NHS waiting lists in England hitting new high of 7.2M people | Hacker News Reader

NHS waiting lists in England hitting new high of 7.2M people

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I think it was such a bad move to tie the driving purpose of Covid Restrictions in the UK to "Saving the NHS". One obvious flaw is that people will retrospectively tie the success of lockdowns with the post-Covid state of healthcare. Given that the NHS was already barely functional pre-Covid, denying healthcare for several years and simultaneously making it harder to give healthcare was a recipe for disaster.

Many of us predicted that the Covid restrictions would kill more people than they would save.

Excess deaths have been high all year and this is likely to remain the case for the next decade. We’ve obliterated the health service and also damaged the economic engine to pay to fix the problem.

(And I’m still downvoted. Open your eyes people, it’s basically Stockholm syndrome at this point!)

How have you determined that the excess deaths are due to "covid restrictions" and not for example, long term sequelae of covid itself or other factors?

Thanks for saying that, 100% agree! It was obvious from the start that the restrictions will do more harm then good. Almost everyone in my circles that has kids is reporting psychological problems. Teachers report that they have to care for three suicidal kids during a school trip. People having long term side effects from the vaccination. And still, the restriction-fanatics are trying to ignore the obvious.

I wonder what kind of psychological problems result when you watch your loved ones catch covid and end up hospitalized or worse for long periods of time? We'll never know, I guess.

Fortunately, most of our loved ones under 80 only suffered with a few days in bed, so the psychological scarring wasn't too deep.

And the ones over 80 ended up catching it anyway.

There are rather fewer of these people (in fact, I haven't heard from any of them), than people who have had to tell their children they have to stay inside due to the horrible virus stalking outside.

The trouble with anecdotes is that I have examples of people who were bed-ridden for 6 months with a COVID infection, and I was lucky because other people have examples of corpses from it. My secondary school 22 years ago had enough pupils that, if it’s the same size now, half a dozen to a dozen of those pupils will have faced relatives dying from it, and those stories will have spread around the playgrounds/social media.

Then there’s the fact that, even though it’s milder for pupils, they can still get: if you know what it can do to your granny before you get it, it’s going to be terrifying; and if you get it mildly and then granny dies from it, you’re going to feel survivor’s guilt and worry if you killed her.

Then there’s the fact that parents were already keeping their kids off school before the official lockdowns, because so many people saw the government wasn’t taking it seriously (which later became the PM almost dying from it, but it was obvious they didn’t care well before then).

What's worse than anecdotes is 3rd-hand anecdotes. I've heard so much about "those with Covid corpses", but have yet to hear from them. I'm sure they exist, but there are way fewer of them than people seem to think.

I don't really know which way the balance goes, but that the calculus wasn't made is borderline criminal to me.

And I don't think it really was done, when UK decided to not implement any lockdowns initially (right or wrong, don't know), most of the response was emotional. How dare you not care about dying people???

Yes, many did; and yes, excess mortality is up; so I can sympathise with thinking that’s a smoking gun — but COVID itself also caused excess mortality, some of which was by the pathway “The hospitals are now full of COVID patients so we have to turn away others” followed by “OK, so the COVID has cleared up and we can get back to the others… oh, 10% of those others have since died”. And given this is about the UK, I can also point at Brexit, the final stage of which happened during the pandemic and which I specifically predicted would cause a non-specifically large number of deaths: https://kitsunesoftware.wordpress.com/2019/10/25/oh-no/

(I’m glad to say that Boris Johnson pattern-matches against what I wrote in the final few paragraphs).

I’m sure some deaths will have a causal connection to the lockdown, but I can confidently say that about literally every possible course of action or inaction by any major government on any topic no matter how mundane; to talk about risk to the NHS, one must show that the caused effect is also a substantial part of the total.

The hospitals were never "full" of Covid patients. During the two years from March 2020 onwards, the NHS treated about 70% the number of people that it does during more normal years. These were also mostly not Covid patients. The only reason the NHS stopped treating people during those years is because it was determined that it was too "unsafe", not because the hospitals were full of Covid patients.

In fact, now that Covid is more or less over, our health service has become so dysfunctional that only now we are turning people away due to capacity issues (or leaving them in the back of an ambulance for 10+ hours).

We didn't save the NHS, we broke it.

The current breakage is many things, including but not limited to:

* Overloaded nurses retiring early or shifting career (one of my in-laws switched from nursing to become a builder).

* Pay offer too low to encourage new nurses to join the NHS, as they are valued worldwide and have offers in other countries.

* Long-term systematic political footballing.

* Brexit (harder access to the UK from the rest of the EU combined with the exchange rate shock making the pay offer look worse).

* Many elderly patients have nowhere suitable to go after they’ve been treated, because community care is covered by council taxes not central government and the local councils can’t cope. Fixing this requires shifting the tax burden in ways that the government does not have sufficient support to get through even if they wanted to, and it’s not clear to me if they want to.

* Medical costs dominated by the elderly, combined with demographic shifts (important because the non-elderly not only pay the taxes but also do the actual work) which IMO was caused in part by newspapers in the 1980s and 90s deciding that the topic they wanted to treat as a social scandal was all the single mothers and teenage pregnancies, leading to government policy of making all the students of that era as frightened as possible of starting families ever, leading to later families, leading to smaller families, which combined with the social dynamics of basically ending the construction of new council housing (and any boost to the private sector being insufficient) meaning that poor people had a much harder time getting a home, and also the fact that effectively forcing widespread two-income-no-kids relationships without extra home construction leads to house price (and rent) inflation rather than people being able to afford more which again leads to the same demographic shift. Oh, and all that also makes the take-home pay of nurses much worse than it might otherwise be, making it even harder to get nurses from overseas or to keep nurses trained in the UK.

* COVID and long COVID

You're blaming the wrong things. Its a system problem.

Waiting lists for elective treatment are high because hospitals are full of mostly elderly people who can't be safely discharged because the social care system is broken - largely due to lack of capacity due to underfunding. And the government recently cancelled the national insurance rate rise that was supposed to fund improvements in social care.

Accident and emergency departments, as well as intensive care, can't move patients into regular and high dependency hospital areas because of the problem above. Which is why ambulances have to wait for so long outside hospitals. Which is why ambulance waiting times are seriously dangerously high.

The NHS generally has a lot of burnt-out people who are quitting or retiring faster than they can be replaced. Part of the problem is low pay (arguably partly due to under-funding of the service) and perception of that NHS roles are high-stress. The same is true for GPs (who generally aren't NHS employees) although the shortage of people wanting to become GPs is less about pay and more about the stressful nature of the job. The stress of dealing with the pandemic also substantially contributed to burn-out.

Ultimately, the UK isn't willing to fund public services properly. Health, education, social care, police, military - they're all grinding to a halt after running hot for too long with not enough people or funding.

If you want to take the argument further - we're looking at the economic damage caused by 14 years of austerity topped-off by brexit. The UK economy can no longer fund the expected activities of the state at the level that people expect.

It is - like everything else, our response to Covid has just accelerated anything that was already in decline. The best we can hope for is a well-managed transition to a hybrid healthcare system that all of the other sensible countries use.

>the social care system is broken

Here, you are talking about social care for old folks. The relevant question here is - why has it got worse over the past 2 years? What we had before wasn't great - old folks basically sold everything they had so minimum-wage staff could care for them in their dying last few years, and needed constant attention from NHS-provided services. Which part of that is now properly broken, and why?

Other thing that happened in the last two years: Brexit.

A post about this from two years ago: https://www.ageuk.org.uk/our-impact/campaigning/care-in-cris...

Paying cheap imported labour to care for isolated elderly people certainly was an "already broken" system.

> Which part of that is now properly broken, and why?

Residential social care (primarily for elderly people, but also for younger people with specific issues) is mostly provided by the private sector and part-funded by the state. The amount that the state will pay care businesses to provide that care hasn't kept pace with their costs, and private care homes are increasingly ejecting loss-making residents and/or closing-down completely. This has been going on since at least 2017 and is starting to accelerate as energy costs increase. The state has very little residential care capacity left.

Home-based care is also a mess - again due to lack of funding. Salaries don't compensate for the job stress, and people still working in the sector are over stretched and burning out. So people who might have been able to live semi-independently in their own homes are pushed into the residential care system which (except at the high-end) is crumbling.

Again, its a system/coordination problem. I'd argue that part of the problem is inherent complexity, but a bigger part is that the politicians who are setting policy are ill-equipped to deal with these types of problem because very many of them believe in market-only solutions. When a system gridlocks like this, they don't know what to do.

Not forgetting the obvious problems with turning your entire population into "bubble people". I'm not very excited about the Scarlet Fever outbreak here in the UK, as I have two small kids of my own.

I don't know if it's as general as that. I just checked excess mortality, France VS UK [0] as they have a similar GDP and similar health system (and I know France situation better). This summer, we had three heatwaves, reached new record temperatures in 9/12 of all cities I've lived in, and had the longest heatwave ever recorded, as well as the earliest one. We had way more excess death during the 2020 summer, or even the 2021 summer (tbh, although it was pre-omicron, the excess death can probably also be caused by car crashes).

It seems to me that the excess death in my country will reach the baseline (maybe a bit higher since the average age is growing, but not much) as long as this summer is an outlier. UK data almost tell the same story, but I don't think you had the same heatwaves, and I don't know how to explain what is happening right now.

Putting that on the lockdowns only would need explaining why this effect isn't seen in France, as ours were both longer and more numerous I think (we had three, and only two in the UK, right?).

[0]https://ourworldindata.org/grapher/excess-mortality-p-scores...

Covid it's a red herring. As is the attention given to long ambulance queues, overrun A&Es. This isn't a front door admissions problem.

What we're seeing is a long and accelerating dissolution of social care in the community, mostly elderly nursing but also mental health.

Most hospitals are at least 40% occupied by patients awaiting discharge but who can't be discharged because there isn't a nursing home space, or enough community nursing to support them at home. They stay in hospital.

This blocks admissions. Which blocks ambulance transfer. Hospitals give surgical beds over to ease waits but this only makes things worse. Now people aren't getting surgical treatment, and it's more likely they'll end up coming in for the symptoms.

Covid made things worse, mainly by treating nursing staff horribly, but this was already a trend. We urgently need to pay nurses more, and desperately train a hundred thousand more. Neither look likely under this government.

It's not just the waiting lists, it's the dire situation at A&E. Folks waiting around 10 hours to be seen and ambulances parked up with patients onboard as there are no beds available for them to offload and see to the next emergency.

And a lot of this comes from upstream. It’s bordering on impossible to see a GP so you need to go to A&E for anything semi urgent. I cannot even speak to our family GP, and if I could I would be offered a telephone appointment in 3-4 weeks.

The NHS has effectively collapsed.

It's further upstream than that, it's the successive cuts to all public service.

This makes GPs the backstop for all social problems in the UK, which eventually spills into the hospitals.

What kind of social problems are people seeing GPs about, that they otherwise wouldn’t?

The example usually given is the other way round, that the woeful provision of care by the NHS leads to other public services (notably the police) becoming the backstop, e.g. for those with mental health issues.

Cuts and refactoring of Universal Credit is an obvious one.

Recently PIP payments were delayed.

Cuts to services for young people. Worsening mental health until crisis point.

Cuts to care services, leading to old people ending up in hosptial care.

All these failings compound to resulting in a medical need.

Your example of the police is where it becomes circular, as the emmergency services become the provision for other cut services.

Controversial opinion: Social care services are a way to paper over cultural and societal issues that will inevitably out-grow the funding used to do so.

We're about to discover the true depth of our societal issues, now that we've run out of wallpaper.

Current approaches to social care services are designed to paper over symptoms rather than tackle the cause. But again, that is due to poor govermental policy.

It's all top-down

> The NHS has effectively collapsed.

Yep. A lot of people don't realise it because the loudest voices are often Brits that happen to live in locations where it has not collapsed yet, but there is basically no health service in England for a huge proportion of the population. It is only a matter of time before resources get diverted away from those locations where it still happens to be good to try and patch up the failed areas, but that won't solve the problem. Therefore, it is only a matter of time before total collapse in all locations.

Currently there is a lot of ignorance about it. People hear that it's bad but because they happen to live in an area where it happens to be good they can't really accept it. Seriously ill or dead people don't have the energy or motivation to spend time complaining about it on social media or to the press.

There is also an ideological problem for both sides. Both Labour supporters and socialists do not want to admit that the NHS is failing, because they know that if it goes then it is very unlikely to ever return, and they want to generally support nationalisation. On the other hand, Tories don't want to admit that the NHS is failing, because even for the pro-Capitalist Tories, the NHS is a patriotic symbol of the UK loved even by hardcore conservatives, and a symbol of the "blitz spirit". They also are aware of the fact that its collapse would be a sign of its own failures, since the Tories have been in power for a vast majority of the time that the NHS has been collapsing, so who else is there to blame?

I think most likely the Tories are going to try and blame this on Putin, which is quite comical.

Obviously there is this idea going around that this is being done on purpose by the Tories to encourage a move to private medicine, but I don't think this is true because the private medicine in the UK is heavily reliant on the NHS to function and the UK government aren't really doing anything at all to encourage more private hospitals to open either. If the Tories really wanted to move people from the NHS to private healthcare they would offer a statutory insurance system like in France or Germany and tell people to use it at private clinics.

Currently they blame everything on the member for Islington north!

Don't you guys have urgent care centers? They're fairly common in the USA.

Yes, but they are also extremely overwhelmed, like everything. You will be waiting many hours in one of those

We have the concept of a "walk in centre", but there aren't many, they are over-subscribed and they can't do much (for instance prescribe antibiotics). The typical experience there is to wait for 4+ hours to then be seen by a nurse and either sent home or sent to A&E. I am not being cynical here either!

A subtle way that government has cut services is to hand things like walk in centres to local councils to run but without increasing the funding for the councils. The councils then close them and take the political flak. The UK is not a good place to be sick and poor.

Apparently the problem is also downstream - namely the inability to discharge patients who are ready to go home due to lack of sufficient community care available to support these patients.

Thus taking up a lot of extra beds and having a knock on effect on A&E queues etc

That and a recruitment problem - as I understand it. (Likely partly due to poor wages but that’s an assumption on my part)

We hired a few people from the NHS. Admin staff. They were over the moon and working hard even with lower salaries as long as they won't need to work for NHS. The workloads are insane and the shitty cynical attitude is all over the place, which doesn't help at all with morale.

We left the UK last year. I liked many things there, but the NHS was never one of them. The GPs who are often borderline incompetent. The administrative staff and their endless errors. Wait times were always bad. A few years ago we waited 9 months so for an appointment with a pediatrician. I recently had to make a couple of appointments with specialists, cardiologist was one of them. Less than two weeks wait time+ multiple doctors to choose from. In the UK I would have waited for month for this to happen.

It seems like there's a massive cognitive dissonance in the UK. Everyone 'loves' the NHS, says nurses are underpaid and decries any attempt to privatise provision. But everyone also has endless complaints about it. Useless doctors/nurses, appalling administrators and reception staff, mistakes with test results and communication and so on.

I think for an average Brit the NHS is the same as the queen used to be: you may not like it, but if anyone says something negative about it, you are absolutely ready to die for it. At least this was the impression I used to get whenever I brought up the subject.

Did the government ever solve the NHS PFI scandals?

I remember these being a massive topic some 10 years ago but haven't heard much if anything of them since.

Edit: It looks like some trusts still pay insane interest rates for some of these projects https://www.theguardian.com/politics/2019/sep/12/nhs-hospita...

I remember at the time hearing that PFI was some sort of magic money tree that was better for everyone. You would have to be massively naive to believe that.

Remember how Brexit was going to save the NHS [1]? It has instead worsened the situation [2]. Remember how the previously short-lived PM Liz Truss wanted to drive up the deficit with massive tax cuts [3] instead of, oh I don't know, spendin gmoney on the NHS backlog and staff shortages?

Here's something you may not know: the cost of living situation is a genuine crisis in the UK, Russia's unjustifiable war on Ukraine and the resulting cut in gas supply and rising energy costs have led to the creation of Warm Hubs in the UK [4]. What's a Warm Hub? It's somewhere warm people can go because they literally cannot afford to heat their homes.

This is no doubt contributing to demands on the NHS.

It's wild to see comments even here suggesting Covid lockdowns were the problem. No, the collapses we're seeing in the NHS were the very thing lockdowns avoided.

[1]: https://www.healthjobs.co.uk/health-care-uk/blog/what-happen...

[2]: https://www.theguardian.com/society/2022/nov/27/brexit-worse...

[3]: https://www.npr.org/2022/10/23/1130782408/how-liz-truss-aggr...

[4]: https://www.lep.co.uk/news/people/cost-of-living-crisis-warm...

> Russia's unjustifiable war on Ukraine and the resulting cut in gas supply and rising energy costs

While true, Putin's war is being used as a scapegoat in the UK for poor policy decisions. For a country in Europe with the lowest reliance on Russian gas, we have seen some of the largest increases in energy prices.

It doesn't really matter where the UK's gas comes from. That's not how global commodities markets work. If it was domestically produced you could legislatively do something about it but the UK's gas seems to primarily come from Norway.

Also, the UK has the second-highest dependence on natural gas in their energy mix (after Italy; ignoring Belarus and Russia) [1].

[1]: https://www.aljazeera.com/news/2022/9/6/infographic-how-much...

Don't worry UK friends, Australia is on its way.

In the health care world, you either have private, or wait until your condition worsens. Then get put on a different waiting list for that.

There are the haves and have nots.

I wonder if going the Singapore route would work? Probs not though, UK is significantly larger than Singapore.

Ironically, one issue with the NHS is retention of staff. A sizeable majority of the new cohorts of junior doctors are steadily migrating to Australia due to the better working conditions.

Don't worry spaniards will cover for them and doubling the salary doing so.

The UK style healthcare system is fundamentally flawed as it does not attempt to address the root cause of a health problem, and is skewed towards providing a tactical solution to the health problem instead. I.e. fixing up the patient just enough to make them come back later again either with the same or with a new but related health problem. Patients are seen as commercial clients (i.e. cash cows) rather than somebody in a real need. It does not matter who pays (the state or the patient out of the pocket or through a health insurance), as somebody generates the revenue stream for the doctor anyway. Which creates a vicious circle for the patient and adds a unnecessary extra burden on the already strained healthcare system.

Australia and New Zealand face the same problem, but Australia is rolling downhill at a faster pace.

Much better source than some schlocky tv channel copy

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-w...

I believe the new policy document from the Labour party is trying to put healthcare in the constitution, which would help with this.

The UK doesn't have a constitution in the sense that countries like the US do. Are they going create a constition as well?

Yes, and get rid of the House of Lords etc.

It seems quite a smart strategy, they're effectively talking about Brexiting from the Westminster elites and "taking back control".

https://www.instituteforgovernment.org.uk/explainers/labour-...

>"taking back control"

I never want to hear that phrase again.

Clearly something has to change.

We have a constitution - it just isn't codified [1]. Therefore doing so would just mean having a set of written laws that effectively make public healthcare part of the UK political structure.

[1] https://en.wikipedia.org/wiki/Constitution_of_the_United_Kin...

Labour (under Jeremy Corbyn) shares a lot of blame for this situation. Why? In the last election, Labour refused to take a stance on remaining in the UK [1]. To be fair, there was also a massive, coordinated and successful smear campaign against Corbyn. Brexit won by a narrow majority (52-48) and there was no party to vote for to vote against it in the election.

The Conservatives went from having a narrow majority (and requiring DUP support for that) to having a massive majority not seen in 40+ years.

[1]: https://www.reuters.com/article/uk-britain-election-corbyn-b...

And now the tories are imploding it looks like we are going to get a massive Labour majority at the next election. And that probably isn't good either. Especially given that Labour prefer to spend all their energy fighting each other.

I think the antiquated first-past-the-post system is at least partly to blame for the mess that is UK politics.

Welcome to Italy.

This is roughly 1 in 10 people

More like 1 in 8 because this is just England, not the entire UK

Glad to see the leftist lilt on HN downvotes and flags anything contrary to the narrative.

If you're in the UK, please go private if you can afford it. You cannot rely on the NHS.

This helps the individual, but doesn't do much to help the NHS. The NHS is one of the best things about the UK and we need to fight for it. Making big corporation and the super wealthy pay taxes would be a good start.

It helps the NHS in as much as it reduces load on them. Though what percentage of people would have to do that to have an appreciable benefit is another matter, and it doesn’t do anything about A&E.

The overlap of people who can go private, and use the NHS is very slim. It really would have an miniscule effect.

All complications from private healthcare spill into the NHS. There's no such thing, yet, as private A&E for example.

But the more people go private the more excuse it gives the government to privatise the NHS ("it isn't working, look how many people are going private"). Also many of the private doctors are also NHS consultants. Getting more private work might just mean they reduce the hours they do for the NHS. So it isn't clear to me that going private helps the NHS, possibly the opposite. Also, if you pay your taxes, you shouldn't have to go private.

It seems to me the main factors here are:

a) Healthcare is getting more expensive due to an ageing population and ever more elaborate and expensive treatments.

b) The greed of the wealthy (who would rather have a third card than pay taxes to fund the NHS). Who also control much of the UK media.

c) The incompetence and venality of the UK government. How many hospitals could have been built by the money paid out in fraudulent COVID loans or trousered by mates of the government for COVID PPE?

d) The lack of long-term thinking and investment. We seem to change ministers like most people change theri underwear. It is beyond shameful that the NHS is hovering up doctors and nurses trained in developing countries to make up the shortfall.

Healthcare is a life or death situation. I'm not going to abandon my own health because I think that if I don't do so I might hurt the NHS

I completely understand. Overall it would be best for everyone if we had a really well run and funded NHS. But it is better for the individual (who can afford it) to pay and skip the queue. It is basically 'the tragedy of the commons'.

You've got to be kidding

The NHS is still functioning. I am still able to get GP appointments within two weeks, be prescribed medication, etc... . Your suggestion, if widely adopted, risks splitting the country into a two-tier system and hastening the demise of the NHS. Much better to vote in a party that will start to fund it properly and undo some of the privatisation and mismanagement that has been damaging it for years.

Ours cannot offer a telephone appointment for 3-4 weeks. That is not acceptable for pretty much any situation require healthcare.

The NHS has a record budget of £200 billion for 2022. Serious questions: How much extra money do they need to provide an adequate health service, and how would another party fund the gap considering our current economic situation?

Via Twitter, recheck accuracy:

> So. All those dodgy VIP purchases the Tories made in 2020/2021. They were added as a spend on the NHS budget, to make it look like they were spending more money on our National Health Service

https://twitter.com/davidjboughton/status/159842616839019733...

Nice so a bunch of that NHS cash is sitting in some offshore account owned by that “Lord” (Lady?) who just took a leave of absence…

"Ours cannot offer a telephone appointment for 3-4 weeks". This is labelled an anecdote. My anecdote is that I can always get an in-person appointment on-the-day at my London NHS GP, and I live not in a particularly affluent location.

It doesn't take much time to find raw, trusted statistics in about the same time as it took to type this message. The source I found [0} explains that:

38.9% of appointments in October 2022 took place on the same day that they were booked, 46% <= 1 day, 66% <= 1 week, 80% <= 2 weeks, 89% <= 3 weeks, 99.91% <= 4 weeks. And 73% of appointments were face to face.

There is always more to the data, sure. e.g. I just made an appointment for my GP about an annual asthma check, and I asked for it to be late next week.

If your GP can not offer a telephone appointment for 3-4 weeks, then it is clearly a national outlier. Throwing your anecdote into a heated debate does little to manage the temperature. I recommend referencing primary source information to support your assertions.

[0] https://digital.nhs.uk/data-and-information/publications/sta...

> The NHS has a record budget of £200 billion for 2022

Spending over the last couple of years is obviously going to be an outlier due to the effects of COVID and COVID restrictions.

> How much extra money do they need

The strangling of the NHS has been occurring over many years, so it's difficult to give a simple figure in response.

But it is telling that in 2016 junior doctors organised the first general NHS strike in 40 years in response to Hunt's contract scrapping overtime rates while increasing overtime hours. We now have a serious issue with junior doctors leaving the NHS: https://onlinelibrary.wiley.com/doi/full/10.1002/hsr2.419

This year the Royal College of Nursing organised a strike for the first time in its 100+ year history, in response to years of below-inflation pay rises.

In 2018, the Health Foundation put out a response to the government's proposed budget increase of 3.4%:

https://www.health.org.uk/news-and-comment/news/health-found...

> Increases of at least 4% a year are the minimum needed to tackle the backlog of financial problems from eight years of austerity. Increases of just 3.4% a year mean longer waits for treatment, ongoing staff shortages, deterioration of NHS buildings and equipment, and little progress to address cancer care.

> It’s worrying that yet again, the funding increase appears to only apply to NHS England’s budget. This excludes vital areas of health spending such as staff training, capital investment and public health. There are at least 92,000 staff vacancies in the NHS and public health spending fell by a fifth in real terms between 2013/14 and 2018/19.

£200 billion looks like a big number, but it's meaningless when critical front-line services are seeing real-terms cuts. There is a consistent pattern of the government cutting investment to the front line, ignoring the objections, and deflecting blame when the inevitable consequences occur. We are seeing those consequences not because the NHS is inherently wasteful, but because the government is choosing to make public services look like they perform badly.

>risks splitting the country into a two-tier system and hastening the demise of the NHS.

You mean, something like the rest of Europe has? Sign me up!

It would potentially be something more like the US where your level of care is heavily dependent on what you can afford. The US is pursuing full market access for their pharmaceutical companies - who are notorious for their price gouging tactics - and the UK is in a pretty weak position post-Brexit. There's a reasonable likelihood that UK health spending will sky-rocket while patient outcomes plummet.

No, they mean something like England already has for dentistry or social care or opticians - access is available if you pay for it, and not much available if you can't pay for it.

Sounds like what we have already! Given OP's choice of words ("two-tier"), it brought to mind something more like the European system.

Is it still the case that if you're in a private hospital for anything bigger than an ingrown toenail, and something goes wrong, then they'll shove you in an ambulance and take you to the nearest NHS teaching hospital, because:

- that's where all the big kit is - that's where all the top experts are - that's where the nurses and procedures are in place for critical care

Because that was the case 10 years ago. BUPA is great for seeing a doctor quickly with a non life threatening condition. And the biscuits [cookies] were nicer.

My knowledge of the NHS is almost a decade out of date though.

Yes I think this is still the case, however the emphasis is on “if something goes wrong”.

I don’t know how often something does go wrong to trigger this scenario though!

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