Sign up for our free Health Check email to receive exclusive analysis on the week in healthGet our free Health Check emailThe NHS has come under additional scrutiny this week, following comments from shadow health secretary Wes Streeting.On Monday, Streeting warned the NHS will get no extra funding from Labour without “major surgery” or reform, including more use of the private sector.Public satisfaction with the NHS at lowest level on recordWe asked Independent readers how they felt the NHS could be improved, and whether a total reform of the service was necessary. Some argued against significant reforms, emphasizing the importance of proper funding and reducing bureaucracy within the NHS. Many cautioned against privatisation, while others stressed the need for better working conditions for healthcare staff and improved infrastructure, such as more modern hospitals. Concerns were also raised about the balance between managerial roles and frontline healthcare providers, as well as the consequences of whistleblowing and the potential loss of NHS principles. Here’s what you had to say:‘What kind of healthcare does society want?’Deep breath. The first thing to do is to try and identify what kind of healthcare society wants and what it is willing to give up to achieve that. Part, but only part, of that is who pays? Is it to be paid for out of current income or future income (debt) to be paid for by future generations? The second thing is how do you impose discipline on the provision of a service that is either wholly funded or partially funded by the state. What stops it being self-indulgent, complacent and lazy, and what drives it to strive every minute of every day to do its best to make its patients satisfied? The third thing is how do you encourage healthy practices that reduce demand for health services? Which models do the most for promoting self-care and reduce a kind of state healthcare provision dependency whereby responsibility for health is farmed out to a third party? Finally, none of these questions can be answered without thinking about what the alternatives are, how their efficiency and effectiveness compares, and what the barriers to change are.Bruxellois‘Less managers’The NHS doesn’t need reforming, what it does need is doctors, nurses and assorted clinicians and far less managers; the last time I checked there was a manager of some sort for every four staff.TomSnout‘The NHS does not need root and branch reform’The NHS does not need root and branch reform. Apart from anything else, reform takes time and money, the NHS has neither of these things.Let us face facts, when the (soft, firm and hard) right say ‘reform’ they mean scrapped. Perhaps more accurately they mean the founding principles of ‘free at the point of delivery’ needs to be scrapped.You can hide behind all the rhetoric you want, you can string all the usual platitudes about ‘illegal immigrants’, ‘freeloaders’, ‘self-inflicted’, blah, blah, blah at the end of the day, at some point removing the ‘free at the point of use’ principle will mean that normal decent, people will be denied healthcare at some level because it is unaffordable to them.What Streeting’s ‘middle class, lefties’ need to confront is what those ‘socially liberal, decent Tories’ at the dinner party mean by modernise’ is that they want a tax cut and if poor people suffer so much the better.It is rather strange that those ‘paitriots’ who find hot tick buns and purplish St George flags so objectionable are willing to abandon a uniquely British institution designed during the Second World War on British culture?Anyone who thinks our NHS needs a whole raft of health insurance bureaucracy welded onto the side, and then expect a better outcome are deluding themselves.Jim987‘Healthcare shouldn’t be about personal profit’The NHS needs to be properly funded. The current government provide 1.5% funding per year when 3.5% funding at least is needed. Protect whistleblowers. Doctors, nurses and care assistants have raised concerns about patient care but have then been sacked. Rather than cover-ups, support for whistleblowers would protect patients and enhance NHS care. Stop entrepreneurs like Branson and Mone bidding for NHS contracts: healthcare shouldn’t be about personal profit/gain. As for the suggestion by the shadow health secretary, Wes Streeting about using the private health sector, as private hospitals stand, it’s unsafe and unworkable; private hospitals don’t have A&E nor critical care facilities as backup unlike NHS hospitals. Furthermore, there is only a skeleton staff at night, no doctors to oversee patient care; if anything goes wrong, the patient has to be ferried to an NHS hospital for care. Better to keep patients within a well-funded and well-structured NHS. Keep the private sector completely separate.Benitas‘The people’s health should be a cooperative venture’If the UK experience of NHS reform is the template Solzhenitsyn is bang on the money. Health is not a “good” to be traded in the marketplace. The creation of an internal market has not led to improved outcomes for patients but increased profits for players. The most obvious example being PFI which is not unlike borrowing from loan sharks. More and more loans become necessary to service earlier loans.The people’s health should be a cooperative venture not a competitive venture.PinkoRadical‘Big is not always better’The problem with using private hospitals is that it makes NHS waiting lists longer. The consultants in the private sector are the same consultants practicing in the NHS, consequently more “private” patients equals consultants spending more time in private practice and less in NHS. Consultants need to be made to provide a minimum number of hours in NHS medicine or leave it altogether and promote the registrars to consultant posts. It also may be better to split up the regional services into more smaller units. Big is not always better. The regions have continued to centralise services making it more difficult for people in outlying areas. The old model of a matron also worked very well and should be considered again.Stardust‘Kicking the can down the road’“Using the private sector” usually boils down to getting the private sector to provide the upfront cash required, which they do in exchange for profits over the longer term. The most famous example is the PFI hospital building which has cost us a considerable amount more in the long term. It’s not a fix, it just kicks the can down the road, causing long-term budget issues and is poor value for money.The Mark in remarkable‘Cut the bureaucracy’Just cut the bureaucracy. Internal market dogma has almost brought the NHS to its knees. All levels of staff spend more time on paperwork than on delivering care.Paul‘Invest’Instead of reducing N.I. contributions the money should have been invested in NHS. Unless the intention from the government is to sell it off to the US and other foreign companies.Worker‘Look elsewhere before taking a saw to the NHS’The NHS provides a core functionality and should not be changed. I disagree strongly with Labour that the NHS is suffering from 1948 organization syndrome. Other countries do it differently, and this is shown in the performance tables where the UK languishes at the bottom of most of them. Germany has a strong network of independent medical specialists that take patients under the government’s legally required insurance scheme, as well as private schemes. Later in life people often suffer being in the private schemes as they can no longer afford them, in early life the private schemes cost less than the legally required schemes. Laws are changing in Germany, but patients can go directly to specialists. For example, if I developed a cataract I would just go direct to the eye doctor. This relieves both the GPs and hospitals of unnecessary load. It could be argued the small specialist clinics are more efficient than the hospitals. For something standard like a cataract operation in Germany, this is now a “conveyor belt” operation outside of the hospitals. Anything difficult with such an operation still ends up with the hospitals. The same applies to many frequent ageing illnesses, and specialists outside of the hospitals handle them. The UK should check other systems before taking any saw to the NHS, as the finest of surgical changes will be more successful, and that requires careful analysis and consultation.MP‘Postcode lottery’The NHS cannot be run like a business which is what the Tories tried to do. Too much money spent on bureaucracy towards that end. There needs to be a review to retain what is necessary and discard what isn’t. Healthcare has become a postcode lottery and this should not be the case. Failing hospitals need to be given detailed plans to resolve their identified issues within a timeframe and to be reviewed without notice within that time. Not all healthcare staff are angels and some are incompetent and a threat to their patients. The competent ones are leaving and the reasons are heartbreaking; their concerns for patient care are being ignored or they are being forced out. Whistleblowing can have dire consequences in hospitals with a toxic management culture. Standardized treatment protocols may be useful as some hospitals do not appear to have them or are ignoring them if they do. Cutting waiting lists would have to involve triaging patients in terms of urgency and perhaps identifying hospitals with shorter waiting lists and available beds to send them to. The other major issue is bed blockers, and that means sorting out social services also so suitable accommodation can be found in order to free beds. The Tories destroyed a vital functioning national resource and a somnolent populace couldn’t see it.Galileo666‘Hospitals are overloaded’Should the NHS be reformed to improve service?’Many have tried and failed.Until it’s recognised that the NHS is dealing with people and unpredictable events, nothing will change. You can plan as much as you like but no-one can forecast a major incident that fills all the hospitals in a region on a Saturday night when fewer doctors are working or the outbreak of a disease, virus etc. that closes a hospital down and so on. Until the planners see this and it’s calculated in nothing can change.It isn’t only about money. It’s about working conditions. The only way to improve things is to include those working in the NHS in discussions about change.The hospitals are simply overloaded. There has to be a better system for dealing with those who don’t need to go to hospital but do because they simply can’t get help anywhere else. There should be more day clinics for routine surgery where people arrive in the morning and depart later after treatment instead of having to go to hospital in the first place. It operates well in other countries.How any of it can be achieved without the new, modern, well-equipped hospitals the Tories promised but didn’t deliver, is hard to see!AmibigirlsSome of the comments have been edited for this article. You can read the full discussion in the comments section of the original article.All you have to do is sign up, submit your question and register your details – then you can then take part in the discussion. You can also sign up by clicking ‘log in’ on the top right-hand corner of the screen.Make sure you adhere to our community guidelines, which can be found here. For a full guide on how to comment click here. More
