NHS

[foxy]

More than 5 million people are made bankrupt in the US every year due to medical bills. None in Britain or Europe. So keep your views on the NHS to yourself.

At least they lived to be made bankrupt, the ones at Stafford hospital didn't under the watch of Andy Burnham

 

[Cheshire Cat]

Grasping at straws now are we. Health for the rich is a disgusting concept and why are you so keen on British life when you live in paradise.

 

[foxy]

Grasping at straws now are we. Health for the rich is a disgusting concept and why are you so keen on British life when you live in paradise.

Not grasping at straws, presenting the facts, surely you would have private health cover for life, corporate managers it would be a standard package.
While it does sound good to have both systems, the public and private health, the biggest problem is while the private patients will get their procedures carried out within a week or so. it is the same surgeons carrying out the procedures on private as well as public. Therefore putting the public patients further behind.

 

[Dutto]

….. the biggest problem is while the private patients will get their procedures carried out within a week or so. it is the same surgeons carrying out the procedures on private as well as public. Therefore putting the public patients further behind.

At last!

We get an admission from @foxy that maybe there is something terribly wrong with the way this Government is running something! In this case it’s the NHS!

Foxy states:
“… it is the same surgeons carrying out the procedures …”

I agree wholeheartedly, but the reason is THE GOVERNMENT DO NOT PAY THE NHS SURGEONS ENOUGH!

The fact that other Governments have allowed the current system to carry on is also relevant; as is the failed promise by this Government to supply the number of Surgeons, Doctors and Nurses required!

 

[foxy]

At last!

We get an admission from @foxy that maybe there is something terribly wrong with the way this Government is running something! In this case it’s the NHS!

Foxy states:
“… it is the same surgeons carrying out the procedures …”

I agree wholeheartedly, but the reason is THE GOVERNMENT DO NOT PAY THE NHS SURGEONS ENOUGH!

The fact that other Governments have allowed the current system to carry on is also relevant; as is the failed promise by this Government to supply the number of Surgeons, Doctors and Nurses required!

Or conversely the private health insurers overpay the surgeons. Not a good state of affairs.
I have read that surgeons do spend less than 30% of their time in the public sector.
I suppose they are no different to anyone else, they are out to make a buck too.
Either way I know which side of the fence I would rather be on.

 

[lancon]

A recent case here was a guy needed urgent surgery to remove a tumor, the surgeon wanted $10,000 the unfortunate bloke didn't have $10,000 said he would join a private health insurance, can't do that with a pre existing, said he would go on the waiting list the surgeon told him he would be dead before his name came up. His brother loaned him the money.

If a person is on minimum wage, zero hour contract who is going to lend them the money for the life saving operation?

 

[Chippy_Tea]

What a horrible world we live in, if you cannot afford the high gas prices heat or eat, if you cannot afford an operation die.

 

[foxy]

If a person is on minimum wage, zero hour contract who is going to lend them the money for the life saving operation?

What a horrible world we live in, if you cannot afford the high gas prices heat or eat, if you cannot afford an operation die.

Looking at the NHS compared to other countries they don't fare to well. Even leaving politics aside. What is the answer? Pay more into the NHS? As Dutto says the NHS should pay more for surgeons, if that is the case then a rise in national insurance and taxes should have to take place to cover the costs. Neither govt (Tory or Labour) wants to do that so it is up to the individual. One question, if you opt for private health insurance in the UK does the govt chip in?
https://www.bmj.com/content/367/bmj.l6326

 

[DocAnna]

I am going to dip a toe into this conversation, just a wee bit. It is to point out that there are many different models of healthcare funding beyond polar opposites of all state funded and all private. This includes Canada with a mandatory health insurance contribution but private care providers funded from this; China with a part health insurance contribution and fixed fees per procedure or illness condition, New Zealand with part Health insurance, fixed fees and copayment, and Singapore with near private service that is part government subsidised. Many low to middle income countries have the most 'private' of healthcare systems of fee per service without regulation of costs. The outlier in almost all health economic and outcome analyses is the US healthcare system, with highest cost per person and poorest health outcomes at a population level per spend.

The other consideration is to point out that surgery is the tiny high cost tip of a very much larger iceberg of healthcare. Many of the causes that lead to surgery and high cost procedures are most effectively addressed through population public health measures, eg Smoking regulation, dietary and exercise promotion, clean water, vaccination programmes and effective primary care provision. These are not the 'sexy' parts of health but they give the greatest value overall for the most people. The interventions that have made the biggest difference to your health right now will include clean water (inc chlorination and fluoridation), sewage management, vaccinations (childhood and adult eg COVID), air pollution reduction, smoking cessation, national screening programmes (bowel, breast, newborn & pregnancy, cervical, diabetic eye, and aortic anerysm eg Scotland), and food supplementation policies (vit D, folic acid).

So before you all debate the merits of health care funding by examining the costs and access to complex surgery, do consider that there is an awful lot more to healthcare for a lot more people than surgery.

[Ok note to self - do remember this is a homebrew forum Anna ]

 

[DocAnna]

Oh and one more thing..... one of the problems with studies that are reported about health outcomes and costs that need to be considered is the scope of the data. One of the things the NHS is the undisputed world leader on is population health statistics. We know more about what is happening to the most people in our population than any other country, including more data on the poorest and disenfranchised, data across primary care, secondary care, and mandatory quality reporting from the private sector. This means we get a 'warts and all' picture of the health of the nation. You need to keep this in mind when reading comparative papers where a country's reported health data is taken from, as any system that has a filter to reach services and interventions dependent on ability to pay will be biased to those with better health able to pay.

 

[foxy]

I am going to dip a toe into this conversation, just a wee bit. It is to point out that there are many different models of healthcare funding beyond polar opposites of all state funded and all private. This includes Canada with a mandatory health insurance contribution but private care providers funded from this; China with a part health insurance contribution and fixed fees per procedure or illness condition, New Zealand with part Health insurance, fixed fees and copayment, and Singapore with near private service that is part government subsidised. Many low to middle income countries have the most 'private' of healthcare systems of fee per service without regulation of costs. The outlier in almost all health economic and outcome analyses is the US healthcare system, with highest cost per person and poorest health outcomes at a population level per spend.

The other consideration is to point out that surgery is the tiny high cost tip of a very much larger iceberg of healthcare. Many of the causes that lead to surgery and high cost procedures are most effectively addressed through population public health measures, eg Smoking regulation, dietary and exercise promotion, clean water, vaccination programmes and effective primary care provision. These are not the 'sexy' parts of health but they give the greatest value overall for the most people. The interventions that have made the biggest difference to your health right now will include clean water (inc chlorination and fluoridation), sewage management, vaccinations (childhood and adult eg COVID), air pollution reduction, smoking cessation, national screening programmes (bowel, breast, newborn & pregnancy, cervical, diabetic eye, and aortic anerysm eg Scotland), and food supplementation policies (vit D, folic acid).

So before you all debate the merits of health care funding by examining the costs and access to complex surgery, do consider that there is an awful lot more to healthcare for a lot more people than surgery.

[Ok note to self - do remember this is a homebrew forum Anna ]

I can relate somewhat to that. I think that it is ingrained in the UK population that health care should be free. A member of the fishing club I am in had a bowel screening test done, it was advised he should have a colonoscopy done forthwith. He had no private health cover, owned two houses and as he often used to state more money than he could ever spend. He was told it would be $200 for a colonoscopy (about 100 GBP) he wouldn't pay and opted to wait for the free test on NHS 9 months later he was diagnosed with bowel cancer and it was so advanced there was nothing to be done. He was a pom from Lancashire who believed that health cover should be free. He would sooner die than pay $200.

 

[DocAnna]

I can relate somewhat to that. I think that it is ingrained in the UK population that health care should be free. A member of the fishing club I am in had a bowel screening test done, it was advised he should have a colonoscopy done forthwith. He had no private health cover, owned two houses and as he often used to state more money than he could ever spend. He was told it would be $200 for a colonoscopy (about 100 GBP) he wouldn't pay and opted to wait for the free test on NHS 9 months later he was diagnosed with bowel cancer and it was so advanced there was nothing to be done. He was a pom from Lancashire who believed that health cover should be free. He would sooner die than pay $200.

The time to colonoscopy after a screening result being positive is a lot lot shorter than 9 months - less than 6 weeks for the vast majority though some waiting up to around 3 months. Costs for private colonoscopy is one part, but there is then the cost for any subsequent surgery.

I cannot nor could I comment on your friend's specific circumstances so please don't take the absence of comment here as lack of care or empathy, but you I hope will understand that I simply cannot.

 

[foxy]

The time to colonoscopy after a screening result being positive is a lot lot shorter than 9 months - less than 6 weeks for the vast majority though some waiting up to around 3 months. Costs for private colonoscopy is one part, but there is then the cost for any subsequent surgery.

I cannot nor could I comment on your friend's specific circumstances so please don't take the absence of comment here as lack of care or empathy, but you I hope will understand that I simply cannot.

I am in Australia, so it will have a slight difference to the UK.

 

[Chippy_Tea]

What is the answer? Pay more into the NHS? As Dutto says the NHS should pay more for surgeons, if that is the case then a rise in national insurance and taxes should have to take place to cover the costs. Neither govt

Why don't we stop spending obscene amounts of money on things that benefit the minority not the majority high speed train travel for a start why don't they mothball it and spend the money getting us out of the **** we face over the next couple of years.

 

[Brewnaldo]

The idea of private supplementing public is probably relatively sound in practice.

But what we are talking about here, apparently with a straight face, is the haves paying more to help out the have nots. Very noble, something I am sure we can all get behind......

How much convincing does anyone still need that this is not how it would play out under the Tories.

If you want a real world example of how this would play out in real life, you only have to look at the relentless seethe caused by the Scottish Tax system relative to Englands. A system which costs the better off in society a couple of hundred quid a year in order that the lowest paid can pay a bit less.

If you think the voters of this country who continually return Tory governments despite it clearly being against their own interests, because they happen to be unable to resist the latest racist/xenophobic/benefit scroungers dog whistle, are going to accept paying more to help those less well off, then you quite simply haven't been paying attention.

 

[foxy]

The idea of private supplementing public is probably relatively sound in practice.

But what we are talking about here, apparently with a straight face, is the haves paying more to help out the have nots. Very noble, something I am sure we can all get behind......

How much convincing does anyone still need that this is not how it would play out under the Tories.

If you want a real world example of how this would play out in real life, you only have to look at the relentless seethe caused by the Scottish Tax system relative to Englands. A system which costs the better off in society a couple of hundred quid a year in order that the lowest paid can pay a bit less.

If you think the voters of this country who continually return Tory governments despite it clearly being against their own interests, because they happen to be unable to resist the latest racist/xenophobic/benefit scroungers dog whistle, are going to accept paying more to help those less well off, then you quite simply haven't been paying attention.

Be it Tory or Labour, you will never see any difference. Alf Garnet summed it up precisely in his rant to the bank manager when he came into money. First 4 minutes.

 

[lancon]

Looking at the NHS compared to other countries they don't fare to well. Even leaving politics aside. What is the answer? Pay more into the NHS? As Dutto says the NHS should pay more for surgeons, if that is the case then a rise in national insurance and taxes should have to take place to cover the costs. Neither govt (Tory or Labour) wants to do that so it is up to the individual. One question, if you opt for private health insurance in the UK does the govt chip in?

I think the way "tax rise" has come to mean everyone gets a tax rise is the language of the tories, (remember the meaning of the word). If tax rises were targeted for instance as presently discussed with the proposed energy companies windfall tax, but this could be spread further, a millionaire tax is was suggested in a report from the LSE that "a one-off wealth tax on millionaire couples paid at one per cent a year for five years, we found, would raise £260 billion".

Now a 1% extra on billionaires and the NHS would have no worries? And no need to worry the ordinaryperson in the street with this scaremongering of blanket tax rises

 

[Rodcx500z]

aortic anerysm

This i can comment on, i visited my doctor in early 2018 with a very bad cough, to cut this short i went for a ct scan the day after i got a phone call can you come in today, i went there and then i had another scan i then saw who would be my surgeon Dr Graham Riding who told me i had an aortic anerysm that was 5.2 centimetres the limit is 5.5 then surgery is required, i asked him are their alternatives he looked me in the eye and said no and that because were mine was i would need open surgery, i also asked him how big of an op was it answer as big as it gets, i then went for a lot of tests heart blood breathing, i went to see him again on 9/7/2018 he explained everything to me then made a phone call right he said i will see you on weds morning at 7-30am 11/7/2018 i was done and back home on the 16th and yes it is a massive operation i didn't do much un september, as Anna stated above England has no screening for this illness known as the silent killer it has no symptoms, i was lucky had i not had that scan i wouldn't be here now, i believe our health service is up with the best it makes my blood boil the amount of abuse it gets instead of use has it should be it is for everyone it's free to use don't abuse it, both my kids are now on the registar and will get scans when they are older, and thank you Anna for a very informed write up

 

[Brewnaldo]

This i can comment on, i visited my doctor in early 2018 with a very bad cough, to cut this short i went for a ct scan the day after i got a phone call can you come in today, i went there and then i had another scan i then saw who would be my surgeon Dr Graham Riding who told me i had an aortic anerysm that was 5.2 centimetres the limit is 5.5 then surgery is required, i asked him are their alternatives he looked me in the eye and said no and that because were mine was i would need open surgery, i also asked him how big of an op was it answer as big as it gets, i then went for a lot of tests heart blood breathing, i went to see him again on 9/7/2018 he explained everything to me then made a phone call right he said i will see you on weds morning at 7-30am 11/7/2018 i was done and back home on the 16th and yes it is a massive operation i didn't do much un september, as Anna stated above England has no screening for this illness known as the silent killer it has no symptoms, i was lucky had i not had that scan i wouldn't be here now, i believe our health service is up with the best it makes my blood boil the amount of abuse it gets instead of use has it should be it is for everyone it's free to use don't abuse it, both my kids are now on the registar and will get scans when they are older, and thank you Anna for a very informed write up

I won't, but I could, tell a very specific aortic aneurysm horror story that occasionally keeps me awake at night amd very much illustrates the need for men to get better at going and getting warning signs checked out ASAP.

Suffice to say that yes, it's a very dangerous thing

 

[StJayJay]

it is the same surgeons carrying out the procedures on private as well as public. Therefore putting the public patients further behind.

Partly correct for the NHS, in that it’s sometimes the same surgeons not really the case that private work is at the expense of NHS capacity. The NHS consultant contract is structured around a 40 hour working week. Most consultants, medical and surgical, have on call/out of hours commitments but these are not in addition to the 40 hours. Everything is annualised so it’s spread out meaning typically, full time consultants may do 4 full days “in hours” in a typical week. Consultants who do private work in addition to the NHS tend to use the non working day for that, plus evenings etc.

The capacity to carry out operations is only partly dependent on the surgeons

THE GOVERNMENT DO NOT PAY THE NHS SURGEONS ENOUGH!

With the starting pay for consultants about to be uplifted to around £90k finishing around £120k before add-ons, that’s hard to justify. If you speak to consultants who have given up NHS work to practise privately, it’s never the earnings, there’s usually other factors. Additionally, a lot of consultants have one eye on how much pension they are accruing and there are quite a few facing hefty tax bills due to topping out their tax free limits and are looking to reduce their NHS incomes by working less as they can’t reduce their pension contributions, not sure how welcome a big wage hike would be for that reason.