Nurses: The NHS is at breaking point
Discussion
Our NHS and all social swrvices needs to become one single National asset. Continue effieciency drives, off load the use of agency staff, increase the reward for medical staff. Stop foriegn aid and divert some of that cash into our NHS. Discontinue the decades old party politics playing around and create one National scheme that takes the service forward, that scheme to be adhered to by all colours of Government.
Lozw86 said:
There are thousands of European doctors and nurses working in the NHS
A third of doctors and 21% of nurses born abroadhttp://www.telegraph.co.uk/news/uknews/12071030/Mo...
That probably doesn't count doctors born in the UK to immigrant parents, so the ratio is bound to be much higher.
shed driver said:
I'll make an admission here. I'm a nurse - I have been for over 30 years.
Oh no. Someone with some actual expertise and insight. This ruins OpinionHeads.But shed driver is right.
The Kings Fund have the average age of an adult inpatient at 83 or 87 or something. These people are frail, they tend to have more conditions which means treatment is often more complex and this in turn means longer hospital stays. It also means that their discharge needs thinking about, (-can they look after themselves, is their house suitable? Etc.) The problem with older people who have a big health event is that it often becomes a big watershed moment where they/family say 'enough is enough we can't manage any more' so it all needs sorting out. Where they live, who cares for them etc.
So where do they go in the interim? As Shed Driver says, with demand for social care beds outstripping supply they sit there in hospital with no place to go. -There's a blockage, backlog and eventually it literally spills out of the hospital front door when times are bad (particularly in winter when all the respiritory infections are about).
Because the NHS system generally treats unscheduled care in the same system as planned care (emergencies versus planned operations) emergencies will get precedence. Ops are cancelled -another backlog, waiting lists soar. People get more and more poorly on waiting lists and then turn up in A&E as emergencies.
In the meantime, Primary care (GPs etc) are in crisis. Ageing population, sicker, more demand for GP time with fewer GPs about. Practices closing, access to appointments tougher. This risks early detection of health problems and effective management of conditions that reduces sudden 999 crisis calls. It also makes people more likely to turn up to A&E because it's open access.
In the background we're seeing lifestyle changes leading to more chronic disease earlier, so more diabetics = more appointments to see GP, specialist nurse, consultant, podiatrist, retinopathy screening, dietician, etc etc keeping NHS busier and busier.
Aditionally there's a recruitment crisis. Workforce planning hasn't been very good and medics in some fields are understandably going to the highest bidder, (Canada, Australia have been recruiting heavily in UK and pay much more). So the NHS is 'renting' rather than 'buying' it's staff and this increases costs massively.
I should have just blamed the foreigners, wouldn't have had to type this.
There are many things I don't understand about our NHS.
I picked up a prescription last year and one thing I noticed was that I appeared to be the only one in the queue who paid for the prescription - most of the population appear to be exempt. I would have thought that with the UK inhaling about a billion or so pills a week that the NHS would be making a profit!
I picked up a prescription last year and one thing I noticed was that I appeared to be the only one in the queue who paid for the prescription - most of the population appear to be exempt. I would have thought that with the UK inhaling about a billion or so pills a week that the NHS would be making a profit!
272BHP said:
There are many things I don't understand about our NHS.
I picked up a prescription last year and one thing I noticed was that I appeared to be the only one in the queue who paid for the prescription - most of the population appear to be exempt. I would have thought that with the UK inhaling about a billion or so pills a week that the NHS would be making a profit!
Some 1 billion prescriptions are dispensed annually in England, with around £450m raised from prescription charges in 2012–2013. The think tank notes that while 40% of the population are liable to pay the prescription charge, in practice 90.6% of prescriptions are dispensed free of charge.I picked up a prescription last year and one thing I noticed was that I appeared to be the only one in the queue who paid for the prescription - most of the population appear to be exempt. I would have thought that with the UK inhaling about a billion or so pills a week that the NHS would be making a profit!
http://www.pharmaceutical-journal.com/news-and-ana...
Sick people need more medicines - those with long term complaints - diabetes, epilepsy etc are eligible for free presciptions. The generally well who need occasional treatment have to pay.
Make it too expensive and people will weigh up what treatments they can afford - in the long run that costs more.
SD.
shed driver said:
gruffalo said:
Having to cope with population growth equivalent to 150% the population of Swindon a year may help.
Just cull Swindon then? 
SD.
Or we could just build a new town a year with associated infrastructure and train the staff to run that infrastructure and magic up the money to pay for it all.
shed driver said:
Some 1 billion prescriptions are dispensed annually in England, with around £450m raised from prescription charges in 2012–2013. The think tank notes that while 40% of the population are liable to pay the prescription charge, in practice 90.6% of prescriptions are dispensed free of charge.
http://www.pharmaceutical-journal.com/news-and-ana...
Sick people need more medicines - those with long term complaints - diabetes, epilepsy etc are eligible for free presciptions. The generally well who need occasional treatment have to pay.
Make it too expensive and people will weigh up what treatments they can afford - in the long run that costs more.
SD.
I dont think any prescription should be completely free rather a nominal fee should be charged of say 99p.http://www.pharmaceutical-journal.com/news-and-ana...
Sick people need more medicines - those with long term complaints - diabetes, epilepsy etc are eligible for free presciptions. The generally well who need occasional treatment have to pay.
Make it too expensive and people will weigh up what treatments they can afford - in the long run that costs more.
SD.
A recent TV program raised the issue of people who qualify for free prescriptions using the NHS to fund basics such as aspirin that would cost 28p from the supermarket. The cost to the NHS however was circa £7 for every prescription issued.
sidicks said:
There's probably some scope for fewer management, greater hands on staff too!
There is most certinaly a management and organisational issue - top-heaviness.Greg66 said:
Seriously, when is the NHS not at breaking point/in crisis/at defcon 1?
We spend almost £32 million on it every day.
How much would it cost to take it out of crisis mode?
We spend almost £32 million on it every day.
How much would it cost to take it out of crisis mode?
I know exactly what you mean, but I do agree with Sidicks that before we look at further increasing the already inflated budget, there just has to be scope for greater efficiency.I'd also agree with the OP that better care for the elderly would free up services and beds and address the demographic squeeze we are currently seeing. On that latter point, this is peak, but it is also not permanent.
IMHO the NHS was actually, in many ways, better off before New Labour bloated it. What the money went into was rarely 'front line' people or services, but management - layers and layers of it - and PFIs. All scandalous wastes of budget, some of which are easier to get rid of than others, but it is a sobering demonstration of how inflating budgets of public sector organisations can go wrong.
Edited by Digga on Thursday 12th January 16:24
Digga said:
IMHO the NHS was actually, in many ways, better off before New Labour bloated it. What the money went into was rarely 'front line' people or services, but management - layers and layers of it - and PPIs. All scandalous wastes of budget, some of which are easier to get rid of than others, but it is a sobering demonstration of how inflating budgets of public sector organisations can go wrong.
Spot on. Throwing more money at the NHS is as bad as increasing overseas aid, if there is no proper control of the money. One only has to look at the management bloat and utterly ruinous PFI deals set up by Labour.I've never managed to figure out in my head why people are so afraid to die.
It's happening all over the planet. All day and every day. You get some time, and eventually it is over.
If you're inclined to listen to the Buddhists then you'll get (many) another go at it all.
If you're inclined to listen to the Christians then you're going to have to wait a bit longer.
Dead dead dead some day you'll be dead.
Get on with it.
It's happening all over the planet. All day and every day. You get some time, and eventually it is over.
If you're inclined to listen to the Buddhists then you'll get (many) another go at it all.
If you're inclined to listen to the Christians then you're going to have to wait a bit longer.
Dead dead dead some day you'll be dead.
Get on with it.
shed driver said:
I'll make an admission here. I'm a nurse - I have been for over 30 years. I work in the NHS in a fairly specialist area. We have been at 100% bed occupancy (or above) since before September last year. With only 12 beds there are some times that we admit patients onto the unit, stabilise them and transfer them out to other wards or departments just so that we can admit another patient. Some beds may have three patients in within one day.
However we also have some patients that no matter how hard we try we cannot discharge them due to a lack of effective social care - with an aging and increasingly frail population this will only increase.
I'm not naive enough to believe that there aren't efficiencies to be made, although many of the easy, quick fixes have already been tried. Watching the BBC2 documentary last night showed a surgeon, theatre and associated staff left unused due to a lack of bed capacity - this isn't just isolated to one hospital though, it's endemic at all of them.
Funding alone isn't the answer, neither is a knee jerk "sack all the managers" call as is seen so often. I'm in the twilight of my career - I've never seen it so bad, I can't wait to retire although with a permanently damaged back whether I can continue to work until then is a rather moot point.
SD.
Bed blockage is a key problem. Couple of observationsHowever we also have some patients that no matter how hard we try we cannot discharge them due to a lack of effective social care - with an aging and increasingly frail population this will only increase.
I'm not naive enough to believe that there aren't efficiencies to be made, although many of the easy, quick fixes have already been tried. Watching the BBC2 documentary last night showed a surgeon, theatre and associated staff left unused due to a lack of bed capacity - this isn't just isolated to one hospital though, it's endemic at all of them.
Funding alone isn't the answer, neither is a knee jerk "sack all the managers" call as is seen so often. I'm in the twilight of my career - I've never seen it so bad, I can't wait to retire although with a permanently damaged back whether I can continue to work until then is a rather moot point.
SD.
1) On R4 before Christmas, PM or Today were comparing and there are striking differences between the link up between A&E/General Hospital/Social Services between trusts. Those hospitals that have better utilisation of beds, shorter occupancy times and more surgeries (due to be able to get beds released for waiting list) are running what, in my software delivery business, would be called a war room: all parts of the system sat making allocation decisions especially with regards to Social Service availability. They were literally reacting on an hour by hour basis but because they had all parts (input and outflows) covered off it reduced extended comms and made decision making much more streamlined. Looked pretty impressive.
2) A friend, who will remain anonymous, is a senior manager at a well known Trust. He has had multiple serious conversations with senior colleagues on how best to handle OAPs who are almost in continuous occupancy while social services are unable to provide a solution. This has included something really as basic as well heated warehouse/hangar accommodation which would allow the parking of terminal types. Heartless it may sound, but currently the impact of gerentocare is rendering Hospitals unable to provide basic healthcare provision for the rest of the population: extended waiting lists drive up complications, people discharged inappropriately early because of bed pressure, hospitals having to provide a range of services more appropriate for aged care. You name it its being impacted by a tidal wave of elderly. Simply throwing more money at Social Services won't really address the issue. The warehouse solution never flies because it would be a PR disaster, despite it being probably a sensible solution from a care point of view.
Well, I've just spent the afternoon in a ward at the infirmary of a major midlands city. Yes, the beds are full but there's little sign of urgency or stress. Lots of people walking about, standing about chatting.
I'm reminded of when I was in business; if I'd had a factory running in such a relaxed manner I'd have been worried.
Maybe it's different elsewhere, but the above is my experience today.
I'm reminded of when I was in business; if I'd had a factory running in such a relaxed manner I'd have been worried.
Maybe it's different elsewhere, but the above is my experience today.
barryrs said:
I dont think any prescription should be completely free rather a nominal fee should be charged of say 99p.
A recent TV program raised the issue of people who qualify for free prescriptions using the NHS to fund basics such as aspirin that would cost 28p from the supermarket. The cost to the NHS however was circa £7 for every prescription issued.
Interesting point. Remove some drugs from prescription, perhaps. Or issue more supply than 1 month at a time.A recent TV program raised the issue of people who qualify for free prescriptions using the NHS to fund basics such as aspirin that would cost 28p from the supermarket. The cost to the NHS however was circa £7 for every prescription issued.
I'm prescribed 3 drugs, all common and cheap. I have to request a repeat every month, which has to be signed off by a doctor, dispensed by a chemist and accounted for. Expensive and time consuming process.
In most of Europe I can buy a years supply of all three drugs for around 75 euro over the counter. Seems simpler.
Guybrush said:
Digga said:
IMHO the NHS was actually, in many ways, better off before New Labour bloated it. What the money went into was rarely 'front line' people or services, but management - layers and layers of it - and PPIs. All scandalous wastes of budget, some of which are easier to get rid of than others, but it is a sobering demonstration of how inflating budgets of public sector organisations can go wrong.
Spot on. Throwing more money at the NHS is as bad as increasing overseas aid, if there is no proper control of the money. One only has to look at the management bloat and utterly ruinous PFI deals set up by Labour.This is a failure of government - who are responsible for planning public services to meet the needs of the people. We have more people in work in the UK than ever before - why can't we pay for additional capacity in the NHS?
Various politicians, Burnham to the forefront of this, have been campaigning on social care & and integrated healthcare system for years now. The Tory response has been to slash local gov funding which pays for social care, and the forecast effects of this on the NHS are now manifesting themselves.
https://www.nice.org.uk/ is already there for evidence based guidance on effective and affordable treatments - they will never be popular though.
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