NHS Crisis? What Crisis?

[McSpreader]

26 minutes ago, Cyclizine said:

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.

I don't think health tourists head for Inverness tho' so it wouldn't be your experience tbh. Elsewhere it's a different story.

With more people working than ever before and working longer hours there most definitely is a need for longer surgery opening hours....Not in every GP practice, granted. But one size does not fit all and the Health service.....GP's included, need  to be more flexible to changing demographics and work patterns.

The funny thing is, your partner would soon get used to the later start and finish times and having a day off midweek and would learn to enjoy that. The early start day and late finish day is simply paying lip service to the problem. Also , if patients don't want those later/earlier appointments because there is no need then that may suggest that people are turning up at GP's when perhaps an alternative option would suit, such as a visit to the practice nurse or a pharmacist on the High Street so the change in hours would improve his/her workload and allow those who currently find it difficult to access GP services to have more options.....win/win !

AS for Health outcomes at the weekend If I read this report correctly it suggests otherwise....https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality

[McSpreader]

4 minutes ago, ThatBoyRonaldo said:

 

As someone who actually works in the NHS - so much of this post is bullshit.

Most nurses have no experience of dealing with dementia patients?

Bullshit - a large minority of all patients admitted to hospital have a dementia diagnosis. Any acute nurse will deal with several on a daily basis.

9 levels of management grades?

Bullshit. AfC means the pay grades go from 1 to 9, with a couple of sub grades, but that's with porters on band 1 and execs on band 9. NHS Scotland is actually getting rid of band 1 as part of paying everyone the living wage.

Nurses getting 'low or no pay rises' while management get large rises?

Bullshit - everyone gets the standard uplift. This year it was 1%, which is shit, but it was the same for everyone.

People do and should expect better from the NHS but myths like the above and some of the questionable 'solutions' you have offered help nobody.

 

Well that is my partner's experience.....and Welshbairn's!....MOST ( not all) nurses who aren't specialist trained in Mental Health do not know how to deal with dementia patients . And if they DO then how come they do such a shit job when dementia patients are in a general ward?  You can get angry all you want, I don't give a fuck, but that's the reality.

So you agree about the 9 grades.....thank you.

1% on 25,000pa and 1% on £55,000 pa.....you do the math.

[Cyclizine]

47 minutes ago, McSpreader said:

I don't think health tourists head for Inverness tho' so it wouldn't be your experience tbh. Elsewhere it's a different story.

With more people working than ever before and working longer hours there most definitely is a need for longer surgery opening hours....Not in every GP practice, granted. But one size does not fit all and the Health service.....GP's included, need  to be more flexible to changing demographics and work patterns.

The funny thing is, your partner would soon get used to the later start and finish times and having a day off midweek and would learn to enjoy that. The early start day and late finish day is simply paying lip service to the problem. Also , if patients don't want those later/earlier appointments because there is no need then that may suggest that people are turning up at GP's when perhaps an alternative option would suit, such as a visit to the practice nurse or a pharmacist on the High Street so the change in hours would improve his/her workload and allow those who currently find it difficult to access GP services to have more options.....win/win !

AS for Health outcomes at the weekend If I read this report correctly it suggests otherwise....https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality

I don't actually work in Inverness (haven't for a while) I actually work in one of our brand spanking big city centres of excellence (haha), so yes, I do know how it works. Also, the Highlands has one of the highest proportions of 'out-of-area' admissions (i.e. a lot of tourists) of all hospitals in Scotland...

There are longer opening hours already, as you've been told - there isn't the uptake. The changing demographic is to the older, retired population.

Right... I've already pointed out what hours my partner works. Would you like to hazard a guess at what the other five GPs in her practice work? It's the same. Unless you want to cut the number of appointments during the day, which, as has been pointed out, are the ones in demand, not evening and weekend ones, how do you suggest your plan gets off the ground?

You haven't read the report correctly. Mortality is actually higher if you're admitted on a Tuesday (it's not statistically significant) but, anyway. The reason that mortality appears higher for weekend admissions is because they are emergency admissions. During the week, you also have elective admissions as well as emergency admissions. Almost by definition, emergency admissions are sicker than elective admissions and are more likely to die. So, if all your admission are emergencies then... you will have a higher proportional mortality than if you have both elective and emergency admissions.

[RedRob72]

All that happens is they get yet another crisis loan. These people wont pay for appointments, its all just adding another level of nonsense for the public to pay for. The solution is re-education and to help people understand what you can and cant go to the doctors for.

Who are 'these people' they come from all sections of society, not just the financially worse off.

[Cyclizine]

3 minutes ago, RedRob72 said:

Who are 'these people' they come from all sections of society, not just the financially worse off.

He's right though. The folk who are least likely to turn up are those living hand-to-mouth or with chaotic lifestyles. You penalise them and it'll either be ignored or you tip them into another crisis and you get a more expensive emergency admission.

[NotThePars]

We already have enough difficulty in persuading men in particular to go and see a doctor about their health problems so I'm not sure trying to discourage people from seeing a GP is the sensible option.

[RedRob72]

We already have enough difficulty in persuading men in particular to go and see a doctor about their health problems so I'm not sure trying to discourage people from seeing a GP is the sensible option.

I wasn't talking about GP appointments tbh, but secondary care referrals.
Research shows that it isn't necessarily 'poorer' socio-economic groups who are the highest offenders. Data sourced by Experian reported that 25% of missed appointments are recorded by 'Young, well educated City dwellers'!

Link below

http://www.experian.co.uk/assets/public-sector/brochures/reducing-dnas-factsheet.pdf

[CountyFan]

On 06/02/2017 at 17:25, McSpreader said:

 

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 

You've described the NHS culture twenty years ago. It's nothing like that now. 

The biggest things that would improve the 'inefficiencies' in the NHS are not rocket science. Tell people with lifestyle-related illnesses to get to the back of the queue and seriously invest in the social care sector. The NHS is getting it tight from the media for the current difficulties that are seriously exacerbated by lack of places to send people who are medically fit but require a care home/social care package. Why nobody is holding councils to account for some of this mess is beyond me. 

[CountyFan]

1 hour ago, McSpreader said:

Well that is my partner's experience.....and Welshbairn's!....MOST ( not all) nurses who aren't specialist trained in Mental Health do not know how to deal with dementia patients . And if they DO then how come they do such a shit job when dementia patients are in a general ward?  You can get angry all you want, I don't give a fuck, but that's the reality.

So you agree about the 9 grades.....thank you.

1% on 25,000pa and 1% on £55,000 pa.....you do the math.

Also... re: expensive layers of management. There are 25,000 staff working for NHS Lothian for example - how do you propose those staff are recruited, trained, developed, supported etc if there is nobody there to ensure that's done? There's an argument that more management is actually needed as when it is done well it frees up doctors and nurses to actually focus on the patients. A model with no managers would see Consultants (who earn significantly more than managers by the way) wasting their time administering the services instead of actually, you know, delivering them. 

On top of that, professional managers can go to the private sector and earn twice as much for half the hassle, meaning there is little incentive for those other than the most conscientious to actually do the job. 

In short, your generic 'manager bad! He paid to much!' stuff is nonsense. 

[Benjamin_Nevis]

On 06/02/2017 at 17:25, McSpreader said:

 at least 9 (Nine) levels of management grades

 

3 hours ago, ThatBoyRonaldo said:

Bullshit. AfC means the pay grades go from 1 to 9, with a couple of sub grades, but that's with porters on band 1 and execs on band 9. (The average nurse is a band 5). NHS Scotland is actually getting rid of band 1 as part of paying everyone the living wage.

 

3 hours ago, McSpreader said:

So you agree about the 9 grades.....thank you.

The thick cunt even types out N-i-n-e to unintentionally accentuate the utter fail of a post. Magnificent. 

 

ETA: McSpreader appears to have c & p'd a Sun Editorial from around 1993. 

 

Edited February 7, 2017 by jupe1407

[McSpreader]

12 minutes ago, jupe1407 said:

 

 

The thick cunt even types out N-i-n-e to unintentionally accentuate the utter fail of a post. Magnificent. 

 

ETA: McSpreader appears to have c & p'd a Sun Editorial from around 1993. 

 

A level 9 ( Nine) Cringeworthy post from The Resident Sad Act ......Not his worst but purty darn close

 

Would be nice to get an original thought or idea from the pr*ck ! You need a functioning brain cell for that so I'll  not hold my breath, ha ha!

[McSpreader]

1 hour ago, CountyFan said:

Also... re: expensive layers of management. There are 25,000 staff working for NHS Lothian for example - how do you propose those staff are recruited, trained, developed, supported etc if there is nobody there to ensure that's done? There's an argument that more management is actually needed as when it is done well it frees up doctors and nurses to actually focus on the patients. A model with no managers would see Consultants (who earn significantly more than managers by the way) wasting their time administering the services instead of actually, you know, delivering them. 

On top of that, professional managers can go to the private sector and earn twice as much for half the hassle, meaning there is little incentive for those other than the most conscientious to actually do the job. 

In short, your generic 'manager bad! He paid to much!' stuff is nonsense. 

So all is Hunky Dory in the Health Service. It's perfectly run by brilliant managers not one of whom is a former nurse or doctor., they're all just managers...that's good then. Can't imagine why I got it so wrong.....It's all good. Phew!!

[Benjamin_Nevis]

Just now, McSpreader said:

A level 9 ( Nine) Cringeworthy post from The Resident Sad Act ......Not his worst but purty darn close

 

Would be nice to get an original thought or idea from the pr*ck ! You need a functioning brain cell for that so I'll  not hold my breath, ha ha!

You could start by explaining why your 9 (nine) management grades included Porters at 1, and Nurses at 5. 

Idiot.

Alternatively, you could go back to trying to tell an actual medical professional with clearly extensive experience where GP surgeries are going wrong. That was a fucking doozie

[McSpreader]

1 hour ago, CountyFan said:

You've described the NHS culture twenty years ago. It's nothing like that now. 

The biggest things that would improve the 'inefficiencies' in the NHS are not rocket science. Tell people with lifestyle-related illnesses to get to the back of the queue and seriously invest in the social care sector. The NHS is getting it tight from the media for the current difficulties that are seriously exacerbated by lack of places to send people who are medically fit but require a care home/social care package. Why nobody is holding councils to account for some of this mess is beyond me. 

I agree with investing in Social care in the community, Mental Health investment and working to change lifestyles....better food production as well.

But that culture still exists today.

[pandarilla]

Also... re: expensive layers of management. There are 25,000 staff working for NHS Lothian for example - how do you propose those staff are recruited, trained, developed, supported etc if there is nobody there to ensure that's done? There's an argument that more management is actually needed as when it is done well it frees up doctors and nurses to actually focus on the patients. A model with no managers would see Consultants (who earn significantly more than managers by the way) wasting their time administering the services instead of actually, you know, delivering them. 
On top of that, professional managers can go to the private sector and earn twice as much for half the hassle, meaning there is little incentive for those other than the most conscientious to actually do the job. 
In short, your generic 'manager bad! He paid to much!' stuff is nonsense. 

Before this thread descends into chaos...

You seem pretty well informed here. Are you genuinely saying the nhs requires more managers? And do you think the current set-up is pretty efficient?

Unfortunately I've had too much experience of the system as a patient - but I'm not sure where the problem lies (obviously a lack of funding, increasing demand etc but I'm talking about the management of the whole thing).

In education there's huge waste in box ticking administration that is all too often meaningless. There are plenty who build little empires and councils buy in 'education consultants' to show how busy they are bringing about change.

[McSpreader]

3 minutes ago, jupe1407 said:

You could start by explaining why your 9 (nine) management grades included Porters at 1, and Nurses at 5. 

Idiot.

Alternatively, you could go back to trying to tell an actual medical professional with clearly extensive experience where GP surgeries are going wrong. That was a fucking doozie

You really are a Sad Act. You're saying that I'm not allowed an opinion on how GP surgeries operate. That is mind blowingly stupid.

So only economists can have an opinion on the economy.

Only Teachers can have an opinion on education.

Only Politicians can have opinions on politics.

What about sex ? Only prostitutes can have an opinion on sex by your reckoning .

Seriously, take your time  and reread your posts before pressing the 'submit reply' button......that's friendly advice btw!

[Benjamin_Nevis]

36 minutes ago, McSpreader said:

You really are a Sad Act. You're saying that I'm not allowed an opinion on how GP surgeries operate. That is mind blowingly stupid.

So only economists can have an opinion on the economy.

Only Teachers can have an opinion on education.

Only Politicians can have opinions on politics.

What about sex ? Only prostitutes can have an opinion on sex by your reckoning .

Seriously, take your time  and reread your posts before pressing the 'submit reply' button......that's friendly advice btw!

So, 9 management grades eh? 

You are of course entitled to an opinion, just as i'm entitled to think your opinion is a ridiculous pile of shite. Cyclizine gave you an in-depth explanation of why your theories weren't workable, and your comeback appeared to consist of "Aye but you work in Inverness", which he doesn't. 

[RedRob72]

So, 9 management grades eh? 
You are of course entitled to an opinion, just as i'm entitled to think your opinion is a ridiculous pile of shite. Cyclizine gave you an in-depth explanation of why your theories weren't workable, and your comeback appeared to consist of "Aye but you work in Inverness", which he doesn't. 

From Bands 7-9 there are almost 40 Management level Pay Grades /Increments (AfCApril 2016), try looking it up for yourself Jupe?
Fine with being corrected.

[CountyFan]

8 hours ago, pandarilla said:

 

Before this thread descends into chaos...

You seem pretty well informed here. Are you genuinely saying the nhs requires more managers? And do you think the current set-up is pretty efficient?

Unfortunately I've had too much experience of the system as a patient - but I'm not sure where the problem lies (obviously a lack of funding, increasing demand etc but I'm talking about the management of the whole thing).

In education there's huge waste in box ticking administration that is all too often meaningless. There are plenty who build little empires and councils buy in 'education consultants' to show how busy they are bringing about change.
 

 

I'm not saying the NHS requires more managers necessarily, but the idea that managers are putting the shackles on clinicians with box ticking exercises is lazy and wrong. The idea that complex Multi-billion pound organisations would be left in the hands of anything other than a group of experienced professionals is nonsense. There are many excellent NHS managers with clinical backgrounds and many without, but the idea that 'having been a doctor or a nurse' is enough in itself to be best placed to step in to management is unrealistic. In fact, one of the problems we often face is that excellent clinicians with no management experience are promoted on the basis of that clinical experience leading to issues when it comes to e.g. people management. 

Organisations everywhere have good and bad staff and that is no different in the NHS. The thing I take issue with is lazy lies peddled by e.g. McSpreader and the Daily Mail which completely dismiss the contribution of an entire group of dedicated staff. Anyway, I'm away in to work so I can see where today's bed shortage is going to be plugged. Or would you all rather I asked a busy clinician to do that? 

[McSpreader]

Well there might be more managerial grades .....maybe I was being cautious knowing how vitriolic the 'Defenders of The Faith ' are

https://www.healthcareers.nhs.uk/about/careers-nhs/nhs-pay-and-benefits/agenda-change-pay-rates