NHS=Negligent Health Service

theone8181 · 20 Dec 2021 at 19:47

Just make nhs cover only applicable for those that have worked rather than the ones that live off the dole. There I said it I know it's not a popular view but it would save the country something.

ik9000 · 20 Dec 2021 at 20:27

ahar said:
You're confusing the way of paying for a health system with the organisations that deliver the care.

Other European countries have universal health care but different ways of paying. France for example has charges to see a GP, but if you're poor you can claim the money back. Most countries have some kind of mandatory health insurance system with provision for unemployed, students, kids, retired etc.

Then you have the organisations that deliver the care. In France for example, they have a mixture of state, non profit and for profit hospitals. However, there shouldn't be a difference in what you pay between state, non profit etc (with the exception of a few).

How would more private organisations involved help the UK? Well, it entirely depends on which organisations and how you use them. The private sector tends to be good at doing a few simple things lots of times really efficiently. It tends to be bad at complexity. The problem is that the NHS organisation may not be well set up to use the private sector in the right way. However, we can see from other countries that it can work.

The most obvious problems I have seen with the NHS have been the bits they've already privatised and outsourced, where they're meant to be simple, namely:

Cleaning - where hospital staff can't get the cleaning staff to do a decent job as they need them to because of the difference in who they report to - i.e. "we don't work for you, if you need that doing call my boss" I will also never forget watching a hospital cleaner walk into the toilets and use the same cloth to wipe the sinks he'd just used on the toilet bowls. Bury Hospital if anyone cares, though a good few years ago now.
Car parking - outsourced to vultures going by online comments and news. I wouldn't be quite that strong myself but it is currently min £3 per visit at the moment and that's just short stay, going up if they overrun or you have to have extra tests. If you're a frequent visitor that soon adds up. We're rocking £20 in the last month or so alone. That money isn't going into the hospital. It's not the NHS getting the bulk of the profit. They get a fixed rate. The parking company are then on a mission to get as much money as they can. The NHS could keep that in-house, or get the same amount of money and the end user could pay less overall. What is good value about the private provider for the taxpayer exactly?
Ditto in-hospital TV and comms.
And in some cases the catering.

Malevolence · 20 Dec 2021 at 20:34

theone8181 said:
Just make nhs cover only applicable for those that have worked rather than the ones that live off the dole. There I said it I know it's not a popular view but it would save the country something.

Wouldn't need to do that if they started charging foreigners, but mainly health tourists, for using the NHS when they haven't paid a penny into the system. Think I mentioned the house in the next street to me a few years back, the one that had a constant stream of young, pregnant Romanian girls who come here to have their babies on the NHS, get all the free post-natal treatment and than scuttle off back home.

Energize · 20 Dec 2021 at 20:38

tres said:
Just to critique your post though - certainly not impossible to see a GP - JOIN A DIFFERENT PRACTICE IF YOU ARE HAVING ISSUES. Any serious issues will get a same day review by the duty GP in any of my 8 local practices.

What do you do when one NHS practice has been given a monopoly? All 6 practices in my area have merged into one so there is no option to change practice.

ik9000 · 20 Dec 2021 at 20:39

Efour said:
Covid was a squandered gift. Think of how many 100s of Thousands of burdens we could have had removed from society and the NHS.
Maybe the next pandemic they make will do the lords work.

I think the Lord might suggest you'd misrepresented his priorities there and that his work is salvation not destruction. "Peace on earth and goodwill to all men", "I come to seek and save the lost" etc etc. Equally it does say the fool will get his rewards and the like so meh... I think the prophet Gump had it best. "Stupid is as stupid does" but is it right to effectively wish people dead? Also if this is followed "burden" can start to expand quite rapidly to a eugenics (etc) style model of anyone who is slightly impaired, inconvenient, or such like. It's a slippery slope.

Malevolence said:
Wouldn't need to do that if they started charging foreigners, but mainly health tourists, for using the NHS when they haven't paid a penny into the system.

This is the bigger issue. We've had a foreign rellie use the NHS -for a lengthy and complicated (and completely out of the blue emergency) treatment. They did get charged, but nowhere near what they'd get in the US. Their insurer paid out so fast they couldn't believe it wasn't more. On the one hand US prices are obscene, but the problem is the NHS is not geared up to a charging model where every pill, drip, nurse minute etc is logged and billed. Quite right too, but it does make charging when it's needed a lot harder to get right.

ik9000 · 20 Dec 2021 at 20:43

Energize said:
What do you do when one NHS practice has been given a monopoly? All 6 practices in my area have merged into one so there is no option to change practice.

ditto here, all the local ones now part of one big behemoth.

Werewolf · 20 Dec 2021 at 21:02

theone8181 said:
Just make nhs cover only applicable for those that have worked rather than the ones that live off the dole. There I said it I know it's not a popular view but it would save the country something.

Why not just line them up and shoot them?
Even cheaper, you don't have to pay dole money.

Despite the tabloid rag headlines there are very people who don't want to work, most of those who "live off the dole" are doing so due to things like long term health problems.

ik9000 · 20 Dec 2021 at 21:12

Werewolf said:
Why not just line them up and shoot them?
Even cheaper, you don't have to pay dole money?

Yeah I share your sarcasm. Not a great trajectory. But if it's going ultra-totalitarian-utilitarian you've missed the intermediate option for chain gangs and forced labour first though - then you get something back to at least cover the bullets and admin, and you don't have to pay for the grave digging either. Not that I'm advocating such a route.

Werewolf said:
Despite the tabloid rag headlines there are very people who don't want to work, most of those who "live off the dole" are doing so due to things like long term health problems.

Also we loose more in fraud and tax evasion etc from those who do work than we do in benefits. But the Tories defund benefits and downsize the HMRC. If we had better press than the Murdoch influenced empire we'd be less susceptible to this "all benefits are spongers" BS.

Minstadave · 20 Dec 2021 at 21:12

Malevolence said:
Wouldn't need to do that if they started charging foreigners, but mainly health tourists, for using the NHS when they haven't paid a penny into the system. Think I mentioned the house in the next street to me a few years back, the one that had a constant stream of young, pregnant Romanian girls who come here to have their babies on the NHS, get all the free post-natal treatment and than scuttle off back home.

Health tourism is a drop in the ocean compared to the total NHS budget. It does happen but there are far bigger issues.

Minstadave · 20 Dec 2021 at 21:15

Werewolf said:
Many of the problems the NHS has is due to previous attempts to "streamline" things...

Much of the current "middle management" are there because they remove the need for clinicians to try and run things (which can help, if they understand the clinical reasons for doing it one way vs another), or because the government wants every thing run to a target and that target to be fully documented.

I suspect it also hasn't helped that to try and "reduce costs" in the past many of the things that the NHS used to do in house are now outsourced, often resulting in a nice profit for various party donors whilst the staff on the ground are doing more at lower rates of pay and worse conditions.

This is very much the truth from my experience. Some bright spark recently came up with the idea of consultants filling out "harm reports" when patients reached a certain point of being late for follow up. Rather than using the time to type up harm reviews it was quicker and easier just to call the patient and catch up, moronic.

The practice of taking nearly all experienced nurses and shuffling them into offices is a constant frustration.

ik9000 · 20 Dec 2021 at 21:18

Malevolence said:
Wouldn't need to do that if they started charging foreigners, but mainly health tourists, for using the NHS when they haven't paid a penny into the system. Think I mentioned the house in the next street to me a few years back, the one that had a constant stream of young, pregnant Romanian girls who come here to have their babies on the NHS, get all the free post-natal treatment and than scuttle off back home.

You sure they weren't already here i.e. not just the unfortunate victims of trafficking for seedy work? If it is that blatant you should report it for further investigation, particularly under the human slavery concerns - it will get more priority than NHS tourism.

Werewolf · 20 Dec 2021 at 21:21

ik9000 said:
ditto here, all the local ones now part of one big behemoth.

The same thing basically happened here.

Largely because of the changes after Shipman where from memory there was a massive amount of pressure to close down single man/two GP practices, and then because as the numbers of GP's dropped it became a good way to maximise how much the remaining ones could do/reduce the disruption if say one was off, not to mention the cost savings in admin etc.

We lost IIRC two small (2-3) GP practices in the space of a few years here largely because one partner retired then the remaining one couldn't find anyone to assist (my childhood GP spent something like 5 years trying to keep going*), which meant the remaining practices were struggling and one of the larger ones basically merged with a couple of the remaining small ones. The town is/was still short several GP's, but if one is off ill/on leave the practice doesn't shut down even if the turnover of employee GP's is high.

*Apparently he only kept going that long because the local NHS trust kept promising to help encourage new GP's to join him (the NHS trust knowing the town was already short given it's size and couldn't afford to lose another one).

Malevolence · 20 Dec 2021 at 21:27

ik9000 said:
You sure they weren't already here i.e. not just the unfortunate victims of trafficking for seedy work? If it is that blatant you should report it for further investigation, particularly under the human slavery concerns - it will get more priority than NHS tourism.

No, not trafficked nor were they prostitutes. The old girl over the road from the house in question got to know a few of them quite well and they were just young women who had come here to have their babies before buggering off back to Romania. I believe she'd counted 19 at the last count, this was before Brexit and before Covid too. I don't know how much it costs to have a baby on the NHS but I'm guessing it must easily be in the thousands.

Chris Wilson · 20 Dec 2021 at 21:29

Minstadave said:
Health tourism is a drop in the ocean compared to the total NHS budget. It does happen but there are far bigger issues.

When the NHS say health tourism is a drop in the ocean what they are really saying is we can't be arsed to do the billing or paperwork correctly That attitude in a private company would have people fired. If I go privately for medical treatment I would have my card charged before I left the premises, if not before I had the treatment. It's a lame and frankly shocking excuse typical of places using others' finances, in this case the tax payers.

ik9000 · 20 Dec 2021 at 21:34

Chris Wilson said:
When the NHS say health tourism is a drop in the ocean what they are really saying is we can't be arsed to do the billing or paperwork correctly That attitude in a private company would have people fired. If I go privately for medical treatment I would have my card charged before I left the premises, if not before I had the treatment. It's a lame and frankly shocking excuse typical of places using others' finances, in this case the tax payers.

An overworked NHS frontline staff without a system to log and bill accurately is not going to create one. If it was a private company it would be the manager in the firing line, and that is exactly what people have been saying isn't it? The deadwood in the bloated management structures? I can't comment on the NHS staffing structure but I think I'd include certain health ministers in that definition.

Minstadave · 20 Dec 2021 at 21:42

Chris Wilson said:
When the NHS say health tourism is a drop in the ocean what they are really saying is we can't be arsed to do the billing or paperwork correctly That attitude in a private company would have people fired. If I go privately for medical treatment I would have my card charged before I left the premises, if not before I had the treatment. It's a lame and frankly shocking excuse typical of places using others' finances, in this case the tax payers.

Whilst it is true the NHS is not good at recouping costs from health tourists (most of it because they receive emergency care and leave, elective care is handled better) that doesn't change that the fact that the actual amount that health tourism costs the NHS is not very large compared to much bigger inefficiencies (PFI contracts, outsourcing, litigation etc.). It's popular to mention it because "foreigners" but the NHS has far more valuable issues to tackle.

Every trust screens patients for overseas status and has teams in place to recoup costs. The challenge of recouping costs from someone who leaves the country after receiving emergency care is not a small task. Take the Romanian girls mentioned above, they're largely destitute and rock up un-booked in labour, do you make them deliver in the carpark? The other example I've seen is people coming across with unborn babies with severe abnormalities, do you just leave the child to die? It's not really an issue private companies have to deal with so the comparison is poor.

ik9000 · 20 Dec 2021 at 21:51

Minstadave said:
The other example I've seen is people coming across with unborn babies with severe abnormalities, do you just leave the child to die?

Possibly as wasn't someone a few posts back advocating turning them away? Again the totalitarian utilitarian would say that's an opportunity lost. Let them in then make them work for their debt. Presumably in some kind of house of work set up to make sure they paid every penny with interest. I mean that would be a delightful right thing to do that our ancestors would never say they got wrong, or spend hours debating in the press and parliament of the time...

arknor · 21 Dec 2021 at 03:48

theone8181 said:
Just make nhs cover only applicable for those that have worked rather than the ones that live off the dole. There I said it I know it's not a popular view but it would save the country something.

or just bring back deathsquads and kill any rich people whos employees rely on universal credit top ups and partial housing benefit payments
maybe just maybe they get hired by someone who pays a real wage and then the government has more funding to devote to areas like health care.

people who work for the queen don't get much money right, I wonder if they are getting benefits too some of them... doesn't seem like a living wage for london

theone8181 · 21 Dec 2021 at 06:17

It was aimed at people who take the ****, and don't contribute anything to society.

ik9000 · 21 Dec 2021 at 10:53

theone8181 said:
It was aimed at people who take the ****, and don't contribute anything to society.

I think everyone feels that to some degree but the problem is what constitutes "contributing". There are many different ways and abilities to do that, and not all of them depend on being waged or on PAYE.

It might be easier to define in terms of those "actively detracting from society" persistent thieves etc