In retrospect, was the NHS such a good idea?

HUGE question Kittylester!!
Although I had the nerve to be born before the NHS and therefore cost my poor parents - a habit I continued all their lives- I have no personal experience of other systems so I will be interested to hear what others think.
As far as we go, DH must have had hundreds of thousands of pounds worth out of the NHS -transplant surgery, lymphoma, bowel resection, heart surgery,blood transfusions every couple of weeks, blah, blah, blah and I suspect the current private health insurance policies might not have continued to pay out for pre-existing conditions.

I am sure if you were designing the NHS now we wouldn't want it to stay as it is. It is in a mess. When it was designed in the 1940s it was to tackle infectious diseases which have almost completely disappeared . People can now live much longer with chronic ailments which require medication, so the costs have risen exponentially. I wonder if charging, say, £10 , to visit a GP with the usual exemptions for children, those on benefits etc, it may discourage people from rushing to the doctor with any minor sore throat, cut finger etc. I know that suggestion will cause an uproar amongst some, but something should be done to improve the service we currently now have. Not just throw money at it.

I am sure that a lot of us wouldn't be here if it wasn't for the NHS. I do agree that radical reform is needed to prevent it's total collapse.

Apart from anything else, there was a recent report (from a survey) by Price Waterhouse Cooper that found that 70% of the respondents (all NHS employees) do not understand the national architecture (structure) of the NHS.

Sorry don't have any answers.

Something has to be done, doesn't it? The trouble is ( to me) it's the sacred cow and anyone who dares to voice the unthinkable is looked upon as the devil incarnate.

At the risk of being frivolous, this could be seen as apposite.

I think it was our best, and most noble, idea.

And yes, still relevant and viable, though we are going to have to bite the bullet and accept that we have to treat it with respect and fund it properly.

At one extreme, try googling any symptoms of ill health on an American site. They are full of people terrified that they may have to go to a doctor, knowing that their health insurance won't cover their treatment.

At the other, many systems are, of course, superior in the care offered, waiting times etc, but that is because more is paid in. We can't expect a world class service at a bargain basement price.

We also have to tackle the widespread abuse of the system (I have personal experience of people going to A & E with a cold, and others demanding antibiotics for minor ailments), but it was ever thus. I remember my dad saying that as soon as the NHS came into being, all the neighbours were off for their new glasses and false teeth, whether they needed them or not

I would charge a nominal fee for visits to the doctor, say £10, with a lower rate for those who could not afford it. I have found that people question themselves the minute even a small amount of money has to be paid. To give an example - I was leaving a country and was selling off our belongings. Children's books which had been used I priced at 0p, they went quickly and the second sale I priced them at 10p and was left with loads. Charging for a visit would make people decide whether or not they really needed to see the doctor. Similarly with prescriptions. In Scotland we do not pay for prescriptions yet charging just £1 per item would prevent the huge buildup of unused medicines which so many people have at home ( especially the elderly).
Then don't let me get started on preventable diseases. If you smoke why expect free treatment? If you are grossly overweight .......etc.

sounds to me like the thin end of a wedge....prescription charges have already gone sky-high from 20p...

That's a good question Kittylester. The NHS has to be viable/retrievable because we all need it, from cradle to grave. I'd be happy to contribute more towards it via takea and I expect so would the majority. I feel anxious at the idea of charging a nominal amount for a GP appointment. For some people, £10 would be the choice between food on the table or seeing the doctor.

It must be possible to make sure that people who don't live in the country, who are not entitled to free medical help should pay for any treatment received when they visit.

I don't believe the NHS should refuse to treat people who smoke, take drugs, drink or eat to excess (or starve themselves). To call health problems resulting from lifestyle 'preventable diseases' is harsh, to put it politely. In England we pay over £8 for prescriptions, it's up to Scotland and Wales what they do about the cost of medicines. I do believe some thought needs to be given as to allowing people to get e.g. paracetamol on prescription when it can be bought so cheaply (I mean those of us entitled to free prescriptions)

As suggested, I would be very happy to pay £10-£20 to see a GP but then as I pay nearly 10 times that a month for private medical insurance, it's all relative.
I think we could have a far better triage system by having more GPs (who do say a basic 3 year training) to sort out the minor problems and diagnose, then refer to a specialist if necessary. That way GPs wouldn't be under so much pressure and the system wouldn't get clogged up. Do they really need to train for donkeys years just to look at people's sore throats or piles?

Yes, perhaps more local nurse led clinics like the minor injuries one I went to when I had a fall recently and broke a bone in my hand. Small, efficient, excellent care without a doctor on site.

Having been born at the very beginning of the NHS (Jan 48) trained as a nurse in the NHS and having a DGS whose life was saved by the NHS, I am very disturbed by the way it is being abused. It is not a free service, we pay for it in our taxes, but there seems to be an assumption that it can be all things to all people. It was conceived in a different time, when medicine was not so advanced, people did not live so long and social care was done mainly within families. We do need to take care of the vulnerable in society, but until the dogma of entitlement to have everything 'free' has been replaced by a fair and cost effective NHS nothing will change.

We all must take responsibility for our own health. The model in use is now not fit for purpose, but it is a sacred cow that no one seems to be able to do anything about. Unless it is modernised and brought in to the 21 century it will always be a crisis service, leaving some in dire need while pampering to others.

I had a discussion about this with the practice manager ages ago and he said that it would cost too much to administer. I was getting irate about specifically Polish patients making an appointment, asking for an interpreter and not turning up. The interpreter still had to be paid. The surgery has a large % of Polish patients.

I have personal experience of patients flying into London, pregnant or HIV+ and costing the NHS millions receiving treatment.

A relative by marriage used to pop over from Spain to have major heart surgery on the NHS having moved to Spain years before.

I remember my mother paying the GP when I was a child - and one occasion when I was the patient refusing any money as it was a child! He also told her to take the bottle of Lucozade back to the chemist and tell him to give her a packet of glucose instead to put in my drinks.

There must be some way of charging for a GP visit - they all have a good number of office staff now to administer this. People on benefits or low salary and pensioners could still be free or low cost.
At the moment here in France we pay the doctor himself - and he processes our health cards by putting it in a card reading machine and eventually we get some of it back from the health service and the rest from our health insurance. I think there are levels of payment depending on income level and some illnesses are covered completely by the state - but it looks to me that it also depends on whether or not you have insurance. A few months ago after a normal prostate op DH contracted an infection and spent six days in intensive care at a different hospital. The cost of the intensive care alone was €12,000 and that was without any medication. You regularly get statements from the health system and also the insurance company. Any money you do need to pay at point of use (such as about €48 for a scan) is reimbursed straight into your bank account.

To go to this sort of system in UK would cause great controversy and resistance to put into place but might be what the system needs in the way of money. The issuing of cards would maybe also help with the eligibility of people to use the system.
Whether or not you take out insurance here is up to you and there are different levels of cover - friends of ours (who incidentally have a higher income than us) only pay for hospitalisation whereas we choose to pay for all costs to be covered - for the two of us it costs €150 a month. We consider this to be well worthwhile for the peace of mind this gives us. The price is also dependant on where you live and the level of charges the local clinics and hospitals charge. Our level is the middle one and covers us for the big teaching hospitals too.

pippa the NHS came into being in July 1948, so I am afraid that you, like me (March 1948) were also a "private baby."

Daphne you are quite right, apologises. I have just remembered my mother saying she paid £5 for the delivery and 'Nursing Home' stay!!!

You are brave to pose such a question Kitty. Of course it was a fantastic idea at the time of it's inception but how could it's pioneers ever have been able to foresee what was coming down the line and how the nature of health care and the dmands on the NHS would change. I'm inclined to agree with petra it's a sacred cow. What they have in America is the worst case scenario as far as health care is concerned, but there are other systems in other countries that seem a half way house between the US and what we have here. Possibly some charges for some things need to be implemented for THOSE WHO CAN AFFORD THEM.Although remembering a time when dental care was free, I have gulped at times when presented with the dentists bill The NHS is such an unwieldy bureaucratic mess. I never really understand why some of the management of certain health trusts are paid ridiculous salaries for failure, get enormous pay offs and then assume another post with a similar sort of remuneration. However, some will disagree, but I think there has to be an onus on individuals to assume a certain responsibility for their own health. You would have to live in a vacuum not to know where obesity, lack of exercise, smoking and over indulgence in alcohol will lead. I'm not sure what the answer is, I know addictions need specialist treatments, but over indulgence that leads to a Saturday Night/party time A&E visit, imo should lead to some sort of fine being levied for tying up the time of the paramedics. I know some will disagree with that but once upon a time people who ended up in that state would have been charged with being drunk and disorderly, but we are too benovolent to those who put themselves in such a dangerous place. Not everything can be free.

My husband has a great friend who is a retired anaethetist and he was always complained about the fact that collapsable wheelchairs and crutches don't seem to be used again here and what a waste of money that was, this doctor was half Pakistani and would arrange for consignments of say crutches to be sent out to Pakistan where they would be gratefully received. Small example of waste no doubt, but on a national scale

A very interesting thread. I don't think I have much to say other than to agree with the many sage observations previously made by other posters. My late Dad was a GP whose practice straddled the end of the old system and the birth of the NHS. He saw both sides and over time became convinced that people don't value what they don't obviously pay for. A small charge for an appointment and a prescription charge might deter some of the dafter reasons for wanting to see a Dr - eg with a sore nose from wiping it when having a cold!
He was very impressed with the French and Swiss systems. It said something to me that Dad, an NHS GP, had private medical insurance!

lillie Could you clarify what you mean by GPs having a basic 3year training?
Instead of or as well as their MB BS degrees which take 6 years?
Triage by practice nurses is already carried out in many practices and I think the NHS is piloting the idea of assistant physicians who are less well qualified than GPs.
The problem is that not everyone goes to their GP with minor sniffles and complaints.
Some are presenting with symptoms of cancer or incipient heart attacks and it takes knowledge and experience to identify them. Medicine is so extremely complex now and unless GPs have good knowledge and keep up to date, they won't be able to refer appropriately.

The NHS is completely fixable if we stop the privatisation which is happening, stop messing about with the administration, unify health and social care and invest in both. Yes it probably will take extra taxation. At Halloween I came up with a new tax-25% on all goods sold for celebrations and festivals. No-one needs a figure of death as a butler to stand at their front door. The money would go straight to the NHS.
The alternatives, private insurance, paying some costs,etc would lead to a 2 tier system where the best care would go to the better off and the poorest would have the worst treatment.

It was a good idea at the time, and for many years, but has become unsustainable due to a huge population and an expectancy that is higher than ever before.I hope it will continue in some form, but there are bound to be big changes to come, as people live longer.

Question : Do Consultants pay for the use of NHS hospital facilities when they treat private patients?

I have no idea, maybe someone can enlighten me.

My grandfather died in 1939 because they could not afford medication for him. That's when my mother started her nurse training.
Nobody in my family has died since because of lack of medication.

The NHS is affordable. We should not be talking about £10 being a nominal fee to pay to see a GP.
The government does not wish to prioritise the NHS, that's all.

Cuba has a better health service, free at the point of use, and a healthier and longer living population than the UK. Maybe we should copy Cuba now, rather than the USA.

Of to the GPs now.