NHS whats happened?
Discussion
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.
Yes and not just this as there were changes in working practices during the pandemic as well, E.g. GPs.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.
In my view the NHS is rather poor and is the envy only of those countries not rich enough to have a proper health system. However it seems to be in virtual collapse due to the pandemic, and the response to that pandemic, without that it would have probably kept muddling along being a bit rubbish.
Previous said:
What hasn't happened to it?
Poor management;
Poor procurement policy;
Poor procurement even within policy;
Aging population;
Growth in types of ailments its expected to fix;
Wider awareness of mental health (and expectations to treat);
Lower mental health funding;
Lower social care funding meaning beds taken up unnecessarily;
General public apathy;
Lack of public differentiation between free and free at point of use;
People attending when they don't really need to;
People calling ambulances when they don't need to;
Aging workforce for experienced GP's;
Lack of funding for dental issues;
Low pay;
Poor staff retention (better pay elsewhere when qualified);
Lack of access to staff (redued immigration);
Inefficiency due to overzealous bureaucracy;
Poor IT and adoption of Meditech at pace and scale;
Aging hospitals and increased maintenance costs;
Expensive PFI service costs;
Health tourism and a reluctance to fix;
Political interference of all kinds;
Each a complex issue in itself. Collectively...
I'm surprised it works as well as it does.
Yep, there is no one problem that if solved will fix it. Some think that the solution is to just throw money at it but that'll only make the problems worse long term as it's just papering over the cracks. Poor management;
Poor procurement policy;
Poor procurement even within policy;
Aging population;
Growth in types of ailments its expected to fix;
Wider awareness of mental health (and expectations to treat);
Lower mental health funding;
Lower social care funding meaning beds taken up unnecessarily;
General public apathy;
Lack of public differentiation between free and free at point of use;
People attending when they don't really need to;
People calling ambulances when they don't need to;
Aging workforce for experienced GP's;
Lack of funding for dental issues;
Low pay;
Poor staff retention (better pay elsewhere when qualified);
Lack of access to staff (redued immigration);
Inefficiency due to overzealous bureaucracy;
Poor IT and adoption of Meditech at pace and scale;
Aging hospitals and increased maintenance costs;
Expensive PFI service costs;
Health tourism and a reluctance to fix;
Political interference of all kinds;
Each a complex issue in itself. Collectively...
I'm surprised it works as well as it does.
Edited by Previous on Friday 13th January 01:05
Klippie said:
The problem is with GP's...its widly reported that tyring to get a GP appointment is along the same odd's as winning the lottery, people can't get to see a doctor the next port of call is a hospital.
These stuck up cretins need to be taken down a peg or two, they are hired to provide a service not to dictate why they should not be seeing patients, they are no different to any other employee and should be treated no differently.
LOL. If you went into a pub with that attitude you would get barred pretty fast. Why should doctors have to put up with your bullsThese stuck up cretins need to be taken down a peg or two, they are hired to provide a service not to dictate why they should not be seeing patients, they are no different to any other employee and should be treated no differently.
t?BobToc said:
I agree with that, although money is part of the solution.
I agree with you that money is part of the solution, but how much, over what period and spent on what? I've not seen anyone actually define that.Most people, including myself, would like a 'Free at point of use' health service but as has already been mentioned, we need to decide what level of service should be provided, how much it is going to cost and how it is to be paid for.
As a suggestion, perhaps, like NHS dentistry, we should all pay a fixed fee for certain services? However, that would probably be a political non-starter.
bobbo89 said:
Oh aye definitely but the way things are right now any sum of money will just get pissed away and not result in any long term changes.
Maybe, but it’s very hard to see how social care capacity can be increased to get otherwise well people out of acute beds without spending.Puddenchucker said:
I agree with you that money is part of the solution, but how much, over what period and spent on what? I've not seen anyone actually define that.
Most people, including myself, would like a 'Free at point of use' health service but as has already been mentioned, we need to decide what level of service should be provided, how much it is going to cost and how it is to be paid for.
As a suggestion, perhaps, like NHS dentistry, we should all pay a fixed fee for certain services? However, that would probably be a political non-starter.
Dentistry is a particularly difficult problem but as a general observation I don’t think excessive provision of care is the issue.Most people, including myself, would like a 'Free at point of use' health service but as has already been mentioned, we need to decide what level of service should be provided, how much it is going to cost and how it is to be paid for.
As a suggestion, perhaps, like NHS dentistry, we should all pay a fixed fee for certain services? However, that would probably be a political non-starter.
I don't think it helps that you get thickos rolling up to A & E and wasting time/resources in there.
I took my dad recently and he and 2 other patients were called for x-rays. One of the others went in and dad and the other were waiting. Anyway the thicko waiting with my dad decided that after 5 mins or so, actually she'd just wander back to A & E. The X Ray nurse of course then called for her.
Back in A & E she happened to sit next to me and I pointed out that they were waiting for her. She looked at me surprised and said "really?". FFS you thick cow. She was a complete chavvy muppet.
I took my dad recently and he and 2 other patients were called for x-rays. One of the others went in and dad and the other were waiting. Anyway the thicko waiting with my dad decided that after 5 mins or so, actually she'd just wander back to A & E. The X Ray nurse of course then called for her.
Back in A & E she happened to sit next to me and I pointed out that they were waiting for her. She looked at me surprised and said "really?". FFS you thick cow. She was a complete chavvy muppet.
Rufus Stone said:
The tax payer should not be picking up the tab for adult social care. People have a lifetime to prepare for meeting the cost of any assistance they need because they are old and infirm.
My local MP is currently raging against the allocation of money for rural counties like ours (Shrops). She has stated that 75% of the local govt budget is spent on social care!RichB said:
ost GPs in our area are still 'working from home'. WTF 
Same here. In our local surgery there used to be at least 6 doctors and 3 nurses working at the same time. Now there is 1 doctor and 1 nurse, if you are lucky. I was in recently to see the nurse and she said she had had to take her own bloods that morning, as there was no one else qualified to do it in the building.From the FT:
Seemingly there are about 70,000 free beds in the care sector, according to data from property consultancy Knight Frank, far more than the 13,000 patients waiting for discharge.
Social Care has been neglected for years, and this is now backing into the NHS.
The UK is number 37 on the list of hospital beds per head of population, and it has been falling since 2014
https://en.wikipedia.org/wiki/List_of_countries_by...
Capital spending has been dead in the NHS for 10 years, and so everything is old
Brexit has blocked the use of Doctors and Nurses from the EU working in the NHS
Basically the NHS has been run down into the ground for the last 10 years, and we are now seeing the results of this.....
Seemingly there are about 70,000 free beds in the care sector, according to data from property consultancy Knight Frank, far more than the 13,000 patients waiting for discharge.
Social Care has been neglected for years, and this is now backing into the NHS.
The UK is number 37 on the list of hospital beds per head of population, and it has been falling since 2014
https://en.wikipedia.org/wiki/List_of_countries_by...
Capital spending has been dead in the NHS for 10 years, and so everything is old
Brexit has blocked the use of Doctors and Nurses from the EU working in the NHS
Basically the NHS has been run down into the ground for the last 10 years, and we are now seeing the results of this.....
heisthegaffer said:
I don't think it helps that you get thickos rolling up to A & E and wasting time/resources in there.
There’s a few thickos rolling up at A+E but there’s also too many who could be treated in a primary care setting but aren’t able to access that until their situation deteriorates and they turn up at the door of an acute hospital.Thin White Duke said:
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.
Plus the A&E at Accrington Victoria and the minor injuries unit at Clitheroe Hospital at a time when the population of the Ribble Valley has increased by almost 10%, BWD 7%, Burnley 9% and Pendle 8% btwn census 2011 & 2021It 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.
As you say, massive increase in population and big reduction in availability of care. They closed the A&E at Chorley in 2016 but were forced to reopen it in 2021 as the demand from the area was overwhelming RBH and Preston Royal
Brainpox said:
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?
So pensioners need to pay NI.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
Then build pensioner hospitals which can clear out hospitals for accidents/body faults sorts of stuff.
NI based on BMI.
Stop providing free care for heavily drunk people.
To give balance to Ops sample size of one:
Fell off my bike , wrist hurt, presumed I broke it, but lived in denial a few days , after 3 days popped to local Swindon hospital
Brand new urgent care section, very nice , new seats, free wifi, was nice not having to sit on top of people like in the past
Nurse on the door, telling people to rest at home or go to pharmacy, or go to casualty as lots of people seemed to turn up at urgent care when it was not the best option
Triarge'd in 20 mins - lovely nurse
2 hour wait - told I needed x ray
20 minute wait for xray
another hour ish wait
Saw nurse (practitioner) who informed me of my break, gave me a splint , let me take photos of xray and off I went on my merry way, as I would be intending a "virtual fracture clinic"
Next day had a call from fracture consultants secretary, she told me all the specifics , what to do next and relayed any questions I had
TBH great treatment and well organised
I work in business systems, IT and workflow and bloody hell the NHS have a job on their hands keeping everything working, I wouldn't fancy it!
I'm under no illusion that the NHS is struggling, but surely the Government should Govern ius and not piss around with Brexit pipe dreams, lawbreaking and generally being st
Here is a alternative argument - The NHS is too good, its keeping people alive very long and therefore placing too much pressure on itself
Furthermore :
Social care is crippled , broken and gone - people don't want to look after relatives - "Thats for the NHS & Council" - its causing huge backlogs
Lots of peoples lifestyles are st, no exercise, st processed diets and then need their hand held by the NHS for the last 30 years of their life
Mental health support systems are gone - thanks Tories
Cant fill NHS roles - huge recruitment crisis - nurse bursaries gone (they were bloody good) & brexit have compounded this.
Ultimately we need a Government who can govern and after 10+ years of the Tories, they simply haven't governed very well
Fell off my bike , wrist hurt, presumed I broke it, but lived in denial a few days , after 3 days popped to local Swindon hospital
Brand new urgent care section, very nice , new seats, free wifi, was nice not having to sit on top of people like in the past
Nurse on the door, telling people to rest at home or go to pharmacy, or go to casualty as lots of people seemed to turn up at urgent care when it was not the best option
Triarge'd in 20 mins - lovely nurse
2 hour wait - told I needed x ray
20 minute wait for xray
another hour ish wait
Saw nurse (practitioner) who informed me of my break, gave me a splint , let me take photos of xray and off I went on my merry way, as I would be intending a "virtual fracture clinic"
Next day had a call from fracture consultants secretary, she told me all the specifics , what to do next and relayed any questions I had
TBH great treatment and well organised
I work in business systems, IT and workflow and bloody hell the NHS have a job on their hands keeping everything working, I wouldn't fancy it!
I'm under no illusion that the NHS is struggling, but surely the Government should Govern ius and not piss around with Brexit pipe dreams, lawbreaking and generally being s
tHere is a alternative argument - The NHS is too good, its keeping people alive very long and therefore placing too much pressure on itself
Furthermore :
Social care is crippled , broken and gone - people don't want to look after relatives - "Thats for the NHS & Council" - its causing huge backlogs
Lots of peoples lifestyles are s
t, no exercise, st processed diets and then need their hand held by the NHS for the last 30 years of their lifeMental health support systems are gone - thanks Tories
Cant fill NHS roles - huge recruitment crisis - nurse bursaries gone (they were bloody good) & brexit have compounded this.
Ultimately we need a Government who can govern and after 10+ years of the Tories, they simply haven't governed very well
Mr Whippy said:
So pensioners need to pay NI.
Then build pensioner hospitals which can clear out hospitals for accidents/body faults sorts of stuff.
NI based on BMI.
Stop providing free care for heavily drunk people.
What about free care for:Then build pensioner hospitals which can clear out hospitals for accidents/body faults sorts of stuff.
NI based on BMI.
Stop providing free care for heavily drunk people.
diabetics due to excess weight?
heart disease to unhealthy lifestyle?
sports injuries?
RTC injuries (free at the point of care but insurance pays up eventually)
Its an easy thing to pluck out of the air to say make drunks pay but there are swaths of people in A&E who if they did something differently wouldnt be in A&E and same goes for drunks. Also there is the ethical principle of rinsing someone who at that time does not have the capacity to consent as well. Queue the no win no fee lawyers taking hospitals through small claims.
Its not an easy fix but the simplest way is just to get medically fit patients out of hospital into care settings or home with care packages. the difficulty is the NHS are not responsible for this service but are bearing the brunt of the problem. IN my trust we currently have 22% (as of yesterday) capacity taken up by patients waiting to be discharged who do not need to be in a hospital bed. That number is one third of the daily A&E attendees
DBSV8 said:
LivLL said:
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.
once it arrived at hospital is where the problem arose
he was then sat outside the hospital in the ambulance for 14 1/2 hrs which seems a waste of resources
Very unpleasant break, seen one first hand. The leg muscles no longer have the femur holding the leg straight so they slowly contract, "folding " the leg up. Someone has to (carefully) pull it straight at some point, making sure to avoid the artery. I have never heard an adult man scream so much in my life when they did it in the back of the ambulance, and he was on gas and air!
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