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Saturday, 18 November, 2000, 19:19 GMT
Have we lost faith in the NHS?
Three UK hospitals are under fire following the publication of highly critical reports into poor management and abuse of the elderly.
The Commission for Health Improvement has found poor standards of care, lack of supervision of inexperienced doctors and a shortage of staff.
And a GP, who was previously struck off the medical register in the 1970s, has admitted that sub-standard hygiene at his acupuncture clinic was responsible for an outbreak of the liver infection Hepatitis B.
Do you feel safe in their hands? How can trust in the NHS be restored? Do you think the NHS's condition will improve or decline?
This Talking Point is now closed. A selection of your e-mails are posted below.
Guy Chapman, UK
How many nurses are the NHS short. All trusts have personnel departments that cost vast amounts of money to run. Why not centralise all nurse recruitment to one agency and allocate staff from it to hospitals who need staff as opposed to the farce of hundreds of job vacancies in nursing press. The armed forces have used this system for years.
May I respond to the comment made by SB, the hospital manager. He/she says that the managers work harder than the doctors. Well if he followed the average hospital doctor (both junior and senior) around the hospital for a day or night he would need a day off to recover. And that's just the physical aspect of it, not to mention all the difficult decisions they take everyday.
And yet doctors do it day in and day out. Managers are essentially bureaucrats who go to endless, aimless and often fruitless meetings all the time and have to create work for others. The government could liberate millions of pounds of valuable resources overnight that could go directly to patient care if they stopped all the hospital managers from hindering the work of clinicians who treat the patients.
The experience of family members with the NHS in the UK suggests that there is, indeed, something chronically wrong with the whole system. That said, if you think that's bad, try the system over here! With 40m (15%) Americans without healthcare coverage, and everybody else getting ripped off by the medical community's cartel, some bright spark has got to come up with a better way ... starting off with the premise that it is immoral for someone to profit from the health needs of another. Oh, and stop calling it "insurance" ... the inevitability of all of us requiring medical attention at some point in our lives puts it more in the category of "assurance".
While I do not argue for the adoption of the US system of health care, it does have some merits worth studying. First, the mentality of a 3rd party-payer system is diminished necessating more accountability in the doctor-patient relationship. Second, although 50 million have no health insurance, it is incorrect to state that they have NO access to health care. Anyone entering an Emergency Room in an American hospital is guaranteed health care by federal law.
Perhaps a mix of privatised and public health coverage is the solution.
I feel sorry for those who work under the NHS. They take a lot of stick for something that really isn't their fault. The NHS body is slow and many GPs are clearly in favour of sending patients to private clinics and so private health care is always that bit faster. The problem is that many illnesses that could have been cured go too far to be cured because of the long waiting list time and the obvious reluctance of doctors to hurry anyone through who has a real problem.
Many doctors and nurses out there work heroically for very little thanks and I say well done to them, but there are a number of doctors who are clearly looking for kickbacks from private clinics.
While I do not argue for the adoption of the US system of health care, it does have some merits worth studying. First, the mentality of a 3rd party-payer system is diminished necessitating more accountability in the doctor-patient relationship. Second, although 50 million have no health insurance, it is incorrect to state that they have NO access to health care. Anyone entering an Emergency Room in an American hospital is guaranteed health care by federal law.
Perhaps a mix of privatised and public health coverage is the solution.
Maybe people who complain about the state of the service should stop whinging and put their hands in their pockets. It seems many in the UK think it is a God given right to have a free health care service. That may have been a good idea in the late 40's when nobody had money but nowadays with excess cash going into leisure maybe people should now consider that it is time to pay. I pay in Germany and I get excellent health care - 40 minutes to have a fracture dealt with.
With regards to waiting lists to see NHS consultants, I waited for a few months to see a consultant, which were the longest months in my life. I do believe the waiting lists are too long for a National Health Service in one of the most developed countries in the world.
I was shocked when I saw a "bulletin" on the wall in the waiting room in the hospital. It listed statistics, of the last few months, of the number of patients who had made appointments, never turned up and did not have the basic civility to call the hospital and cancel their appointments. I think these patients hold part of the responsibility for the inefficiency of the NHS with regard to the length of waiting lists.
Mike Chriswick, UK
The NHS is neither national nor a health service.
It has enormous regional disparity and clearly cares for the sick not the healthy.
To truly reform the NHS we must be prepared to be very radical.
I suggest we allow the regional NHS trusts/ boards etc, to devolve power from the state.
We must allow nurses, doctors and surgical specialists the freedom to run their own affairs.
Instead of being slaves to paperwork and bureaucracy the professionals can then get on with the jobs they set out to do.
I wouldn't trust a politician to run a tap let alone one of our most important industries.
Twenty years of under-investment under the last administration who were trying to force us all into private health insurance provision cannot be rectified quickly. Even should this Government get NHS spending up to the European average there will still be a huge backlog caused by under-investment to be overcome.
Chris Salt, UK
Two things to fix the NHS:
1. Tax private health care like any other service - charge VAT and end charitable status. If it was essential there would be private A&E departments.
2. Introduce exclusive contracts for all publicly trained doctors and nurses. Anyone who wants to work in the private sector is welcome to, but can pay their own way.
Like private education, the public pays for the training of the people who work in the private health sector but gets no benefit unless they pay out yet again for private health insurance.
In this scenario, Neil and others like him can then happily pretend to be living in a cosy little enclave of private patients without talking rubbish.
We need to stop people becoming ill in the first place. We put far too much emphasis on cures and machines that go bleep and we don't prevent illnesses. Most heart disease is not inevitable but is because we eat meat and dairy-centric diets. The NHS will always fight a losing battle when so many of the people that use its services are there through bad diet.
If you think you're any safer in the hands of private health care, then you better think again. Frequently, private hospitals have to move acutely ill patients to NHS hospitals because they are not equipped to handle difficult problems - do you really want a three miles or more ambulance ride when your life is in the balance? I think not! Lets stop moaning and start paying what our health is worth.
I'd so much rather be in casualty in England than here in America. In England, a nurse wouldn't ask what insurance you had before she saw you. It happens here. The resources here are more plentiful but they are wasted. Tests are ordered when they are not needed.
Firstly we need to debunk the persistent 'angels' myth and treat nurses and other staff in the NHS as workers with responsibilities they are paid to carry out. I worked in medicine from 1974 to 1986 and left with a deep sense of disquiet at the way so-called health professionals see the NHS as their meal ticket.
Managers save money by planning well and targeting resources to avoid waste. They remove a burden from doctors and nurses allowing them to concentrate on serving the needs of their patients. If there is a fault with the NHS as a whole (apart from a shortage of cash), it is a lack of stability, brought about by the fact that the top management (the government) changes every five years. Don't be misled by a few scare stories in the paper - these things are few and far between. Finally, I have to say that inappropriate use of the service (especially GPs and A&E departments) costs us millions. Its not all the NHS's fault!
All of you who think that privatising health care is the answer just take a look over here. Over 50 million with no health insurance - that is 50,000,000!
Reciprocal agreements should be abolished with less fortunate countries to have access to the NHS free of charge. Electronic photo I.D's should be issued and swiped as in Passport control. Better still ask the Nurses what really goes on to drain the services of the tax payers money when genuine cases lose out.
Mary Jones, Australia
The NHS is attempting far more than it has the resources to do. I believe the NHS is there to ensure that there is decent A&E care, that births are safely managed, that preventative medicine is prescribed and that urgent operations are attended to. But I don't believe that the NHS should fund niche needs, like IVF, sex change operations or treat those that don't pay their National Insurance except in cases of Emergency. If the NHS trimmed off the fat they would be in a much better position to care for the majority.
Jim Lovette-Black, USA
With all the fuel tax revenue being poured
directly into the National Health Service, surely we
must have the best service on the planet.
Peter, Oxford, England
I agree with Tom Miller's point that the way to sort
out the mess is to do what Greg Dyke
did at the BBC and sack whole layers of
overpaid, over-promoted hospital
managers who are essentially
jumped-up pen-pushers with no idea
about patient care.
Also I think people should not confuse and
equate the work of doctors and nurses.
Doctors work infinitely harder and train for
longer, put in many many more hours
(and, unlike nurses, never go home until the
work is done which is usually well past their
contracted hours), and they carry much more
responsibility for their actions. It saddens
and depresses me that the NHS does not
recognise that and seems to take the
doctors' goodwill for granted.
I think the NHS - or those running it - need a big shake-up and people need to be more accountable for how they waste money. Having injured my knee ligaments skiing in March this year I have to wait until 31st March next year to have an MRI scan - leaving me in pain and with a knee that gives way with no notice for over a year. Once I am seen I can envisage a long wait before it is operated on, then another 9 months intensive physio and the prospect of never skiing again. In the meantime a 16 year old who wants to be taller (and at 5 ft I know how she feels) gets not only growth hormones but a £12K op on the NHS!
The NHS, like the Medicare system here
doubtless has severe problems to overcome, but do not think that switching to a totally private system will provide the answer. Here, private health insurance is held by around 38% of the populace (including me) but inefficiencies still occur and the costs of administering such schemes are actually higher than the Government model and frankly, having been treated under both systems, the actual care given varies little. Sure, the surroundings may be somewhat more luxurious and doubtless waiting times are nowhere near as long as under the State scheme but one does wonder if the cost is worth it. And as for following the U.S. system of health-care - God forbid.
Peter Fermoy, England
The NHS was the envy of the whole world until the Thatcher government wrecked it by continuously eroding and under funding it. The only hope now rest with investment in the NHS and encouraging people to become doctors, nurses etc by good pay and conditions. This of course isn't particularly tempting at the moment given that anyone wanting to study to be a doctor could probably have to face a seven year student loan, placing him or her in debt before their career has even started - another great Tory idea!
I think we should have the choice to opt out of the NHS. I begrudge paying every month out of my wages for a service which is basically rubbish. I recently waited 10 months to be seen by a consultant. I was advised by my GP to go private but I don't see why, after having to pay National Insurance, we should have to fork out for private treatment because our National Health system is badly run. We're paying for the NHS but we still have to pay around £7 for prescriptions and the government have the cheek to suggest that we pay £10 to visit our GPs. I believe in a socialist state where everyone should get medical treatment but in this country the NHS is just an expensive shambles.
Nap, USA (ex UK)
I feel that if we want to keep our nurses in the NHS then they need to be paid a decent wage, as most of them after all endure 4 years at university to become a nurse with very low pay. I have not lost confidence in the NHS and live with a nurse who would never go private but she sometimes loses her confidence with the Government when they offer a poor £500 increase in wages instead of giving them what they deserve for one of the most difficult jobs in the UK!
Some people cite the excessive deference to medics as the root of our loss of faith in the NHS. Current practice is to include the patient and/ or carers in the treatment process, emphasising that doctors and nurses are partners with the patient and not gods.
NHS staff are fed up of the drip-drip-drip of negative publicity due to a small number of rogue practitioners. There is a lot of very good practice in the NHS: look behind the headlines and see why people write to their local media praising their treatment.
Godfrey Bartlett, UK
My mother broke her leg recently, they put it in a cast and sent her home.
One of our friends is a physiotherapist and wondered why my mother hadn't been given a physio appointment.
Fortunately my brother is an NHS auditor and the answer was easy to find - the fractures clinic didn't have any more money left for buying physio time.
It is funny that the UK is going to a US scheme for health care when most Americans think that the big business attitude to health care is terrible and you become no more important than your credit rating.
Graham Melbury, England
I think that the NHS has degenerated into a national disgrace and I dread the day when I will need treatment for some serious condition. I recently spent two weeks in an NHS hospital so I can speak with some conviction. One evening I was told that I needed a test the next morning and I was to be kept "nil by mouth" until the test. It was not until 4pm the following day that I was told the test had been postponed for the day because there was only one doctor who could carry it out and he had phoned in sick. When I enquired at what time did they know this, I was told 9am!
I would like to go private but why would I still have to pay my NHS contributions if I didn't use the service?
Scrap the NHS completely and do it like the Americans. That way the Government will not have to keep propping it up and we will all be better off.
Robert Leggat, Bedford
Who cares? The NHS is for the poor, everybody I know goes private. Let's do away with it now and get out taxes down.
David K, England
I have been in hospital, for one thing or another, in France, New Zealand, Rwanda and England.
I would put those 4 countries in that order for the level of service received and the standard of cleanliness.
I must admit that I was in Rwanda in 1989, before the massacres and destruction of Kigali, but the hospital there was better than the Tropical Diseases Hospital in London which I attended on my return.
Why am I paying so much in tax?
The NHS would be an efficient system if it was not burdened with carrying out 'cosmetic' operations like the girl who had her legs broken so that she could be taller. I had cosmetic surgery 2 years ago and I would never have dreamed of asking anyone else to pay for it!!!
Dave Tankard, UK
I have a lot faith in the NHS. I don't however have any faith in the people running it!
More doctors, more nurses, more money, less administrators and less paperpushers.
Colin B, Oxfordshire, UK
Some years ago my brother was involved in a motorbike accident. One of his feet was badly cut, so much so that it dripped blood. The nurse who tended to him in hospital looked at her notes and, despite the fact that only one foot was dripping blood, announced that the uninjured foot was to be operated upon. How is it possible to have any confidence in a system where staff give notes greater credence than what is plainly visible in front of them?
Tony B, UK
After the appalling treatment meted out to my young daughter (17) at the East Surrey hospital this past weekend, all I can say is the sooner the NHS is rebuilt from the bottom up, the better.
She was left lying in casualty for 21 hours with little or no attention. Requests for pain killers were ignored. Samples were taken for tests and lost. Samples were retaken, tested and the results lost. Promises on timing of further tests were made without any hope of them being fulfilled.
Eventually she took my advice and discharged herself and will get the tests done privately.
Unfortunately, many I know have lost faith in the NHS. A friend of mine was put on a waiting list to see a consultant about a strange lump on her neck During the time it took between booking the appointment and attending it, cancer of the lymph glands set in. Now it is so advanced she will probably die. She is 24 and has two young children. If only the appointment came sooner!!!
There are many privately run hospitals in the UK. If anyone thinks the NHS is an expensive and inept waste of taxpayers money just phone one up and ask for their price lists. You may change your view on the NHS very quickly.
I work for the NHS and would do not trust it at all. I would much prefer to pay private, as I have seen from experience, private patients being seen quicker and being given better treatment than their NHS counterparts.
I have recently spent over a week in an NHS hospital in Southend following an emergency caesarean operation and have nothing but praise for the team of midwives and auxiliaries that worked there. I fully appreciate that the NHS is completely over stretched and that inferior treatment does occur, however I believe that the problem is not with the hospital staff themselves but with the lack of funding and general bad management of what little funds hospitals are given.
Although the NHS as a concept is a good one, its implementation is outdated and flawed. One of the reasons we are where we are is the hanging on to the concept that whatever the cost the country will bear the burden. That's outdated socialism and what we need is a deeper review and re-think than the current government dogma will allow. The huge increase in private care should surely show there are alternatives. Let's hope that before it's too late we get a change in attitude that breaks clean with the past.
Whilst I support the NHS, I do not believe pouring taxpayers money into the system will improve it. Improvement will occur when the vested interests are faced down (consultants, public sector unions etc.) and root and branch reform occurs. Unfortunately it appears the political costs of this is too high so expect the cracks to be papered over with £5 notes.
I feel safer in the hands of the NHS than I do in those of the private sector who legally do not have to meet the same standards as an NHS hospital. To suggest that the whole country has lost faith in the NHS is as stupid as it is untrue. The NHS will continue to decline since this has been unspoken government policy as evidenced by their actions since at least 1979.
We treat these people with too much respect as though they are infallible.
Their attitude needs a whole culture revision - they are only human and make mistakes like the rest of us after all.
Although I am a socialist I pay for private medical insurance. At first I felt guilty but not any more.
The NHS needs to get its priorities right. I would be perfectly happy to wait for a while to see someone about a broken bone or something fairly trivial if I thought someone's life could be saved in the process. While Labour's investment in the NHS shouldn't come into question, maybe its management should. I don't think we have lost faith in what the NHS does; I think we have lost faith in the time it takes to do it. Waiting lists have to be cut, and A&E wards need to stop being closed, and instead be heavily supported. And don't criticise the government for this, the root of the problem comes firmly from the previous Tory administration.
The NHS is grossly under funded, as are most other public health services in every country in Europe. It is the present economic thinking which is to blame, which believes in under funding public services and then arguing that they should be privatised. Whether standards in the NHS improve or decline will eventually depend on whether the NHS is well or badly funded.
John B, UK
When the NHS came into being after nationalisation, it was a good thing and the world looked to Great Britain. Now people just come here to abuse our system because it is free to all and sundry! It should not be privatised but kept as one whole unit. If other people from the world over want our treatment, then they should pay for it, not the people who live in the UK! Let's put the GREAT back into Britain and have something to be proud we can say is ours. At this rate, by the time comes for the next election, Blair and his cronies will have completely ruined the country!
I think it's very interesting that so much debate focuses on the cure and not the prevention. We could surely save the NHS a fortune if we all stopped smoking, exercised regularly, and ate more salad! Maybe we've come to take the NHS for granted, and should start taking more responsibility for our own health.
There can be no sadder reflection on the state of the NHS, as when so many doctors themselves have chosen to have private medical insurance.
What hope the rest of us?
Doctors/nurses are only human, in what is probably the most stressful job in the country they do remarkably well.
Its not surprising mistakes are made with the workload these people put up with.
I haven't lost faith in the NHS, I have however lost faith in accountants. Accountants dominate the senior management of both the NHS and Railtrack. The rest is history.
Tim Miller, England
I have to say that I have every confidence in the NHS. I recently had a stay in Waldsgrave Hospital for a lung operation which went very well. I have been left with minimal scarring, the procedure was a complete success and I was taken care of superbly. I would also add that due to the urgent nature of my problem (a chronic/repeating lung collapse) it took me 2 weeks to get an appointment, and I was back at work within a month.
The people who make up the NHS are as compassionate and able as anyone anywhere. So if the people are not to be criticised it is a problem with the NHS system and its funding. But how can we give them more money with freezes on petrol tax and increased minimum income guarantees for pensioners?
Glen Grant, UK
We should disband the NHS and start again, private medical care is the only way forward, make them accountable for their finances and the quality of care will invariably improve. I would make mental health an exception and keep this under state control, as it clearly needs huge investment now.
I sincerely hope that it's a case of better inspections and investigations rather than a general trend within our NHS. I still put all my faith in the health service, basically because I can't afford not to. The NHS is a symbol of free life Britain, let's not let it slip away from us.
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