O/T:- The NHS strike - for or against?

[Rez1862]

It's pretty obvious we aren't going to get 19%, it's a start of negotiations to meet somewhere in the middle.

And no, you shouldn't pay more tax. There are many using tax avoidance loopholes who should, and not just for public sector worker pay rises.

[Magpies1959]

So Elite, if as you say neither of the two leading political parties MP's will ever suffer the poor treatments and long waiting lists of the vast majority. Why do you think Labour will do a better job of solving the problem. I am guessing you would be more accepting of the huge tax increases it will take to even start to address the problems of higher staff wages and mis management, if these were dolled out by Labour, rather than the nasty Tories. Who ever is able to find a solution, if any one can, can only lead to the general public being worse off. Presumably all those in favour of the strike will be more than happy to take a pay cut through higher taxes, to fund a better standard of living for the few.
If as you say the issue is more to do with staffing and care for patients,than money, why are there so many nurses apparently leaving their jobs for higher pay in the supermarkets, that doesn't seem to add up to me.

[Elite_Pie]

So Elite, if as you say neither of the two leading political parties MP's will ever suffer the poor treatments and long waiting lists of the vast majority. Why do you think Labour will do a better job of solving the problem.

I have never, ever said that Labour would do a better job. It's yet another thing you've made up.

Who ever is able to find a solution, if any one can, can only lead to the general public being worse off.

Yet again, you completely misunderstand what this is really about. The general public might individually be very slightly worse off financially, but the solution will in some cases lead to a loved one living rather than dying. Which is more important to you?

If as you say the issue is more to do with staffing and care for patients,than money, why are there so many nurses apparently leaving their jobs for higher pay in the supermarkets, that doesn't seem to add up to me.

Of course it doesn't add up to you, because your calculation is based on lies, media propoganda and fantasy. Nurses aren't leaving for higher pay in supermarkets (although I'm sure the Mail has convinced you that's the case) they are leaving because this government, through chronic mismanagement and underfunding, has made it impossible for them to do the job they signed up for.

[jackal2]

There's plenty of people on lower pay or lower incomes than NHS workers, rail staff, teachers etc. If these strikes end up forcing inflation up even further, the vulnerable will suffer more.

True

My views on the NHS differ from most. Whilst it is admirable that it is held in such high regard, there are better universal and no payment at service systems out there which we should be looking at. When a big chunk of the NHS budget pays for administration, buildings and maintenance of buildings, if the NHS didn't own the buildings and just paid for the treatment, how much more could be done with the budget?

I’m happy to support nurses getting more pay, but the resources need to be released from within the system, not by throwing more money at it. The NHS is a huge unwieldy beast that needs to be divided into smaller, more manageable segments, regardless of whether those segments are state-run, privately run or both. It’s encouraging to hear even Labour folks like Wes Streeting acknowledging that the NHS needs reform, because treating it as sacred cow won’t do the organisation or the public any favours.

I been in hospital more times than I care to remember and can tell you not all nurses are great at their job.

I've seen and heard several examples of shocking bad practice including cases affecting my own family, but to be fair I’ve also seen and heard many examples of excellent care too. It’s the Curate’s egg.

The problem with the current NHS structure is that managerially it doesn’t weed out the poor operators quickly enough, if at all, and it isn’t just patients who suffer the consequences of poor practice. The pieces have to be picked up by the good professionals who then get more overloaded and burned out.

Healthcare is provided free of charge.

No it isn't. It's free at the point of use, except where you pay prescription charges, but ultimately the NHS is funded from the public purse, so we should all be keen to see the money we spend on it being used as efficiently as possible. It isn’t at present.

The money has to come from somewhere. So that either means cuts elsewhere, higher taxes for you and me, or creating money out of thin air, which is what they did during COVID.

We’ve had two extraordinary global events in Covid and the economic impact of what’s happening in the Ukraine, and the public spending response has been equally extraordinary – especially from a Conservative government! Many would say this response was necessary in exceptional circumstances, but you’re right that the books always have to be balanced in the end, and printing money is a recipe for inflation.

The NHS has been underfunded, understaffed and lacking in serious investment for decades by various governments that have found it harder and harder to keep it going. Anyone waiting for the land of milk and honey promised by a Labour government in 2024 will be disappointed. There needs to a completely different way of thinking about the way it's funded in future and most people will not like it.

The NHS has actually been massively funded, but it's a bottomless pit - a hopelessly outdated and impractical operating model. In that sense you're right - there needs to a completely different way of thinking about the way it's funded in future and some people might indeed not like it, which is why politicians on all sides won't grasp the nettle and keep hiding behind platitudes about ‘our wonderful NHS’, but eventually it will just collapse under its own weight. In fact it already is.

Of course the country can't afford 19% for nurses but that figure is an opening gambit for 'negotiations' - which Tories refuse to take part in.

True - unions have always pitched their initial demands high as a negotiating tactic, while privately hoping for perhaps half or two thirds of that figure. The question is, have they over-egged the pudding with this demand, such that even members of the public who support the premise of a decent pay rise view that figure as excessive, thus making it easier for the Govt to claim that negotiations are pointless and that they've already agreed a fair, independently recommended rise? If the unions' accompanying argument is that “this isn't all about money”, then asking for 19% seems to undermine their own case.

And yet we're the least healthy nation in the developed world. It's a system that infantilises people and discourages them from taking responsibility for their own health, alcohol in-take in particular which apparently creates the biggest strain of all on NHS resources. It was a great idea when it was introduced at a time when large swathes of the population were still living in Victorian conditions. It's not fit for purpose in the 21st century however.

Yep.

My own life survives purely because a wonderful surgeon performed a tricky operation in the nick of time. He told me that he had given me an extra 6 years' life. Well, I'm still here 12 years on.

Long live Sidders! A mate of mine was in a serious car crash and owes his life to a brilliant NHS surgeon, though ironically his recovery was undermined by some very shoddy post-op NHS nursing care. Basically, the surgeon had spent hours putting his arm and wrist back together like a jigsaw puzzle, and the nurse whose only job was to occasionally check that my mate’s arm was in the right position in a specially constructed sling neglected to do so, meaning he never got as much use back in that arm/wrist as he should. The surgeon was livid, and I can tell you he wasn’t blaming it on lack of resources!

The NHS needs reform but its founding principles hold good to this day.

Totally agree with you Sidders. I must need a doctor!

My daughter is now a prescribing nurse ... you can imagine what she thinks about the situation ... NO MORE MONEY FOR THE NHS; CUT THE ADMIN/MANAGEMENT.

I've heard several NHS professionals of various types say the same.

Just focusing the pay fight on nurses also excludes People like physios, OTs, ODPs, SALTs, dieticians etc at infinitum. All are just as [important] as nurses. The focus should be on fair pay across the board, not just one, or a few, groups. In terms of the NHS overall, maybe we need to radically rethink it.

If we reform the NHS in the right way, such that money is used far more efficiently than it is now, then we’ll actually have a better idea of whether and how much more money is truly needed, and where. Then it becomes easier to ensure we have the right quantity of all types of staff being paid what they deserve. Chucking more money at the current structure is throwing good money after bad though.

I have a few close friends who work within the NHS in varying roles and the general opinion is the same - it doesn't matter how much money you throw at the NHS, it won't solve the problem as most of it is lost through inefficiency and mismanagement.

It’s a recurring theme. Radical reform is essential, but it’s a bloody big job facing any Government irrespective of political colour, requiring leaders who are brave enough to have “difficult conversations” with the public. Are the current crop of career politicians up to it?

Back in the real world, I work in a job that is equally important and keeps the health care "industry" ticking. I will be lucky to get a pay rise this year and if I get one, it will be way below inflation and that will be because in my performance review I am over achieving. I don't get overtime, I'm salaried so any extra time I work is effectively free and my personal performance is actively monitored. I'd love all public sector workers to have these conditions on them, it would certainly drive up efficiency, maybe it's time for the government to implement that?

I can imagine some people responding to your observation by saying “we shouldn’t be in a race to the bottom” in terms of pay and conditions, and I agree we shouldn’t. That said, I think some people in the public sector take their protections and benefits for granted compared with the private sector and especially compared with self-employed folk. As bule1 says:

If they drop the stupid% pay request I would be more inclined to get behind them.

I've seen massive inefficiency within the NHS (not just management, from nurses and doctors as well!) I'd like to see pay be based on performance rather than you're just an employee. Might retain the better staff and give a kick up the backside to the lower performers, can't ask for that if you're in a union though can you!

What?? It's the thin end of the wedge I tell ya!!

It's about the future of the NHS, and it should be very important to all of us who don't have private medical insurance, because we never know when we'll need it.

True, and that's why the service has to be reformed quite radically, otherwise it will eventually break down completely, irrespective of which Government runs it now or in the future.

[Elite_Pie]

I’m happy to support nurses getting more pay, but the resources need to be released from within the system, not by throwing more money at it. The NHS is a huge unwieldy beast that needs to be divided into smaller, more manageable segments, regardless of whether those segments are state-run, privately run or both. It’s encouraging to hear even Labour folks like Wes Streeting acknowledging that the NHS needs reform, because treating it as sacred cow won’t do the organisation or the public any favours.

Some very detailed answers there jackal (when is your second novel out!), but I agree with the bit I've quoted. If the waste and mismanagement was sorted, it would probably fund a 100% increase for NHS staff across the board.

It's really a separate issue to this strike, but it's definitely been a main contributor to the problem.

[jackal2]

Some very detailed answers there jackal (when is your second novel out!)

If you've ever seen Dave Gorman's Googlewhack Adventure, then my motivation and discipline to write a novel is on a par with his!

[OchPie]

I’m happy to support nurses getting more pay, but the resources need to be released from within the system, not by throwing more money at it. The NHS is a huge unwieldy beast that needs to be divided into smaller, more manageable segments, regardless of whether those segments are state-run, privately run or both.

I think the best response to this is the very decentralised (and hybrid public-private) social care system, which has been for years a complete disaster.

No it isn't. It's free at the point of use, except where you pay prescription charges, but ultimately the NHS is funded from the public purse, so we should all be keen to see the money we spend on it being used as efficiently as possible. It isn’t at present.

You can't cut your way to efficiency though. One big issue with the Tory starving of the NHS has been the knock-on impact on care quality, which the system then has to scramble to fix. (Of course the starting point, the health of the nation, plays into this too - but the Tory love of selling off playing fields plays into that as well.)

Look at the lack of capital expenditure. This means patients get in and out less quickly. Inefficiency.

The NHS has actually been massively funded, but it's a bottomless pit - a hopelessly outdated and impractical operating model. In that sense you're right - there needs to a completely different way of thinking about the way it's funded in future and some people might indeed not like it, which is why politicians on all sides won't grasp the nettle and keep hiding behind platitudes about ‘our wonderful NHS’, but eventually it will just collapse under its own weight. In fact it already is.

This just doesn't match the historical record. Fund the NHS like a contintental healthcare system and it provides care of the quality of a contintental healthcare system - Labour proved that.

I do agree that it's good to have an honest conversation about the advantages and disadvantages of the NHS system, but I see no evidence the NHS system couldn't be fit for purpose. The key advantage for the wealthy right in pushing other models is that care rationing - which EVERY health system does in one way or another - EVERY healthcare system is a bottomless pit because demand has no limit - shifts away from clinical need and towards individual ability to pay.

There are ways around that too. The Swiss system works pretty well, all told, in outcome terms. But it's extraordiarily expensive in European terms and has massive inequality issues, with poorer Swiss actively avoiding healthcare checks due to the cost. That has to be a political decision ultimately. The NHS still does amazingly at providing low income adults with care, by design. Making a decision to stop doing that should be properly articulated.



Reform is definitely needed - though one of the biggest drivers of inefficency in the NHS is that reform hasn't stopped there in decades, often seemingly for its own sake.

Additionally: managers stop front-line healthcare workers from having to do admin and allows them to get on with healthcare. That point seems to elude many, unfortunately. The Tories in the coalition government slashed the number of managers - it's now about 2% of the NHS workforce. That number is far, far lower than the national average of ~10% - which is also the level of most large, successful organisations.

As for the nurses - if this were a free market I think they'd already be getting far more than 19%. The UK relies on foreign healthcare workers and the competitiveness of the UK in that market has absolutely tanked. Meanwhile the UK has made it harder for British HCWs to get trained. So with massive demand for labour, supply is already shrinking. Shifting to a different system doesn't change that reality - but British nurses with private sector market power, like their foreign colleagues, I suspect would be in a far better position to extract money than those with public sector rights to strike. Be careful what you wish for.

[BigFatPie]

I don't think nurses are greedy at all. My point was lots of people feel they should be paid more, particularly given the increased cost of living, but don't have a mechanism in place to demand it.

Entirely correct. Join a union.

[BigFatPie]

[GranthamPie]

Excellent synopsis OchPie