NHS whats happened?
Discussion
The amount of money in has not kept up with the money needed. Coupled with stupid budgeting rules and the horrendous PFI deals.
The NHS is very efficient in terms of outcomes vs spend when compared to other countries. But it's been close to breaking down for years now. I saw it even 5 years ago when I did some radiotherapy work - the system was only 'working' because it was propped up by staff doing lots of unpaid overtime to make sure patients got their treatment on time. It had gone from something people did rarely when there was an unexpected demand surge, to something they had to do all the time just to keep the service running.
The NHS is very efficient in terms of outcomes vs spend when compared to other countries. But it's been close to breaking down for years now. I saw it even 5 years ago when I did some radiotherapy work - the system was only 'working' because it was propped up by staff doing lots of unpaid overtime to make sure patients got their treatment on time. It had gone from something people did rarely when there was an unexpected demand surge, to something they had to do all the time just to keep the service running.
pavarotti1980 said:
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
Elysium said:
I spent 12 hours in A&E waiting for help about 25 years ago.
Cut to my hand with tendons visible and stitches needed.
In the end they sent me home and told me to come back for an appointment the following day. Guy who stitched me up was pissed off. He said he had been quiet all day, I got stuck because the triage people were too busy to refer me to him.
The NHS has been broken for decades.
That seems to be a glitch in the system. See a receptionist I need someone to sew up my hand. Wait to see a triage nurse who will say you need someone to sew up your hand, wait to see the person to sew up your hand. Surely some could go straight through. Cut to my hand with tendons visible and stitches needed.
In the end they sent me home and told me to come back for an appointment the following day. Guy who stitched me up was pissed off. He said he had been quiet all day, I got stuck because the triage people were too busy to refer me to him.
The NHS has been broken for decades.
I think the overall problem is thinking that the NHS is a monolith. It is not, it is a myriad of small business units that need a certain level of coordination.
On that snowy weekend just before Christmas, my wife injured her knee. Google suggested it could be serious and she should call 111. Their queue was so long they said speak to GP, or pharmacy. Our GP had stopped taking calls, though normally they are excellent. The BBC News was saying A&Es everywhere were in despair. NHS Direct said if the joint cannot bear weight, you must attend A&E
So we decided to set the alarm clock for 6:30 for Saturday morning with a view to being near the front of any queue. We arrived at our nearest hospital about 7:30am. Poor signage led us to the wrong entrance, where a doctor saw our predicament, told me where to get a wheelchair and led us to where we needed to be. On the way, there were 3-patients on beds in the corridor, and one guy with his arm in a sling, massive bruises and obviously in pain. His wife was sleeping across some chairs, clearly they had been there a long time. Our hearts began to sink.
At A&E reception there was no queue, but no triage nurse either. The second arrivals were a young family who were very concerned that their twin-girls had Step-A.
At about 7:50 a male nurse flounced into reception announcing that he was off, he had “already done his 16-hours”. I feel certain that H&S in most technical organisation would not allow someone to tend machines for such long shifts. The woman on reception replied that he should quit and work through an agency.
At 8:00 sharp, the triage nurse arrived, she then spent 10-mins cleaning her room. A cleaner had been cleaning the reception area so why she did not clean is hard to understand. We saw the triage nurse, who wrote a few notes and told us to wait with the guy with the bust shoulder. No mention of what expect next.
While waiting it became clear that there were two ambulances waiting outside. However everything seemed very calm, staff calmly walking back and forth as paperwork was needed from the triage nurse. Not sure why paper records do not travel with the patient, or are transmitted electronically.
At about 8:40 a very pleasant woman called us having got the paperwork. The guy with the bust shoulder was obviously in a different pathway. The kids with Strep-A went to see the out of-hours GP. I don't think she was a doctor but perfectly capable of making an assessment. We asked her why nurses were working 16-hour shifts, its because it suits them, they rack up a lot of hours in 3-days and then get 4-days off. After a quick checkover we were sent to X-Ray, dealt with immediately - no queue - and returned to the senior nurse who already had a new pair of crutches waiting. She checked the X-Ray, no bone damage - a ligament issue that would cure over time. She demonstrated how to use the crutches and we were done. She explained that someone would contact us on Monday, no one did.
By New Year my wife was walking normally and no longer needed the crutches, no mention if they should be returned somehow, so we made a special trip. “Just put them in that box over there” A huge box full of nearly-new crutches. I don't think they get re-cycled - perhaps just scrapped.
From this brief experience, I suspect that doctors and nurses are probably not overworked, just genuinely tired from long hours. The queue starts by attempting to triage. It not a field hospital the receptionist could point most people where to go. But queues seem to be odd, we would love to know why the guy with the bust shoulder was not being dealt with as a greater priority.
My experience in France was that if you went to A&E the first available nurse spoke to you and decided the process, Doctor, X-ray etc. I also had a heart ablation, paid for by their system but in a clinic specialising in routine heart operations, on a medical village away from the main hospital that did routine operations like hip replacement, cataract surgery, dermatology etc. They work a basic 35-hour week and so shift changes overlap and the service is continuous without disruption to the main hospital.
I also had Cardioversion at a private clinic while on holiday in Spain. This cost €1800 and involved two cardiac specialists an anaesthetist and a nurse. It seemed very good value for the cost compared to seeing one cardiologist in the UK costs £250 for 20-mins with no ECG. Spain cost €159 with a room full of specialist equipment and a nurse present. In France it is €59 but that has to be subsidised in some way.
My feeling is that fixing the NHS is a distant dream for any government. It has to be down to individual units to fix their own problems. But the only solution that they can see is that more money will fix it.
As an aside a friend is a volunteer first responder for his village in Devon. In the week of the ambulance strike he attended about 100 calls, on the day of the strike he attended 9, of which only one actually required an ambulance, the rest could journey by car, or taxi.
On that snowy weekend just before Christmas, my wife injured her knee. Google suggested it could be serious and she should call 111. Their queue was so long they said speak to GP, or pharmacy. Our GP had stopped taking calls, though normally they are excellent. The BBC News was saying A&Es everywhere were in despair. NHS Direct said if the joint cannot bear weight, you must attend A&E
So we decided to set the alarm clock for 6:30 for Saturday morning with a view to being near the front of any queue. We arrived at our nearest hospital about 7:30am. Poor signage led us to the wrong entrance, where a doctor saw our predicament, told me where to get a wheelchair and led us to where we needed to be. On the way, there were 3-patients on beds in the corridor, and one guy with his arm in a sling, massive bruises and obviously in pain. His wife was sleeping across some chairs, clearly they had been there a long time. Our hearts began to sink.
At A&E reception there was no queue, but no triage nurse either. The second arrivals were a young family who were very concerned that their twin-girls had Step-A.
At about 7:50 a male nurse flounced into reception announcing that he was off, he had “already done his 16-hours”. I feel certain that H&S in most technical organisation would not allow someone to tend machines for such long shifts. The woman on reception replied that he should quit and work through an agency.
At 8:00 sharp, the triage nurse arrived, she then spent 10-mins cleaning her room. A cleaner had been cleaning the reception area so why she did not clean is hard to understand. We saw the triage nurse, who wrote a few notes and told us to wait with the guy with the bust shoulder. No mention of what expect next.
While waiting it became clear that there were two ambulances waiting outside. However everything seemed very calm, staff calmly walking back and forth as paperwork was needed from the triage nurse. Not sure why paper records do not travel with the patient, or are transmitted electronically.
At about 8:40 a very pleasant woman called us having got the paperwork. The guy with the bust shoulder was obviously in a different pathway. The kids with Strep-A went to see the out of-hours GP. I don't think she was a doctor but perfectly capable of making an assessment. We asked her why nurses were working 16-hour shifts, its because it suits them, they rack up a lot of hours in 3-days and then get 4-days off. After a quick checkover we were sent to X-Ray, dealt with immediately - no queue - and returned to the senior nurse who already had a new pair of crutches waiting. She checked the X-Ray, no bone damage - a ligament issue that would cure over time. She demonstrated how to use the crutches and we were done. She explained that someone would contact us on Monday, no one did.
By New Year my wife was walking normally and no longer needed the crutches, no mention if they should be returned somehow, so we made a special trip. “Just put them in that box over there” A huge box full of nearly-new crutches. I don't think they get re-cycled - perhaps just scrapped.
From this brief experience, I suspect that doctors and nurses are probably not overworked, just genuinely tired from long hours. The queue starts by attempting to triage. It not a field hospital the receptionist could point most people where to go. But queues seem to be odd, we would love to know why the guy with the bust shoulder was not being dealt with as a greater priority.
My experience in France was that if you went to A&E the first available nurse spoke to you and decided the process, Doctor, X-ray etc. I also had a heart ablation, paid for by their system but in a clinic specialising in routine heart operations, on a medical village away from the main hospital that did routine operations like hip replacement, cataract surgery, dermatology etc. They work a basic 35-hour week and so shift changes overlap and the service is continuous without disruption to the main hospital.
I also had Cardioversion at a private clinic while on holiday in Spain. This cost €1800 and involved two cardiac specialists an anaesthetist and a nurse. It seemed very good value for the cost compared to seeing one cardiologist in the UK costs £250 for 20-mins with no ECG. Spain cost €159 with a room full of specialist equipment and a nurse present. In France it is €59 but that has to be subsidised in some way.
My feeling is that fixing the NHS is a distant dream for any government. It has to be down to individual units to fix their own problems. But the only solution that they can see is that more money will fix it.
As an aside a friend is a volunteer first responder for his village in Devon. In the week of the ambulance strike he attended about 100 calls, on the day of the strike he attended 9, of which only one actually required an ambulance, the rest could journey by car, or taxi.
I find the inefficiencies somewhat infuriating.
My son broken his arm last autumn, so we had numerous appointments at the fracture clinic. We’d get to the clinic in advance of our appointment time and be put in the waiting room, usually for about half an hour. Then they’d always say they needed new X-rays in order to check the arm, so they’d send us off to the X-ray dept, which obviously required a wait because it’s on spec. So we’d wait there for 30 minutes to an hour to get some X-rays, then back to the fracture clinic to actually be review. By which time other people would be having their appointments so we’d have another wait until the consultant had a moment free.
Now, given they already knew we needed X-rays before we even turned up, why aren’t people scheduled for an X-ray first, and then a fracture clinic consultation? Multiply that inefficient process by thousands of appointments and we start to see why it’s such a s
tshow.
My son broken his arm last autumn, so we had numerous appointments at the fracture clinic. We’d get to the clinic in advance of our appointment time and be put in the waiting room, usually for about half an hour. Then they’d always say they needed new X-rays in order to check the arm, so they’d send us off to the X-ray dept, which obviously required a wait because it’s on spec. So we’d wait there for 30 minutes to an hour to get some X-rays, then back to the fracture clinic to actually be review. By which time other people would be having their appointments so we’d have another wait until the consultant had a moment free.
Now, given they already knew we needed X-rays before we even turned up, why aren’t people scheduled for an X-ray first, and then a fracture clinic consultation? Multiply that inefficient process by thousands of appointments and we start to see why it’s such a s
tshow. CAH706 said:
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.
Agree with much of that. 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.
Automation only works if it serves a patient need. Sounds obvious, but by way of example, my GP SMSs me now and then asking for my blood pressure. I routinely enter a horrendous value and guess what happens? Nothing. That activity will have had a huge cost to it. What value is being created?
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.
Not sure if that's satire or not, but the BMA and the European Union of General Practitioners say a safe number of patient contacts per day is 25. Across the board GPs deal with getting on with double that. Fundamentally we need more GPs not an attitude readjustment (well, maybe the great unwashed could start taking some responsibility).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.
pavarotti1980 said:
oyster said:
And where's the money coming from to boost the care sector?
Well the NI uplift for NHS and adult social care was scrapped so they will have to look down the back of the sofa apparently. Plus the £750m announced by the PM this week for this exact scenarioNtv said:
The money should come from phasing in NICs for the retired population, recognising they essentially get a huge and unwarranted income tax reduction right now, and that they are the biggest consumers of the areas of healthcare with rapidly increasing costs.
So what did their NI contributions pay for when they were working when they were likely to be non-users of the service?I always thought the current generation of pensioners are funded by the next generation(s) and then the cycle goes again. WHich is why the NI increase u-turn was a bad idea. Also dont forget that there was an adult social care uplift in council tax as well but HMG have just bent local authorities over a barrel to the point 75% of their budget is social care costs.
pavarotti1980 said:
Ntv said:
The money should come from phasing in NICs for the retired population, recognising they essentially get a huge and unwarranted income tax reduction right now, and that they are the biggest consumers of the areas of healthcare with rapidly increasing costs.
So what did their NI contributions pay for when they were working when they were likely to be non-users of the service?Taxes have gone up generally, though have gone up less for the retired population than rest of the population, despite them being the big consumers of the services that increased revenue is needed for.
Why should there be a huge (effective) income tax reduction on retirement?
I do agree it needs to be phased in, as the differential is so vast.
Boringvolvodriver said:
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?
My Great Grandad worked at a company called Mather and Platts in Manchester in the 1930's, he fell off a scaffold and nearly died as nobody noticed him, not from his injuries per se (which were life changing) but the fact there was snow on the ground and he was there hours before anyone noticed.
I think we all need to be mindful of the pressure the NHS is under, and I know most medical emergencies are unavoidable, but plenty are. I know nobody wants to injure themselves but at the moment I would err on the side of caution unless you want to sit in a corridor for hours.
So, maybe dont go out on your bike if its a bit icy, defer jobs involving ladders, dont get absolutely s
tfaced, watch where the dog is when using the stairs (dominate them if necessary), keep your speed down when driving, etc etc. Just think about everything you do and what the risks are, sounds time consuming but a few seconds vs hours in casualty putting extra pressure on the NHS which is on the ropes.Watch me have an accident now I said all that
hairykrishna said:
The amount of money in has not kept up with the money needed. Coupled with stupid budgeting rules and the horrendous PFI deals.
The NHS is very efficient in terms of outcomes vs spend when compared to other countries. But it's been close to breaking down for years now. I saw it even 5 years ago when I did some radiotherapy work - the system was only 'working' because it was propped up by staff doing lots of unpaid overtime to make sure patients got their treatment on time. It had gone from something people did rarely when there was an unexpected demand surge, to something they had to do all the time just to keep the service running.
On one hand we seem to want an efficient NHS, and pumping more money into it seems like a waste of time and we should just "make it efficient". On the other hand we have people being sick and needing treatment, and they can't get it. Can't have it both ways.The NHS is very efficient in terms of outcomes vs spend when compared to other countries. But it's been close to breaking down for years now. I saw it even 5 years ago when I did some radiotherapy work - the system was only 'working' because it was propped up by staff doing lots of unpaid overtime to make sure patients got their treatment on time. It had gone from something people did rarely when there was an unexpected demand surge, to something they had to do all the time just to keep the service running.
What is the short term (i.e. now) plan - so that people can get adequate treatment, and the plan for the future? What we can't do is just talk about "making it more efficient" when that could take generations.
NHS faced bed blocking issues before 2020 due to care worker shortages. Sajid mandated covid jabs for care workers so many decided their minimum wage job wasn’t worth the risk so walked away. End result is even fewer care workers.
Due to fewer care workers, there are fewer care packages available. Result is patients cannot be discharged from wards. If patients cannot be discharged from wards, A&E is unable to move patients out for long term care. Result is that A&E becomes both a ward and an emergency unit.
Because A&E is now over capacity and severely understaffed (why work in A&E when you can earn the same doing less on a ward), there are no spaces to offload patients. Result is that Ambulances are now blocked and unable to be used for call-outs as they’re now a cubicle.
On top of this you have people who’ve missed appointments over the past few years, people who’ve missed treatment etc. an increasing number of elderly in the population who are more susceptible to illnesses or damage from falls. Then you have people abusing it for a free bed, to get rid of relatives for a week, to get free morphine, family day out for a paper cut etc
Add it all up and you have a health service that’s screwed and easily overwhelmed.
Due to fewer care workers, there are fewer care packages available. Result is patients cannot be discharged from wards. If patients cannot be discharged from wards, A&E is unable to move patients out for long term care. Result is that A&E becomes both a ward and an emergency unit.
Because A&E is now over capacity and severely understaffed (why work in A&E when you can earn the same doing less on a ward), there are no spaces to offload patients. Result is that Ambulances are now blocked and unable to be used for call-outs as they’re now a cubicle.
On top of this you have people who’ve missed appointments over the past few years, people who’ve missed treatment etc. an increasing number of elderly in the population who are more susceptible to illnesses or damage from falls. Then you have people abusing it for a free bed, to get rid of relatives for a week, to get free morphine, family day out for a paper cut etc
Add it all up and you have a health service that’s screwed and easily overwhelmed.
Brainpox said:
The problem starts in social care.
On the subject of social care - did Boris' grand social care plans actually have anything to do with the quality or availability of social care? The driver always seemed to be placing a cap (86k) on personal contributions, with the rest coming out of the public purse. In other words the main policy goal was to preserve inheritances, which very much appeals to many tory voters. IMHO there's simply no justification for social care coming out of the public purse while an inheritance is preserved and ring-fenced for the beneficiaries.Ntv said:
Paid for a smaller state and smaller health service.
Taxes have gone up generally, though have gone up less for the retired population than rest of the population, despite them being the big consumers of the services that increased revenue is needed for.
Why should there be a huge (effective) income tax reduction on retirement?
I do agree it needs to be phased in, as the differential is so vast.
Larger state currently paying for larger health serviceTaxes have gone up generally, though have gone up less for the retired population than rest of the population, despite them being the big consumers of the services that increased revenue is needed for.
Why should there be a huge (effective) income tax reduction on retirement?
I do agree it needs to be phased in, as the differential is so vast.
Income tax reduction due to income reduction dropping them below taxation thresholds. Same as a working person receiving the lower levels of income.
Olivera said:
Brainpox said:
The problem starts in social care.
On the subject of social care - did Boris' grand social care plans actually have anything to do with the quality or availability of social care? The driver always seemed to be placing a cap (86k) on personal contributions, with the rest coming out of the public purse. In other words the main policy goal was to preserve inheritances, which very much appeals to many tory voters. IMHO there's simply no justification for social care coming out of the public purse while an inheritance is preserved and ring-fenced for the beneficiaries.The problem with many proposals to "reform" the system is that they seem more concerned with protecting the assets of the wealthy.
JagLover said:
Agreed
The problem with many proposals to "reform" the system is that they seem more concerned with protecting the assets of the wealthy.
There is a different angle to the elderly social care funding issue though which does deserve a proper discussion.The problem with many proposals to "reform" the system is that they seem more concerned with protecting the assets of the wealthy.
Why should someone who takes a year or so to die of cancer be fully funded but someone who takes a year to die of dementia has to pay for it all themselves?
I personally think there is something wrong here with the current implementation that Boris was attempting to fix - it wasn’t about preserving inheritances…
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