NHS in crisis

Discussion in 'General Discussion' started by backontrack, 6 Jan 2017.

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  1. backontrack

    backontrack Established Member

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    A quick warning that this thread contains material that some may find distressing.

    The state of the NHS in this country is sickening. Really sickening.

    It's clear that the intent of the Government is to run down our health service as best they can. Heck, the man in charge of the UK's health, Jeremy Hunt, wrote a book about privatising the NHS.

    Once again, we've got a horrific, ignorant government, and a totally ineffective opposition in the form of Corbyn and chums. It's just that things are really starting to hit the fan now.
     
  2. telstarbox

    telstarbox Established Member

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    I can't agree with this. A&E departments maybe but I don't think this can be applied to the NHS as a whole. Over the past five years I've been for multiple acute care appointments and operations in three NHS hospitals in different parts of the country and the care and service has been generally good in all three.
     
  3. backontrack

    backontrack Established Member

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    There's no doubt that this country has brilliant GPs and nurses, but the NHS as an organisation is being ruined and the Government are looking the other way.
     
  4. ainsworth74

    ainsworth74 Moderator Staff Member Moderator

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    Similarly my experience with the NHS, outside of A&E, has generally been very positive. Both for treatment that I've required and the treatment that my very elderly grandfather received.
     
  5. Trog

    Trog Established Member

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    If you cut out the political point scoring, much of the NHS was just as bad under Labour. I know our local Hospital treated my wife and some other patients she shared a ward with very shoddily. A lot of the staff know they have a job for life, and that nobody cares if they don't do much. Which must really grate on those that do still have a sense of dedication.

    As I see it the problem is two fold one the NHS is a money pit if they were given every penny in the country they would spend it and still moan for more, this is just due to the nature of things in that there is always something more you can do. The second problem is like the rest of the country they are knee deep in managers, managers who manage other managers and senior managers who go to meetings about meetings about managing things. Vast sums will be spent on new initiatives that are the all important for a few months, then quietly dropped as the next new thing is introduced.
     
  6. Clip

    Clip Established Member

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    I think the NHS has been in crisis ever since I was born.

    You can blame any government you want really - from Labour and its grand PFI failings to the Tories wanting to privatise it(allegedly).
     
  7. Arctic Troll

    Arctic Troll Established Member

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    I really can't agree with that. Labour made plenty of errors- PFI being the big clanger- but in terms of urgent and primary care they put the money where it was needed. In 2006 the NHS were seeing more than 98% of their A&E patients within four hours, but in 2016 this has dropped to about 90%.

    The reasons are complicated, but they all come back to the Conservative government's "austerity" that is neither needed nor wanted.

    The main reasons are a lack of beds and a lack of staff- caused by Conservative cuts to NHS funding in the last six years- and an inability for hospitals to discharge vulnerable patients because they have no social care at home- caused by Conservative cuts to social care funding in the last six years. "Bed-blocking" is an increasingly big problem; the patients are well enough to leave but there's nowhere for them to go to, so they sit in hospital preventing others from getting the bed. That's how you end up with people waiting in corridors on trolleys.

    I don't want to say that the NHS was fabulous and perfect under Labour, because it wasn't. But anyone who claims that it was as bad as this is quite simply wrong, using any metric that you wish to judge performance by.

    My personal view is that most of these problems stem from the Conservatives' desire to create a commercial market in the NHS, something that Labour started to be fair. The commercial market creates an inherent instability, both for staff and managers: in my wife's field, permanent contracts rather than rolling annual contracts are like gold dust, mostly because the trust doesn't know what income it will have from one year to the next, because it has to "compete" for every penny. It ruins continuity of care. And that's before we consider that the best way to get public support for privatisation outsourcing to private providers is to trash the existing service.
    --- old post above --- --- new post below ---
    If you want a cushy job, the NHS isn't really the place to go for one. There are KPIs in everything for everything, staff have to justify their every working second, the idea that staff are lounging around doing nothing is offensive as well as laughable.

    Mistakes happen when people are overworked. Morale drops when people are underpaid and taken for granted. NHS staff haven't had a pay deal that keeps up with inflation for years. Given the cost and commitment required to get an NHS care job- even entry level nursing requires a degree that will now cost £40,000+ to obtain, thanks to funding cuts- this is driving people away from the NHS. And these people are not being replaced by experienced permanent staff because the trusts can't commit to the funding because the new NHS market means they could lose a contract at any moment.
     
  8. Bletchleyite

    Bletchleyite Veteran Member

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    Privatisation has nothing to do with it. The problem is that it is underfunded. We need to be willing to pay higher income tax to properly fund the service - that's what it comes down to. How you implement the service, provided it is free at the point of use, is far less of a concern to me - it should be done in the most cost-effective way in order to allow as much provision as possible for limited funds in my book, whatever that way happens to be.
     
  9. Trog

    Trog Established Member

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    There appears to be an element of luck involved or possibly a sixteen stone bloke, is regarded as being less of a good idea to annoy than a small woman.

    As while my treatment by the NHS has been OK, my wife had several very bad experiences with various parts of the NHS, culminating with us being accused by an ambulance crew of wasting their time, by calling them out when there was nothing wrong with my wife except hysteria. She was at the time so weak and short of breath that she could not stand, and collapsed and died less than two hours later.
     
  10. Hornet

    Hornet Member

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  11. Arctic Troll

    Arctic Troll Established Member

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    I think it's slightly more complicated than that, because of the way the Health and Social Care Act in 2012 has imposed commercial competition in the NHS.

    There is no continuity of service, because the Commissioners can (and do) revoke contracts at will. The Commissioners are advised by the likes of McKinsey and PWC, who are heavily invested in and advisers to private providers.

    This leads to cherry-picking, where private providers will do the easy stuff and leave the existing trusts to pick up the difficult stuff, or stuff that couldn't be profitable because they got their sums wrong. We saw that in North Tyneside where a private provider was appointed for the IAPT mental health service, couldn't do it, and ended up handing it back to the existing mental health trust.

    I think the NHS is being deliberately underfunded, just as the railways were in the 1980s, to pave the way for privatisation as the solution to all the issues.
     
  12. GatwickDepress

    GatwickDepress Established Member

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    Even my A&E experience has been positive. The only thing was they had to do the procedure in a store cupboard!
     
  13. Paul Sidorczuk

    Paul Sidorczuk Veteran Member

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    Would your aspiration of funding by the payment of a higher rate of income tax to "properly fund" the service bring in enough monies to fund the ever-increasing drugs bill borne annually by the NHS, let alone other staffing costs.

    Many people are already taken out of the payment of income tax, so they as the poorest wage earners would not contribute anything to this scheme, so would you then put a special tax surcharge on them? If so, would both optical and dental services then also be free of charge to one and all, or would you set income bands of combined income tax and national insurance to cover such an eventuality?

    What do you propose should happen to those who already subscribe to private medical services?
     
  14. Senex

    Senex Established Member

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    I think there's a large element of luck. Some people seem to have totally satisfactory experiences throughout, others less so. My own experience has been very mixed -- generally excellent on the GP side but pretty awful on the hospital side, in all sorts of ways but in one case leading to a formal complaint about life-threatening negligence that was upheld. But who is the NHS for? There seems to be far too much of an impression that it's what they feel inclined to do to us, not what we need doing for us. I caught a trailer on BBC1 this lunchtime for some programme to come about the NHS that inmcluded a woman (I wasn 't clear whether manager or medic) saying that her duty was ultimately to do what was best for the hospital, not for the individual. If I heard right, that just about sums up the impression of this state operation that I have gained over the years.

    As for cost, wasn't the original Bevan theory that costs would be controllable because the general health of the population would improve? SOme of us will have experience of various other systems, and I'm sure none of us would like the US system that is so often held up as the only alternative. But other European countries seem to have health systems delivering good care that people seem to be willing to pay for. And it certainly isn't true that most other Europeans envy us our NHS. How do we get a national conversation about what sort of a service we want into the future and how much -- and how -- we are prepared to pay for it?
     
  15. vrbarreto

    vrbarreto Member

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    It's not the funding... Jeremy Hunt has been on a battle to screw over the very doctors who staff the 24/7 NHS.. Those NHS staff who are on these anti social hours contracts can simply join a locum agency and do the same job they were doing for the NHS under a fixed term contract for very large amounts of money as a locum.. Case in point. My Mrs will effectively have a pay cut under the new contracts being dished out.. One of her junior colleagues left but has been re-employed into the same position as a locum.. Only difference? He is on 2 and a half times his previous salary for the same job.. His pay won't be cut as he is on a fixed daily rate (circa £800 per day) which is a whopping £168,000 a year without having to work weekends (they need to get another locum to do this). Unbelievable.. junior doctors are losing their faith in those running the NHS and are leaving for distant shores.. We're kicking ourselves that we didn't move to Australia as many of our friends are there and are much better off...
     
    Last edited: 6 Jan 2017
  16. AlterEgo

    AlterEgo Established Member

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    We also might have to be willing, as a nation, to make difficult, and sometimes cultural decisions about the prioritisation of medical procedures.
     
  17. OneOffDave

    OneOffDave Member

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    Depending what her role is, that approach may be exactly what's required. There may be beds available in Neuro ICU but you can't send poor old Mrs Bloggs who's 85 with pneumonia there as that means that anyone coming in who really needs a neuro ICU bed won't get it, despite from Mrs Bloggs' pov, any bed would be better for her than on a trolley in A&E. Patients regularly get placed on wards which are other than the speciality that they 'should' be under (called outliers in the trade) but certain departments and beds are kept for the poorliest patients even though that means other patients have a longer wait in A&E.

    Actual care decisions will be taken in the best interest of the individual patient but system related decisions such as which patient gets which bed will be taken based on the hospital as a whole. The 4 hour target can also distort the situation as where it may be appropriate to actually keep someone in A&E for 5-6 hours and get test results back then treat and discharge, this would be classed as a breach and the trust penalised, so they go up to a ward and take up a bed. Due to the nature of how the teams on the wards operate, this may mean that they'll spend 24 hours on the ward and have the full more time consuming discharge process, taking up more resource.

    The most efficient bed occupancy rate taking into account restocking and infection control is about 85% but trusts are under pressure to have higher occupancy rates to get more use out of the resources. 98%-100% occupancy rates aren't at all unusual these days and on occasions hospitals have had 105%-110% occupancy, managed through the use of discharge lounges etc.

    The real issue with the NHS today that shows up in these waits in A&E is what's called Delayed Transfers of Care and Delayed Repatriations. In the first, there isn't safe and appropriate care provision available for the patient to be discharged home and there aren't any intermediate care beds for them to be transferred to either, esp since the large scale closure of what used to be know as convalescent hospitals. In the latter, patients are transferred from hospital A to, usually, a bigger hospital B for specialist care. Once that specialist part of their care is carried out, they should be repatriated to hospital A, however there aren't any beds at hospital A so the patient gets stuck at hospital B. ~This means the pressures on larger specialist hospitals become greater. The tricky bit of all this is that a big part of the problem is actually outside of the NHS as social care is managed by Local Authorities
     
  18. Arctic Troll

    Arctic Troll Established Member

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    I can't comment on the particular quote, but what's best for the individual isn't always the most appropriate course of action. There are cancer drugs that cost £50,000 for a course and will add weeks to a person's life. Giving them the drugs is probably best for that individual, but it's not the best way of spending a finite amount of money for the system as a whole. Any sort of healthcare system will have these sorts of decisions to make, whether it is NICE deciding on NHS drugs spending or whether it is an insurance underwriter refusing to pay for the drugs.
     
  19. Bletchleyite

    Bletchleyite Veteran Member

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    Indeed. One advantage of going for an insurance based system, even if payment for that insurance is, as it is in most European countries, on the basis of ability to pay rather than risk, is that the benefits you get for said insurance can be clearly defined.
    --- old post above --- --- new post below ---
    To me the biggest issue is money wasted by grindingly inefficient, archaic business processes. I've recently been treated for DVT by MK Hospital, and while the treatment was successful and fine in and of itself I added up potentially over a hundred pounds of money wasted unnecessarily[1] in the way this was done, not to mention a lot of my and staff's time wasted as well.

    [1] One example alone - because of a shortage of capacity in MK Hospital's main phlebotomy outpatients facility, they were seeing some people, including me, in the Macmillan (cancer) ward. Fine so far (though sitting in a waiting room with a load of people who you know may well not survive very long is quite sobering). But because I was there, I was offered (but didn't take, I went by bus) free car parking (which is something that's meant to be offered to cancer patients only because of the frequency of visits) and I had a few "standard" blood tests done at each visit which were of no relevance to my condition. That alone is a huge waste, and I could come up with more of it.
     
    Last edited: 6 Jan 2017
  20. OneOffDave

    OneOffDave Member

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    Were these extra 'standard' tests just done by the phlebotomists as a matter of course or were they specifically requested by the requesting medic?

    In a private system I know that extra tests often get added both to avoid liability issues in case something unexpected crops up and also they tend to be quite profitable.
     
  21. Bletchleyite

    Bletchleyite Veteran Member

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    I asked, and they were standard tests that were done to everyone attending an oncology unit phlebotomy appointment regardless of the reason for doing so, and had I attended the regular phlebotomy unit they would not have been taken. I forget what they actually were, but they were basically a waste of money.
     
  22. PHILIPE

    PHILIPE Established Member

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    Whenever the subject is mentinoned, Jeremy Hunt just says the NHS is doing a good job and praises the staff. He is completely in denial. We have the problem of bed blocking problem due to shortcomings in Social Care. The two should be linked and Councils not brought into it as they have to tolerate funding cute and close care homes to save money. Releasing from hospital and Social Care should both be within one organisation, i.e. NHS
     
  23. ainsworth74

    ainsworth74 Moderator Staff Member Moderator

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    Yes I think that that is a very good point. We do seem to have reached a stage where there is a 'Cult of the NHS' (at least in the media) which means that you basically can't talk about doing anything different to the way its done now without being accused of being a baby murder and wanting off Pensioners.

    Which is a shame as I do think there is a discussion to be had about whether or not we have a good and workable system. Is there any reason we couldn't look at perhaps whether adopting or at least stealing parts of say the German or Swedish or French way of doing things might not be a good idea?

    But we don't seem to be able to have those conversations without it rapidly becoming very acrimonious and accusations flying around with great rapidity.
     
  24. 507021

    507021 Established Member

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    I absolutely agree the NHS is in crisis. My 80 year old father required the services of an ambulance twice last year, and both times we were waiting around two hours before he was taken to hospital. On the second occasion the service phoned me back to apologise for the delay. The first time he was taken into hospital at around 23:00, and when I went back in to check on him at 10:00 the next morning, he was still waiting in Resus to be transferred to a ward. It wasn't until after he'd been in hospital for over twelve hours that he was finally transferred to a ward.

    I find it absolutely shameful at the suggestion we should have to pay for the use of the NHS, especially those who are struggling to get by (which is a large amount of the population) as it is. That's what National Insurance is for, so I really don't see why we should have to pay for it again.
     
  25. ainsworth74

    ainsworth74 Moderator Staff Member Moderator

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    National Insurance has very little to do with paying for the NHS it is primarily about paying for Contributory Benefits and State Pensions and little to nothing of NI goes to the NHS.
     
  26. backontrack

    backontrack Established Member

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    Very well said.
     
  27. ainsworth74

    ainsworth74 Moderator Staff Member Moderator

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    You see this is what I mean! Any other system is immediately dismissed! What is wrong with the systems they have in Germany and France?
     
  28. backontrack

    backontrack Established Member

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    Seriously???? I'm just agreeing with him.
     
  29. ainsworth74

    ainsworth74 Moderator Staff Member Moderator

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    But you agreement with that statement immediately rules out a French system, for example, where there are fees for various services which we currently have for free with our system (such a GP consultations).
     
  30. Senex

    Senex Established Member

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    If that's what was meant, that certainly was not the way it came across to me -- I heard it as referring to precisely those actual care decisions.
    --- old post above --- --- new post below ---
    I'm not even sure that it would be best for the individual -- we seem to be in a situation where any extension to life is regarded as essential to strive for, regardless of the quality of that life. The politicians have wished NICE upon us, but does NICE speak for us or represent us? I'm back to the question of where and how these complex issues are debated in such a way that we can all feel confidence in the outcome. To take a couple of extremes: spend money on those cancer drugs that prolong life for some weeks regardless of quality, or spend money on keeping alive some baby born physically and mentally severely disabled and never going to be able to live independently and will always be a burden on the state, or spend much more money on hip replacements and research into prostate cancer and dementia? Because the money will never be aavailable to do it all.
     
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