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Unfortunately the NHS is [broken]— — — —[sub-optimal] (choose where on the spectrum you wish to stick your pin) “architecturally”. I dont mean technically, alth

Unfortunately the NHS is [broken]— — — —[sub-optimal] (choose where on the spectrum you wish to stick your pin) “architecturally”. I dont mean technically, although yes there are problems there. I mean in the way the various parts of it are arranged as a whole and regionally. To fix this will require another major reform and since the UK has (foolishly IMO) collectively decided the NHS should be the national religion… nobody in power is going to reform it. It’s like the 3rd rail of British politics. Touch it and you die. A real shame.

DanBC 4y ago
> nobody in power is going to reform it This kind of thing is only ever said by people who've got no idea how the NS works. Just today Javid announced his intention for a new, major, change to the way that primary care will work.
akpa1 4y ago
Back in the 1950s when the NHS was created, it was doing a very different thing to what it's doing now. People are living longer, there's more treatment options for everything, there's new branches that never existed - all kinds of stuff. The NHS was never designed for the sheer scope and magnitude of what it's doing now, and it shows.
etothepii 4y ago
The OP makes the point that there already is a primary key. It strikes me as the standard enterprise response to say, we can't fix your thing til we fix the whole thing, and fixing the whole thing will never happen. My suspicion generally is that fixing small things at scale is more likely to lead to enterprise level results than trying to fix big things in a particular silo. But, it's just a feeling.
- flir 4y ago
  Refactoring, in other words. I wonder if OP has spoken to NHS Digital.
  - flir 4y ago
    I see they have. OP, there's a trick to navigating bureaucracies, you just bounced off the armour. You need an insider, someone you can have an off-the-record chat with.
daedalus_f 4y ago
You say that, but the government is currently engaged in a new reform of the NHS. Having previously pushed decentralisation, competition and increased use and engagement with private providers (Health and Social Care Act 2012 [1]) they are now reversing their position and instead centralising control of everything, abandoning competition, disbanding many of the bodies they created and recreating old ones with new names [2]. This constant churn of politicians with new ideas about how to “fix” the NHS is a big part of why it’s broken. You should also remember that the British public says they love the NHS but they don’t like paying for it. Current health care funding per capita is well behind other equivalently wealthy nations [3]. [1] https://en.wikipedia.org/wiki/Health_and_Social_Care_Act_2012 https://en.wikipedia.org/wiki/Health_and_Social_Care_Act_201... [2] https://www.kingsfund.org.uk/publications/health-and-care-act-key-questions https://www.kingsfund.org.uk/publications/health-and-care-ac... [3] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Marazan 4y ago
Except the NHS has went through multiple massive reforms. Like the Conservatives instituted one after they came to power in 2010 (after famously promising not to institute a massive top down reform pre-election they promptly went ahead an did probably the largest change since the formation of the NHS)
IshKebab 4y ago
I completely agree. If you criticise the NHS on Reddit you're instantly branded as a Tory sympathiser who just wants to destroy it, even though it's pretty obvious that there are loads of things that need to be improved. Appointment booking is probably the most obvious clusterfuck. I still can't book appointments with my GP online. We got a referral to ENT for a child. They sent us a letter, telling us to call them. On the phone they said they have chosen an arbitrary appointment date for us and will send the details in another letter. When we get that letter, if the time isn't convenient then to call them back to rearrange it. Madness! It is very very slowly improving, so I think eventually these sorts of brain dead issues will mostly go away. Hopefully while I'm still alive.
- OJFord 4y ago
  > I still can't book appointments with my GP online. You can, you just have to decide which of the myriad fly-by-night apps you want to (give access to your data and) use. Bafflingly insane IMO, the list of random scammy sounding private companies I was given a non-exhastive no-recommendation list of when signing up to a new GP. Why isn't it just one 'NHS GP' app? I say this as a staunch Conservative. What are they possibly going to compete on?
  - IshKebab 4y ago
    > You can I can't. As I understand it, it's organised separately by each surgery. So you might be able to but I can't. That also explains the use of sketchy apps! > Why isn't it just one 'NHS GP' app? Completely agree. They already have an app!
    - desas 4y ago
      Who is They? GPs are typically small independent businesses contracted to the NHS, which is one of the reasons for the fragmentation.
      - IshKebab 4y ago
        The NHS of course. GPs already have to interface with other NHS systems.
Zariel 4y ago
I will counter this with the following. My mother turned 60 late January this year, she received a bowl cancer screening kit which she did and they recommend she come in for a colonoscopy, which identified she highly likely had bowl cancer. 3 Weeks later she received the results for a CT with contrast scan which found no evidence of cancer else where in her major organs and nodes. 3 Weeks later she is having surgery to remove the cancerous bowl. All for free. Tell me again why America has the highest rate of Stage 5 Cancers over 65.
- deleted 4y ago
  [deleted]
- avianlyric 4y ago
  Just because the NHS doesn’t fail in all scenarios, or even most scenarios, doesn’t mean it doesn’t have serious problems. GP isn’t making any claims that the US system is better, they don’t even mention the US, they’re pointing out that the NHS has some pretty serious deep seated issues. Which quite frankly should be obvious to anyone who’s interacted with it. Knee jerk responses like this are precisely why attempting to fix the NHS is political suicide. It impossible to even have a open discussion out the problems the NHS faces without people piling on to defend the NHS and drown out criticism. Personally I worry about the future of the NHS. The inability to have an honest and open discussion about the future of the NHS means it’s just going to continue lumbering on until it collapses completely from extraordinary pressures it’s placed under.
  - austinjp 4y ago
    > The inability to have an honest and open discussion about the future of the NHS means it’s just going to continue lumbering on until it collapses Agreed. Unfortunately, it often seems that "honest and open discussion" rapidly segues into rancour. The NHS is a behemoth, and healthcare can be astonishingly complex. The NHS was designed for different times and different needs. It's been hacked about and is struggling to hang together. It's a political football, and it's been under-funded for years, probably decades. Cash isn't the only way to fix things, but it's a big part.
- 4y ago
deleted 4y ago
[deleted]
HL33tibCe7 4y ago
Among the Europeans I know living in the UK, the NHS (the system - not the excellent staff) is a laughing stock. There is a better way, but I worry that the public of the UK are so militantly resistant to any change to the NHS’ structure that it’ll never be changed.
- Marazan 4y ago
  The UK spends far less per head on Health than other European countries. It is incredibly cost effective. The first step would be spending as much as other countries do before judging if a different structure would be better.
  - HL33tibCe7 4y ago
    I agree, it should be funded more, but I think there are definitely problems which are inherent to the NHS’ current structure. A lot of mismanagement, beyond the point where I can just blame it on underfunding.
  - mmarq 4y ago
    No, the UK spend on the NHS slightly more than the EU14 average. The NHS is more expensive than the Italian and Spanish healthcare systems, while being significantly worse. Among Italian expats we wonder how is it possible that a paracetamol dispenser with some ni-no-ni-no cars is so expensive.
    - Marazan 4y ago
      Have you taken into account account for private expenditure? There are far more out of pocket expenses in Italy for patients than there are in the UK.
b3nji 4y ago
Sad, but true. NHS is the new religion of the U.K. Remember the mindless banging of pots and pans in the street for them? When quite a lot of the hospitals were empty? I can vouch for this because I worked in the biggest hospital in Brum. Anyway, what am I saying, of course socialist works, were just not doing it right! All hail the NHS!
- scrlk 4y ago
  I found the "pots and pans" thing back in 2020 to be eery. It was once said "Prussia was not a country with an army, but an army with a country"; the UK is not a country with a health service, but a health service with a country.
oliwarner 4y ago
My better-half works in a hospital where the concrete roof is 20y past designed life and is now actively failing to the point of being supported by hundreds acrow props. Tory government says it's still deciding if it'll be one of the arbitrary eight hospital projects they'll fund. They made nursing a degree course, put tuition up to £9kpa, and removed both the nursing bursary and final-year medicine tuition grant... and wondered where all the new doctors and nurses went. You're not right. It's not foolish to want to protect the NHS, it's foolish to trust a Conservative to fund it adequately. And yes, some of these problems were caused by poor policy of their Labour predecessors.

DanBC 4y ago

> nobody in power is going to reform it This kind of thing is only ever said by people who've got no idea how the NS works. Just today Javid announced his intention for a new, major, change to the way that primary care will work.

akpa1 4y ago

Back in the 1950s when the NHS was created, it was doing a very different thing to what it's doing now. People are living longer, there's more treatment options for everything, there's new branches that never existed - all kinds of stuff. The NHS was never designed for the sheer scope and magnitude of what it's doing now, and it shows.

etothepii 4y ago

The OP makes the point that there already is a primary key. It strikes me as the standard enterprise response to say, we can't fix your thing til we fix the whole thing, and fixing the whole thing will never happen. My suspicion generally is that fixing small things at scale is more likely to lead to enterprise level results than trying to fix big things in a particular silo. But, it's just a feeling.

flir 4y ago
Refactoring, in other words. I wonder if OP has spoken to NHS Digital.
- flir 4y ago
  I see they have. OP, there's a trick to navigating bureaucracies, you just bounced off the armour. You need an insider, someone you can have an off-the-record chat with.

daedalus_f 4y ago

You say that, but the government is currently engaged in a new reform of the NHS. Having previously pushed decentralisation, competition and increased use and engagement with private providers (Health and Social Care Act 2012 [1]) they are now reversing their position and instead centralising control of everything, abandoning competition, disbanding many of the bodies they created and recreating old ones with new names [2]. This constant churn of politicians with new ideas about how to “fix” the NHS is a big part of why it’s broken. You should also remember that the British public says they love the NHS but they don’t like paying for it. Current health care funding per capita is well behind other equivalently wealthy nations [3]. [1] https://en.wikipedia.org/wiki/Health_and_Social_Care_Act_2012 https://en.wikipedia.org/wiki/Health_and_Social_Care_Act_201... [2] https://www.kingsfund.org.uk/publications/health-and-care-act-key-questions https://www.kingsfund.org.uk/publications/health-and-care-ac... [3] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

Marazan 4y ago

Except the NHS has went through multiple massive reforms. Like the Conservatives instituted one after they came to power in 2010 (after famously promising not to institute a massive top down reform pre-election they promptly went ahead an did probably the largest change since the formation of the NHS)

IshKebab 4y ago

I completely agree. If you criticise the NHS on Reddit you're instantly branded as a Tory sympathiser who just wants to destroy it, even though it's pretty obvious that there are loads of things that need to be improved. Appointment booking is probably the most obvious clusterfuck. I still can't book appointments with my GP online. We got a referral to ENT for a child. They sent us a letter, telling us to call them. On the phone they said they have chosen an arbitrary appointment date for us and will send the details in another letter. When we get that letter, if the time isn't convenient then to call them back to rearrange it. Madness! It is very very slowly improving, so I think eventually these sorts of brain dead issues will mostly go away. Hopefully while I'm still alive.

OJFord 4y ago
> I still can't book appointments with my GP online. You can, you just have to decide which of the myriad fly-by-night apps you want to (give access to your data and) use. Bafflingly insane IMO, the list of random scammy sounding private companies I was given a non-exhastive no-recommendation list of when signing up to a new GP. Why isn't it just one 'NHS GP' app? I say this as a staunch Conservative. What are they possibly going to compete on?
- IshKebab 4y ago
  > You can I can't. As I understand it, it's organised separately by each surgery. So you might be able to but I can't. That also explains the use of sketchy apps! > Why isn't it just one 'NHS GP' app? Completely agree. They already have an app!
  - desas 4y ago
    Who is They? GPs are typically small independent businesses contracted to the NHS, which is one of the reasons for the fragmentation.
    - IshKebab 4y ago
      The NHS of course. GPs already have to interface with other NHS systems.

Zariel 4y ago

I will counter this with the following. My mother turned 60 late January this year, she received a bowl cancer screening kit which she did and they recommend she come in for a colonoscopy, which identified she highly likely had bowl cancer. 3 Weeks later she received the results for a CT with contrast scan which found no evidence of cancer else where in her major organs and nodes. 3 Weeks later she is having surgery to remove the cancerous bowl. All for free. Tell me again why America has the highest rate of Stage 5 Cancers over 65.

deleted 4y ago
[deleted]
avianlyric 4y ago
Just because the NHS doesn’t fail in all scenarios, or even most scenarios, doesn’t mean it doesn’t have serious problems. GP isn’t making any claims that the US system is better, they don’t even mention the US, they’re pointing out that the NHS has some pretty serious deep seated issues. Which quite frankly should be obvious to anyone who’s interacted with it. Knee jerk responses like this are precisely why attempting to fix the NHS is political suicide. It impossible to even have a open discussion out the problems the NHS faces without people piling on to defend the NHS and drown out criticism. Personally I worry about the future of the NHS. The inability to have an honest and open discussion about the future of the NHS means it’s just going to continue lumbering on until it collapses completely from extraordinary pressures it’s placed under.
- austinjp 4y ago
  > The inability to have an honest and open discussion about the future of the NHS means it’s just going to continue lumbering on until it collapses Agreed. Unfortunately, it often seems that "honest and open discussion" rapidly segues into rancour. The NHS is a behemoth, and healthcare can be astonishingly complex. The NHS was designed for different times and different needs. It's been hacked about and is struggling to hang together. It's a political football, and it's been under-funded for years, probably decades. Cash isn't the only way to fix things, but it's a big part.
4y ago

deleted 4y ago

[deleted]

HL33tibCe7 4y ago

Among the Europeans I know living in the UK, the NHS (the system - not the excellent staff) is a laughing stock. There is a better way, but I worry that the public of the UK are so militantly resistant to any change to the NHS’ structure that it’ll never be changed.

Marazan 4y ago
The UK spends far less per head on Health than other European countries. It is incredibly cost effective. The first step would be spending as much as other countries do before judging if a different structure would be better.
- HL33tibCe7 4y ago
  I agree, it should be funded more, but I think there are definitely problems which are inherent to the NHS’ current structure. A lot of mismanagement, beyond the point where I can just blame it on underfunding.
- mmarq 4y ago
  No, the UK spend on the NHS slightly more than the EU14 average. The NHS is more expensive than the Italian and Spanish healthcare systems, while being significantly worse. Among Italian expats we wonder how is it possible that a paracetamol dispenser with some ni-no-ni-no cars is so expensive.
  - Marazan 4y ago
    Have you taken into account account for private expenditure? There are far more out of pocket expenses in Italy for patients than there are in the UK.

b3nji 4y ago

Sad, but true. NHS is the new religion of the U.K. Remember the mindless banging of pots and pans in the street for them? When quite a lot of the hospitals were empty? I can vouch for this because I worked in the biggest hospital in Brum. Anyway, what am I saying, of course socialist works, were just not doing it right! All hail the NHS!

scrlk 4y ago
I found the "pots and pans" thing back in 2020 to be eery. It was once said "Prussia was not a country with an army, but an army with a country"; the UK is not a country with a health service, but a health service with a country.

oliwarner 4y ago

My better-half works in a hospital where the concrete roof is 20y past designed life and is now actively failing to the point of being supported by hundreds acrow props. Tory government says it's still deciding if it'll be one of the arbitrary eight hospital projects they'll fund. They made nursing a degree course, put tuition up to £9kpa, and removed both the nursing bursary and final-year medicine tuition grant... and wondered where all the new doctors and nurses went. You're not right. It's not foolish to want to protect the NHS, it's foolish to trust a Conservative to fund it adequately. And yes, some of these problems were caused by poor policy of their Labour predecessors.