NHS Crisis? What Crisis?

[sparky88]

The NHS is like Aldis, you can get everything you need there, it's fine etc. But if you want to get served a bit quicker (I.e not wait for three hours for a maternity appointment because the docs were dealing with emergencies) then you can go to Waitrose i.e. Private. 

[Jambomo]

I was looking at Private Health insurance. One thing I noticed is that they don't cover chronic illness which actually could cover quite a large area of illnesses. Imagine paying all those premium's (and at £50-odd quid a month its not cheap) and then have them say you aren't covered when you are ill. Insurance is a total scam anyway, imagine wanting to base your chances of survival on some computer somewhere saying you are/aren't covered.

[Fide]

57 minutes ago, sparky88 said:

The NHS is like Aldis, you can get everything you need there, it's fine etc. But if you want to get served a bit quicker (I.e not wait for three hours for a maternity appointment because the docs were dealing with emergencies) then you can go to Waitrose i.e. Private. 

Not necessarily true. 

I've just had the all clear for cancer.  I was dealt with amazingly quick, all on the NHS.  From diagnosis, to surgery to chemo, to all clear, super fast.  I can't speak highly enough of them.

[DublinMagyar]

NHS is brilliant at the real serious stuff. Crap at the day to day mundane. Mostly because patients are fucking imbeciles.

[Wee Willie]

19 minutes ago, Fide said:

Not necessarily true. 

I've just had the all clear for cancer.  I was dealt with amazingly quick, all on the NHS.  From diagnosis, to surgery to chemo, to all clear, super fast.  I can't speak highly enough of them.

well done

[McSpreader]

On 27/01/2017 at 18:07, welshbairn said:

My only disappointment with the NHS (excellent experience otherwise) was when my Dad broke his shoulder and nowhere in Inverness had a bed free. There's a community hospital a few hundred yards away that would have been perfect. Not their fault, but he had to go to a village hospital about 40 miles away. Not that bad again, but the staff seemed to have no idea how to look after a very old man with dementia, which is surprising given all the bed blocking you hear about. They didn't know that they had to show him a few times where the toilet was so he could find it himself, instead they put him in a nappy and caged his bed so he wouldn't go wandering about. Of course he didn't have a clue what to do when he needed a pish so he pulled up the nappy and tried to pish over the side of the bed. It took him a week or so when he came home to stop being incontinent. All the staff were very kind and well meaning, and perhaps they didn't have enough time to deal with him properly, but I was surprised they seemed so inexperienced.

That's an excellent point re: dementia patients in general wards.

What you have to realise is that caring for dementia patients is a specialism that the vast majority of general or acute nurses do not have any experience of. 

Dementia patients have a tendency to fall and harm themselves, get confused or angry/upset very easily.

If a dementia patient has hurt him herself whilst in a specialist dementia  unit and is then sent across to a general ward  it can be very difficult for the dementia ward to spare a dementia nurse to stay with him and the general nurses struggle to cope......it's a major area of concern.

 

With regard to the NHS in general, yes it's brilliant and as my partner works for the NHS I know the dedication of the staff.....however.....too much time and money spent on form filling and ticking boxes, at least 9 (Nine) levels of management grades.....draconian management culture of fear, bullying and pressure to save money ...which means low or no pay rises for nurses but big bucks for management.

Inefficiencies are endemic within the NHS and simply asking for more money isnt the answer. A root and brand structural deconstruction of the NHS is what is needed. Get back to basics....Trust the nurses and the doctors who are at the coal face to apply best practice, Empower matrons to provide credible professional leadership and NOT corporate management responsibilities. Smash the drug cartels that profit disproportionately from supplying the NHS.....Stop the Health Tourism fiasco.......Run a 24/7 system  for hospitals and a 16/7 for  local GP's surgeries

So NHS amazing....Staff amazing, as long as they don't go on strike , but much improvement possible

[Wee Willie]

32 minutes ago, McSpreader said:

That's an excellent point re: dementia patients in general wards.

What you have to realise is that caring for dementia patients is a specialism that the vast majority of general or acute nurses do not have any experience of. 

Dementia patients have a tendency to fall and harm themselves, get confused or angry/upset very easily.

If a dementia patient has hurt him herself whilst in a specialist dementia  unit and is then sent across to a general ward  it can be very difficult for the dementia ward to spare a dementia nurse to stay with him and the general nurses struggle to cope......it's a major area of concern.

 

With regard to the NHS in general, yes it's brilliant and as my partner works for the NHS I know the dedication of the staff.....however.....too much time and money spent on form filling and ticking boxes, at least 9 (Nine) levels of management grades.....draconian management culture of fear, bullying and pressure to save money ...which means low or no pay rises for nurses but big bucks for management.

Inefficiencies are endemic within the NHS and simply asking for more money isnt the answer. A root and brand structural deconstruction of the NHS is what is needed. Get back to basics....Trust the nurses and the doctors who are at the coal face to apply best practice, Empower matrons to provide credible professional leadership and NOT corporate management responsibilities. Smash the drug cartels that profit disproportionately from supplying the NHS.....Stop the Health Tourism fiasco.......Run a 24/7 system  for hospitals and a 16/7 for  local GP's surgeries

So NHS amazing....Staff amazing, as long as they don't go on strike , but much improvement possible

It's no often I agree with ye but well said.

[RedRob72]

Commentary on the news tonight, stating again how much lower our % spend of GDP on Healthcare is than Germany and France for example. The difference being that around 97% of our spend comes from the public purse, whereas private insurance covers a much higher % of healthcare provision in neighbouring countries of a similar size (population and economy). We either change the model or stop using this as a misleading comparison.

[Cyclizine]

For once, I do agree with some of what you say, however...

2 hours ago, McSpreader said:

... smash the drug cartels that profit disproportionately from supplying the NHS

Where would you like us to get our drugs from? To be honest, the majority of drugs used are old and generic and therefore fairly cheap. Drug development is an expensive business. I'm not one for pretending drug companies are nice, fuzzy, friendly companies, but they're not charities either. They get 15 years exclusivity on new drugs.

Quote

...stop the Health Tourism fiasco

It's a total drop in the ocean - a useful deflection for the real issue of underfunded health and social care: "blame the immigrants". I don't have Scottish figures, but England 'health tourist' cost was ~£200m in 2015 (approximately ~£75m was ex-pats coming back!). England's health budget is £116 billion, so <0.2% of the budget.

Quote

...run a 24/7 system  for hospitals

What exactly do you mean  by this? Do you mean I wasn't actually supposed to be working nights over Hogmanay? Hospitals are and have always been open all the time for emergency care. The deliberate muddying of waters by conflating emergency and elective care was part of Hunt's strategy against the junior doctors.

Quote

...a 16/7 for  local GP's surgeries

Eh? You mean 0800-0000 or 0600-2200 all week? Or 24h Mon-Fri? I'm not sure what you'd expect this to achieve other than more burnt out GPs. There's the slight issue of where do these GPs come from as well...

And since you brought up pay... it's not as if it's a secret: Doctors and dentists and all other NHS staff.

[Cyclizine]

3 minutes ago, RedRob72 said:

Commentary on the news tonight, stating again how much lower our % spend of GDP on Healthcare is than Germany and France for example. The difference being that around 97% of our spend comes from the public purse, whereas private insurance covers a much higher % of healthcare provision in neighbouring countries of a similar size (population and economy). We either change the model or stop using this as a misleading comparison.

But does it really matter if you're spending £x / year on health insurance or being taxed £x / year into the health budget? You're still £x down.

If you want an insurance system, then how do you want it to run? Can the insurance companies exclude pre-existing conditions? Can they refuse to renew your cover? Can they increase your premium if you develop a new and interesting disease? Because if they can't, then the premiums will be extortionate and if they can, then just pray it doesn't happen to you.

On the other hand, a population based model, where the risk is spread across everyone, I think is fairest. Yes, you could do this through 'insurance' but it's just as easy to lop it off as taxation.

[WILLIEA]

Not going to quote them all but every single point made by Cyclizine is a very good one

[RedRob72]

But does it really matter if you're spending £x / year on health insurance or being taxed £x / year into the health budget? You're still £x down.
If you want an insurance system, then how do you want it to run? Can the insurance companies exclude pre-existing conditions? Can they refuse to renew your cover? Can they increase your premium if you develop a new and interesting disease? Because if they can't, then the premiums will be extortionate and if they can, then just pray it doesn't happen to you.
On the other hand, a population based model, where the risk is spread across everyone, I think is fairest. Yes, you could do this through 'insurance' but it's just as easy to lop it off as taxation.

The NHS is a fantastic service, free at the point of entry and equitable access for all, pressure of increasing demand continues year on year however and shows no sign of abating. A careful combination of funding streams would surely give us more flexibility to respond to a burgeoning list of healthcare needs? Seems to work well enough with other developed countries.

[Cyclizine]

The NHS is a fantastic service, free at the point of entry and equitable access for all, pressure of increasing demand continues year on year however and shows no sign of abating. A careful combination of funding streams would surely give us more flexibility to respond to a burgeoning list of healthcare needs? Seems to work well enough with other developed countries.

But my point still stands; if you're personally spending £x on health, it's still £x whether it's all from taxation or from various sources. Unless you're advocating different tiers of health provision dependent on how you as an individual choose to fund your combination of funding streams - now that's a different argument.

Yes, as an individual it may be cheaper, so long as you stay in good health and avoid any accidents. However on a population level, spreading risk is cheaper.

[welshbairn]

The whole point of insurance used to be to spread the risk as widely as possible so premiums were low but you'd be covered if something bad happened. Private health insurance will if it hasn't already demand a copy of you genes and any pre existing conditions before they'll think about granting coverage. Much better just to have the risk spread around the whole population.

[RedRob72]

But my point still stands; if you're personally spending £x on health, it's still £x whether it's all from taxation or from various sources. Unless you're advocating different tiers of health provision dependent on how you as an individual choose to fund your combination of funding streams - now that's a different argument.

Yes, as an individual it may be cheaper, so long as you stay in good health and avoid any accidents. However on a population level, spreading risk is cheaper.

A two tier system already exists for those who can afford private healthcare cover or are lucky enough to have their employer provide it as part of the renumeration package. The Social insurance model deployed across much of Europe is paid for through a separate pay deduction according to means/income and subsidised accordingly. Surveys continually suggest that people (who are able)would be be prepared to pay a little more to protect the NHS, why don't we test that commitment?

The screams of backdoor privatisation won't help us find a solution and are counter productive.

[McSpreader]

2 hours ago, Cyclizine said:

For once, I do agree with some of what you say, however...

 1)Where would you like us to get our drugs from? To be honest, the majority of drugs used are old and generic and therefore fairly cheap. Drug development is an expensive business. I'm not one for pretending drug companies are nice, fuzzy, friendly companies, but they're not charities either. They get 15 years exclusivity on new drugs.

 1a)We would get our drugs from the same companies as now but not be held over a barrel on pricing as now. When you see how much the NHS pays for Paracetomol it is shocking. It would be cheaper if Tesco or  Lidl supplied it to the NHS. It's a complicated issue but Even The Office of Fair Trading has argued that drug prices should reflect their clinical benefit as current practices waste NHS resources.

2)It's a total drop in the ocean - a useful deflection for the real issue of underfunded health and social care: "blame the immigrants". I don't have Scottish figures, but England 'health tourist' cost was ~£200m in 2015 (approximately ~£75m was ex-pats coming back!). England's health budget is £116 billion, so <0.2% of the budget.

2a) You don't know that because it's a problem accepted to be under reported. Your politicising of the issue  to that sort of base level is typical of people who aren't strong enough morally to face uncomfortable truths and resort to virtuosity signalling. It's an easy policy to implement as proven by every other country in Europe who actually value the sanctity of their finite resources.

3)What exactly do you mean  by this? Do you mean I wasn't actually supposed to be working nights over Hogmanay? Hospitals are and have always been open all the time for emergency care. The deliberate muddying of waters by conflating emergency and elective care was part of Hunt's strategy against the junior doctors.

3a) Hospitals should not be run on 'skeleton crews ' over weekends and bank holidays as is often the case now. To say there is not a reduced service over these periods is not my experience, or that of my partner , who works in a general hospital. If you are in hospital at these times and your condition worsens you a have an increased chance of a worse outcome. Why do you think that's alright?

4)Eh? You mean 0800-0000 or 0600-2200 all week? Or 24h Mon-Fri? I'm not sure what you'd expect this to achieve other than more burnt out GPs. There's the slight issue of where do these GPs come from as well...

4a) I may have got carried away with this one. Local GP surgeries should run 6 days a week and run 12 hrs on each of those days. No one is asking any individual GP to work more hours. For example if there are 6 GP's in a surgery why not 2 work 8.00-16.30  , 2 work 10.00 -18.30, and 2 work 11.30- 20.00 ?  Just an idea to create better access and LESS liklihood of people missing appt's .

Also charge £5 per appt unless on benefits or low income. 

Also scrap free prescriptions for anyone not on benefits or low income.

 

5)And since you brought up pay... it's not as if it's a secret: Doctors and dentists and all other NHS staff.

5a) I'm not ploughing through that lot this time of night, thank you!

 

 

Edited February 6, 2017 by McSpreader

[doulikefish]

Fully expecting an "nhs in crisis" story this week in the beeb jockoland

[Cyclizine]

I agree totally that drugs should be funded based on their benefits - this is why we have the SMC (and NICE down south). I know how much paracetamol costs thanks, my hospital pharmacy nicely tell us how much each drug costs (and in my line of work I administer a lot of drugs). Paracetamol is less than 2p/tablet. IV preparation is about £1.50.

I know that health tourists are not really an issue because I work in a acute specialty. I can't remember the last non-entitled person who was abusing the service. Reasonable number of tourists (their notes get special stickers and we have a manager who chases their insurance), and, yes, we have a lot of Eastern Europeans, particularly in the Maty, but that's because, shock horror, immigrants are usually young. They're not abusing the service, they live and work here and are entitled to use it!

Out of hours, we have less staff, because we do less. Out of hours we deal with urgent and emergency care. We don't do routine elective stuff. There's good reason for this, not least because people don't want their tonsils out at 3am... We staff (medically anyway) safely out of hours. I'm aware that my nursing colleagues do have worse staffing issues. However, your point that you have worse outcomes at these times has been comprehensively shown to be false. Even Jeremy Hunt has stopped banging on about it because he can't back his statements up.

The vast majority of GP appointments are for young children and the elderly, patients who can be seen during the normal working day. You obviously have no idea what a GP's day involves if you're suggesting 0800-1600 and 1000 to 1800! My other half works officially 0800-1800 Mon-Fri. Her surgeries are four hours long with 5 appointments per hour: 0800-1200 and 1400-1800. During her 2 hour 'lunchbreak' as I suppose you'd call it she has to do 3-5 home visits, write referral letters, deal with correspondence, review results, oh, and have lunch. Her surgery run an early morning 0700 start surgery and a late 2000 finish surgery each week. They never fill the appointments. There is no real demand for routine appointments outside 0800-1800 and shifting staff to these hours just means that there are less to deal with the majority of patients.

Regarding charging for appointments, there's a balance between how much it costs to administer the system and how much you'd save, equally with free prescriptions.The majority of prescriptions collected are for people who wouldn't have paid anyway under the old system i.e. children, pregnant women, elderly, chronic conditions. It's over 90% in  England. I'm not against this, I just don't think the evidence is there for it.

[RedRob72]

How about charging for missed appointments (without prior cancellation)? Wonder how much does it cost in admin, clinical prep, organisation of medical records plus the impact on waiting lists when 'Did Not Attends' are simply re-referred back into the system?

[RedRob72]

Folk wont pay, the vast majority of missed appointments from my experience are people who lead chaotic lifestyles, they dont have the money to pay for missed appointments.

You pay a reasonable flat fee up front. (benefits taken into consideration) If you just simply 'miss' the appointment your fee is retained. Yes there would be a cost to administer this, but payment could be taken at the same time as agreeing the date and time of your appt, just as with any other booking system. It would recover costs that we aren't recouping at the moment plus it might encourage/incentivise patients to comply with how the referral system works for them?