Unpopular opinion - NHS is useless

To remind you of the OP:
"
"I'll pass the message on, she's working at home" - told that numerous times, no one ever EVER got back to me.

Phoned and phoned. Basically begging in terms for an appointment. No one will tell you anything, no names nothing.

You never speak to the same person ever. No responsibility. Zero care. Constant fobbing off."

Under staffed, under trained, under pressure, seriously? Schoolkids could do a better job of answering the phone and taking messages. Pathetic.

Ratio to GDP is a useful metric for some comparisons, but I think something like spending power adjusted cost per capita is probably a better index. Given how much higher their GDP per capita is, I suspect that would show the US system in an even worse light. I think that a system which allocates resources by ability to pay rather than by clinical need will always give worse clinical outcomes in aggregate.

Although your claim is of course unsupportable at least it sounds like some acknowledgement from you that "the system" is failing.

I hate it when "institutional failings" are blamed and no one is named.

95% of PHers know people who work in the NHS, and know how rubbish many of the staff are.

But let's start at the top. Chief Executives who never walk around their own hospital. Continuous whistle blowing scandals:

"The chair of West Suffolk hospital trust has resigned over a whistleblowing scandal exposed by the Guardian, as fresh questions are asked over why the trust continues to pay at least £270,000 a year to its former chief executive."

"https://www.theguardian.com/society/2021/dec/23/west-suffolk-hospital-chair-resigns-after-whistleblowing-scandal"

No excuses.

Clearly didn't read the thread then.

Who sets the budget for the NHS?
Who sets expectations for the services that the NHS provides?
Who controls wider public health policy that directly impacts the workload on the NHS?
Who sets controls that limit the working conditions and available talent that the NHS has to choose from?

Not a single person employed by the NHS.

I've no complaints.
Ambulance came, saved my life.
Took me to hospital.
Fitted a stent.
A week later took me in for a day because my heart rate was below 40. Took me off beta blockers.

Apart from my GP surgery. Who phoned me to say I need to book a blood test in 3 weeks.
Great. How about this day in three weeks?
ER NO. You can only book 2 weeks in advance.
Wtf? Maybe you could phone me in 2 weeks then?
No you phone them.
It will take 1 hour to get them to answer the phone.
I haven't got an hour to be on hold.

Locally:

1. Can’t get a face to face GP appointment in 3 weeks. Impossible.
2. If you can persuade, and I mean PERSUADE the receptionist that it’s urgent then miraculously you get a call back that day.
3. The leaning is then towards ‘if you’re ill and we can’t diagnose it over a phone line go to A&E’.

So IMO it’s hardly surprising A&E’s are overflowing while the GP’s try and avoid face to faces.

Primary care - by which I mean GP's and dentists - is a mess where I live. I haven't been able to see a dentist since before COVID-19 and they're now saying "after August, maybe. We'll call you, don't call us" for a check up.

You cannot get an in person appointment with our GP practice and they won't even do an e-consult. Oh, but they're still paid I believe, since they are remunerated on the basis of how many are on their books even if they never see any of us!

Of course, when it came to COVID-19 vaccines the same GP's were only too quick to administer the jabs, at £20 per shot or whatever it was. As someone else said, priorities.

An acquaintance of mine had an insect bite that turned septic. "Send us a photo" said the GP. "No, we won't see you." He sent the photo. "Yeah, bit of cream will sort that" he was told, or words to that effect. Of course it didn't work. He ended up in A&E where they immediately admitted him and gave him their strongest antibiotics. Later, they told him he was hours away from full on sepsis or losing his arm.

We, and our friends, are forced to go private, to a walk in place in Gosport, or straight to A&E at the QA main hospital. We have all complained bitterly to our MP (Suella Braverman), the Clinical Commissioning Group and of course the GP practice. Nothing changes.

Oh yes, and 111 is a waste of time. All they do is say "call your GP".

Absolutely. GDP per capita is useful but obviously fairly crude.

On any metric US health provision is staggeringly expensive given the outcomes. I did a thumbnail calculation quite a few years ago that suggested the cost per capita of the admin associated with medical insurance claims in the US was more than the entire NHS spend per capita in the UK. UK spending had rocketed since then, and I've no idea what's happened in the States, but I doubt the picture has changed dramatically.

Healthcare does not easily work efficiently under conventional, direct market forces. Again, this is not a political point, it's purely practical.

There's not much elasticity of demand. "Three for the price of two kidney replacements at Mt Sinai Medical" ... unlikely to work. There's not much substitution. "The heart op is expensive, so maybe I'll get my piles done instead?" ... nice bum, shame about the heart attack. Purchasing medical care is almost entirely reactive, not the considered purchase of a rational economic agent, and it tends to have unpredictable timing and to be ferociously expensive and therefore purchased indirectly via insurance. And buying things via insurance creates all kinds of perverse incentives that undermine market efficiency. At the point of consumption the end consumer couldn't care less about the price; some other bugger is picking up the tab. The insurer doesn't care much about the quality of what's being bought; they just want to get the cheapest price they can get away with. And the provider of the medical services knows they're dealing with two parties and will try to play them off against each other.

If someone can come up with a framework that allows a market solution to work effectively for healthcare, please step forward. Anyone saying "private is better than NHS just because free markets", have a think about what mechanisms make free markets work efficiently.

Hush. Common sense is not acceptable here.

Just a couple of points:

Run ragged - everyone has a different threshold, and IMO if they communicated promptly and properly they would be a lot less hassled. If mine and OP’s experiences are anything to go by it takes literally hours to get a response and sometimes that call is to cancel/amend/update so without that call getting through a cockup happens. I’ll bet many people give up when phoning to cancel an appointment so it goes down as no-show.

Performance - yes it’s poor. Just looking at the first 6 months of Covid we were way above other countries for deaths v infections. So much so Govt stopped issuing ‘recovered’ numbers less than 6 weeks into it. We rolled at a 30% of hospitalisations dying for a while, that figure taken from (again) a rolling death number against a rolling hospitalisation number - far higher than other countries. Govt had no strategy in 2020 there was no ‘Covid care pathway’ at all and it was left to individual Trusts to make it up as they went along but none did.

All in all a mess.

Privatisation? No ! Can you imagine being treated by ‘Global Health (Vietnam) Corp’ just because they’ve swung a tender? The whole lot would implode. No, it needs WARD MANAGERS, WARD SISTERS whose job it is to make it work smoothly and every patients kin able to access them by email at the very least.


Edit: I see we are now running at 5-10% of hospitalisations resulting in death. Still a lot but a darn sight better!