NHS

[Weston Super Saint]

Is the NHS no longer fit for purpose?  Does it need a complete overhaul?

There doesn't seem to be many situations that the NHS can cope with - too cold / winter 'flu and it reaches breaking point, too hot and it has a meltdown.  Ambulances wait for most of the day to drop patients off, local surgeries run out of appointments by 5 past 8 every morning.  Is this the norm or sensationalist headlines from isolated cases tarnishing the whole of the NHS?

Can it be 'fixed' and if so, at what cost?

[AlexLaw76]

Too big and unpredictable population 

Far too wasteful

not enough money

massive money it gets could be spent so much better

if you invented the NHS today, it would look very different to what we have, yet change is almost impossible as people froth at the idea!

if the view of the NHS from the general public shifted from a religious cult to a paid for service, change may be possible. After all, nothing is free!

Edited 15 July, 2022 by AlexLaw76

[Dman]

1 hour ago, Weston Super Saint said:

Is the NHS no longer fit for purpose?  Does it need a complete overhaul?

There doesn't seem to be many situations that the NHS can cope with - too cold / winter 'flu and it reaches breaking point, too hot and it has a meltdown.  Ambulances wait for most of the day to drop patients off, local surgeries run out of appointments by 5 past 8 every morning.  Is this the norm or sensationalist headlines from isolated cases tarnishing the whole of the NHS?

Can it be 'fixed' and if so, at what cost?

Interesting thread and a debate I was having with a friend not all that long ago. 

Ive had a couple of relatives who’ve spend a fairly lengthy period of time in the hospital recently, 1 in the general and another private. If I’m honest, the NHS is on its knees especially when compared to the private hospital. Everything was better from the food to the ‘customer’ service from the nurses. 
 

Not all of course, but for some reason those that work for the NHS seemingly think they’re better than everyone else and don’t get me started on the increased pay argument. 
 

Long and short, NHS is a great idea but it’s not moved with the times or demand. Massive change is needed. How we get there, I don’t know. 

[revolution saint]

No one moaned about the NHS under Blair and it's not that long ago.  He chucked money at it, and it worked.

[Turkish]

2 hours ago, AlexLaw76 said:

Too big and unpredictable population 

Far too wasteful

not enough money

massive money it gets could be spent so much better

if you invented the NHS today, it would look very different to what we have, yet change is almost impossible as people froth at the idea!

if the view of the NHS from the general public shifted from a religious cult to a paid for service, change may be possible. After all, nothing is free!

too fat and lazy population. I listen to a podcast by a GP who reckons 70% of issues can be fixed by diet and lifestyle change. The first thing he does when a patient enters his surgery is ask them about their diet, excercise and how much time they spend outside. The problem is so many others will give them a pill and send them away.

[AlexLaw76]

50 minutes ago, revolution saint said:

No one moaned about the NHS under Blair and it's not that long ago.  He chucked money at it, and it worked.

No one moaned when he made a part of it private. 

let’s just leave that there!
 

 

[AlexLaw76]

44 minutes ago, Turkish said:

too fat and lazy population. I listen to a podcast by a GP who reckons 70% of issues can be fixed by diet and lifestyle change. The first thing he does when a patient enters his surgery is ask them about their diet, excercise and how much time they spend outside. The problem is so many others will give them a pill and send them away.

Very good point. I will be popping out in a mo and will likely see some horrific sights. 
There is a younger lad at work, no older than 30. Out of breath going up the stairs, and all his clothing is at breaking point. Oddly, he now struggles to get about the site to do his job. Guess what, others have to pick up the slack!

why do people allow themselves to get (and remain) morbidly obese? 

Edited 15 July, 2022 by AlexLaw76

[Sheaf Saint]

1 minute ago, AlexLaw76 said:

why do people allow themselves to get (and remain) morbidly obese?

Because humans are hardwired to gorge themselves on high calorie, sugary food. It's an evolutionary instinct hungover from when we used to live as hunter gatherers. If you didn't know where your next meal was gonna come from, you eat as much as you could when it was available.

Unfortunately in the modern western world, such foods are too easily available and aggressively marketed through advertising / product placement etc. You can try and educate people, of course, but a large percentage of the population just don't have the ability to rationalise and override their primal instincts. 

[revolution saint]

18 minutes ago, AlexLaw76 said:

No one moaned when he made a part of it private. 

let’s just leave that there!
 

 

What part of it did he make private?  Are you talking about the PFI schemes?

[Turkish]

25 minutes ago, Sheaf Saint said:

Because humans are hardwired to gorge themselves on high calorie, sugary food. It's an evolutionary instinct hungover from when we used to live as hunter gatherers. If you didn't know where your next meal was gonna come from, you eat as much as you could when it was available.

Unfortunately in the modern western world, such foods are too easily available and aggressively marketed through advertising / product placement etc. You can try and educate people, of course, but a large percentage of the population just don't have the ability to rationalise and override their primal instincts. 

Bit of that, but mainly the sedentary lifestyle we live, most people sitting at desks all day and spend then their evenings sitting in front ot the TV watching shit on telly. laziness, people cant be arsed to cook from scratch, too easy to stick a ready meal in the microwave or pizza in the fridge or have food delivered to your front door 24/7. It's very simple, if a company has a marketing department then why would you buy their product? If you dont know some of the stuff on the ingrediants label or it's got a list as long as the packet of stuff in it, why would you buy it? Then some people think if they go to the gym 3 times a week they can eat what they want when in fact even going all out for an hour you'll still only burn about 20% of your DCE at the gym. Much more sensible to reduce your intake by 10-15% and train for strength.  Plus building strength means you stay out of old peoples home much longer and can still carry bags and get up the stairs in your 80s

Edited 15 July, 2022 by Turkish

[trousers]

3 minutes ago, revolution saint said:

What part of it did he make private?  

https://www.theguardian.com/society/2006/feb/16/health.politics

Quote

Tony Blair today welcomed 11 private healthcare providers into the "NHS family", as he promised them the chance to gain a stronger foothold in the NHS.

Predicting that the private sector would soon provide up to 40% of NHS operations, Mr Blair said the independent providers could help drive up the quality of service to patients which he said was the "most important thing".

"By 2008 we could have as much as 40% of acute operations done in the private sector being done under the NHS banner," he told health bosses.

Mr Blair's praise for the private sector came as he and the health secretary, Patricia Hewitt, held a Downing Street summit with the newly launched NHS Partners Network, a loose alliance of private sector and not-for-profit healthcare companies delivering the first wave of independent sector treatment centres (ISTCs).

The network, made up of 11 partners from key providers including Bupa, today pledged in a signed document their shared interest as partners in ensuring the "future success" of the NHS.

But the announcement was met with derision by healthcare Unison, who dubbed the network a "sham" outfit with its sights focused solely on "milking" the NHS dry.

The network's spokesman, Mark Smith, admitted the changing healthcare market meant the independent sector was increasingly looking to the NHS for business. Some companies had "specific targets for a large number of patients to be NHS patients in the future, because undoubtedly things are changing," he said.

The network document avowed the companies' commitment to delivering the government's NHS reform programme: "Wherever people are treated - in a traditional hospital, an independent hospital, a new treatment centre or in the community - it is the protection afforded to them of tax-funded healthcare, according to need and not ability to pay, which makes them NHS patients."

"We believe there is a growing consensus that it is the standard of diagnosis and treatment provided to the individual NHS patient that really matters, not the type of ownership of any particular institution making that provision."

"For us, the sterile debate between public and private healthcare provision is over."

The document echoes the prime minister's own belief that independent treatment centres now see themselves as completely integrated into the "NHS family", and are changing patient services for the better, according to a prime ministerial aide.

A Number 10 spokesman said: "When ISTCs were established many said they would be the end of the NHS as we know it. In reality they have been integral to the NHS delivering the public's priorities of shorter waiting and improved choice in a health service free at the point of use based on need not ability to pay."

Unions and doctors' leaders are at loggerheads with the government over the policy decision to bring in the private sector to drive up competition and choice, which they fear will fragment the NHS through the closure of traditional NHS sites. This, they fear, will result in an increasing reliance on the private market to deliver healthcare, and an erosion of pay, terms and conditions for staff.

As non-NHS employers, independent providers are free to set their own pay and terms and conditions of employment, including flexibility over the provision of pensions. NHS employers meanwhile are bound by the pay modernisation scheme, Agenda for Change, recently rolled out to ensure staff receive equal pay for work of equal value as well as relevant training.

Unlike the NHS, private companies are free of the burden of directives imposed on NHS facilities covering clinical performance and management.

But the government insists mixed provision will drive up NHS standards.

Mr Blair's meeting with ISTC representatives, held this morning, coincided with a Department of Health report citing the "major role" the independent sector is playing in reforming the NHS, including reducing waiting lists, increasing choice for patients and spread "pioneering" practice into the public sector.

Unison condemned the new network of private sector providers as a "sham"

Unison's head of health, Karen Jennings, said the private providers were "milking the NHS for all they can get. "Unison has always said that patients should not have to wait in pain for their operations, but we now have the obscene situation where NHS operating theatres, scanners and even wards are being left idle or underused because multi million pound contracts have been given to private companies," she said.

"These companies are given five-year contracts, with guaranteed incomes, and some Primary Care Trusts now face financial meltdown because they have been forced to use private providers at the expense of the NHS. It is a crying shame that there is no recognition that it is NHS workers who are driving down waiting lists."

The government first introduced ISTCs three years ago to increase NHS capacity and deal with the backlog of elective surgery cases such as cataracts, and knee and hip replacements. The 21 ISTCs already in place have delivered 250,000 treatments or diagnostic tests from an independent service provider, the report claims.

When ISTCs were first introduced, the government insisted that no more than 10% of NHS treatment would be delivered by the independent sector. The government swiftly revised the cap on private sector provision to 15%, before removing it completely under the new patient choice agenda.

A second wave of ISTCs now out to tender are being introduced to increase competition in the new NHS market environment set up under patient choice.

Under patient choice, patients currently have one of four healthcare options for receiving treatment, including one private sector provider.

By 2008, patients will be able to choose treatment from any provider. Unions have repeatedly warned against the "creeping privatisation" of the NHS, which they say will put traditional NHS services and patient care at risk.

Since money follows patients, NHS facilities could close down because of a lack of patient numbers, union and doctors' leaders fear.

Ms Hewitt has repeatedly sought to play down union fears that ISTCs would lead to the privatisation of the NHS.

The British Medical Association has also criticised the programme. It has accepted the centres have cut waiting lists, but said they could destabilise local health economies and compromise the quality and continuity of care received by patients.

A BMA survey also found concerns that the centres "cherry pick" the easiest operations and leave the NHS to deal with the most complex and costly patients.

 

[trousers]

1 hour ago, revolution saint said:

No one moaned about the NHS under Blair and it's not that long ago.  He chucked money at it, and it worked.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1871752/

Quote

NHS: the Blair years
Polly Toynbee, political and social commentator

Waiting lists have fallen and resources have grown, yet staff and the public are still unhappy with the NHS. As Tony Blair prepares to step down, Polly Toynbee analyses why his legacy has gone horribly wrong

In what state of health has Tony Blair left the National Health Service? The story could have been one of dazzling success. If, on that May morning back in 1997 a soothsayer had told him what the results would be 10 years later, he might reasonably have expected to rank somewhere alongside Aneurin Bevan as a hero of NHS history.

Instead doctors and nurses are united in fury while voters tell pollsters that they think the service is worse than it was and they expect it to get worse still. For the first time ever, a majority of the population think the NHS would be safer in Conservative hands. Results have never been so good, yet the public view of the NHS has never been so glum. How did this happen?

The Labour government began well with a 10 year national strategy agreed after lengthy consultation with NHS staff led by Tony Blair himself. The Wanless report uncovered the depth of need after decades of funding that almost always fell below real NHS inflation rates. The public agreed money was needed; national insurance rates were raised to pay for it. NHS spending will have trebled by next year to £94bn (€138bn; $187bn), easily reaching the European Union average, as promised. Ever since Attlee cut back its budget before it was even launched, the NHS has been pinched for funds. It has certainly never enjoyed such a time of plenty.

Where has the money gone? Opposition parties will keep up that chant until the next election, accusing Labour of giving poor value for the cash spent. But a fair reckoning requires some memory of what the NHS was like in previous under-funded decades. Every winter there was an NHS crisis: as the BBC's social affairs editor I used to mark it in the news diary as an expected annual event. Sometimes it was flu that had elderly patients overflowing on to trolleys in hospital corridors. But always by February and March it was money running out that caused theatre and ward closures, with surgeons left to twiddle their thumbs while waiting lists spiked up until the new financial year.

Look back down memory lane at some of the headlines before Mr Blair came to power: “400 critically ill children turned away from intensive care units in the past three months due to a chronic shortage of beds and nurses” (Mirror, 21 January 1997). “1 in 7 operations cancelled due to cutbacks” (Mirror, 18 November 1996). “Chaos mounts as wards turn away the sick” (News of the World, 28 January 1996), ”Doctors reveal winter chaos in NHS” (Independent, 10 January 1997). Pictures of patients on trolleys abound among the old cuttings.

Even allowing for the usual media exaggeration, few objective NHS watchers would deny how much improvement there has been since then. In 1997, 283 866 people had waited 6 months or more for operations.1 By last March, ministers announced there were only 199. Back in 1997 few would have believed Tony Blair had he promised to cut waiting times to its present average of 6.6 weeks, (which does, of course, hide wild variations).

In 2003 when the target was set, 75% of patients were seen within four hours in accident and emergency departments; last year it was 98.5%.2 Even allowing for statistical fiddling, nobody doubts refurbished accident and emergency departments are better. There are now 20 000 more consultants and general practitioners, 70 000 more nurses, 118 new hospitals, and 188 new general practice clinics. As ever, demand rose too: there were 3% more users a year and 75% more emergency ambulance calls.2

All those are NHS in-puts—but what of real health outcomes? Tsars for cancer and heart disease saw deaths from both fall. Over 10 years life expectancy rose by 2 years, to 81.2 for women and 76.9 for men—but the hard truth is that the life expectancy graph has been on a similar steady gradient upwards for a long time and the rise may have happened anyway.

Every government vows it will shift priorities towards prevention and public health. Like every other leader, Blair failed to do that significantly, although a smoking ban will help. Every government promises to redirect resources into community services where 90% of treatment happens—but like every government, Blair's failed to stop hospitals siphoning off the lion's share. Mental health had early extra money, but along with all community, maternity, and health visiting services, it suffered badly in the latest sharp spending squeeze.

Nevertheless, the Blair record is good, so why are NHS staff and voters convinced everything is worse? This has been a decade of turmoil, with zigzag reforms dictated from the top, only to be countermanded again from the top. The history of his “reforms” hardly bears repeating. First he dismantled general practice fundholding and some aspects of the Tory internal market. He set up primary care groups, remade them into primary care trusts, and then merged them again into half the number. Demolished regional health authorities were resurrected as 28 strategic health authorities and then merged again back into the original 10 regions. The public health director for the south west region provides one graphic example of what has happened on the ground in this breathless deckchair shuffling. He has held the same job since 1994, but has had to reapply for it seven times since then because of reorganisations.

With each turn of the screw, Tony Blair became more convinced that only a fiercely competitive market could jolt the NHS into better productivity. He castigated Bevan's “monolithic” state driven model and trusted the magic of Adam Smith's “hidden hand” to drive greater efficiency. But he made a fundamental error by putting the power in the hands of the providers and not the purchasers. He built up mighty foundation hospitals and independent treatment centres first, neglecting weak and feeble primary care trusts without the managerial clout to power his great market machine. Instead, the hospitals sucked money out of the pockets of the primary care trusts' inexperienced finance directors.

Making a market caused rows with his own party, but all this organisational stuff was of zero interest to patients. They woke up to the change only when the market began to bite in painful ways. The market demanded no deficits, no more collaborative loans between hospitals that were now supposed to compete, so in one breakneck year long-standing debt had to be tortured out of the system. This the public did suddenly notice.

How can there be deficits with so much money sloshing around the NHS? The debt squeeze accelerated “reconfigurations” that meant some 60 local hospitals would close or lose their accident and emergency or maternity services. Many of these closures had been due for years and this was just the inefficiency the market was designed to throttle, but here was the gift a resurgent Conservative opposition needed. Save Our Hospital campaigns sprang up everywhere, even sometimes where there was no threat.

Just as the deficit squeeze started to freeze posts and even to cut some jobs, news of the accidental overpayment of consultants and general practitioners reached public ears. True, there had been a shortage of doctors in 1997 and they needed a good increase, but the bungled contracts looked like money out of control. Add in the saga of the mighty Connecting for Health information technology system, which over-ran in cost and time and failed to deliver in ways that were well-predicted by all the experts. Add that to the growing outbreaks of methicillin resistant Staphylococcus aureus and Clostridium difficile, and the public decided the NHS was in meltdown.

However often Tony Blair and his health ministers recite their litany of successes and improvements, public opinion heads downwards. Voters asked about the NHS said it was a disaster, although when asked about their personal experience they reported that their local services were indeed better.3 But they just presumed they were lucky and chose to believe increasingly lurid anecdotes in the press rather than their own experience. Few can remember a decade ago to make useful comparisons: no one waiting three months for a hip operation now will remember waiting 18 months back then. Voters don't do gratitude.

The press, as ever 75% right wing, sense an issue to put the wind in the Tories' sails. Bad NHS stories are a staple diet of the media second only to crime—but bad hospital stories are now multiplying exponentially. With 1.3 million NHS staff each grumbling to scores of family and friends, alienating them is politically lethal too. David Cameron may have won the hearts and minds of NHS staff with his promise of no more reorganisations—if they believe any new health minister can ever resist the temptation to disorganise everything all over again.

Blair came to power famously promising to save the NHS. He feared public support would vanish without reform. In a sense, he succeeded, as it is David Cameron who has finally had to force his party to accept a free tax funded NHS with no flirtations with top-up payments or private insurance.

Tony Blair leaves with the NHS as his Iraq on the home front. But history may be kinder if in a couple of years the new system has been allowed to bed down. The internal market may work and good results may speed up. If so, Blair's NHS legacy may be rewritten more favourably, but his successor will have serious problems.

 

Edited 15 July, 2022 by trousers

[revolution saint]

Just now, trousers said:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1871752/

 

Got anything about the reduction in waiting times?  They came down quite dramatically.  The internal market was always a crap idea though - I'll give you that.  

[trousers]

5 minutes ago, revolution saint said:

Got anything about the reduction in waiting times?  They came down quite dramatically.  The internal market was always a crap idea though - I'll give you that.  

Yep, that's covered by Polly Toynbee in my second post 👍

Edited 15 July, 2022 by trousers

[trousers]

I'd probably go for something akin to the German healthcare system if we were to start again from scratch

https://www.expatica.com/de/healthcare/healthcare-basics/german-healthcare-system-103359/

[S-Clarke]

The NHS is a bit of a sore subject for me, as I'm very close to it and have been for almost 15/16 years. To cut a long story short, there is way, way, way too much middle management. Back in 2012 the Torries abolished 'PCT's to do away with middle management, but actually the extreme opposite happened.

- PCT's were abolished. The staff who were part of PCT's moved into CCG's (clinical commissioning groups), CSU's (pointless organisations that provided support to CCG's), NHS England, NHS Property Services. In most cases in 2013, when this all kicked off, there were at least 6/7 CCG's per region. So from single PCT's with single boards of directors, you ended up with 10+ additional organisations per region each with their own levels of directorship and management. Absolute nonsense.

- Guess what's happening now? CCG's are being abolished and are moving into what is being called an 'ICB' (integrated care board). In all purposes this is just a new name for a PCT, as they've brought all the CCG's and local authority services back under a single organisation per region. I don't know if this latest re organisation will work or not, but there's still a hell of a lot of nonsense in the NHS before you even get to the 'care' side of it.

I know people clamor for money needing to be spent on the NHS, but a lot don't realise how much is wasted on middle management nonsense and re-organisations. Taking a tiny thing into isolation from a few years ago, 'NHS England' put pressure on all the CCG's to ensure 'Patient Wifi' was available at all GP Practices. This lead to lots of organisations such as Daisy, Virgin Media, BT etc smelling the $$$$ and offering massively overpriced solutions to the NHS which they paid for, and are now struggling to get out of the contracts as they're not fit for purpose - and no one uses them. Who'd have thought it, patients use their own mobile data when in GP practices...not patient wifi!

So, there's a lot of money that goes into the NHS. Lots and lots and lots of waste, until the waste is sorted the and the nonsense 'looking after themselves' middle management is done away with then there shouldn't be anymore money pumped in, as it never gets to where it needs to as there are too many hoops for it to cross.

[trousers]

3 minutes ago, S-Clarke said:

there's a lot of money that goes into the NHS. Lots and lots and lots of waste, until the waste is sorted the and the nonsense 'looking after themselves' middle management is done away with then there shouldn't be anymore money pumped in, as it never gets to where it needs to as there are too many hoops for it to cross.

(I have family members that work in the NHS and this echos what they tell me)

Edited 15 July, 2022 by trousers

[cloggy saint]

The NHS is a joke. I recently had to wait over a year for a wisdom tooth extraction and in that time it went from being slightly manky to full on knackered and ended up taking more time (and money) to put right. I don't even bother with GP visits as the waiting time is usually a minimum of 2 weeks, in which time I'll either be better or dead. I say privatise it. In Holland I paid about £80 a month and the service was amazing. Same day GP appointments, scans done within a week etc, money well spent.

[Turkish]

7 minutes ago, cloggy saint said:

The NHS is a joke. I recently had to wait over a year for a wisdom tooth extraction and in that time it went from being slightly manky to full on knackered and ended up taking more time (and money) to put right. I don't even bother with GP visits as the waiting time is usually a minimum of 2 weeks, in which time I'll either be better or dead. I say privatise it. In Holland I paid about £80 a month and the service was amazing. Same day GP appointments, scans done within a week etc, money well spent.

I really dont understand the obejection to privatising the NHS, it isn't 1960. No we've got a much larger population with a load of fat, lazy cretins or snowflakes claiming they've got stress or anxiety because they had a bad morning at work.

Edited 15 July, 2022 by Turkish

[S-Clarke]

7 minutes ago, cloggy saint said:

The NHS is a joke. I recently had to wait over a year for a wisdom tooth extraction and in that time it went from being slightly manky to full on knackered and ended up taking more time (and money) to put right. I don't even bother with GP visits as the waiting time is usually a minimum of 2 weeks, in which time I'll either be better or dead. I say privatise it. In Holland I paid about £80 a month and the service was amazing. Same day GP appointments, scans done within a week etc, money well spent.

It's a half way house at the moment, parts are being privatised by stealth and parts aren't. Nothing is joined up in the middle. 

If we're going to privitaise it then just do it, that's my view. I'm not precious about 'my NHS' or bollocks like that, all I know is from being on both the inside and the outside is that it's currently not working. The 'public' ownership of the NHS is actually making it worse, as like Turkish said above it encourages entitlement. Not just from patients, but also those who work in it. 

I have worked with people who have left the NHS and went into the private sector, they lasted a matter of months before they came crawling back to the NHS and into another cushy job. 

Don't get me wrong, I'm not saying all NHS jobs are cushy at all - there are some amazing people that work in the NHS, but there is a hidden cohort of absolute nobodies who are paid extortionate amounts for doing very little.

[Tamesaint]

I have recently had treatment in both private and NHS hospitals and can say that the standard of care in the NHS was much better that that of the private hospital. The food was better in the private hospital and I ate off better quality plates but the standards of nursing care in the NHS were much better. Some basic practices were not adopted in the private hospital.

If you want to have something cosmetic done and want to stay in a hotel then go private. If there is something actually wrong with you then my advice is to go NHS.

 

[S-Clarke]

9 minutes ago, Tamesaint said:

I have recently had treatment in both private and NHS hospitals and can say that the standard of care in the NHS was much better that that of the private hospital. The food was better in the private hospital and I ate off better quality plates but the standards of nursing care in the NHS were much better. Some basic practices were not adopted in the private hospital.

If you want to have something cosmetic done and want to stay in a hotel then go private. If there is something actually wrong with you then my advice is to go NHS.

 

This is true, once you can 'get' to where you need to get to the care is pretty good. But it's getting the referral, getting seen, the delays, waiting lists etc - that's the problem. And that all steams from cruddy management. Nothing wrong with the care in the NHS, there's just too much stopping people getting the right access.

[aintforever]

The NHS always goes to shit under the Tories. You get what you pay for and if people are too tight to pay the required tax then expect to wait 6 hours for an Ambulance.

[RedArmy]

My biggest issue with the NHS is the number of consultants and surgeons who are having their cake and eating it too. 

If you’re working for the NHS in imporantant roles you should be working for the NHS only. People shouldn’t be getting told they’ll need to wait x amount of months for important and sometimes life saving treatments and are then left feeling like their only option is to go private because it’s much quicker only to be greeted by the same people who told them they’d need to wait to have to have their treatment/surgery on the NHS. 

 

 

[buctootim]

5 hours ago, Weston Super Saint said:

Is the NHS no longer fit for purpose?  Does it need a complete overhaul?

There doesn't seem to be many situations that the NHS can cope with - too cold / winter 'flu and it reaches breaking point, too hot and it has a meltdown.  Ambulances wait for most of the day to drop patients off, local surgeries run out of appointments by 5 past 8 every morning.  Is this the norm or sensationalist headlines from isolated cases tarnishing the whole of the NHS?

Can it be 'fixed' and if so, at what cost?

This has been done to death. There is a lot of data to show the NHS compares with the best in the developed world when measured as outcomes per per pound spent but is consistently mid table in absolute performance because most comparable countries spend more. Thats it. There is nothing else to say 

[Lord Duckhunter]

GP service is appalling a round here. You’ve got to get past the Gestapo before they arrange for the doctor to call you back. Then if you’re lucky, you may get to see the doctor in about a week. Horrendous service, yet people put up with it and happily stood there clapping like demented half wits. People wouldn’t put up with it from anything else they’re paying for, yet can’t make the correlation  between paying via taxes and shelling out of their wallets. GP’s are taking the piss, they need sorting out. 

Hospitals are as bad. The snap dragon regularly comes home from work in tears , not because of the nasty Tory cuts (and she’s a fucking leftie),but because of lazy fellow workers and senior managers that take the piss. 
 

 

Edited 15 July, 2022 by Lord Duckhunter

[cloggy saint]

I tried making an appointment with my GP in person a while ago. The receptionist told me that they only take telephone appointments. I asked if it would be her who took the call and she confirmed it would be, so I took out my phone, called the surgery and she answered and made an appointment, all the while I was standing 2 feet away, I kid you not!

[Turkish]

21 minutes ago, cloggy saint said:

I tried making an appointment with my GP in person a while ago. The receptionist told me that they only take telephone appointments. I asked if it would be her who took the call and she confirmed it would be, so I took out my phone, called the surgery and she answered and made an appointment, all the while I was standing 2 feet away, I kid you not!

Why didn't you call them in the first place rather than wasting time going there in person?

[cloggy saint]

Because I was getting a haircut which is very close to the surgery. HTH.

[S-Clarke]

59 minutes ago, cloggy saint said:

I tried making an appointment with my GP in person a while ago. The receptionist told me that they only take telephone appointments. I asked if it would be her who took the call and she confirmed it would be, so I took out my phone, called the surgery and she answered and made an appointment, all the while I was standing 2 feet away, I kid you not!

The prob with GP's, is whilst they brand themselves NHS, they are just private companies in their own right and run themselves exactly as they want. They are bound to certain rules stipulated by NHSE/CCG's, but in the main the running processes they employ are individually managed. That's why responses from different GP's vary so much.

They also do what they want with their budgets, so they can spend money on phone systems if they want to without being accountable to anyone.

[Weston Super Saint]

4 hours ago, aintforever said:

The NHS always goes to shit under the Tories. You get what you pay for and if people are too tight to pay the required tax then expect to wait 6 hours for an Ambulance.

So the answer is to spend more - how much and where?  Is it more ambulances because there aren't enough or is it more hospitals because whilst there are enough ambulances they can't deliver their patients anywhere because the hospitals are full?

[whelk]

I am healthy and never been in hospital other than A and E a couple of times for football injuries. Missus is exactly the same and one of kids fell over and needed checking over and that is only time any of them have been in hospital. I pay shedload of taxes and NI and family have been very little burden on NHS so overall massive net contributor. So can’t really comment from personal experience but agree with Turkish that our lifestyle is shocking in so much as people not looking after themselves then wanting a medical fix.

Hate the thought of it being privatised though as see what hell poor people in US experience.

 

[sadoldgit]

I spoke to a guy today who knows a senior manager in the NHS in the south east. He says that staff are leaving in droves putting more pressure on those remaining. He also said that their are two more different strains of Covid about to land which they think will cause major problems for the Service in the autumn/winter. The ambulance service seems to be on its knees already. Grim. Still, at least our current PM can leave office with his head held high.

As for people taking responsibility for themselves, I have spent a lot of time in my local doctors surgery and hospital over the last few years and have seen plenty of people in waiting rooms. I don’t know if they smoke, drink excessively and/or eat poorly but the vast majority of them are not what you would call obese, they just look normal. The human body relies on millions of things working properly all of the time to work efficiently. The graveyard is full of people who had healthy lifestyles but had died well before their three score years and ten just as there are people who smoke, drink and eat poorly who live to a ripe old age and have rarely have need of the NHS. A&E units are full of people who have accidents playing football, doing DIY etc. Should we point the finger at them for putting themselves in harms way too? We live in an imperfect world and the NHS has to have the resources to deal with it. 

Edited 15 July, 2022 by sadoldgit

[cloggy saint]

4 minutes ago, whelk said:

I am healthy and never been in hospital other than A and E a couple of times for football injuries. Missus is exactly the same and one of kids fell over and needed checking over and that is only time any of them have been in hospital. I pay shedload of taxes and NI and family have been very little burden on NHS so overall massive net contributor. So can’t really comment from personal experience but agree with Turkish that our lifestyle is shocking in so much as people not looking after themselves then wanting a medical fix.

Hate the thought of it being privatised though as see what hell poor people in US experience.

 

America is an extreme example of privatisation ($10k for giving birth!?) I've lived in European countries where it's reasonably priced and the service is second to none. 

[Weston Super Saint]

4 minutes ago, sadoldgit said:

I spoke to a guy today who knows a senior manager in the NHS in the south east. He says that staff are leaving in droves putting more pressure on those remaining. He also said that their are two more different strains of Covid about to land which they think will cause major problems for the Service in the autumn/winter. The ambulance service seems to be on its knees already. Grim. Still, at least our current PM can leave office with his head held high.

I don't suppose he mentioned where the droves of staff are going once they've left.  I'd imagine the clinical staff have pretty limited opportunities of either private or NHS unless they move to an entirely different field.  'Admin' staff on the other hand, meh.

[buctootim]

13 minutes ago, Weston Super Saint said:

I don't suppose he mentioned where the droves of staff are going once they've left.  I'd imagine the clinical staff have pretty limited opportunities of either private or NHS unless they move to an entirely different field.  'Admin' staff on the other hand, meh.

Thats why I dont bother to debate this issue. You dont have a clue how the service works but always have an opinion - normally along the lines of we could run the best healthservice in the world for next to nothing if only we cut out the waste.

Some doctors retire a few years early or go part time. Some nurses move into occupational health in private companies. The 'meh' admin staff are often on minimum wage - those who operate essential services like medical records, medical secretaries (you think appointment letters send themselves) reception, IT, porters, patient transport etc go somewhere they earn more and are more valued. Payroll and HR staff leave for more money and less abuse. Pathology staff go work for pharmaceutical companies.  etc etc.  

 

 

Edited 15 July, 2022 by buctootim

[buctootim]

19 minutes ago, whelk said:

I am healthy and never been in hospital other than A and E a couple of times for football injuries. Missus is exactly the same and one of kids fell over and needed checking over and that is only time any of them have been in hospital. I pay shedload of taxes and NI and family have been very little burden on NHS so overall massive net contributor.

Thats true of most people tbf, until they hit late 50s and eveything starts to fall apart.   

[RedArmy]

3 hours ago, sadoldgit said:

I don’t know if they smoke, drink excessively and/or eat poorly but the vast majority of them are not what you would call obese, they just look normal. 

Are you saying fat people are not “normal”? 
 

Fat shaming bigot. 

[sadoldgit]

3 hours ago, RedArmy said:

Are you saying fat people are not “normal”? 
 

Fat shaming bigot. 

By “normal people” I was referring to people who Turkish would define as not, by the look of them,  abusing fast food outlets on a daily basis. Of course fat people are normal people. I’m not the one calling out people’s lifestyle choices here but if you want to hitch your wagon to his ideology go ahead and enjoy the ride.

[Weston Super Saint]

12 hours ago, buctootim said:

Thats why I dont bother to debate this issue. You dont have a clue how the service works but always have an opinion - normally along the lines of we could run the best healthservice in the world for next to nothing if only we cut out the waste.

 

And yet that's not what my opening post was alluding to is it - or did you not bother to read it before you entered rant mode?

As I hinted at in my first post, I think the NHS is tarnished by some of its poorest operations.  The phrase 'you're only as good as your weakest player' seems to be the norm when commentators mention the NHS.  The best elements always tend to get overlooked.

Can the service be improved - reading some of the posts above made by people who work in / with the NHS, it seems that undoubtedly it could.  Much like many other people, my own experience of the NHS is limited.  An appendectomy, a scan on my knees and a couple of visits to the local GP certainly doesn't make me an expert on the service, but by and large my experience has been OK.

The post you've quoted was a response to yet another of Soggy's nonsense posts where he's blaming Boris for the absolute demise of the NHS.  I'm not praising Boris for his role over the past 3 years, I just don't agree with Soggy that 'droves' of staff are leaving after yet another of his anecdotal meetings with a senior manager in the NHS on the very same day a thread about the NHS was created!  Walter Mitty leads a sheltered life compared to our Soggy.  I also don't agree with Soggy that the Ambulance service is 'on it's knees'.  Undoubtedly some parts of the service are experiencing issues at the moment, but I'm not convinced they are all their making - after all, what should they do if they can't drop off the patients they've picked up at the hospital, just dump them in the car park and hope for the best?

[Turkish]

15 hours ago, sadoldgit said:

By “normal people” I was referring to people who Turkish would define as not, by the look of them,  abusing fast food outlets on a daily basis. Of course fat people are normal people. I’m not the one calling out people’s lifestyle choices here but if you want to hitch your wagon to his ideology go ahead and enjoy the ride.

As usual soggy quick to absolve people of any personal responsibility for their behaviour and lifestyle. Of course people get sick and die if they live healthy lifestyles anyone can have a car crash or get knocked over or get some incurable disease sadly that’s the card you get dealt but the fact is you’ve got a much better chance of living a longer, healthy life if you take care of yourself and can avoid all this lifestyle conditions which put a huge strain on the NHS.  . Type 2 diabetes costs the NHS 10% of its budget and this is a lifestyle illness, ie eating and drinking too much shit. Nearly 63% of people in this country are overweight, so “normal” in this country is fat

Edited 16 July, 2022 by Turkish

[Fan The Flames]

On 15/07/2022 at 13:52, Lord Duckhunter said:

GP service is appalling a round here. You’ve got to get past the Gestapo before they arrange for the doctor to call you back. Then if you’re lucky, you may get to see the doctor in about a week. Horrendous service, yet people put up with it and happily stood there clapping like demented half wits. People wouldn’t put up with it from anything else they’re paying for, yet can’t make the correlation  between paying via taxes and shelling out of their wallets. GP’s are taking the piss, they need sorting out. 

Hospitals are as bad. The snap dragon regularly comes home from work in tears , not because of the nasty Tory cuts (and she’s a fucking leftie),but because of lazy fellow workers and senior managers that take the piss. 
 

 

GPs are independent contractors to the NHS, CCGs were GP led commissioning groups started is 2015. The GP service has gone down hill over the last 5-7 years. There is probably a connection.

You're right the receptionists are witches, for a reason as they haven't git the GP slots, the amount of GPs have fallen. The tories pledged 5000 more GP but it's fallen by 1500, so we are 6500 short. 

So people can't get GP appointments, so go to urgent care or A&E and block that up and this blocks up ambulances. On the other side there are not enough ward spaces, winter pressure wards have been converted to other uses, even if there were enough wards there aren't enough nurses to staff them. So people bottle neck in A&E.

What can appear like crazy decisions in hospitals are made because they are walking on a tightrope trying to balance the resourses and demand and trying to free up pathways to keep people moving through the system.

[Fan The Flames]

On 15/07/2022 at 17:20, buctootim said:

Thats why I dont bother to debate this issue. You dont have a clue how the service works but always have an opinion - normally along the lines of we could run the best healthservice in the world for next to nothing if only we cut out the waste.

Some doctors retire a few years early or go part time. Some nurses move into occupational health in private companies. The 'meh' admin staff are often on minimum wage - those who operate essential services like medical records, medical secretaries (you think appointment letters send themselves) reception, IT, porters, patient transport etc go somewhere they earn more and are more valued. Payroll and HR staff leave for more money and less abuse. Pathology staff go work for pharmaceutical companies.  etc etc.  

 

 

The old cut the non-clinical staff bollocks is always trotted out, they always call them disparagingly 'middle managers'. Hospitals need loads of non-clinical staff to operate and as you say a lot of them are on low wages, who can get better pay at their local supermarket. People throw out these easy lines but like anything the answers aren't easy.

[badgerx16]

2 hours ago, Fan The Flames said:

The old cut the non-clinical staff bollocks is always trotted out, they always call them disparagingly 'middle managers'. Hospitals need loads of non-clinical staff to operate and as you say a lot of them are on low wages, who can get better pay at their local supermarket. People throw out these easy lines but like anything the answers aren't easy.

True, but that doesn't bother the headline writers of the Fail or Torygraph.

[whelk]

4 minutes ago, badgerx16 said:

True, but that doesn't bother the headline writers of the Fail or Torygraph.

12 years on and it’s just about cutting waste innit. Simple

[S-Clarke]

3 hours ago, Fan The Flames said:

The old cut the non-clinical staff bollocks is always trotted out, they always call them disparagingly 'middle managers'. Hospitals need loads of non-clinical staff to operate and as you say a lot of them are on low wages, who can get better pay at their local supermarket. People throw out these easy lines but like anything the answers aren't easy.

I don't think people are saying ''cut all non-clinical staff'', but I think there needs to be a realisation that there is simply too much middle management and a hell of a lot of duplication. That isn't cheap to fund and that money could be directed elsewhere.

Read up on CSU's, NHS funded organisations packed to the rafters with Band 8a and above management (50k+ salaries) and tell me exactly what their purpose is, and why their jobs cannot be done by an 'ICB' as it is now? (or a CCG back in the day).

There is a need for middle managers and non-clinical staff, absolutely, but there is simply too much as of today - but I'm somewhat hopeful, maybe naively, that ICB's will be the start of some sense being re-applied by removing some of that duplication. (CCG's were a ridiculous duplication at the time)

[buctootim]

10 minutes ago, S-Clarke said:

I don't think people are saying ''cut all non-clinical staff'', but I think there needs to be a realisation that there is simply too much middle management and a hell of a lot of duplication. That isn't cheap to fund and that money could be directed elsewhere.

Read up on CSU's, NHS funded organisations packed to the rafters with Band 8a and above management (50k+ salaries) and tell me exactly what their purpose is, and why their jobs cannot be done by an 'ICB' as it is now? (or a CCG back in the day).

There is a need for middle managers and non-clinical staff, absolutely, but there is simply too much as of today - but I'm somewhat hopeful, maybe naively, that ICB's will be the start of some sense being re-applied by removing some of that duplication. (CCG's were a ridiculous duplication at the time)

Which country has the nirvana? What is the model you think we should adopt?  What stats are you basing your views about excess of middle managers on?  

Edited 17 July, 2022 by buctootim

[S-Clarke]

7 minutes ago, buctootim said:

Which country has the nirvana? What is the model you think we should adopt?  

I don't think this debate is about what country we should copy, it's about making what we have better and I think it's pretty obvious what we can do to make it better. There are a lot of good things about our model and why countries do look envious at it, but it also creates it's own problems in terms of bloated organisations and a lack of accountability.

As I said above, ICB's are a sign that more joined up care is in the thinking again as immediately it has removed a ton of duplication of roles and services done by commissioners. Still a lot of work to do, but I think the next 18 months - 2 years will see some fundamental changes to the way the 'back office' commissioning arms of the NHS is run, and not before time imo. Until that side is sorted out, care will always suffer.

Edited 17 July, 2022 by S-Clarke

[buctootim]

32 minutes ago, S-Clarke said:

I don't think this debate is about what country we should copy, it's about making what we have better and I think it's pretty obvious what we can do to make it better. There are a lot of good things about our model and why countries do look envious at it, but it also creates it's own problems in terms of bloated organisations and a lack of accountability.

As I said above, ICB's are a sign that more joined up care is in the thinking again as immediately it has removed a ton of duplication of roles and services done by commissioners. Still a lot of work to do, but I think the next 18 months - 2 years will see some fundamental changes to the way the 'back office' commissioning arms of the NHS is run, and not before time imo. Until that side is sorted out, care will always suffer.

Surely the answer is to look at other countries with proven higher quality, lower cost systems and adopt them? (if there are any). If you arent looking at other countries and seeing a model where they get better outcomes at less cost what are you basing your criticisms on? You must have some measure to proclaim inefficiency?  No? if not its just another pop at public services in support of yet another vanity project by yet another minister wanting to make a name for themselves.

Why will this system - not proven or adopted by any of the healthcare systems in comparable countries be the silver bullet? You're claiming that this new minister led change - at least the 30th major change in the NHS since its formation 75 odd years ago, that this will be the one? Despite most previous changes having actually increased costs by constant changes - each one with its own appointments, redundancies, contract letting, lease terminations etc etc and general chaos as everyone gets used to yet another new system. You know its the same people who get shuffled everytime right? the only real change is that their previous knowledge and experience doesnt work anymore and they have to grapple with a whole new process, again.   

Interesting view

Edited 17 July, 2022 by buctootim

[suewhistle]

There's a few significant points nobody has mentioned: the number of vacancies particularly of doctors, nurses and specialist medical staff. Nursing is now a degree level course with all the costs that entails, they've sold off the cheap accommodation and wonder why it is difficult to recruit. I was chatting to a nurse the other day and we both agreed that our local MP was a gurning idiot who was basically lobby fodder who voted against pay rises for nurses,  and they told me they hadn't had a pay rise for 5 years.

There is also the issue of an ageing population so we should be increasing the comparatively low level of spending which has already led to a low number of GPs based on population. Related to that is the level of bed blocking in that older patients can't be discharged for lack of care options.

So whilst I'm sure there may be an excess of middle managers common to all large organisations, it's a bit simplistic to say that getting rid of them will be more than a minor saving, and lack of cost controls may well end up being shafted by suppliers. PPE anyone?