NHS whats happened?
Discussion
interested on thoughts what exactly is going on with the NHS
an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called , went to Poole hospital in Dorset .
remained in the ambulance for 14 1/2hrs ............. He was told its not life threatening . subsequently he had the leg set , put in one of those leg braces and was sent on his way
Now i know casualty is busy ... but What is the reason , for such a wait
Shortage of doctors
Too many patients
not enough beds .................this didnt require a bed
poor assessment triage
or is there a darker reason , NHS going slow due to pay deals ?? political; reasons unions etc
no idea but this needs fixing
an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called , went to Poole hospital in Dorset .
remained in the ambulance for 14 1/2hrs ............. He was told its not life threatening . subsequently he had the leg set , put in one of those leg braces and was sent on his way
Now i know casualty is busy ... but What is the reason , for such a wait
Shortage of doctors
Too many patients
not enough beds .................this didnt require a bed
poor assessment triage
or is there a darker reason , NHS going slow due to pay deals ?? political; reasons unions etc
no idea but this needs fixing
Lots of things including an aging and generally more unhealthy population, longer life expectancy, better medicine making more things curable.
Add in inefficiencies, short term thinking useless politicians (across party lines and decades) and the massive social care issue and the chickens are coming in to roost.
Add in inefficiencies, short term thinking useless politicians (across party lines and decades) and the massive social care issue and the chickens are coming in to roost.
Dingu said:
Lots of things including an aging and generally more unhealthy population, longer life expectancy, better medicine making more things curable.
Add in inefficiencies, short term thinking useless politicians (across party lines and decades) and the massive social care issue and the chickens are coming in to roost.
Add in increasing population and some areas getting more and more densely populated with no proportional increase in A&E facilities. Add in inefficiencies, short term thinking useless politicians (across party lines and decades) and the massive social care issue and the chickens are coming in to roost.
Personally I believe the NHS is a bottomless money pit than can never be satisfied and if allowed would gobble up everything thrown at it. There are many areas than can be addressed to save money but sadly any attempt is seen as an attack on the saintly NHS by evil capitalist greedy politicians. Waste is huge as is often the case with public entities.
I remember 12 years ago a colleague of mine broke his leg in a fall from height (femur as above), despite being close to a large airport there were no available Ambulances as it was deemed non life threatening and he had a wait of an hour and a half before being collected from the shop floor. All we could do was keep him warm and comfortable until a meat wagon was free. I'm sure this being on a nightshift around pub closing time had zero to do with it....
Things clearly haven't improved. The monster is too big and too politicised for it to ever change, you just have to hope if you have a serious issue you get that lucky flip of the coin and have the NHS gold start treatment they are very, very capable of delivering most of the time.
I think the increasing population is one of the big factors. This isn't just putting a strain on the health service, but on everything.
It probably is the biggest problem our government has to deal with (much more so than climate change, wars, education etc...)
If money is being pumped into the NHS it doesn't seem to be being spent on what's right.
In the North West, they closed the A&E dept at Burnley and now everyone has to go to Blackburn. Surely with an ever increasing population and more houses being built in the area we should be creating more hospitals (as well as other infrastructure), not reducing things.
It probably is the biggest problem our government has to deal with (much more so than climate change, wars, education etc...)
If money is being pumped into the NHS it doesn't seem to be being spent on what's right.
In the North West, they closed the A&E dept at Burnley and now everyone has to go to Blackburn. Surely with an ever increasing population and more houses being built in the area we should be creating more hospitals (as well as other infrastructure), not reducing things.
Jasandjules said:
The cynic in me says the Govt has spent many years ensuring the NHS is not fit for purpose so they can then sell privatisation of the NHS to the stupid who will welcome it. Then their rich friends will profit and hey presto, the poor will be screwed ever further.
The flaw in that line of thinking is that the NHS was s
t under Labour too. I would say the issue is that the senior management/directors are incompetent and there's far too many of them. I'd carry out a thorough pruning of the management structure, getting rid of as many of them as possible. Invite them in for an interview to justify their jobs! That would release millions that could be used to employ nurses etc. When I see Midlands NHS adverting for a "Director for Lived Experience" at £110,000 - £120,000 I can be pretty certain where the problem lies - what a load of b
ks! 
LivLL said:
I remember 12 years ago a colleague of mine broke his leg in a fall from height (femur as above), despite being close to a large airport there were no available Ambulances as it was deemed non life threatening and he had a wait of an hour and a half before being collected from the shop floor. All we could do was keep him warm and comfortable until a meat wagon was free. I'm sure this being on a nightshift around pub closing time had zero to do with it....
Ambulances aren’t an infinite resource, as an example I visited Scottish ambulance a few years back and for Aberdeen it was something like 4 ambulances. When you call 999 they triage you and then that’s categorised 1-4 with 1 being the most serious. Now take Aberdeen, 1 ambulance dropping off, 1 RTC, a false call and a heart attack, you can now see why when your friend was conscious and breathing despite a femur injury he was put lower down on the list.
Spending the best part of two years telling people effectively to stay away from the NHS has built up enormous pressures, which are now being felt across all aspects of the system. The NHS was in poor shape going into the pandemic so it’s no surprise it’s on its knees now.
Of course, I’m sure the Government's rigorous cost benefit analysis will have taken this into account and shown that lock downs were worth the pain and misery we are now experiencing (including the excess deaths), and will do for many years to come….
I did a double take when Whitty mentioned last week that a proportion of the excess deaths were a direct result of people not accessing health care for the last two years (cancer screening and heart issues etc.) Really? That was a blatantly obvious consequence at the time.
Of course, I’m sure the Government's rigorous cost benefit analysis will have taken this into account and shown that lock downs were worth the pain and misery we are now experiencing (including the excess deaths), and will do for many years to come….
I did a double take when Whitty mentioned last week that a proportion of the excess deaths were a direct result of people not accessing health care for the last two years (cancer screening and heart issues etc.) Really? That was a blatantly obvious consequence at the time.
tim0409 said:
Spending the best part of two years telling people effectively to stay away from the NHS has built up enormous pressures, which are now being felt across all aspects of the system. The NHS was in poor shape going into the pandemic so it’s no surprise it’s on its knees now.
Of course, I’m sure the Government's rigorous cost benefit analysis will have taken this into account and shown that lock downs were worth the pain and misery we are now experiencing (including the excess deaths), and will do for many years to come….
I did a double take when Whitty mentioned last week that a proportion of the excess deaths were a direct result of people not accessing health care for the last two years (cancer screening and heart issues etc.) Really? That was a blatantly obvious consequence at the time.
This is from Dec 2nd: https://www.dailymail.co.uk/health/article-1149187...Of course, I’m sure the Government's rigorous cost benefit analysis will have taken this into account and shown that lock downs were worth the pain and misery we are now experiencing (including the excess deaths), and will do for many years to come….
I did a double take when Whitty mentioned last week that a proportion of the excess deaths were a direct result of people not accessing health care for the last two years (cancer screening and heart issues etc.) Really? That was a blatantly obvious consequence at the time.
No s
t Sherlock. Part of me does wonder why we "the public" haven't revolted over this and thrown people like Whitty in the Thames. Interesting reading the comments where many folk are blaming it on the vaccines. I'm not blaming it on that, but it is interesting to see how people's opinions have swung in the past 12 months.
DBSV8 said:
an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called.
Why call an ambulance for a fractured leg?Why could someone not get him in a vehicle and off to A&E?
It’s very much a postcode lottery. We’ve had to use A&E twice this winter with a child both times not serious. Both times A&E was pretty quiet we were seen within the hour and on our way with meds.
Likewise our friends newborn had all the symptoms of strep A (which are similar symptoms to lots of other minor illnesses) ambulance was outside their house in 10 mins. He didn’t have strep A.
Likewise our friends newborn had all the symptoms of strep A (which are similar symptoms to lots of other minor illnesses) ambulance was outside their house in 10 mins. He didn’t have strep A.
272BHP said:
DBSV8 said:
an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called.
Why call an ambulance for a fractured leg?Why could someone not get him in a vehicle and off to A&E?
272BHP said:
Why call an ambulance for a fractured leg?
Why could someone not get him in a vehicle and off to A&E?
Broken femur, yup well just lift him up and pop him in the fiesta. Ok.Why could someone not get him in a vehicle and off to A&E?
It’s just an example of how like the OP, years ago same was apparent. We all know it isn’t a bottomless pit of resources, I’m sure the MHS has plenty of stats to show overall performance rather than individual cases.
The problem starts in social care. Not enough carers in care homes and not enough carers working in the community. The pay is st and it's stressful work so no one wants to work in them. Patients are getting older and more complex and the spaces for the numbers of patients with complex needs are not sufficient as it's difficult to make enough money to pay staff when patients are complex. Complex patients are also higher risk with more potential for incidents, and the NHS is all about minimising incidents, nothing can ever go wrong - not helped by everyone trying to sue it every 5 minutes. The population is aging generally so fewer working people with plenty of casual jobs available that are less stressful and pay better.
This hits community hospital sites. Community hospitals are there to build patients up after an acute admission to get them back home/into a new care facility appropriate to their needs. They are small as they are intended as half way houses. Any delays getting people out causes a backlog.
The backlog means acute hospital sites can't clear beds. Patients sit around ready to leave for days while a place in a community site or care home is made available, or adaptations are made to their home. These have to be assessed, actioned, and tested before patients can be discharged.
If there are no empty beds on wards, patients that need to be admitted will stay in A&E for hours/days while they wait.
Patients waiting for a bed on a ward still need looking after but there are the same number of drs/nurses/HCAs in A&E whether there are 10 people booked in or 200. There are delays getting people seen. Except that comment about the same number of staff being available is wrong, as people don't want to work in A&E anymore. HCAs are paid at band 2 and there are far easier band 2 jobs available, so people go and work there instead.
If A&E is full ambulances can't offload and instead sit outside A&E acting as mobile cubicles. Each one that sits there is unavailable for a job along with the two paramedics on board. The abuse paramedics get, the pressure they work under, the unsocial hours involved, all means they are flooding out and earning double driving HGVs instead. With both staff shortages and waiting outside A&E there aren't enough ambulances to go round.
I think the general public is really struggling with this idea that we are heading to society that you call for help and it won't arrive. It's just unimaginable. People think the strikes are causing a real disruption, but those striking are at least going back to work the next day. Loads of nurses, doctors, paramedics etc are leaving quietly with their transferrable skills and making more money in less stressful jobs with better hours. These people are not being replaced. EU workers helped fill the gaps but no more. Most overseas workers come from India and the Philippines but the NHS is competing with America and the Middle East, both of which pay more, which means these people can send more money home each month. The strikes don't cause 18 hour waits for ambulances - they are already happening, and it will only get worse if no one is going to do anything about making the roles more attractive for new recruits, and to retain existing staff.
I think the unions have missed the message a little bit. They have been talking about 10 years of below inflation pay rises, which is true and a part of the reasoning so many people are leaving (over 1 in 10 NHS posts are vacant). But I think we should be focusing the general public's mind that if nothing is done, people will continue to leave, and there will be no emergency healthcare at all, because no one wants to work in it, and can get more money doing literally anything else.
What we have however is the government trying to turn the general public against healthcare workers, because how dare they threaten people's lives to demand a pay rise? Lives are being threatened regardless and will continue to be, because honestly, who the hell would want be a nurse or paramedic right now?
t and it's stressful work so no one wants to work in them. Patients are getting older and more complex and the spaces for the numbers of patients with complex needs are not sufficient as it's difficult to make enough money to pay staff when patients are complex. Complex patients are also higher risk with more potential for incidents, and the NHS is all about minimising incidents, nothing can ever go wrong - not helped by everyone trying to sue it every 5 minutes. The population is aging generally so fewer working people with plenty of casual jobs available that are less stressful and pay better.This hits community hospital sites. Community hospitals are there to build patients up after an acute admission to get them back home/into a new care facility appropriate to their needs. They are small as they are intended as half way houses. Any delays getting people out causes a backlog.
The backlog means acute hospital sites can't clear beds. Patients sit around ready to leave for days while a place in a community site or care home is made available, or adaptations are made to their home. These have to be assessed, actioned, and tested before patients can be discharged.
If there are no empty beds on wards, patients that need to be admitted will stay in A&E for hours/days while they wait.
Patients waiting for a bed on a ward still need looking after but there are the same number of drs/nurses/HCAs in A&E whether there are 10 people booked in or 200. There are delays getting people seen. Except that comment about the same number of staff being available is wrong, as people don't want to work in A&E anymore. HCAs are paid at band 2 and there are far easier band 2 jobs available, so people go and work there instead.
If A&E is full ambulances can't offload and instead sit outside A&E acting as mobile cubicles. Each one that sits there is unavailable for a job along with the two paramedics on board. The abuse paramedics get, the pressure they work under, the unsocial hours involved, all means they are flooding out and earning double driving HGVs instead. With both staff shortages and waiting outside A&E there aren't enough ambulances to go round.
I think the general public is really struggling with this idea that we are heading to society that you call for help and it won't arrive. It's just unimaginable. People think the strikes are causing a real disruption, but those striking are at least going back to work the next day. Loads of nurses, doctors, paramedics etc are leaving quietly with their transferrable skills and making more money in less stressful jobs with better hours. These people are not being replaced. EU workers helped fill the gaps but no more. Most overseas workers come from India and the Philippines but the NHS is competing with America and the Middle East, both of which pay more, which means these people can send more money home each month. The strikes don't cause 18 hour waits for ambulances - they are already happening, and it will only get worse if no one is going to do anything about making the roles more attractive for new recruits, and to retain existing staff.
I think the unions have missed the message a little bit. They have been talking about 10 years of below inflation pay rises, which is true and a part of the reasoning so many people are leaving (over 1 in 10 NHS posts are vacant). But I think we should be focusing the general public's mind that if nothing is done, people will continue to leave, and there will be no emergency healthcare at all, because no one wants to work in it, and can get more money doing literally anything else.
What we have however is the government trying to turn the general public against healthcare workers, because how dare they threaten people's lives to demand a pay rise? Lives are being threatened regardless and will continue to be, because honestly, who the hell would want be a nurse or paramedic right now?
Edited by Brainpox on Thursday 12th January 21:36
Boringvolvodriver said:
Fall from height at the workplace - I think that the H&S policy would dictate that an ambulance should be called otherwise the company’s may be open to a claim from the employee
Excellent, then they sue the company anyway for putting them at risk as the company should have been aware there was no ambulance service available for many hours.Then sue the NHS for not providing said ambulance in a timely manner as I am sure thousands upon thousands have been doing in the last few weeks adding to the billions the NHS have to pay out already.
Lawyers are doing well for themselves I am sure.
DBSV8 said:
interested on thoughts what exactly is going on with the NHS
an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called , went to Poole hospital in Dorset .
remained in the ambulance for 14 1/2hrs ............. He was told its not life threatening . subsequently he had the leg set , put in one of those leg braces and was sent on his way
Now i know casualty is busy ... but What is the reason , for such a wait
Shortage of doctors
Too many patients
not enough beds .................this didnt require a bed
poor assessment triage
or is there a darker reason , NHS going slow due to pay deals ?? political; reasons unions etc
no idea but this needs fixing
I had to go to A&E last year and it was a pretty abysmal experience although not as bad as your friend. From chatting to people, the problem <caveat>at this hospital at this time</> was that there was just one doctor on. Lots of nurses (not doing that much) and the triage was quick. But the doctor was run ragged. an example we had a friend who had an accident at work fall from height and fracture of his leg ....It was an obvious break , not a potential sprain. femur . Ambulance was called , went to Poole hospital in Dorset .
remained in the ambulance for 14 1/2hrs ............. He was told its not life threatening . subsequently he had the leg set , put in one of those leg braces and was sent on his way
Now i know casualty is busy ... but What is the reason , for such a wait
Shortage of doctors
Too many patients
not enough beds .................this didnt require a bed
poor assessment triage
or is there a darker reason , NHS going slow due to pay deals ?? political; reasons unions etc
no idea but this needs fixing
From talking to my (fourth year med student) daughter this is more common than just my one experience.
An aging population hasn’t helped but the current extreme position is primarily caused by
1) shutting down treatment during various stages of the pandemic - the waiting lists are just ridiculous and of course a lot of those waiting become urgent care requirements
2) failing to provide sufficient social care etc - this has been a worsening issue for a while now. The covid vaccine mandate also exacerbated staffing issues in that sector. If you can’t discharge well people (and there are a lot) this ultimately leads to ambulances sitting waiting to offload patients.
3) Additional strain from covid/flu and a hit from other respiratory illness this year
4) Additional strain from the excess deaths we are seeing - possibly linked to points 1&3
5) Shortages of staff at the sharp end in secondary care - the approach to degree requirements now doesn’t seem to work as well as what we had a few years ago. Pay for nurses is low so won’t be helping attract people either
6) challenges getting appointments at the Drs pushes everyone to A&E
7) the IT systems are a complete joke - out dated and lacking end to end integration
The above was all avoidable.
Countries who didn’t stop health care as much as us have avoided backing up patients in the system. We had the use of private hospitals during the pandemic but had them sat idle whilst we paid small fortunes for the privilege.
The social care element is being looked at now by the gov but they should have addressed this before we got to this stage.
Drs need to start seeing patients again in person much more.
A review (and actions implemented) of recruitment, training and fair pay needs to happen fast. We need to import skilled people rather than lose them abroad which will happen in ever greater numbers
There is of course a need to look at how the NHS operates and reform this but I can’t see this changing any time soon.
1) shutting down treatment during various stages of the pandemic - the waiting lists are just ridiculous and of course a lot of those waiting become urgent care requirements
2) failing to provide sufficient social care etc - this has been a worsening issue for a while now. The covid vaccine mandate also exacerbated staffing issues in that sector. If you can’t discharge well people (and there are a lot) this ultimately leads to ambulances sitting waiting to offload patients.
3) Additional strain from covid/flu and a hit from other respiratory illness this year
4) Additional strain from the excess deaths we are seeing - possibly linked to points 1&3
5) Shortages of staff at the sharp end in secondary care - the approach to degree requirements now doesn’t seem to work as well as what we had a few years ago. Pay for nurses is low so won’t be helping attract people either
6) challenges getting appointments at the Drs pushes everyone to A&E
7) the IT systems are a complete joke - out dated and lacking end to end integration
The above was all avoidable.
Countries who didn’t stop health care as much as us have avoided backing up patients in the system. We had the use of private hospitals during the pandemic but had them sat idle whilst we paid small fortunes for the privilege.
The social care element is being looked at now by the gov but they should have addressed this before we got to this stage.
Drs need to start seeing patients again in person much more.
A review (and actions implemented) of recruitment, training and fair pay needs to happen fast. We need to import skilled people rather than lose them abroad which will happen in ever greater numbers
There is of course a need to look at how the NHS operates and reform this but I can’t see this changing any time soon.
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