h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

A tricky one

I believe we need an NHS as some people can't afford to pay for treatment, I know that if I suddenly had an illness that needed prolonged and expensive treatment, i.e. diabetes etc that I wouldn't be able to afford it.

I do however think that the NHS is having the serious pee taken out of it and something needs to be done about it ASAP.

That’s all I have to say right now!

Where would you like me to start!?

How should the NHS be funded? - The way that the NHS is funded now is the only way to provide a free National Health Service. It remains, after 60 years, the crown jewel of the Welfare State and whilst it seems that elements of the Welfare State are in a parlous state the NHS continues to meet the health needs of the population.

All taxpayers pay for medical services, whether or not they use them. Does this system work well, or should we only pay services as and when we use them? - This is not strictly the case as far as I know. All taxpayers fund the provision of all public services and other state provision. The NHS is just part of this as is defence, the Civil Service, transport, etc, etc. What they are paying for in respect of health services is the certainty that, should they need it, they can receive a comprehensive care package without having to pay. I accept that this is not strictly true as a statement, there are elements of health services that have to be paid for - long term care for the elderly is a case in point but the majority of people in the UK get free care if they need it.

There is a charge for prescription drugs; for some people this is free, but when the charge is more expensive than the drug, should we be entitled to a refund of the difference? When drugs are more expensive, should we be charged more? - IMHO the prescription charge should be abandoned. I comes nowhere near meeting the cost of the drugs, puts some people off having the drugs they are prescribed and costs more to administer than it makes.

Should we be entitled to 'trade' an NHS hospital appointment for a private one to avoid a long wait by paying the difference? - If people want to have private appointments they should have to pay for them. They should also stay in the private healthcare sector for that episode of care rather than using private appointments to 'jump the queue'. The market in healthcare is a false one, as has been shown by the Tories in the 80s and 90s. Many consultants working in the NHS also work in the private sector and I believe that their contracts now prevent them from doing private work at the expense of their NHS work or from 'poaching' patients from the NHS to their fee-paying service

What about an 'opt-out' version of the NHS? We can chose whether we want to pay into it or not, and make our own medical arrangements. - The NHS would be the worse for it if people could 'opt out'. If I could 'opt out' of tax-based services I would 'opt out' of defence, all EU funding, speed camera partnership funding and one or two others and pay more to the NHS.

How does the system in the UK compare with its overseas counterparts? - I don't know what the health provision of other countries is like but I do know that the NHS is the envy of the world.

Is the NHS the best thing since sliced bread? Do you remember the pre-NHS days? - The NHS has its share of problems, not least the fact that any tax-based healthcare system that is free at the point of delivery will inevitably suffer from rationing. I also believe that it has been free for so long that people now expect more from it than it is capable of providing. It is a black hole for cash and to use another analogy it is a leaky bucket - there is a lot of waste and inefficiency within the NHS but not at the front end, the 'comsumer interface'.

IMHO the time has come for some hard decisions to be made about what level of provision should be free and what should not be included in the package.

Rant over.

turvy Ex

To go along with the previous posting to an extent, that is, that the NHS should be funded via public money. I worry now about what we could call "Private Creep", that is, increasing involvement of private comapnies in building and running hospitals, I wonder where that profit is coming from, because these companies exist in order to make a profit for their shareholders, so where is the financial incentive for them to get involved in the NHS, if it is so starved of funds..

Either, they are aquiring land via the PFI initiative, by buying a big old hospital, with grounds, and selling half the grounds off.. or cutting costs, possibly staff pay? Or they could be killing two birds with one stone, by demolishing the old hospital, building a new smaller (Much cheaper) replacement, and then selling the rest of the land off. Either way I get very angry at this, these assets belong to me as a tax payer, and no one has the right to sell them..

Add this to the NewLabour policy of paying private hospitals to carry out operations on NHS patients.. This is to provide choice, apparantly. I don't want "Choice" I want the hospital down the road to be able to treat my illness.

Sorry about the rant....

The NHS (Mental Health)Trust I work for overspent by a million quid last financial year. The main part of this was for paying locum psychiatrists to plug the gaps in a severely stressed service, you just can't get them. The Trust nontheless has to maintain service delivery and pay a mile over the odds for bounty hunting psychiatrists. The joke is that current government policy penalises overspending Trusts by effectively fining them an equal amount to their overspend, so my Trust has to knock two million quid off their budget this year. A brief history lesson, doctors were never included in the NHS pay structures as intended by the great Bevan at the inception of the NHS, there was a huge wave of protest by the medical profession and they have called the shots and held the NHS to ransome ever since. They are a good part of the reason why the money keeps disappearing into the void without any visible improvement in patient services, its not only the 'pen pushers' that the Tories are always on about, the government ought to take on the medics rather than penalising struggling Trusts still further. It would be a great time to start at the beginning of a new election term.

agree with the above posts
although the NHS is not perfect we spend much less as a country on healthcare than do France or Germany
also if people think penpushers in the NHS are bad they should take a look at how much of US healthcare spending gets eaten up by the bureacracy of a private insurance system

The pay scheme really wants to be rethought from scratch. A consultant doctor can earn seventy thousand. A basic grade pathologist (blood tests, urine tests, blood counts etc - most pathologists are not morbid ones) earns fifteen. Something wrong, there.

There's nothing wrong with consultants earning more than more junior doctors. It works the same way in any field of employment, if you didn;t get paid more for more experience and more responsibilites not many people would bother to progress. Why for example would anybody want the stress and responsibilty of managing a supermarket if they could earn the same amount stacking shelves?

Becoming a consultant is like writing your own paycheck at the moment, I can only talk about psychiatry, but even the most basic research will show that a very large proportion of psychiatrists are locums leaping around the country on larger and larger contracts, add to this private practice, fees for Mental Health Act work etc etc which is difficult to disentangle from NHS reponsibilities (do they employ seperate admin services? Do they heck.) Junior doctors do most of their work anyway, and they themselves of course are fighting their way on to the gravy train. In terms of therepeutic relationships with patients of course, especially in psychiatry, this is diastrous but who on earth cares about that? There's more Thatcher than Hypocrites in psychiatric ethics these days I assure you.

I have np problem with consultants being paid more than junior doctors
I do have a problem with them being allowed to work in the private sector as well
Conflict of interest there IMO

What I meant was not the difference in pay between junior and senior doctors, but the differences in pay between the specialisations. If you don't have face to face contact with patients, you don't get paid as much. Is that fair, when you may be as vital to the patients health as those who do speak to them?
Having said that, nurses get rubbish wages.