# UK 'dopers...tell me your thoughts about the NHS **URL:** \ **Category:** Great Debates\ **Created:** [February 5, 2018, 8:53pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260 "2018-02-05T20:53:16Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [February 9, 2018, 11:12am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/61 "2018-02-09T11:12:35Z")
It’s gone in phases, not quite of “boom and bust”, but certainly periods of financial caution followed by periods of catch-up (which may or may not have been wisely spent). Currently we’ve had the same sort of persistent multi-year squeeze (don’t look at the totals, look at the rate of increase per head, which I’ve seen quoted as down to 0.7% in recent years) as, in part, brought down the Major government in 1997. ---
**Author:** ![bob\_2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bob_2/32/3341_2.png) [@bob\_2](https://boards.straightdope.com/u/bob_2)\ **Post date:** [February 9, 2018, 11:20am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/62 "2018-02-09T11:20:06Z")
If we were designing UHC from scratch today; what would be the best way to fund and manage it? ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [February 9, 2018, 12:56pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/63 "2018-02-09T12:56:00Z")
Define “best”… ! What are the priorities? ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [February 9, 2018, 1:17pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/64 "2018-02-09T13:17:48Z")
> [@Grim\_Render](#): > > As a strategy, “Lets move to a more expensive model” lacks appeal. That’s not a strategy I’d suggest. It is possible to pick and choose best practice from across the various UHC systems in order to bring about better outcomes without sacrificing the concept of it being essentially free at the point of delivery. In any case an equally bad strategy is to say “keep it exactly as it is and just put more money into it” seeing as many of the inescapable factors that will impact the NHS mean that remaining exactly the same is not an option. The best advice I can give to such organisations is that if you know what is coming down the road you should make the change before you are forced to. And just so there is no doubt, I’m a massive fan of the NHS, my posting record on support for the NHS and disdain for the hideous mess that is the USA system is clear and unequivocal. I just don’t think that the NHS will improve or even maintain its current performance without some degree of radical thinking and a blind political groupthink that refuses to even consider alternatives alongside increased funding is not helpful. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [February 9, 2018, 1:33pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/65 "2018-02-09T13:33:04Z")
Oh, I don’t think even the most ardent fans of the NHS think it’s perfect or that it can’t be improved in ways other than funding. The problem is that occasionally the government thinks those ways involve privatisation for reasons that usually turn out to be related to whomever has been donating vast sums of money to the party in power at the time rather than for actual constructive reasons. ---
**Author:** ![gracer](https://avatars.discourse-cdn.com/v4/letter/g/8e7dd6/32.png) [@gracer](https://boards.straightdope.com/u/gracer)\ **Post date:** [February 9, 2018, 2:22pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/66 "2018-02-09T14:22:17Z")
> [@Gyrate](#): > > Oh, I don’t think even the most ardent fans of the NHS think it’s perfect or that it can’t be improved in ways other than funding. The problem is that occasionally the government thinks those ways involve privatisation for reasons that usually turn out to be related to whomever has been donating vast sums of money to the party in power at the time rather than for actual constructive reasons. I think an additional reason for privatisation (besides just plain evil) that it can be very hard to predict consequences of privatisation. We can predict “healthy competition” and “market forces” and so things becoming more efficient, but the downsides seem harder to predict and often very specific. ---
**Author:** ![JackieLikesVariety](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackielikesvariety/32/296_2.png) [@JackieLikesVariety](https://boards.straightdope.com/u/JackieLikesVariety)\ **Post date:** [February 9, 2018, 4:54pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/68 "2018-02-09T16:54:08Z")
> [@](#): > > I’m a massive fan of the NHS, my posting record on support for the NHS and disdain for the hideous mess that is the USA system is clear and unequivocal. QFT at least they HAVE a national health service ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [February 9, 2018, 9:51pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/69 "2018-02-09T21:51:31Z")
As I recall, someone’s always proposing reforms and reorganisations of the NHS. The Thatcher/Major government brought in the internal market because that was supposed to increase efficiency, the extra funding under the Blair government was tied to all sorts of changes (NICE, the National Service Frameworks for the main health priority areas), then the top leadership of the NHS itself asked for ways to work better without expecting increases to keep pace with demand, then the Cameron government reorganised the finances and administration nominally to put local GPs in charge, now they have these Service Transformation Plans. But they all have downsides - the moment anyone suggests it might be a better idea to concentrate services here and close down others there, people fight like mad to keep a service at their local hospital (and MPs who are all for more efficiency in the NHS are inclined to turn up on the barricades when it’s a hospital in their constituency that’s up for closing or downgrading). Efficiency and effectiveness are always going to be contestable terms, and all the shiny policy documents in the world don’t convince people when they suspect the underlying priority is actually simply to cut expenditure and/or to open more of the service up to cherry-picking by commercial contractors, simply for the sake of it. ---
**Author:** ![bob\_2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bob_2/32/3341_2.png) [@bob\_2](https://boards.straightdope.com/u/bob_2)\ **Post date:** [February 9, 2018, 11:16pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/70 "2018-02-09T23:16:46Z")
The current thinking is that emergency services are best concentrated in large hospitals with all the bells and whistles, while the smaller units are left to concentrate on so-called ‘cold’ surgery and minor operations. There is a lot of good sense in this idea - a car accident victim with multiple injuries which may include orthopaedic, neurological and cardiological damage, need the facilities that only a large hospital can provide. Not only the fancy machines - PET/CT, MRI, Ultrasound, CT, X-ray, DXA et al, but the skills of the consultants who specialise in those conditions and the dedicated nursing teams in high dependency units. On the other hand, there are outcries when the local A&E says that it will no longer accept paediatric cases and they will have to go 20 miles to the specialist unit; or that they will not accept stroke victims and their relatives are faced with a two bus - 90-minute journey to visit them. There is no model that will satisfy everyone; the best we can hope for is that if we, or our nearest and dearest, are unfortunate enough to need the service it will be there for us. What we are eternally grateful for is that it will do its best regardless of our financial circumstances. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [February 9, 2018, 11:27pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/71 "2018-02-09T23:27:30Z")
> [@PatrickLondon](#): > > As I recall, someone’s always proposing reforms and reorganisations of the NHS. It’s what the model demands, surely. It’s free at the point of delivery which puts enormous pressure on the service, and that - in turn - invites innovation and a constant search for efficiencies. Problems start when the model stagnates. I don’t think reforms demonstrate weakness at all, if that was indeed the inference. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [February 10, 2018, 1:02am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/72 "2018-02-10T01:02:34Z")
Desperately sad news today for Rob Delaney, an American comedian and sitcom person who lives in London - his son died aged 2. Part of Delaney’s statement: > [@](#): > > If you’d like to help other families in the UK with very sick children, please make a donation to Rainbow Trust ([https://rainbowtrust.org.uk](https://rainbowtrust.org.uk)) or Noah’s Ark ([https://www.noahsarkhospice.org.uk](https://www.noahsarkhospice.org.uk)) in Henry’s name or in the name of someone you love. Our family would be in much worse shape right now if it weren’t for them. I would also urge you to take concrete and sustained action to support the NHS, however you can. Do not take it for granted. > **[Catastrophe actor Rob Delaney's son dies of cancer aged two](https://www.bbc.co.uk/news/world-us-canada-43012424)** > > The US actor, best known for his role in the British sitcom Catastrophe, says he is "devastated". ---
**Author:** ![Fiendish\_Astronaut](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fiendish_astronaut/32/3295_2.png) [@Fiendish\_Astronaut](https://boards.straightdope.com/u/Fiendish_Astronaut)\ **Post date:** [February 10, 2018, 1:29am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/73 "2018-02-10T01:29:55Z")
I have a fairly blood condition. The NHS doctors who I have to see on a regular basis are brilliant. I feel so lucky. When I went on holiday recently they gave me a plan for how to manage my medicine around my trip, sent me a letter to accompany my medicine to show the airline/security, and booked me in with a nurse for a last minute pre-trip check up. No paperwork and I don’t even pay prescription charges because my condition is considered serious enough to get me an exception. It saved my life at least once when I had a blood clot and was bleeding internally. I can’t say enough about it. It’s annoying to book GP appointments. I can do it online these days and my surgery is a very modern facility but it’s so busy you usually have to wait days before finding an empty slot. I guess it’s possible to get late notice emergency slots. The one thing I find is that the nurses are impossibly friendly. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [February 10, 2018, 8:09am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/74 "2018-02-10T08:09:47Z")
> [@Fiendish\_Astronaut](#): > > It’s annoying to book GP appointments. I can do it online these days and my surgery is a very modern facility but it’s so busy you usually have to wait days before finding an empty slot. I guess it’s possible to get late notice emergency slots. Might be worth phoning them to understand the whole system. I like to see a particular GP at my Practice and they have a system where you can book as you describe, or just rock up between 10-11.15 and wait. Max wait for me has been about 50 mins. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [February 10, 2018, 8:45am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/75 "2018-02-10T08:45:03Z")
My GP practice has both phone app and online booking systems but I get the impression they’ve set it up for future non-urgent appointments, usually for the junior salaried GPs. Phoning gets a much quicker appointment, and once when I was already there for something else and had to book another appointment, the receptionist took a look and seemed oddly apologetic about the fact that there was a slot if I didn’t mind waiting 20 minutes. I have raised the discrepancies in the different booking systems with them, but I suppose they’d be worried about losing control if they gave online/automated access to the entire system. Or the range of triage options if you were to have an automated decision tree would just be too complicated. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [February 10, 2018, 8:49am UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/76 "2018-02-10T08:49:44Z")
> [@Fiendish\_Astronaut](#): > > The one thing I find is that the nurses are impossibly friendly. Things have changed no end since the days of the dragon lady matron. And sometimes it does feel some of the staff have almost been to a slightly creepy “Stepford Wives” school of bedside manner. But for most of the things I have to see them about it’s sufficiently non-threatening (touch wood) that a bit of mateyness isn’t inappropriate. ---
**Author:** ![Filbert](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/filbert/32/3433_2.png) [@Filbert](https://boards.straightdope.com/u/Filbert)\ **Post date:** [February 10, 2018, 12:18pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/77 "2018-02-10T12:18:00Z")
> [@bob\_2](#): > > On the other hand, there are outcries when the local A&E says that it will no longer accept paediatric cases and they will have to go 20 miles to the specialist unit; or that they will not accept stroke victims and their relatives are faced with a two bus - 90-minute journey to visit them. In rural areas, it can be much further than 90 minutes; having recently moved to Cornwall from Bristol, I’ve discovered that for quite a few medical facilities, the closest option hasn’t changed. It’s a regular topic of complaint here that the nearest long-term paediatric unit here is Bristol, which is over 3 hours drive at best for people in the Western edge of the county. Ditto for several other specialist care unit, but it’s the kids’ facilities that cause the most problems. I mean, I can certainly see both sides; for the parents with kids there, especially if they have other children, that’s really too far to commute daily, so especially if they have other kids, that must be adding a lot of stress to an already very stressful situation (do you uproot the whole family? alternate parents?); but then there’s very unlikely to be enough patients to justify something big enough to actually provide the same level of treatment in a county like this. I’m glad it’s not my decision. ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [February 10, 2018, 4:01pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/78 "2018-02-10T16:01:23Z")
> [@Quartz](#): > > You wouldn’t have had to wait. They would have operated ASAP putting you into an immediate slot that was kept open for emergencies or delayed the operation of someone whose need wasn’t urgent. > > I know I’m repeating what others have said, but Americans seem to be blind to this. You missed my point entirely. I was misdiagnosed by a specialist. The need for surgery was not established. I was able to bypass the misdiagnosis without delay. I called my family doctor with my concerns and she set up additional tests the same day. There are many choke points in any medical system. There are potential waiting times for each of these: - a family doctor - a specialist - diagnostic procedures - surgical teams - post surgical treatment Each one of these exist as part of a linear process and because of that process they carry their own waiting period. Those waiting periods are cumulative. I was able to bypass that process with a phone call. I went from family doctor, to diagnostic tests, to specialist, to more diagnostic tests, back to the specialist (twice), back to my doctor, additional tests, a different specialist, and surgery within days of each event. Any waiting period in any of those events would have cost me my leg. I posted the average wait time of just one of those processes. I used data directly from the NHS. [Here’s their data site](https://www.england.nhs.uk/statistics/statistical-work-areas/diagnostic-imaging-dataset/diagnostic-imaging-dataset-2017-18-data/) showing where you can look up diagnostic imaging delays. The average wait time for an MRI is 23 days. Not hours, DAYS. [From the Guardian](https://www.theguardian.com/society/2018/jan/10/nhs-cancer-hospital-may-have-to-delay-or-reduce-treatment): Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.” I’ve loosely followed the NHS system over the years and it’s not the quality of care that’s the problem, it’s the delay times involved. Time is an important commodity in treatment and NHS has made progress over the last decade in reducing delays. ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [February 10, 2018, 4:25pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/79 "2018-02-10T16:25:01Z")
> [@PatrickLondon](#): > > My GP practice has both phone app and online booking systems but I get the impression they’ve set it up for future non-urgent appointments, usually for the junior salaried GPs. Phoning gets a much quicker appointment, and once when I was already there for something else and had to book another appointment, the receptionist took a look and seemed oddly apologetic about the fact that there was a slot if I didn’t mind waiting 20 minutes. > > I have raised the discrepancies in the different booking systems with them, but I suppose they’d be worried about losing control if they gave online/automated access to the entire system. Or the range of triage options if you were to have an automated decision tree would just be too complicated. Do they have sub levels of medical personal available for entry level consultations? I used to go to a facility operated by 2 doctors and 2 nurses. Now there is a single doctor with, 2 Nurse Practitioners, and a Physicians Assistant. The NP’s and PA’s can handle most of the workload of a doctor. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [February 10, 2018, 4:32pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/80 "2018-02-10T16:32:28Z")
> [@Magiver](#): > > You missed my point entirely. I was misdiagnosed by a specialist. No, I didn’t miss your point. Specialists are human the world over. And humans make mistakes. > [@](#): > > I called my family doctor with my concerns And you can do that under the NHS. It’s called getting a second opinion and is entirely standard. And if you don’t like the NHS you can buy private medical insurance. > [@](#): > > There are many choke points in any medical system. There are potential waiting times for each of these: > > - a family doctor > - a specialist > - diagnostic procedures > - surgical teams > - post surgical treatment And you get those in private health care too. There are only so many doctors. There are only so many specialists. There are only so many surgical teams. And so on. No system is perfect. Why do you think doctors and hospitals in America have such huge insurance premiums? Hospital medical errors are the third leading cause of death in the US. 700 people a day. [Cite](http://www.bmj.com/content/353/bmj.i2139). So to demand perfection is wrong. Could the NHS be better? Yes. Is the NHS good enough? Yes. Is the NHS better for most people than the American healthcare system? Absolutely. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [February 10, 2018, 6:02pm UTC](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260/81 "2018-02-10T18:02:33Z")
> [@Magiver](#): > > You missed my point entirely All of this is your experience as a private healthcare user. Everything you say is available to a similar private healthcare user in the UK. I don’t see the relevance of your point. In fact, I’m not sure what your point is. [Previous page](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260.md?page=3) [Next page](https://boards.straightdope.com/t/uk-dopers-tell-me-your-thoughts-about-the-nhs/808260.md?page=5)