NHS in crisis

[backontrack]

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.

AA Gill?

 

[miami]

Fundamentally it matters not how the funding is raised (the lower the overhead the better of course), what does matter is how much funding there is.

In 2015 the USA spent $9,451 per head. Germany $5,267. France $4,407. The UK only spent $4,003. We're closing the gap -- 66% to 75% of German's spend per head in the 5 years of coalition budget, but still more to close.

The NHS is far better funded now than it was in 2010, although how much of that is taken off by PPP profits is another matter. Fundamentally health care is increasing in cost due to more expensive treatments being available, and more elderly people requiring those treatments.

The best way to increase funding the NHS I think is via a wealth tax, not an income tax. Typically those with incomes don't use much in the way of NHS services, it's those who don't have incomes (long term sick and elderly) that cost the most.

 

[deltic]

The best way to increase funding the NHS I think is via a wealth tax, not an income tax. Typically those with incomes don't use much in the way of NHS services, it's those who don't have incomes (long term sick and elderly) that cost the most.

The latter dont tend to have much money either.

 

[Welly]

It needs to be remembered that the UK has one of the lowest number of doctors per 100,000 population in Europe. We have 200 per 100,000 but Germany has (I think) 300 per 100,000 and Greece has 400 per 100,000!

 

[miami]

The latter dont tend to have much money either.

They often have a lot of capital stored in their houses.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/556615/Table13-2.pdf

Average Net estate 2011-2013

Age 16-44: £160,216
Age 45-64: £312,880
Age 65+: £306,540

 

[Xenophon PCDGS]

It needs to be remembered that the UK has one of the lowest number of doctors per 100,000 population in Europe. We have 200 per 100,000 but Germany has (I think) 300 per 100,000 and Greece has 400 per 100,000!

Greece is not a good example to quote when you see their financial situation.

 

[deltic]

They often have a lot of capital stored in their houses.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/556615/Table13-2.pdf

Average Net estate 2011-2013

Age 16-44: £160,216
Age 45-64: £312,880
Age 65+: £306,540

I agree but it is not ready available cash - there are plenty of people who are asset rich but cash poor.

 

[miami]

I agree but it is not ready available cash - there are plenty of people who are asset rich but cash poor.

Easy enough to put a charge on the assets payable when the asset is liquidated.

 

[Xenophon PCDGS]

Easy enough to put a charge on the assets payable when the asset is liquidated.

Why do I feel that I am suddenly being made a financial scapegoat in this line of thought?....
--- old post above --- --- new post below ---

They often have a lot of capital stored in their houses.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/556615/Table13-2.pdf

Average Net estate 2011-2013

Age 16-44: £160,216
Age 45-64: £312,880
Age 65+: £306,540

Oh dear, those 2011-2013 figures do not bear much reflection on the financial value of my particular property...

 

[tbtc]

Who is going to be brave enough to say that we'll limit NHS care in certain areas... that we'll stop keeping people alive beyond a certain state... that we'll stop spending big money keeping people alive beyond a certain age (a brave politician who says that we should focus resources on the under thirties at the expense of pensioners)... that we'll stop funding things like cosmetic surgery... that we'll stop funding IVF...

...or will we keep kicking cans down the road, expanding the scope of the NHS further and further at the same time that an ageing population/ increased mental health problems etc increased costs?

Will the NHS be there to pick up all of the costs of society (alcohol addition, substance misuse, domestic violence etc)?

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

This is the biggest problem, but how do you deal with it?

A care home costs maybe £25,000 pa? (it'll vary around the country, it'll vary what standard of care you want, but it's not too far off the average wage is it?)

Nursing homes are closing because there's not enough profits in them/ increasing minimum wage makes them not economically viable/ you can't really squeeze any more economies of scale in the care sector (robots won't do bed-baths).

You can't make frail eighty year olds pay for that if they don't have savings.

And if you do give free social care to them then that's a bit of a slap in the face for the pensioners who have diligently saved during their working life!

Maybe you could introduce a system for the under thirties where they pay additional tax in return for a guaranteed care home place, but it'd bankrupt the country if we started paying tens of thousands of pounds per year for each pensioner in need of a bed.

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.

^^ this ^^

I'm left of centre, but I'm getting very bored with the hysterical "YOU CAN'T TOUCH OUR NHS" whenever any change is suggested. We need to stop worshiping the NHS and start funding the NHS/ prioritising the NHS/ limiting the NHS.

But, no, we'll get bombarded with "retweet this to show your support for our hardworking doctors" / "sign this petition to show that you care" etc.

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.

Where do you draw the line?

Is it right that we generally pay for dental treatment?

Is it right that we pay for glasses?

Is it right that we pay for paracetamol/ toothpaste/ cough medicine?

We already pay for some healthcare, we always have. Or should we have free prescriptions for everyone? A line has to be drawn somewhere.

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).

I agree with Clip (as usual)

 

[Xenophon PCDGS]

Is it right that we pay for paracetamol/ toothpaste/ cough medicine?

You could extend this to other items that contribute to health, such as the free provision of toilet rolls, which perform a most useful contribution to the general health of the population at large.

 

[507021]

Where do you draw the line?

Is it right that we generally pay for dental treatment?

Is it right that we pay for glasses?

Is it right that we pay for paracetamol/ toothpaste/ cough medicine?

We already pay for some healthcare, we always have. Or should we have free prescriptions for everyone? A line has to be drawn somewhere.

Personally, I think healthcare is a right and not a privilege. It should be available to everyone, whether they're financially comfortable or they're struggling to feed themselves and heat their home. I do agree that some things need to be paid for such as medication (I pay £8.40 every four weeks for mine), glasses etc; but medical treatment at a hospital is expensive and I doubt many people could afford to pay for the treatment they need without sacrificing other daily essentials, if at all. I certainly couldn't, especially as I'm currently the only one in my house who works and brings in a regular salary.

I'd gladly pay a bit more income tax towards funding the NHS, but I'm totally against outright charging for using its services.

 

[backontrack]

Firstly, the Government needs to redistribute taxpayers' money. And it needs to sort things out...people act like a Robin Hood tax would solve all our problems, but it is true that there's money out there that a mansion tax would help very well with. Then there's bankers' bonuses. And, at this critical point in time, why are the Govt choosing to fund new grammar schools instead?

 

[Bletchleyite]

The best way to increase funding the NHS I think is via a wealth tax, not an income tax. Typically those with incomes don't use much in the way of NHS services, it's those who don't have incomes (long term sick and elderly) that cost the most.

I think you're missing the point a bit. We fund the NHS as working people now, and working people should fund it for us as we age.


Sent from my iPad using Tapatalk

 

[Xenophon PCDGS]

Firstly, the Government needs to redistribute taxpayers' money. And it needs to sort things out...people act like a Robin Hood tax would solve all our problems, but it is true that there's money out there that a mansion tax would help very well with. Then there's bankers' bonuses.

You have just cited a very good example in the part of your posting that I have emboldened of why those to which you refer to in the banking industry should forsake Britain as quickly as possible and relocate to the financial hub centres of Europe, to escape such strictures.

 

[backontrack]

You have just cited a very good example in the part of your posting that I have emboldened of why those to which you refer to in the banking industry should forsake Britain as quickly as possible and relocate to the financial hub centres of Eurpoe, to escape such strictures.

Well, I've never heard of Eurpoe, but I'd gladly be rid of the bankers, that's for sure...

 

[Xenophon PCDGS]

Well, I've never heard of Eurpoe, but I'd gladly be rid of the bankers, that's for sure...

Oh, the very shame of it. Hoist indeed I am on my own lexicological petard...

Incidentally, on the other matter you raised of the mansion tax, what will that tax likely to bring into the coffers? I see that many of these large properties are owned by overseas based people, who will no doubt have their tax advisors working on that particular matter.

 

[Trog]

Easy enough to put a charge on the assets payable when the asset is liquidated.

Depressing how often people who have saved for the future, are just seen as something to be raided to get money to give to those who just p***ed what they earned up a wall.

There was something to be said for the Victorian distinction between the deserving and un-deserving poor. Between those who through misfortune need and deserve our assistance, and those who had the opportunity to look after themselves and chose to waste it.

 

[backontrack]

Oh, the very shame of it. Hoist indeed I am on my own lexicological petard...

Incidentally, on the other matter you raised of the mansion tax, what will that tax likely to bring into the coffers? I see that many of these large properties are owned by overseas based people, who will no doubt have their tax advisors working on that particular matter.

I have not looked into that possibility, but I think that the country could clean up rather well from that. Especially if we also crack down on tax evasion.

Anyway, back to our desperately underfunded NHS.

 

[Arglwydd Golau]

Depressing how often people who have saved for the future, are just seen as something to be raided to get money to give to those who just p***ed what they earned up a wall.

There was something to be said for the Victorian distinction between the deserving and un-deserving poor. Between those who through misfortune need and deserve our assistance, and those who had the opportunity to look after themselves and chose to waste it.

I think that you might be following the Mail/Express line on this. Those people who have saved a few quid from their working life would not be at risk from any so-called 'super tax' (tho' the right-wing press would like you to believe it ). There are those who have untold wealth, often inherited, squirreled away in tax havens, pay little tax through the use of 'tax lawyers' etc and who have done very well out of the 2008 recession, thank you very much. It would very much be in their interest to mobilise those who have managed to save a little to defend their vast wealth.

 

[Xenophon PCDGS]

I have not looked into that possibility, but I think that the country could clean up rather well from that. Especially if we also crack down on tax evasion.

Anyway, back to our desperately underfunded NHS.

One cannot now again play the same 1997 "Pension Funds Raid" made famous by Gordon Brown, but can we not learn anything from history?

How about emulating the coffers replenishment scam of King Henry VIII and sell off all the cathedrals and ecclesiastical properties and then compound that by hiving off all the commercial land and property holdings of the Church of England. Perhaps the Muslim community would be utterly delighted to see York Minster turn into a Great Mosque, as occurred in the Middle Ages in Constantinople when the Orthodox Cathedral of Hagia Sophia, the greatest cathedral in Christendom was, on the fall of that city, turned into a mosque.

 

[Senex]

Depressing how often people who have saved for the future, are just seen as something to be raided to get money to give to those who just p***ed what they earned up a wall.

There was something to be said for the Victorian distinction between the deserving and un-deserving poor. Between those who through misfortune need and deserve our assistance, and those who had the opportunity to look after themselves and chose to waste it.

Very true! Those who paid their mortgages and heeded the politicians' advice to save for their old age get almost everything taken off them to pay for their care homes (and through their private fees subsidise the inadequate fees paid by LAs for their "clients") whilst those who've spent their working lives spending to the hilt get paid for.

The distinction between "deserving" and "undeserving" as applied by the Victorians may not be quite the one we woul want, but some sort of such distinction has a good deal to commend it.
--- old post above --- --- new post below ---

I think that you might be following the Mail/Express line on this. Those people who have saved a few quid from their working life would not be at risk from any so-called 'super tax' (tho' the right-wing press would like you to believe it ). There are those who have untold wealth, often inherited, squirreled away in tax havens, pay little tax through the use of 'tax lawyers' etc and who have done very well out of the 2008 recession, thank you very much. It would very much be in their interest to mobilise those who have managed to save a little to defend their vast wealth.

I think there are an awful lot who have "saved a few quid from their working life" who now get penalised despite being nowhere near a threshold for having "untold wealth, often inherited, squirreled away in tax havens".
--- old post above --- --- new post below ---

How about emulating the coffers replenishment scam of King Henry VIII and sell off all the cathedrals and ecclesiastical properties and then compound that by hiving off all the commercial land and property holdings of the Church of England. Perhaps the Muslim community would be utterly delighted to see York Minster turn into a Great Mosque, as occurred in the Middle Ages in Constantinople when the Orthodox Cathedral of Hagia Sophia, the greatest cathedral in Christendom was, on the fall of that city, turned into a mosque.

"But at last came a King who had greed in his eyes,
And he lusted for treasure with fraud and with lies."
The rather dreadful poetry about Wicked King Henry might very well be applied to some parties and politicians today, but let's not encourage the aspirations of Daesh (?spelling) for Moslem world domination.

 

[backontrack]

One cannot now again play the same 1997 "Pension Funds Raid" made famous by Gordon Brown, but can we not learn anything from history?

How about emulating the coffers replenishment scam of King Henry VIII and sell off all the cathedrals and ecclesiastical properties and then compound that by hiving off all the commercial land and property holdings of the Church of England. Perhaps the Muslim community would be utterly delighted to see York Minster turn into a Great Mosque, as occurred in the Middle Ages in Constantinople when the Orthodox Cathedral of Hagia Sophia, the greatest cathedral in Christendom was, on the fall of that city, turned into a mosque.

The comparison you're making is totally and utterly ridiculous. Forget it, I'm not biting.

 

[Arglwydd Golau]

I think there are an awful lot who have "saved a few quid from their working life" who now get penalised despite being nowhere near a threshold for having "untold wealth, often inherited, squirreled away in tax havens".
[

If that is the case (and I can understand that small savers have been hit hard by low interest rates - funny how the Mail doesn't go on about that) then the wrong people are being hit, but perhaps you would care to give examples? Older people are better off than the young, pensions protected etc - speaking generally of course.

 

[Trog]

Older people should all else being equal be richer than the young, as they should be further through the process of converting life expectancy into years of wages saved.

 

[AlterEgo]

Older people should all else being equal be richer than the young, as they should be further through the process of converting life expectancy into years of wages saved.

I have to say it's not often I agree with Trog on this forum.

Even so, there's an inherent unfairness about the system. My parents are the archetypal strivers. My mother came from a bleak Methodist background in northern England. My father came from a working class background in Ireland. Both worked every single day of their lives and claimed barely thruppence off the state. Now as they approach their 70s we, as a family, have to consider how to split assets to avoid the complete absorption of their life's work - their house - into care costs.

 

[Senex]

I have to say it's not often I agree with Trog on this forum.

Even so, there's an inherent unfairness about the system. My parents are the archetypal strivers. My mother came from a bleak Methodist background in northern England. My father came from a working class background in Ireland. Both worked every single day of their lives and claimed barely thruppence off the state. Now as they approach their 70s we, as a family, have to consider how to split assets to avoid the complete absorption of their life's work - their house - into care costs.

And that's exactly what should not happen. They've paid into the system all their lives in the expectation that when (if) they needed care, that care would be available. They've done exactly what the politicians have encouraged them to do, and yet now they find themselves in the position you state.

 

[Phil.]

When the NHS was semi-privatised by appointing numerous Managers to run "their" hospitals like a business it was the start of the slippery slope.
I have a sister who was a charge-nurse at Whipps Cross who tells tales of staggering amounts of waste. A friend who's a district nurse specialising in respiratory problems says the same. One of the biggest waste is drugs which are issued and never used. Kate's patients demand a new supply every month and when she points out that they still have stuff left over from the previous months she's told that, "I'm entitled to fresh drugs" with the result that perfectly good drugs are thrown away. Now into that equation fill up A&E every Friday and Saturday with drunks. Drunks who used to be rounded up by the police and thrown into a cell to sober up before being either charged with being D&D/D&I before simply sent on their way the next morning. So nowadays whilst 87 year old Doris is waiting for an ambulance said ambulance is transporting 19 year old Sharon and Chardonnay who have passed out in the gutter. Naturally, on the way to A&E they've vomited in the ambulance so now it has to be taken out of service for cleaning.
Then of course there's the ever-popular junkies who've overdosed on whatever they're inhaling/injecting/sniffing.
The population is getting older and this places more demands on the NHS. How many people of 100 years + do you think are alive? 100, 1,000, 10,000?
In 2014 national statistics revealed that there were 14,450 people of 100 or more of which 780 were 105 or more. The numbers of 80 year olds could fill a large town.
If people were charged a flat fee - say £10 - to attend A&E the revenue generated would be immense. But it won't happen and the NHS will continue to run at crisis levels no matter how much money successive governments give it.

 

[Senex]

If that is the case (and I can understand that small savers have been hit hard by low interest rates - funny how the Mail doesn't go on about that) then the wrong people are being hit, but perhaps you would care to give examples? Older people are better off than the young, pensions protected etc - speaking generally of course.

What do we mean now by "ordinary incomes" and what do we mean by untold wealth? Isn't the median income in this country now around £25K - £26K? If so, that means that Eurostar drivers and perhaps VT drivers get double or getting on to double, which is more than most nurses, junior doctors, teachers, university lecturers, etc. Are any of these people the rich, to be fleeced for those who never bothered to look after their own futures? Or can we say that Median to about 2 X Median is actually pretty normal middle income now? I'll give the CEOs of those large companies who have seen their incomes shoot up to crazy figures with no corresponding improvements in their companies' performance as too rich and worth taxing much more, but that's never going to provide enough to provide the sort of NHS and social care that some here seem to want.
--- old post above --- --- new post below ---

When the NHS was semi-privatised by appointing numerous Managers to run "their" hospitals like a business it was the start of the slippery slope.
I have a sister who was a charge-nurse at Whipps Cross who tells tales of staggering amounts of waste. A friend who's a district nurse specialising in respiratory problems says the same. One of the biggest waste is drugs which are issued and never used. Kate's patients demand a new supply every month and when she points out that they still have stuff left over from the previous months she's told that, "I'm entitled to fresh drugs" with the result that perfectly good drugs are thrown away. Now into that equation fill up A&E every Friday and Saturday with drunks. Drunks who used to be rounded up by the police and thrown into a cell to sober up before being either charged with being D&D/D&I before simply sent on their way the next morning. So nowadays whilst 87 year old Doris is waiting for an ambulance said ambulance is transporting 19 year old Sharon and Chardonnay who have passed out in the gutter. Naturally, on the way to A&E they've vomited in the ambulance so now it has to be taken out of service for cleaning.
Then of course there's the ever-popular junkies who've overdosed on whatever they're inhaling/injecting/sniffing.
The population is getting older and this places more demands on the NHS. How many people of 100 years + do you think are alive? 100, 1,000, 10,000?
In 2014 national statistics revealed that there were 14,450 people of 100 or more of which 780 were 105 or more. The numbers of 80 year olds could fill a large town.
If people were charged a flat fee - say £10 - to attend A&E the revenue generated would be immense. But it won't happen and the NHS will continue to run at crisis levels no matter how much money successive governments give it.

Well put! But what about extending the £10 flat fee to GP appointments too to try to cut down on some of the unnecessary pressure there? As to A&E, there was an interesting report on BBC North news during last week about the massive proportion of visits to A&E that simply were completely unnecessary -- that's not Sharon and Chardonnay (however strongly I share your opinion about their self-inflicted problems (and feel they should be made to clean out those ambulances themselves)), but people who simply had no need ay all to be there.

 

[randyrippley]

this was released to the staff at a major northwest hospital trust on friday
I've removed the name of the hospitals involved. I think you'll agree it indicates a system at the edge

Published on Friday 06 January 2017

Response to current NHS pressures from the Senior Management Team

As a Trust we are currently experiencing an unprecedented demand in our Emergency Department and inpatient services. The pressure is also being felt across the region.

Colleagues will have already felt this pressure, especially in the first few days of January and have been working extremely hard during this challenging time.

It is important that we work as a whole organisation rather than focusing on our own individual services and offer support to our colleagues.

Below is an overview of just how pressured this current time is, but most importantly the actions being taken to mitigate these challenges.

Colleagues are being asked to work differently, to be even more flexible than usual and offer support to other staff. Our priority is delivering safe care for our patients and decisions made this week are with that in mind.

Please cascade this full information to your colleagues.



The current situation:

There is an unprecedented emergency demand and increasing delayed transfers of care across the North West.
Our demand has gone up considerably. Attendances at our Emergency Department (ED) and from GP referrals have seen a dramatic increase. There has also been an increase in admissions.
Since the beginning of January there has been a 6% increase in attendances, 13% increase in ambulance arrivals and 45% increase in patients triaged to our resuscitation facility.
Admissions are outweighing discharges.
North West Ambulance Service (NWAS) are currently experiencing deterioration in their ability to respond to calls. This is due to delays in ambulance turnaround at hospitals with delays in handing over patients to the Emergency department. The turnaround times in our ED have at times been up to five hours.
Two wards are closed due to Norovirus with other wards under surveilance. There are also levels of staff sickness caused by Norovirus.
There are 40 medical outliers and 102 medically optimised patients despite the full 96 beds in the community.


Our response so far:

Currently the Trust has 84 additional beds open. Of those, 40 were planned including 30 winter escalation ward beds and 10 (name removed) beds. There have been 44 unplanned, including 30 on the HPV ward.
CCG, CT and DASS are on site each day.
Our elective orthopaedic ward has been converted to non-elective.
We’ve cancelled all elective in patients with daily prioritisation of cancer/urgent patients.
Opened additional community beds and 27 spot purchases over and above 69 intermediate care beds.
We have moved minor injuries to the Walk-in Centre in order to free up ED nurses so they can support ambulance handover and release ambulance crews.
GP support triaging GP referrals and front door of ED.
Cancelled out patients - moved support staff to help deliver care to maintain patient privacy, dignity and safety.
Non-ward nurses to support staffing of areas overseen by senior nursing team.
Use of staffing agencies, overtime rates to cover escalation and staff sickness absence.
Activation of full capacity plan.


What we are asking of colleagues:

The Trust is asking all staff to consider working overtime, paying overtime rates to cover escalation and staff sickness absence.
24-hour operational and nursing presence to support decision making and patient flow.
We need to keep discharging people at the weekend and contemporaneous step down lists are needed to support patient flow.
Staff are also asked to support colleagues/Junior Doctors etc where possible.
We are working as whole organisation rather than as divisions. Everyone is asked to play their part and staff are asked to please be flexible.
The real focus is the safety of the patients in the hospital and being able to help ambulances to get back out into the community.


Further actions moving forward:

To review (name removed) electives and daycase if we need to use beds differently or support escalation areas.
Ensure additional pharmacy support over the weekend.
GP in walk-in centre to offer support.
Agree funding for 20 spot purchase beds.
Review ability to convert elective to non-elective capacity in areas such as diagnostics and physiotherapy.
Continue with proactive and reactive communications to the public and the media.

The current state of play is unprecedented, but as a Trust working together internally with our colleagues and externally with our health and social care partners, we are collectively addressing this challenge. On behalf of the Board and the Senior Management Team, I would like to extend my thanks and gratitude to you all during this very busy period for the NHS.