until,we either contribute more, or devise an insurance payment scheme to cover the shortfall in funding things can only get worse.

    In UK there is no custom of regular health checks. in schools there used to be a cursory health inspection, but I think even that has been discontinued, When I first went to the States (1960's) I was really surprised to find very young women having gynaecological check ups.....I think to this day most women in UK don't have check ups until there is a problem....fir any condition not just gyny.

    Why aren't school children checked ? if they are obese the parent should check if they have a health oriblem & if not change what they feed them. But that bring in yells of Nanny State.

    Making nurse training a university degree subject has also lost the profession many fine nurses who want to care for people , not read about technical nursing. When those that do graduate go on to the wards, many don't want to do the essential tasks like hygiene....& the kind word that lifts a patient's day is often not there.

    Because the NHS is failing we also lose many fine UK trained doctors to countries where people understand paying for a good health service, if someone can pay £225 a month to smoke 20 cigarettes a day..they could smoke a little less & spend the saving on an insurance for health. But that goes against the grain here,

    I really feel throwing more money at it won't help. Efficiencies might...but who has the courage to say enough is enough & force NHS Trusts to get value for money ?

    We all value our NHS ...but I fear we will have to contribute more if we want to continue to get " free" treatment!

    Hope Jeremy Hunt reads HEalth Unlocked!!!

  • Hi AC - I remember when I was in my early 20s, worked as a bar tender because that was all I could find, and they would never offer health insurance. I got sick a couple of times and just tried to "tough it out" because I couldn't afford the care. When I got jobs that offered me insurance if felt like I had hit the lottery. Oddly, we still try not to use healthcare more than we have to, but geez - RA??

    Yeah - We are working on that same mindset. We are now on a third generation of people here that have never worked and are perfectly capable of it..

    And don't get me started on the Affordable Care Act...

    Anyway - before I step on any more toes, I'd better shut up.. Have a wonderful week!

  • Get the message we have plenty of those here too!

    Our affordable care consists of ..you sell your house, give us your pension & we'll house you in appalling conditions & hope you due soon!

    I was so lucky in my last job having private health insurance which continued with my pension! I'm costing them a fortune, but I gave up a percentage of my pension to have it ..didn't even have RA then...I guess I would 't have got that deal if I had!

    On the whole we are still very lucky to have the NHS, but most of our politicians have never run a business & P&L accounts are a mystery to them.....& as it's taxpayer's money they don't answer to any overall "Chairman" when year end accounts are are presented!

    Someone has got to make a decision, but the present people in charge don't know which way is up!

    I have just been fo if shopping for the first time since before Chrustmas ....so have bought lovely goodies like strawberries, avocados & that lovely Italian broccoli to sauté with chilli & garlic!

    Yummy!

  • But do you think the Man from Alabama will help,as AG?

    I'm no happy clappy bleeding heart Liberal..., but...a step too far?

  • Don't "shut-up" Carey/USA! I think you opened up a good dialogue.

  • Thanks - I think there is a careful spot in here where discussions get people upset and then I end up dropping out of the group. Just trying not to go that far :-)

  • A good debate is an excellent way to gain knowledge about different countries medical system, We don't have to agree with eachother, but we don't have to get mad at eachother either. Please don't drop out of the group over a post that others may not agree with.

  • Thanks... I'm just too wordy right now - ha ha.

  • I think I should add my oh's brother had terrible treatment at another hospital, he went to A&E in October last year, 3 times and they treated him for pneumonia and in desperation they asked to see an cardiologist, he had 83% heart damage, very scary treatment. Since then he has had really good treatment and seems to be responding to drugs, fingers crossed for him. Should not have happened though. But unfortunately these things do.

  • Fingers crossed here too

  • The great thing about the USA is that we are 50 states and states rights is built into our Constitution. Individual States handle many things differently. Each one is an "experiment" where the many can benefit from what does work and what doesn't and change local laws and methods to improve efficiency elsewhere.

    As of now we are bound by Obamacare across the Nation. Trump will fight to have insurance across state lines to increase competition and bring insurance rates down while keeping the good parts of the Law.

    Alice

  • It is difficult to reply regarding a complex subject in a nutshell but I will try.

    The NHS has traditionally been a combination of a social care system and a health care system. It operates a priority system where not only certain conditions are better funded and prioritised but certain people are.

    It is organised into primary care (family doctors known as GPs) and secondary care (hospitals with specialist medical staff).

    A patient has to be registered with a GP to get access to secondary care, unless they are an emergency and go to A&E. The GP will filter out the patients needing referral. They are often referred to as "gatekeepers" because their job is to keep patients out of hospital if at all possible. Thus, the GP will try to treat patients by a combination of guesswork. They will refer those with obviously serious conditions or the patients who are medically the worst. The others will either get better or deteriorate by which time it is obvious what is wrong with them and little investigation is needed. However, by the time they are referred, it is sometimes too late, either to treat them or to save their lives. The NHS concentrates very heavily on treating acute conditions or emergencies, and waits for a condition to either clear up or become severe or an emergency. Thus, financially, it is quite an efficient system but that comes with the penalty of suffering by some or possibly death.

    It is good for treating cancer, heart disease and joint replacement, conditions which get the most funding and priority and are the most common in the UK. Its funding on cancer at least matches those of the top spending countries but its outcomes are poorer. This is notably because of the primary GP care system of gatekeeping which causes delays in referral and treatment.

    Conditions which are poorly funded and treated include rheumatology and mental illness.

    You refer to the current crisis in A&E. Two significant causes are (a) the breakdown in primary care resulting in people, often with minor ailments, going direct to A&E and (b) the breakdown in social care, particularly for elderly people. The NHS used to provide social care for the elderly in nursing homes but these were privatised in the 80s onwards. Thus, elderly patients or those with no-one to look after them at home are disparagingly called "bed blockers" as they occupy beds needed for seriously ill patients. It also provides other social care like contraception, sterilisation, abortion free which is not a feature of the medical systems of other countries.

    You mentioned obesity and, I think, diabetes. Diabetes is now the responsibility of primary care but until a few years ago hospitals monitored diabetics direct. This is a significant reason for people not being able to get appts because diabetics need regular monitoring and take up many appts. Some surgeries have a diabetic nurse.

    You mentioned the aims of the founder, Aneurin Bevan:

    i) that it meet the needs of everyone;

    ii) that it be free at the point of delivery;

    iii) that it be based on clinical need, not ability to pay.

    With regard to (i), I can honestly say it does not meet the needs of everyone and it never has. There are numerous conditions that it just does not treat, in particular conditions which it deems "not bad enough" and the patients ends up paying. These might be irritating conditions like endometriosis, skin conditions like psoriasis, but particularly conditions which the NHS deems as both non life threatening and expensive to treat. Its record on mental health is truly appalling. (My local train company has spent millions erecting high barriers on platforms and installed guards to monitor access to the platforms because the high rate of suicides from people jumping under trains was costing so much. Mental health care would be far cheaper.)

    It is free at the point of delivery. It is funded out of taxes (not National Insurance which is for benefits and pensions only).

    It is not always based on clinical need. It is often based on social need, as currently with the elderly population. A further example might be that in limited resources, if there are two patients and one is single and the other has dependents, both with the same clinical need, then the latter will be treated. This is not a widely known fact and it certainly is not admitted freely but it is true.

    I something think it is wrong to be completely free at the point of delivery because it leads to abuse, eg people crowding into A&E with a minor ailment and depriving the dying of care. Another reason A&E is overcrowded is that people just can't be bothered to go to a GP - we are turning into a much more selfish society.

    I do think that the NHS is right to treat genuine emergencies such as car accident cases, heart attacks, infections when the patients are overseas visitors. I certainly don't want infections spread around.

    I hope I have provided an overview which will help you to understand the system. By the way, the Red Cross reference to a humanitarian crisis refers to the plight of the elderly and disabled who are sent home from hospital to live in desperate conditions as they cannot care for themselves.

  • Very well put. I will add though, GP surgeries are creaking under the strain of so many patients. At our practise, it takes about 2/3 weeks for routine visit to see your own GP, you can ring at 8 am for the few appointments left available for that day. If an emergency, you will get a call from the triage doctor who will decide if you need to be seen. Also you may be able to see another doctor in the practice sooner, they have online bookings also. Some people can't be bothered with all this, especially out of hours and just go to A&E. Another point, people make appointments then decide not to go, but don't inform the surgery. A list is put up each month of how many cases of this, around 170, so depriving someone else of an appointment. If they had to pay they would be bothered to call and cancel.!

  • That is awful that people don't call to cancel their appointments. In Canada, more and more doctor's offices are charging a cancellation fee. If you don't show up to your appointment, or cancel 48hrs before your appointment, then you are charged a cancellation fee.

  • I agree, it would stop so much abuse of the system, people are just so selfish and then moan when they can't be seen when they want. We are back to the 'free' question again. The surgery called me this morning about a missing blood test result, someone had taken the trouble to chase it up for me. They do all they can to help you. X

  • Here in the states they charge patients that do not show up and don't call. It doesn't always work, but it does help...

  • Thanks for the additional information and explanation. Sorry it was so much to type :-)

  • An interesting discussion you started there CaerylUSA!

    Someone said the NHS may not treat psoriasis, but in fact they do. Treatment may not be perfect, but the autoimmune condition psoriasis should be treated if necessary. Furthermore, NICE guidelines recommend that both GPs and dermatologists review patients with psoriasis regularly to check for signs of psoriatic arthritis. I have PsA, so you can see why I noticed this.

    Amidst all the discussion about the NHS, nobody ever asks why we are getting sicker, crazier, more demanding, less reasonable. (I think all those things are true, but I can't prove it). I reckon we have fundamental issues at play, a sick society and a cruel one. Because there indisputably is an ageing population, the NHS's troubles are invariably blamed on that but there's also an epidemic of misery and mental health problems amongst children and teenagers.

    Additionally, the number of hospital beds has been halved in recent years. Wish I could specify the time period, I'll check it out. As others have said, the government is actively undermining the health service and growing the independent sector.

    For all that, the Red Cross' choice of words is a little strange. If there's an Humanitarian Crisis in the NHS then the same should be said for many aspects of life & death both here and in the USA, homelessness for example. They must have been frustrated as hell with it all to use those words because once you've used that particular phrase, what is left to say when things get far worse, as they inevitably will?

  • Hey Postle2 - I may be going WAY out on a limb here, but I don't think most people have demonstrated a need for fluoride or mercury, or glycosphate for that matter, and yet they are in our water, vaccines and weed killer. We put all of that into our environment and bodies, and as a consequence, as you said we are sicker and sicker. And it is hard to be magnanimous or generous when you personally feel terrible...

    Homelessness is another matter all together...

  • I don't think you are going out on a limb, on the contrary so many of these areas ARE connected. As for homelessness, well there's more and more of that and it's often a result of poverty and / or mental illness as well a housing crisis (in the UK) and all those things are strongly associated with chronic and intractable ill-health which contributes to the strain on the NHS. Yet at government level every damn thing is dealt with in isolation. I can see why but I still see it as a pitiful approach.

  • Yeah - I did a paper for college on the homeless situation in San Francisco at that time. It was scary but mostly sad. SF was especially bad because they are such a temperate climate for the most part, and they gave actual cash instead of vouchers.

    My frustration with government is the absolutely stupid ways we waste they money they do take. Anyway... sheesh. Sorry - More political here than I intended to be...

  • They gave out money instead of vouchers in San Francisco? How stupid.... the city of Vancouver hands out needles to the heroine addicts....as if heroine addicts can be responsible to dispose of used needles safely.....

    It is just a travesty that the majority of poor people have people looking down upon them negatively because of the drug addict on the street. There are many upstanding poor people, we just don't see them because they have pride. They are busy trying to afford the rent and raise their kids to have a posivte view on life. They are the people working hard jobs with minimum pay just to afford the rent. They aren't the ones bumming money on the streets or wondering around higher than a kite. The working poor suffer from the negative attitude of being a bum.

  • They did for a while, until they started the "Care not cash" program. But by that time, every city in the world had sent their homeless on a one way bus to the Bay area. The last I knew they had vouchers instead..

    Actually I don't think it is because they are drug addicted that people look down on them, although that is true for many of them. Mostly they are looked down on because there are no facilities there for people to use, so they crap and pee everywhere.

    The first time it happened to me I was walking from our office to one of the hospitals and a woman walked up to a recessed doorway, turned around, pulled down her pants, dropped a load in the door way of an open business then pulled up her pants and walked away. My walking partner was laughing so hard because I just stood there with my mouth literally open looking between her and the pile she left. I worked there for 8 years so I got used to it, but it's still not good.

    It is so bad that they now have a poop map: archives.sfweekly.com/thesn...

    There are no easy answers...

  • I never understood why Americans did notlike Obamacare. It was thought by many in Canada to follow our healthcare system. How wrong I was. It is just another 'layer" of pay for health insurance. How sad.

    What, exactly, does “Obamacare” look like compared to Canada's Heathcare/

    U.S. has a multi-tiered system. And despite the hype on both sides of the Congressional aisles, Obamacare keeps the same complex structure in place, while adding another layer through the introduction of health care “exchanges” for uninsured Americans. But the majority of Americans will continue to access care through a variety of health insurance plans made available or subsidized by their employer; nearly 50 million elderly and disabled through the federal Medicare program; another 60 million lowest-income through state-federal Medicaid arrangements.

    Obamacare is not universal coverage: Health care in Canada is based on a simple proposition: every legal resident is covered through a publicly-financed provincial or territorial plan. Canada’s universality principle. Even though Obamacare broadens coverage, the individual mandate relies on a fundamental insurance principle – care depends on type of coverage – and compels Americans to purchase insurance to access care. Americans now have more affordable insurance options and subsidies to cover their costs, and the lowest-income may be eligible for public coverage through the expansion of Medicaid.-

    Obamacare is not “national” health insurance: One of the hallmarks of health care in Canada is that, although each province and territory administers a health plan, everyone can expect to be covered for a comprehensive range of services, no matter where they live. And the federal government is expected to chip in to provincial coffers to make this happen. There’s plenty of intergovernmental friction as a result, but nothing like the fractured federalism of the United States. The implementation of Obamacare will further exacerbate regional and state differences, mainly as a result of the Supreme Court decision to curtail the federal government’s obligation for states to expand their Medicaid coverage. As a result, only about half of the states have chosen to sign on to the new Medicaid program.

    Not equal access: There’s been some controversy in Canada lately over wait times and access to timely care, but this pales in comparison to the wide gulf that exists in access to care in the United States. Obamacare tries to address this in its provisions for insurance reform, such as lifting pre-existing conditions and limits on co-payment. But for all of the emphasis on affordable care, the new law reinforces the notion that access depends on how much you can afford, not how much you need. In the health insurance exchanges, the price of premiums will depend on your age, health, income, and on whether you opt for a bronze, silver, gold or platinum coverage. In Canada, access to necessary health care services is not a competitive sport.

    Obamacare is not cost containment: The sharpest critics of Obamacare argue it does little to address the fundamental challenge of cost control. The new law includes a review of Medicare reimbursement and the expansion of Accountable Care Organizations to reward cost-effective care. But it doesn’t grapple in a systematic fashion with the overall inefficiencies in health care delivery and financing, the administrative burden of multiple payers, providers and plans, and the cost pressures of defensive medicine. Governments in Canada know that health care is a searing financial responsibility, but they have at their disposal cost containment measures – monopoly fee negotiations with providers, global budgets for hospitals – that remain unfathomable in the American context.

    Obamacare is a huge step in American health reform and, if seen to improve the system, will represent a major victory for Democrats. Like other major reforms of the past, however, it will entrench the private nature of the system, and likely render national health insurance, or anything remotely like “Canadian-style” health care, impossible to attain.

    article by Antonia Maioni is an associate professor at McGill University

  • Ah - But one of the biggest differences is in the "legal resident", and our country has around 1.2 MM, while almost half are on welfare benefits of some type other than healthcare. (At least as near as I can dig out from various sources..

    As for how much you need versus what you can afford, that isn't exactly correct. It is more what you need that is emergency or urgent. The only things that legally get put off until you can afford them are "elective" types of things. And honestly, most hospitals have a charity care program. If the person applies for CC, they have a good chance of being approved even for what seems like a pretty good income (in SF we used 400% of poverty level for a family of four).

    And honestly, I didn't want Obamacare. When someone tells me I have to pass the bill to know what is in the bill, that is an issue. Have a great weekend!

  • I honestly don't blame you for not wanting Obamacare. I just see it as another insurance company.

    Yes have a great weekend. :)

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