DEBATE: Healthcare

[fabyak]

Time for more discussions, this time on Healthcare.

What are your views on healthcare, the NHS, Doctors, waiting times, standard of care, anything really!

People... SPEAK YOUR BRAINS

[Dog Pants]

Well, as with Europe, I've not got a lot of information to base my opinions on about the NHS, but I'll voice them anyway.

First up, I think that we take it for granted. Having free medical care is something not a lot of countries have, and the NHS was a massive achievement when it was introduced, and while it might not be as good as it once wad, it's certainly better than nothing for millions of people. On top of that, if you've got a decent amount of money and you're complaining about the NHS then go private. You get what you pay for.

However, the issues I have with the NHS are over the small details. It's the same problem I have with the military, and I expect it extends to every public service. Institutionalisation, excessive bureaucracy, and small minded junior management.

The NHS seems to have been hit hard with regards to institutionalisation because it's so high profile, and it's adopted a more commercial outlook. In fact it's possibly gone the other way (as with education, but we'll keep that for later), with targets being their prime motivator rather than actually providing healthcare. You can see this in the way patients are treated - like they're on a production line, with little continuity or attention to detail.

The bureaucracy problems have been hugely publicised, and I suspect the problems lie in what I've said in the previous paragraph. The over-analysis of this target orientated system, combined with today's ever-present threat of legal problems, seem to have bloated the administrative aspect of the NHS out of all proportion, which is naturally going to be a huge money sink. I do wonder how many people the NHS employ who don't actually do anything productive.

Finally, tied into both those points, are the junior managers. Under increasing pressure from bosses who make unrealistic demands, and directly competing with other managers, they all seem to fall into line, becoming 'yes-men' because they don't want to look bad among all the other managers who are doing the exact same thing. And so the pressure gets passed to their staff, who become overworked and take on a factory worker mentality.

Like I say, I'm only realy got anecdotal evidence to support my opinions, or worse still media evidence (which I suspect is a contradiction in terms), and I base some of it on assumptions that they follow a similar process to the military, but it's my opinion nontheless.

[friznit]

A juicy one for the Americans!

I'm in favour of state sponsored healthcare and despite various protestations to the contrary or media lead horror stories, everytime my family has had dealings with the NHS (breaks, routine ops, cancer etc) they have always been very efficient, professional and of course completely free. The mix of NHS and NGO Charity assistance for my aunt when she died of cancer a couple of years ago was astonishingly good.

In the UK was have the option to suplement this with private healthcare insurance (BUPA being probably the most well known), but fundamentally every individual in the coutry as been guaranteed basic healthcare since WWII.

The bizarrely illogical opposition to public healthcare in the US was baffling. I guess many considered it to be impacting on their inalienable right to die without state involvement rather than a 50 year overdue requirement to extend healthcare to those who couldn't afford it.

[Joose]

Ive got pretty similar views. The NHS is, in general, a Good Thing. The amount of money being poured into the bureaucracy is a Bad Thing. Especially seeing as, despite the huge numbers of managers and administrative staff, they dont seem to be able to find their arse with both hands half the time. Talk to any doctor anywhere, and I bet you that they have some horror story about when they moved hospitals during training. One of Mrs Joose's friends didnt get paid for 3 months once. All they got in recompense was a "whoops, sorry". This sort of fuckup level is not unusual. I could be wrong, as I dont know that much about such things, but I imagine that sort of thing would cause a massive stink in the normal business world.

media lead horror stories

Im going to have to risk a media bashing tangent here, but by all that is holy, is the media physically incapable of reporting medical based things in a responsable, unbiased way? Take, for example, that fuss that was made a year or two ago about the woman who was being refused an experimental cancer treatement on the NHS. Shocking! How could the NHS be so callous! Not spending money on cancer treatment? PUBLIC OUTRAGE.

What they failed to mention on the news is:

1) It wasn't a cure. It would, at best, have extended her life by a matter of months. Which would have been fine except for...
2) It was totally unproven, and may well have not done a god damn thing and...
3) By christ was it expensive.

Which brings me on to another thing. Why is it that when someone is refused treatment due to the cost, its always made out like the NHS are being penny-pinching? They dont spend the remaining money from the budget on hookers and blow. Taking the above example, they could have spent the thousands and thousands of pounds on *maybe* extending one persons life into a few months of hostpitalisation, or they could have spent that same amount of money on a couple dozen hip replacements, totally changing the quality of life for the recipients of something that will definately work.

/rant

[Dog Pants]

Hold on to the media thing, that's for another discussion. I've a lot to say on that and I'd hate to spurge it here.

[amblin]

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[Joose]

Interesting timing for this debate as this anonymous whistle blower's article appeared just this morning on the Telegraph homepage.

Interesting reading, and bang on about the crazy levels of management and bullshit paperwork. His bit about working hours is somewhat oversimplified though. He fails to mention the fact that before these measures were in place, many doctors would work re-fucking-diculous hours. Personally, I dont want to be seen by a doctor that hasnt slept/eaten properly in the past 3 days.

Also, some of that smells of "when I were a lad!" rose tinted twaddle. Particularly:

Medical students of my generation knew that they were joining a profession where the time of day, or day of the week had no bearing on the level of service one was required to provide, whether in general practice or as a specialist. That concept is now to all intents and purposes dead

No it fucking isnt.

[amblin]

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[Anhamgrimmar]

Daniel Reynolds, of the King's Fund, said: 'The vast majority of donations have been used to refurbish hospital departments.

'The money was not specifically for artwork and only a minority of trusts used it for that.' He added that the donation could not be used to pay for equipmentor medical staff according to the rules of the charity.

Well what the shitting christ is the use of donations to a hospital that CAN'T be used on kit or people?

[Akiakaiu]

Speaking as one american, I don't see why we need it personally. Every job I've ever had gave me medical insurance, even working at a fast food place.

My sister doesn't have a job, but is really sick, ala on dialysis 3 times a week, and on very expensive meds since when she was 10 she had a liver transplant. She's on medicare, so the government is already paying for her treatments and stuff.

I don't really see how you can't afford healthcare, I'm poor and can afford it. I still have it even though I'm laid off, and I'm paying a lot less then what the government wants me to pay.

I also know talking with a lot of small businessmen, like my boss who has 4 employees that it may very well cause him to go under from all the extra expenses this will entail. Good thinking to try and implement something that will drain the coffers of the small guys during a recession.

I may be an asshole for saying this, but if you don't have healthcare in the US it's your own damn fault. There are more then enough ways already to get it, people just want the government to hold their hand and not have to think for themselves.

[deject]

Speaking as one american, I don't see why we need it personally. Every job I've ever had gave me medical insurance, even working at a fast food place.

My sister doesn't have a job, but is really sick, ala on dialysis 3 times a week, and on very expensive meds since when she was 10 she had a liver transplant. She's on medicare, so the government is already paying for her treatments and stuff.

I don't really see how you can't afford healthcare, I'm poor and can afford it. I still have it even though I'm laid off, and I'm paying a lot less then what the government wants me to pay.

I also know talking with a lot of small businessmen, like my boss who has 4 employees that it may very well cause him to go under from all the extra expenses this will entail. Good thinking to try and implement something that will drain the coffers of the small guys during a recession.

I may be an asshole for saying this, but if you don't have healthcare in the US it's your own damn fault. There are more then enough ways already to get it, people just want the government to hold their hand and not have to think for themselves.

We're spending an absurd amount of our GDP on healthcare. I think the number is somewhere around 16% and it's going up fast. Compare that to countries like Germany. Germans only spend about 10% of their GDP on healthcare. The French only spend a bit over 11%. We simply cannot afford to be spending 16+% of GDP on healthcare. It is not sustainable and will cripple our economy.

I do not have healthcare right now myself. I could probably afford the premiums, but I seriously doubt any insurer would accept right now because of their stupid ass pre-existing conditions. The fact is unless you have insurance through work or because you're rich out the ass you're not in great shape if shit hits the fan. We need to fix it and if you can't see that then you aren't looking.

[The Shutting Downs]

Three words for the main problem in the NHS. Target driven care.

I work in the Ambulance service. If we hit Category A call 1 second inside the 8 minuite mark, but the patient dies, the call was a success.

If we hit the same call one second over, but the patient lives, the call is a failure.

The 8 Minuite mark was something derived ages ago, with no real grounding, but was stuck to as a measureable target. All across the NHS, this is the case, meaningless targets that MUST BE ADHERED TO!

In order to make sure these targets are met, large numbers of middle management are required to find new ways to reach these targets, pulling funding away from other areas so that these arbitrary targets can be met.

As for the Media and televsion, they have also been less than helpful. People now call up for an ambulance on the belief it gets them seen quicker in A&E because thats how it works on Holby City. And when thier call gets categorised as 'Non life threatening' and they are told it will be a wait, they keep calling back until they get the questions right. Never mind there are people who are near death out there, they want to be seen in 8 minuites and rushed in (where they will be triaged and told to wait anyway).

Another large amount of funding goes into keeping staff operational. our shifts work us 24/7/365, and this has a huge impact physically, mentally and emotionally. This sort of shift work lowers your life expectancy, and the amount of staff lost due to sickness and injury is something that cannot be helped, so to keep constant influx, get them trained and then keep thier training up to date and them equipped costs.

I suppose my main gripe with the service though is that it's not funded as an emergency service, as the Fire Brigade and the Police are. Nope. Funded as an NHS trust, so have to adhere to NHS targets as well as the time scales.

Although, for you Americans here, the system we use to triage calls on 999 here is exactly the same as your 911 use over there.

[Lateralus]

In principle, I love the NHS, and fully believe that it's the best method for the delivery of healthcare. For me, it should be provided as a public services, and whilst this does not mean it should have money thrown at it, the idea of a healthcare system which operates for profit fundamentally undermines what I consider to be its purpose.

In terms of the detail of how it is run, I don't know enough about it to have an informed opinion (a common theme across all our topics it would seem!). However, from the few first-hand experiences I've had with friends and family requiring care, it's been brilliant. The stories coming out of the US when the healthcare system were being discovered made me even more grateful for the system we have, and even more scared of what some Americans seem to believe about other countries.

As an aside, just about the only redeeming factor I can think of about Cameron is that due to his own personal experiences with his son, he'll not hack away at the NHS should he get into power.

[FatherJack]

I'm proud of the NHS, note that Labour brought it in and was horrified how Thatcher started to privatise it.

Things are a little different now, New Labour finished what Thatcher started and the Conservative leader relied on them for his son's care. Not sure he should have used that in the debate, as there's not actually any question about whether the nursing staff do a good job.

It must be awful to be a doctor or nurse in a country where they have to check the colour of your money before treating you and while I don't like having a two-tier system which inevitably pulls experienced staff trained by the NHS into the private system, we're not going to make it go away. I guess if people can afford to go private, they should - to reduce the burden upon the NHS.

The too many managers thing is difficult though. It's oft-quoted that they outnumber medical staff and drain money, but they are there for a reason. Previously absolutely millions were wasted when hospitals were run chiefly by medical staff. Not because they were careless or stupid, just that their primary duty was to care for patients and nobody was checking the costs.

Whether that meant ordering 15ml bottles instead of 50ml ones when they would only be used once, not firing up the X-Ray machine for every patient or using a cheaper drug that was just as effective. While not true of every doctor, I would guess that most didn't have time for all that, so there needed to be someone there keeping score and checking where all the money went.

Of course once they saw how deep the rabbit hole went, they discovered they needed far more staff and needed other levels of management to give them the clout to enforce changes. Now entrenched and holding the keys, it's easy to see why they don't pick axing themselves as a way to save money.

[Roman Totale]

I'm not too familiar with American healthcare, so I can't really comment upon it. Cost and efficiency aside however, it is my view that it is a basic requirement as a human being to look after those that are less well off.

It is true that this is open to abuse by idle scroungers and the like, but that is more an argument against benefits in my opinion.

[HereComesPete]

The problem I see is running the NHS as a series of companies in the form of PCT's, but then shackling them on how much everything costs and how long everything should take.

The NHS is large and bloated and unprofitable, so why try and run it as a company? Why have key performance indicators and cost vs waiting list projections from business impact analysts? It's strange and unique and should get a tailored way of running it instead of being hamstrung by rules that just don't fit.