[SA Chris]

I have had to bit the bullet (bad pun) since live in NE Scotland, as there are never any NHS dentists available. Once I got a place at one, and was relieved to come out and find the car still had 4 wheels and all windows. The dentist wasn't that hot either, clearly more specialised in extraction, rather than repair.

[petejh]

The truly nauseating thing about Zahawi's statement is that this situation is partly resultant from his ilk failing to take clear action against Putin for fear of upsetting the gravy train that was oligarchic investment and money laundering via the City.

Nice rant, but complete bollocks.
Some immoral bankers making serious money by laundering oligarch stolen proceeds through London is small fry compared to the far bigger reality of where a large proportion of Europe's essential physical resources come(came) from than. Noticed any prices going up recently...? European-wide industry shutting down at risk of never re-opening...? European economy in serious trouble...? Nah, can't have been concerns about any of that can it?

Europe's - not just the UK's - stance towards Russia/Belarus up to Feb 2022 had everything to do with concerns about the impact of having supplies of resources used as leverage over the European economy. But no instead lets focus our ire on pantomime villains we all love to hate, we'll look so virtuous (provided we don't pay too much attention to where our shit is made or where the resources to make it came from). Populist politics much?

https://www.reuters.com/business/energy/energy-crisis-chips-away-europes-industrial-might-2022-11-02/
https://www.ft.com/content/75ed449d-e9fd-41de-96bd-c92d316651da
https://www.euractiv.com/section/politics/short_news/european-industry-eyes-china-as-aluminium-factories-shut/
https://www.euractiv.com/section/agriculture-food/news/eu-food-companies-face-closure-as-they-buckle-under-strain-of-energy-crisis/

[Fultonius]

The truly nauseating thing about Zahawi's statement is that this situation is partly resultant from his ilk failing to take clear action against Putin for fear of upsetting the gravy train that was oligarchic investment and money laundering via the City.

Nice rant, but complete bollocks.
Some immoral bankers making serious money by laundering oligarch stolen proceeds through London is small fry compared to the far bigger reality of where a large proportion of Europe's essential physical resources come(came) from than. Noticed any prices going up recently...? European-wide industry shutting down at risk of never re-opening...? European economy in serious trouble...? Nah, can't have been concerns about any of that can it?

Europe's - not just the UK's - stance towards Russia/Belarus up to Feb 2022 had everything to do with concerns about the impact of having supplies of resources used as leverage over the European economy. But no instead lets focus our ire on pantomime villains we all love to hate, we'll look so virtuous (provided we don't pay too much attention to where our shit is made or where the resources to make it came from). Populist politics much?

https://www.reuters.com/business/energy/energy-crisis-chips-away-europes-industrial-might-2022-11-02/
https://www.ft.com/content/75ed449d-e9fd-41de-96bd-c92d316651da
https://www.euractiv.com/section/politics/short_news/european-industry-eyes-china-as-aluminium-factories-shut/
https://www.euractiv.com/section/agriculture-food/news/eu-food-companies-face-closure-as-they-buckle-under-strain-of-energy-crisis/

While you're clearly correct on the leverage thing Pete, is there no link between the presence of well connected political influence and money in London and the lack of criticism of UK and EU policy on resource diversification? (genuine open question, not an area of my expertise)

[James Malloch]

Absolutely wasn't criticising you there James, to be clear.

No I got that, don’t worry. It’s a shit situation - I used my health cover when I was employed a lot (only every physio, but lots of it). And that’s transferred into my normal life now I don’t have cover - as in I’ve never even considered trying to get treatment on the NHS.

But I couldn’t imagine waiting for years to be able to walk/run/climb/do anything again. It’s such a shit situation for anyone in that position. I’d likely try the NHS route for something more serious, but then probably just pay private as I could afford it, and I’d go mad with the wait.

But it is a slippery slope and I think the days of getting good, fast, free treatment are behind us (at least for a long time…)

[spidermonkey09]

But I couldn’t imagine waiting for years to be able to walk/run/climb/do anything again. It’s such a shit situation for anyone in that position. I’d likely try the NHS route for something more serious, but then probably just pay private as I could afford it, and I’d go mad with the wait.

But it is a slippery slope and I think the days of getting good, fast, free treatment are behind us (at least for a long time…)

Worth emphasising out that if you're dying, you get seen in the current NHS and once seen the care is excellent. There are obvious outliers such as the strep A news story but overall the standard is very high. The issue is that due to underfunding thats basically all it can focus on and non emergency stuff is very hit and miss, so stuff that stops people climbing takes a very very long time.

Anecdotally I've had to be checked this year for ang spond in my back and almost every part of the process has been very quick; appt was fast, getting an MRI was fast. Reviewing the MRI was extremely slow but then saw a consultant within a few weeks of that being done. Its all quite random.

Agree that Liam's experiences sound extremely bad and don't blame you for looking at other options!

[petejh]

While you're clearly correct on the leverage thing Pete, is there no link between the presence of well connected political influence and money in London and the lack of criticism of UK and EU policy on resource diversification? (genuine open question, not an area of my expertise)

100% yes, but not limited to London or the UK. The UK and Europe (not all - Nordics for e.g.) could and should have spent the last few decades building out an energy system that was free as far as possible from reliance on suppliers with malicious intent. It could also have had the benefit of being lower carbon if people had thought in the medium term rather than short term/low cost. I 100% agree corruption is involved in political deal-making. But corruption and degrees of looking the other way is part of the human condition, the water in which democracies have swum since the beginning. To suggest it was down to one group of politicians in the UK for a whole continent's decades-worth of reliance on cheap resources is to me completely ridiculous and hence populist bollocks.

It's so ironic how much coal Germany is currently burning for electricity. After Merkel crowing to the US 2 years ago about their green credentials versus the US's reliance on coal - Trump might be a complete wanker, but he correctly called out Germany for its industrial base being almost totally dependent on an authoritarian state's good will. The sheer void of criticism within Europe/UK, of Europe's energy strategy is mind-blowing when you think about it*. Of course Europe's coal-burning is a temporary stop-gap which won't go on forever, and the US is a total basket case for GHG in comparison to most of the world (China excluded). 

But ask yourself who's incentivised to have changed anything? We all love cheap goods, we use shit everyday that we paid bottom dollar for due to cheap resources, including the laptop I'm typing this on. All goods manufactured in Europe would be a great deal more expensive (and will be going forwards, as Europe spends the next decade 'reshoring' much processing and manufacturing) without the cheap energy and raw materials originating from authoritarian states. We're all hypocrites and guilty of sponsoring Russia, China, Belarus and other places over the horizon that we'd personally hate to live in due to their treatment of citizens, because when prices go up we cry like babies and get straight online for the cheapest supplier.

The result of the last 20-30 years of low cost goods and low interest rates/cheap money, is that we're calibrated to that economic system. A big shift in the market is happening and we're currently feeling the severe pain of a shift to less globalised/more localised supply with resultant higher prices, along with higher cost of money all happening at the same time as an energy squeeze. The UK has an additional GDP handicap of Brexit but it's a small part of a much bigger dynamic.




* Off topic but I'm almost (but not yet) willing to believe the US actually might have had a hand in destroying nordstream II. It appears from the outside to have been such a corrupt piece of deal-making between Germany's ex-chancellor Schroder and Russia, which left Germany vulnerable to leverage.

[duncan]

Horrible experience Liam.

More positively, I took the lad to the local A&E a week ago after he'd twatted his thumb playing rugby. I was expecting the worst but he was seen by a nurse-practitioner, had an x-ray (small fracture), was reviewed and sent home with a splint and appropriate advice, in just over an hour. He was reviewed by the 'virtual fracture clinic' - a zoom call - three days later and has a face-to-face hand clinic appointment in a couple of weeks when the splint comes off.

[ali k]

Worth emphasising out that if you're dying, you get seen in the current NHS and once seen the care is excellent. The issue is that due to underfunding thats basically all it can focus on and non emergency stuff is very hit and miss,

Yeh from my experiences recently this sums it up. Without going too much into the details I’ve got a chronic liver condition and a relatively recent checkup (back in August) showed I needed fairly urgent treatment to avoid risk of internal bleeding. As you’d expect the waiting list even for this treatment was long so I was still waiting for a date when just over 3 weeks ago one of the enlarged blood vessels in my stomach burst as predicted and I was puking up lots of blood and went into A&E. I was seen in under 30mins and the hospital treatment was excellent for the 5 days I was in getting blood transfusions, antibiotic drip etc, and also the urgent treatment I’d been on the waiting list for. But then I was discharged back into the general system and recovery hasn’t gone well. I’m not sick enough to go to A&E again but not well enough to work and can’t get a GP appt, speak to the consultant, or otherwise get seen any time soon.

So basically due to the waiting time for what should have been a fairly routine procedure it’s led to a 5 day stay in hospital and what looks likely to be well over a month off work at best. Who would have guessed underfunding your health service would be a false economy? Tory cretins.

[teestub]

It's so ironic how much coal Germany is currently burning for electricity. After Merkel crowing to the US 2 years ago about their green credentials versus the US's reliance on coal - Trump might be a complete wanker, but he correctly called out Germany for its industrial base being almost totally dependent on an authoritarian state's good will. The sheer void of criticism within Europe/UK, of Europe's energy strategy is mind-blowing when you think about it

Germany’s decision to phase out nuclear following Fukushima seemed like a terrible decision at the time and an even worse one now. Not sure when the last time there was a massive earthquake and tidal wave in Germany, maybe a few hundred million years ago?

I thought part of the idea of buying stuff off Russia was to encourage them to play nice as they wouldn’t want to lose all their new customers? Obviously this has failed spectacularly 😬

[spidermonkey09]

Sorry to hear that Ali; hope things pick up shortly!

All the issues seem to feed back to the destruction of social care and and the squeezing of primary care/GPs. Lansley has a lot to answer for, I'd struggle to think of a more catastrophic strategic set of decisions in domestic politics. Would agree that some form of health insurance will be normalised, if not universal in the next 20 years or so.

[petejh]

I thought part of the idea of buying stuff off Russia was to encourage them to play nice as they wouldn’t want to lose all their new customers? Obviously this has failed spectacularly 😬

I think that was the underlying hope with Russia post 90s. Unfortunately they're either too dumb a population (as in misled/misinformed not inherently stupid) or too psychopathic of a government, or both. We'll find out how 'bringing China into the fold of the global market' goes, when (not if imo) they retake Taiwan as their territory.

I think if Ukraine 2022 had gone according to the supposed plan within the blitz timeframe as Crimea 2014 did then we in Europe would be harrumphing a bit and getting on with our comfortable lives virtue-grumbling about how 'ESG' some cause-de-jour is while absent-mindedly turning the dictator-funding-dial central heating up to 22. Instead Russia fucked up its insane invasion plan and doubled/tripled/quadrupled down on the fuck up, now exploring plans J,K and L to explore how much oil, gas, coal and metals it can sell to Asia as cheap inputs needed for industries manufacturing, among other things, goods destined for Europe. 

[seankenny]

So basically due to the waiting time for what should have been a fairly routine procedure it’s led to a 5 day stay in hospital and what looks likely to be well over a month off work at best. Who would have guessed underfunding your health service would be a false economy? Tory cretins.

This very much mirrors my long covid experience - didn’t see a doctor from February to November. Admittedly they weren’t much use even then (in part because we’re not funding the problem in proportion to the degree of personal and social disruption it causes) but there are clearly hundreds of thousands of people unable to work due to lack of appropriate care. There are simple things GPs can do to help us but - and this is a generous interpretation - they seem so stretched they can’t update themselves on new research, or even old but repurpose research. I got myself a referral to a cardiologist based on blood pressure readings I did myself. The implications for widening health inequalities are obvious, and another long term disaster in the making.

It is worth pointing out that the programme of dramatically cutting spending which was started in the 2010 Parliament was pretty popular with many voters.

Sympathies to Ali, Liam and whoever else is having to deal with this awful situation atm.

[MischaHY]

I've been living in Germany since late 2016 and honestly feel like I'm sitting here watching home go to shit. We've contemplated coming back 3-4 times over the last few years because UK is a brilliant place in many ways especially for outdoor community but each time we've been stumped by the sad reality that it would represent a significant real-terms downgrade on many fronts.

For example my wife applied for a markets management role looking for a fluent German/English speaker with B2B/B2C experience and prior teamlead experience etc. Over here you'd be looking at ~48k€/£41k for that kind of role. She told them she'd need minimum £30k to even consider it. They offered £25k and said they really wanted her but that was the absolute best they could do. She earned more than this already doing a much less demanding job with more holiday and a vastly more supportive social system. I've been doing the online equivalent of working in a climbing gear shop and still earned more than that. We're at the low end of middle class here in terms of income.

A few weeks ago I walked into the doctors having forgotten to make an appointment and was seen within ten minutes. Every time I've been to the hospital it's been a fast and high quality experience. If we had a child now she'd be paid her full wage for something like 6 months and can take up to a year off with a reduced income.

Serious question: why is it working here but not back home? (aside from Brexit which is obviously a shit show but clearly not wholy responsible for the situation).

[SA Chris]

I would have thought it was obvious (although some on here would argue). Tories have driven the NHS into the ground, letting it be run by bureaucrats, cutting funding and not incentivising anyone to want to work there.

[Durbs]

Re: The NHS, as others have alluded to - in an emergency, life-or-death / crisis situation, they're very good.

But they're so underfunded and overworked, the routine and non-life-threatening things are all on crazy backlogs. My Mrs works in youth mental health; their waiting lists for things like autism assessments are 2-years - and that's just for the assessment. Once you get (or don't) get a diagnosis, there's another wait for services.  Same for eating disorders and indeed pretty much ALL mental health issues.
Which is made worse given these are kids in their formative years in education - having to wait 2 years to find out yes, you did need extra assistance to help with your a-levels is always coming too late.

If however you're suicidal, you'll get seen immediately - so the entirely of many CAMH services is crisis management and waitlists.

Financially this also makes no sense - prevention/managment is MUCH cheaper (long term) than emergency treatment, but these things take time, and they're years behind in investment. And now recruitment is hard as the reputation of working in CAMHS is horrendous.

[User deactivated.]

My Mrs works in youth mental health; their waiting lists for things like autism assessments are 2-years - and that's just for the assessment.

This is precisely my 4th anecdote. We've been waiting 2 years for an autism assessment for one of my kids that was originally referred through nursery. We considered going private, but it then wouldn't be well joined up with the school, for them to get additional funding, etc. (at least that was my understanding). Currently, the school can't give the right support without a diagnosis but are doing what they can to help.

It's not just healthcare that's fucked; the school system, transport, etc. it seems like everything is falling apart. If I didn't have a family, I'd probably have left this country long ago. Most of my mates have.

[Durbs]

This is precisely my 4th anecdote. We've been waiting 2 years for an autism assessment for one of my kids that was originally referred through nursery. We considered going private, but it then wouldn't be well joined up with the school, for them to get additional funding, etc. (at least that was my understanding). Currently, the school can't give the right support without a diagnosis but are doing what they can to help.

I'm not 100% on this (and the better half is at work), but I thought they'd moved away from diagnostic criteria and all provisions were now needs-based. Certainly with regards to access to support services, not sure on the funding side of things. e.g. you can get access to eating disorder clinics, ASD support groups etc without a formal diagnosis.

[SA Chris]

You do need an assessment, and confirmation before additional support is provided. The process involved an assessment by at least 2 (it many have been 3) qualified child psychology doctors before we got the confirmation.

[Wellsy]

I used to work in the world of healthcare and health & social care feedback. So we'd get a lot of people's stories about people's experiences with the NHS.

I've not been working there for six months but I can tell you that people's experiences had markedly declined in a lot of places and many of the stories I read were truly shocking. Health and social care in Sheffield for example, the Trust who provides mental health services... I would say that the situation was truly dire in terms of feedback.

If you have mental health problems here then I wouldn't even bother going to the NHS. I'd go private. If you can't, well, you probably won't get any help at all.

[TobyD]

I used to work in the world of healthcare and health & social care feedback. So we'd get a lot of people's stories about people's experiences with the NHS.

I've not been working there for six months but I can tell you that people's experiences had markedly declined in a lot of places and many of the stories I read were truly shocking. Health and social care in Sheffield for example, the Trust who provides mental health services... I would say that the situation was truly dire in terms of feedback.

If you have mental health problems here then I wouldn't even bother going to the NHS. I'd go private. If you can't, well, you probably won't get any help at all.

That is certainly my experience. If you go to a GP with mh problems, you get access to an app, unless you're unwell enough to be admitted.

[Oldmanmatt]

I have spent most of the last 12 months overseas. I came back for Xmas three weeks ago and have been shocked by how awful everything feels.
This is a bit airy-fairy and decidedly unscientific but I (we, in the household) had been growing increasingly uncomfortable for a few years and having so many friends and relatives living in Europe and beyond, we felt it was a very UK specific “thing”.
I think we all want out.
I feel incredibly lucky to now have our principle income from outside the UK, selfish though that is.
I’ve watched Polly struggle with her role in school, as behaviour and social problems (truly  horrendous stuff, sometimes) have just gone off the scale. Within the last 12 months in particular. Many staff just crumbling and most not getting through a week without serious bouts of helpless tears, trying to deal with heart rending issues with the children in their care (I think they find “behaviour” easier to deal with, anger doesn’t seem to hurt as much).
I can’t really explain what I mean, not clearly. If I said “the place is fucked and getting more fucked by the day”, it doesn’t convey how sad I feel; it sounds a bit Gammon.
If this government persists much longer, we will lose a couple of generations to hopeless despair.
I wish I could see a way out, but it all looks so broken.

[webbo]

Working in the NHS from 1986 to  2019. I was party to a service that embraced innovation and valued staff which gradually became target focused and cutting corners to achieve this.
It was known that there was going to be a mass exodus of staff retiring around  2010 onwards ( lots of doctors recruited from India and similar, mental health nurses and other specialist nurses able to retire after 30 years service under the old pension scheme) and there hadn’t been anything done to deal with this. This was known from early 2000.

[seankenny]

I've been living in Germany since late 2016 and honestly feel like I'm sitting here watching home go to shit. We've contemplated coming back 3-4 times over the last few years because UK is a brilliant place in many ways especially for outdoor community but each time we've been stumped by the sad reality that it would represent a significant real-terms downgrade on many fronts.

For example my wife applied for a markets management role looking for a fluent German/English speaker with B2B/B2C experience and prior teamlead experience etc. Over here you'd be looking at ~48k€/£41k for that kind of role. She told them she'd need minimum £30k to even consider it. They offered £25k and said they really wanted her but that was the absolute best they could do. She earned more than this already doing a much less demanding job with more holiday and a vastly more supportive social system. I've been doing the online equivalent of working in a climbing gear shop and still earned more than that. We're at the low end of middle class here in terms of income.

A few weeks ago I walked into the doctors having forgotten to make an appointment and was seen within ten minutes. Every time I've been to the hospital it's been a fast and high quality experience. If we had a child now she'd be paid her full wage for something like 6 months and can take up to a year off with a reduced income.

Serious question: why is it working here but not back home? (aside from Brexit which is obviously a shit show but clearly not wholy responsible for the situation).

What’s gone wrong? This is a huge question… which probably no one person is capable of answering. But I can think of a couple of perhaps pertinent facts.

We don’t spend much on the NHS. According to this book review on the Astral Star Codex blog, the U.K. spends 9.6% of GDP on the health service, against 11.5% in Germany (which is richer to begin with) and the same in France.

“The only truly socialist health system here, that of the UK, looks maybe a little worse than average. It has the third-lowest satisfaction, the third-longest wait times, and the fourth-lowest life expectancy. Emanuel’s more thorough look agrees that the UK underperforms. But it’s also very cheap - the cheapest western health system on the list. Emanuel thinks the UK is probably close to the cost-quality Pareto frontier and not making any stupid mistakes, but has made the political decision to not fund its health system very much.”

https://astralcodexten.substack.com/p/book-review-which-country-has-the

About the job thing. You’re in SW Germany, right? And I’m guessing the UK job was anywhere but London and the SE. If that’s the case, then the problem is that these two areas aren’t really comparable in terms of productivity. One is a core part of the strongest European economy, whereas the U.K. is basically the Netherlands in one corner and Puglia in the rest. This is absolutely not a jibe at the workforce in the not-SE parts of the U.K., productivity is much more about broader economic structures than individual abilities (a tech guy moving from Mumbai to the Bay Area becomes way more productive the minute he starts his new job). But yeah, it’s not a fair comparison because much of Germany and much of the U.K. are in different leagues economically speaking.

[seankenny]

Repeat post, ignore!

[TobyD]

I agree that nothing seems to work in the UK at the moment.  This is what happens when you have a government which doesn't seem to have done anything much in 12 years in power other than argue about the EU,  leave the EU and now argue about migration. 

The Conservative party doesn't seem to have a clue what its for now, the bleat about being a tax cutting party is BS, historically its not really true, and definitely not at the moment either.  Johnson in particular just seemed to want power for the sake of it, without any political conviction.