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I came across a man this evening who had just collapsed in the street. I stopped the car along with a couple of other people. We called 999. The man was unresponsive but breathing.
Long story short - after answering questions as best we could no ambulance was going to be sent out. Instead we were asked to wait for a paramedic to phone back. In the interim we checked his id, went to his house and brought his daughter.
Still no call back from a paramedic so we called 999 to provide new information. The man is 51 and had a stroke 6 months ago. With this an ambulance would now be sent. But... not straight away. It would be 30 minutes before an ambulance could be dispatched, so any chance we could bring him to hospital?
We got the man off to the hospital in a car and hopefully he will get the care that he needs. By the time we lifted him into the car he was starting to "wake up" and could say a few words but was clearly really unwell with a suspected stroke for the second time.
I'm not posting this as a rant. I really do love the NHS, my daughter is alive today because of it and will need the care of the tremendous people throughout her life. I'm just a bit shocked by the first hand experience of how a person could be lying in the street with the thought that no one was quickly coming with emergency care. It was a real sinking feeling of despair to be told no ambulance was being sent out.
Is this the reality of what is happening everywhere?
Being deliberately broken ?
Yes.
Firstly well done for being a god human being and helping another in distress.
The NHS is not quite broken but it is right on the edge. Getting that initial access is the major issue as once you are inside the system it is generally ok. The staff, on the whole, are doing their absolute best with what resources they have but that is the main issue: the resources just aren't there. Blame the current lot in Westminster for that. The light at the end of the tunnel is that hopefully by the end of this year we will have a different set of people holding the strings and with it the possibility of things changing direction for the better.
All of the public sector has been broken. Wilfully.
Yes.
Problem isn’t necessarily the NHS being broken as such, but social care is certainly broken, and successive governments have done nothing to address this when we have a population which is living longer and having more complex care needs.
This then means that hospitals can’t safely discharge, which means acute beds don’t become available, when means the ED is full, which means ambulances can’t offload and so it goes.
Add in long-running staffing shortages because HMG won’t pay enough to retain expensively trained healthcare staff…
Having heard Streeting talking I am not at all confident he understands the actual issues, or that a change in government will help.
Yes.
Wes Streeting, as probable Health Secretary in probable Labour government, is not the solution.
The short answer is yes.
I could make several very personal examples to support my view, but ultimatley we are all at fault here, the actual NHS staff, are generally exeptional, there is just not enough of them and they don't get paid enough for what they do.
Take My nan for example, she fell gravely ill last christmst during an NHS strike, so the first reponder was an off-duty fire-man. An ambulance was subsequently called, and the fire guy and the paramedics were beyond profesional.. I couldn't do that for a living, the objectivity and pure cool headed'ness of all of them..
I just don't know how they can cope with it on a personal level...unless they just go into some sort of auto-pilot mode.
When you hear stories about people assaulting the fire brigade or paramedics... I just cannot fathom it.
I guess this post states the obvious and others here are closer to the issues than me and may have different perspectives but…
As an observer with two daughters and son in law working for NHS in clinical roles… and with heavy use of the system by other family members it seems to me that it’s not broken but it’s creaking badly. When things align it works brilliantly. Where gaps appear it falls down. I have waited with an ill mum in an ambulance for nearly two days and I have watched my dad get amazing treatment for complex problems.
My opinion is that the current state of the things in public services was/is not inevitable. That the deterioration has significant inertia so will take time to repair and the gaslighting of us all by the people in power, their policy makers and corporate influencers make it ever harder to start the repairs. <br /><br />
It is hard watching my kids get ground down by the system and as I get older I know that I am getting closer to maybe needing the NHS more than I have done. So I hope change will be forthcoming and we get serious about making sure that we have a health and social care system that is as good as it can be.
Problem isn’t necessarily the NHS being broken as such, but social care is certainly broken, and successive governments have done nothing to address this when we have a population which is living longer and having more complex care needs.
This then means that hospitals can’t safely discharge, which means acute beds don’t become available, when means the ED is full, which means ambulances can’t offload and so it goes.
Having had first-hand experience of looking at the whole system in action these last few months I'd go with that view in general. Obviously there will be regional variances and even variances depending upon the time of day/week these services are needed but in essence the whole system is being held up by the near-complete lack of social care.
It's a systemic issue...if you think of a country as a whole, like your own body, you can easily draw some comparisons.
Many things are intertwined, for example, just from an NHS perspective, there's a lack of policing, a lack of commumity support, etc, etc, etc.
I'm sure Labour will win the next GE, there's almost no point even betting on it... but I'm not hearing many encouraging words from Starmer, his message seems to be to gently try to slow the tide of insanity, rather than a paradigm shift.
Maybe he's correct in his softly softly approach... but there are a lot of people in the UK that just are not ready to be nice yet.
It’s been broken for 5 yrs or so now . COVID was just the icing on the cake.
I don’t think it’s a political thing either, or certainly not a Labour/conservative thing
People are living longer with more complex heal needs, and there are more people. This all needs more infrastructure/ money and until we all are prepared to pay for it , it won’t improve.
It most certainly is a political issue. NOt necessarily a party issue tho I believe it is Its a political decision to waste huge sums on the fake market. |Its a political decision the means social care is a mess of low pay and underfunding.
If you watch the BBC Ambulance programme you can see the ambulance service has had this issue for years.
About 2.5 years ago we had family (in 90s) who kept falling. The careline numbers just ring the emergency contacts. Both were injured so couldn't be lifted by family who arrived on scene. One waited over 8 hours with a broken hip on the floor. The other over 12 hours on the floor.
13 months ago my Dad fell down the stairs and broke a lot (stopped breathing, broken neck & skull). He had good care at the Hospital but after 5 days was discharged with a neck brace they expected my step-Mum to change (she couldn't because she had a fractured arm from the fall), no care plan in place, no referral to GP and so he got zero community assistance. Because he knows the system he managed to call around and get an appointment for ongoing care (e.g. scans to see how the breaks were healing, physio / rehab) but it was really shockingly bad.
As others have said it's complex but derives from lack of social care places or ability to discharge which is complex itself, and every element of the NHS seems to have some areas just really struggling. I would say urgent care gets very near collapse / halting at points, GP care similarly in some locations but not everywhere.
OP, in the middle of winter, your experience is not so different to most for the last few years. Well done for helping out, most wouldn't have. Ambulances and A&E both really struggle this time of year, and the NHS has been underfunded for at least a decade now.
Oh, and there's a 6 day strike on. Up the workers.
Part of the problem with fixing it is that having a serious, national conversation about it is going to be very difficult. The answer is almost certainly not the current structures and systems with more money but discussion of radical NHS reform is very emotive and I'm not surprised the main parties aren't willing to take it on.
The tories have got closer to their aim of a two tier service with those able to pay jumping queues. I know of multiple people who have used private medicine including me to jump queues.
Fortunately they will be out before long and the NHS tends to fare better under labour but Streeting does not fill me with confidence.
There needs to be an honest national discussion about healthcare policy and our ambitions and limits. Healthcare can be ridiculously expensive and many of the population will need some sort of support in old age. Surely its right to use this accumulated wealth that is held by the elderly to fund old age care?
The answer is almost certainly not the current structures and systems with more money
Perhaps long term. short term? Reorganisations drain energy out of the organisation and there is a huge legacy of underfunding. Pump money in and get rid of the most stupid stuff and then leave it alone for a bit to recover
Perhaps long term. short term? Reorganisations drain energy out of the organisation and there is a huge legacy of underfunding. Pump money in and get rid of the most stupid stuff and then leave it alone for a bit to recover
Yes, I agree. Some of the issues could be solved by better funding but I think society has changed so much that some sort of restructuring is necessary. The key thing is that it doesn’t create a two tier system and that the poorest and most vulnerable can access the best care.
Yes its broken and the level of care has been variable for years. However according to the NHS and the press it's been on the verge of collapse for years. Theres pockets of excellance and wide spread mediocrity. There are many reasons for this, the current government being a major reason but there's plenty of others, ageing population combined with an increase in poor lifestyles combined with an entitlement culture. The NHS staff and internal culture is also a problem, it's chaotic at best, and every time someone makes a blanket statement that NHS staff are all wonderful it makes things worse. Of course they are not all wonderful, theres a bell curve and with so many employees theres a fair few at the wrong end of that curve. There needs to be political will to decided what the NHS is for and how it will be managed, then the staff need to start to get to grips with their performance issues, absentism for example., engagement with new methods and more efficient ways of working.
I can only speak from personal experience but for me its not delivering what its claims, as mentionned above getting into the system is a lottery, once in and its a big barrier, things can get better. I'm not sure I buy the it's been deliberately run into the ground, I'm not sure the Tories are that organised, but culturally something needs to fundamentally change from top down to bottom up.
It is completely broken, same as everyone else I have tonnes of anecdotes but the best ones are being told to give up on walking after a leg injury, I ended up going private and am now fully recovered, and being told to “google it” after spending 8hrs waiting in A&E for a serious head injury
My mrs passed out in A&E and would have been left to bleed out had I not started shouting for help and the most recent one is her being referred to an external company of “specialists” by her GP, only to find it is a scam company used by the NHS to reduce waiting lists who never do the referrals and are full of fake reviews on Google and the NHS website
We got scammed by our GP, that is something I never thought was even possible
The NHS is shockingly bad, and while it may not be the nurses and doctors’ fault we need to start saying that to create some accountability somewhere
It's been teetering on the brink for a few years now.
I've had a similar experience as @willq above but with a father-in-law who was found in a confused state and failing a FAST test suggesting a stroke. We called 999 and were told it was a Category 2 call but we'd be looking at around 12h for an ambulance. It should have had a response time of 18 minutes, according to the targets.
I've worked in the ambulance service for a decent length of time so I see it day to day from the inside looking out. Seeing it from the outside looking in was quite the eye-opener.
In my opinion the NHS shouldn't be a politically ran entity, having a "top down reform" every time a new government is voted in is just wasteful and encourages short term views rather than looking at the long-term health of the NHS and the nation. I also believe, controversially, that they already get enough funding, it's just not spent very well. The waste in some areas is eye-watering.
It's broken at all levels.... hospitals, GPs, social care... the lot. Can't help but be totally scared to get ill with any thing.
Many things are intertwined, for example, just from an NHS perspective, there’s a lack of policing, a lack of commumity support, etc, etc, etc.
I agree with the intertwined issue. Ironically if you were to ask many front line cops they’d tell you that they spend a lot of their time dealing with mental health and addiction issues which are really health issues! BUT the NHS is a sacred cow and parties of all colours will always give it more funding rather than working out where to put the money for the greatest overall impact (justice, social care, education, housing, etc).
Having heard Streeting talking I am not at all confident he understands the actual issues, or that a change in government will help.
No, and he’s already mentioned there’ll be more Private Finance Initiatives/Public-Private Partnerships or whatever they’ll be called this time around. We’ll be in debt to the private sector forever.
Here’s an example of how well it works in the Eastern Daily Press (from 2017). EDP
But of course the ‘get behind the team’ Starmerites will tell you ‘at least we’ll get the hospital built’.
Edit.
many front line cops they’d tell you that they spend a lot of their time dealing with mental health and addiction issues
Yes Poly, that was another great idea, it was called Care in the Community, thank you Baroness Thatcher.
Putting all of the 'wilfully' broken politics to one side....
The reality is that the cost of Health Care has increased significantly in the last 75 years. Driven by people being less tolerant to being ill so using the system greater, the increased medical capabilities and solutions on offer, as well as the increased cost of those services and technologies.
The spend on the NHS as a percentage of GDP has increased through its life but the reality. The unfortunate reality is that the funding comes through taxes and who really wants to pay for more taxes?
It's all the same reason as to why there is little of a UK manufacturing industry, the death of the high street and the likes. We talk a good game but we just don't want to pay for it.
There is huge amounts of waste and poor management in the NHS (well certainly the Trust I hear about from my wife). Some of the things I hear about would never happen in the corporate world in which I've worked. I don't want to see it privatised but I can't help thinking if it was it would be run a whole lot better.
Speaking as a GP, there are a number of issues.
Funding is a very large part of it, we pay less in this country than many other comparable countries. In the past increases in funding have led to better outcomes.
The undervaluing of GPs, both politically and financially is a massive issue. Repeatedly, because what we do looks easy (nodding and listening), we have political schemes to replace us on the cheap (inadequately trained doctors, using other professions in our roles, increasing “efficiency” at a cost to continuity of care, treating us a community based juniors to do the bidding of the hospital doctors) which lower quality and increase overall costs IMV. This misses the fundamental point of being a GP which is that we add massive value both through our depth of clinical experience (no other clinicians come close to us in numbers of patients seen) and through continuity of care. Yes, a large part of our job is nodding and listening, the hard part is knowing when more than that is needed.
I’m not sure that the current situation is deliberate, I think it’s more that the Tories are caught in an ideological bind by their commitment to lower taxes.
Yes, reform is needed in the NHS. The main one being moving the focus and funding away from hospitals and towards primary care. As you can imagine this goes down like a turd in a swimming pool with my secondary care colleagues, who are also overwhelmingly over-represented in the higher echelons of the NHS.
Some of the things I hear about would never happen in the corporate world in which I’ve worked.
With all due respect, bollocks. Waste happens just as much in the corporate world and you’re kidding yourself if you think it doesn’t.
Driven by people being less tolerant to being ill
Is there a reliable link to back that claim up?
And the unfortunate reality is that increased spending does not necessarily result in increased patient care when the extra funding goes towards huge private profit - see PFI.
It’s all the same reason as to why there is little of a UK manufacturing industry
I don't see the connection. Short-termism, an immediate drive for profit, and a lack of investment for the future?
It's broken. I had to self fund last year as I couldn't get seen by our GP. Ended up paying for a private GP to refer me to consulatants for the 2 issues I had. Fortunately the GP's original guess of skin cancer was incorrect for one, and the other is an issue that cannot be fixed. In total I spent over 1k getting this information. If I hadn't had 1k available and it had been skin cancer, I would have been an even bigger burden on the NHS than if they caught it early.
To balance things out though, my wife collapsed in a heap on the bathroom floor just before Christmas, unresponsive etc. so called 999. I kid you not, from the moment I dialled to the moment an ambulance arrived must have been a max of 5 minutes, it was amazing, as was the care she got from the paramedics.
I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.
Because that solution works so remarkably well in the United States?
No, and he’s already mentioned there’ll be more Private Finance Initiatives/Public-Private Partnerships or whatever they’ll be called this time around.
The current PFI deals represent about 2% of the overall budget of the NHS. There's probably a discussion about how the NHS affords and maintains and builds new properties that needs to be had, and while some of the early PFI deals were shockingly bad, they're certainly not unaffordable in their current format.
The NHS (like schools, courts, prison, social services, energy provision roads, and so on and on) need to have proper long term funded solutions that have the agreement of all political parties so that they don't become pawns in the game of Westminster.
while some of the early PFI deals were shockingly bad, they’re certainly not unaffordable in their current format.
Well it's good to hear that the Tories have made a better job of PFI than New Labour did but its crippling effect on the NHS should not be underestimated:
Some hospitals are spending more on PFI debt than they are on drugs
When I joined the NHS 15 years ago from the private sector I was surprised at both how much money it had, and how inefficiently it was run locally and from the centre. 15 years later the main change is that demand has risen and funding has not - meaning that it is both inefficient and skint. Numerous reorganisations haven’t fixed it, nor have “the best brains”. My conclusion is that it’s impossible to be truly efficient in objective terms when an organisation is so huge and complex, and it only gets costlier if you break it down into chunks. The only solution is to fund it better.
So many people harp on about waste and inefficiency, but introducing the 'corporate world' to the NHS means that even if they manage to run an organisation that size more efficiently, they also run it with the principal aim of generating profit, so none of the efficiencies go to benefit patients.
After all, our long and proud history of introducing the corporate world to our other utilities has been such a roaring success...you'd have thought people would look at what we are paying for energy, the state of our railways and the amount of shit on our beaches and conclude that maybe, just maybe, the private sector is not the solution to our ills that people say it is.
Make no mistake, parts of the NHS have always been on the verge of falling down, even in eras of decent funding, and there is certainly a role for better management. But the last 10 years of defunding have pushed these over the edge, there is not even a pretence of a service in some areas - and pretty much everything else is sitting on the edge of the precipice.
And now the death spiral has started, is it any surprise that our best clinical staff are running for other countries? Staff who genuinely love the idea of the NHS, and are committed to patients, are the ones who cannot bear to see the suffering being caused by its current state.
just in time health care and out sourcing GP appointment to vietnam what could go wrong.
Some hospitals are spending more on PFI debt than they are on drugs
Which makes for an arresting headline without a doubt, but is it a useful measure of either 1. how inexpensive off-patent drugs are, or 2. how expensive running a hospital [and the surrounding] building are? All the studies I've seen put PFI funding at more or less the same as the budget for upkeep for non PFI funded buildings.
Is 2% of the overall budget an outrageous amount for running the estate?
even if they manage to run an organisation that size more efficiently
IME [both working inside and outside the NHS in healthcare] the NHS needs both more and better management, most noticeably at the junior and mid levels. Politicians make headlines from saying things like "All the money will go to front-line service and not bureaucracy " but in reality what then happens is that doctors/nurses end up with a 2nd unpaid job - The manager of their particular unit. And while I admire and like my clinical colleagues they're often shockingly bad managers of people, budgets and regulation, and who can blame them? They often don't want the job, haven't been trained properly to do it, and don't get paid to either.
Is there a reliable link to back that claim up?
😀 Of course not, this is a mountain biking forum. However, if you believe the young adults of today are as tolerant and robust of aches and pains than our grandparents are then I would suggest you are very much mistaken.
I don’t see the connection.
Of course you don't, try reading again. Despite having far more expendable income than our grandparents , the modern generation (I include myself in this) usually put the value against the cost to self rather than the cost to serve. Increased taxes to support the NHS will be no more promotable for any electable government than it is for a supermarket to charge more for 'fair' priced products, manufacturers to source from the UK, etc. The british public have the deciding vote and we vote with our wallets (and purses).
Is 2% of the overall budget an outrageous amount for running the estate?
You are very dismissive of the crippling PFI costs to the NHS, have you asked yourself why the government announced in October 2018 that PFI would be scrapped?
Hammond abolishes PFI contracts for new infrastructure projects
Controversial funding model has been heavily criticised following high-profile disasters
8hrs my mum waited on an ambulance last year after a fall where she broke her hip.
Its an absolutely travesty the state of the social care system in this country.
Yes theres waste and people abusing it but even still its suffering from years of political point scoring.
It shouldn't be controlled by one party. Should be removed from being a point scoring tool and should be cross party ran with agreed funding and policy to stop this yo yo effect
You are very dismissive of the crippling PFI costs to the NHS
Because; by any measure 2% of the overall NHS budget cannot be described as crippling. That's why I dismiss it. This also needs to come under the folder marked - "long term funding solution agreed by all political parties", as it's currently just used by both parties [and their supporters] as political point scoring and not a solution.
.
Speaking from the inside, is it broken? Pretty much yes. There's too much bureaucracy, it's poorly run and 95% of this because of the government. Whether or not this is deliberate is a discussion for another thread.
The other issue is career opportunities and salary. In a staff of 24 my department has 10 vacancies which the remaining 14 have to cover not including annual leave or sickness cover. 80% of the vacancies are because staff have gone to other less stressful jobs that pay more money.
This means backlogs get bigger and in turn increases the stress. We are metaphorically just about putting the fires out ATM but soon the blaze is going to take hold and burn down the building
My mum also had a couple of hours on a pavement after tripping a few months back. But she votes tory so <shrug>. FiL has now spent 4 nights in hospital awaiting the relevant expert to take a look at his broken elbow. 4 nights! He's just been strapped up and offered painkillers. Dementia so he's got little idea what is going on, not that we have much more of a clue. It took them fully 24h to even phone my wife (named PoA on his medical records).
Anyone who thinks that the NHS is remotely adequate probably hasn't experienced healthcare in any modern successful economy. (I don't blame the front-line staff.)
Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.
Every hear of a corporation going bust? You have? Me too!
Everything is broken.
And from what I hear no-one seems to have an answer, not even the pretty certain nailed-on future Labour government.
The biggest visual thing we see every day is the state of the roads. Major A and B roads are just crumbling away and nothing is done. Chuck a bit of tarmac in and kick the repair down the road to next years budget. Repairs that needed doing after last winter have been left and we'll soon have roads like those in countries we used to laugh at on Top Gear.
IME [both working inside and outside the NHS in healthcare] the NHS needs both more and better management, most noticeably at the junior and mid levels. Politicians make headlines from saying things like “All the money will go to front-line service and not bureaucracy ” but in reality what then happens is that doctors/nurses end up with a 2nd unpaid job – The manager of their particular unit. And while I admire and like my clinical colleagues they’re often shockingly bad managers of people, budgets and regulation, and who can blame them? They often don’t want the job, haven’t been trained properly to do it, and don’t get paid to either.
This is 100% correct from my own limited experience working within the NHS.
The common trope is that spending on management hurts frontline services. The correct expression is that spending on bad management hurts frontline services. Comparing the percentage of 'managers' in the NHS with a corporate entity of any size reveals that the NHS is chronically under-managed. On top of that, as you say, those in 'middle management' tend to be drawn from the clinical ranks. And many of these have no appetite for management, or aptitude, it is simply that this is an alternative to front line work because they are burned out completely. Basically a whole tier of management occupied by people with shell-shock.
There are unnecessary management roles in the NHS (I used to briefly occupy one), but the NHS needs more overall, not fewer.
IME [both working inside and outside the NHS in healthcare] the NHS needs both more and better management, most noticeably at the junior and mid levels. Politicians make headlines from saying things like “All the money will go to front-line service and not bureaucracy ” but in reality what then happens is that doctors/nurses end up with a 2nd unpaid job – The manager of their particular unit. And while I admire and like my clinical colleagues they’re often shockingly bad managers of people, budgets and regulation, and who can blame them? They often don’t want the job, haven’t been trained properly to do it, and don’t get paid to either.
I second this.
Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.
Can I suggest that you've probably had a very limited exposure to the 'corporate world', either by sector or seniority?
For me it's very simple, it's being changed into something very different - one where those that can afford it will get better outcomes at the expense of those that can't and moving profits into the private sector.
There will be an overall saving for some folk, only those that never actually need healthcare AND aren't paying for insurance.
Look at the USA, they spend far, far more on healthcare per capita than we do, and millions can't get affordable healthcare (and when they have to spend the money, healthcare bankruptcies of approx. 500k pa).
Did you vote for Brexit in 2016 or Tory in 2019 - if you did, this is one of the many things you actually voted for. You may deny it, but that just shows continuing ignorance IMO.
I agree. You only need to look at how Circle health ran Hinchingbrooke hospital to see how much better things would be.
Ran being the operative word. 😉
As far as I can see the nhs was largely privatised already over the last few decades. Its a tangled Web of private company surgeries, increasingly owned by offshore capital, and complex trusts. Let's face it, we pay over the odds for the buildings on PFI, we buy medicine and supplies through multinationals that make significant margins (the same companies that are embroiled in serious scandal). The staff is all the NHS has left, and increasingly they are treated like shite.
The very private partnerships that are touted as the solution have a huge interest in the NHS failing and an insurance model coming. Just look at the cost of procedures in vetinary care or car repairs as an indicator of what happens then. Especially as the gatekeepers and policymakers often also benifit...as certain underwear tycoon peers have shown recently.
For me, privatisation of critical infrastructure and services in the UK has only benifited shareholders.
My Families interactions with the NHS over the last couple of years have convinced me it is already broken and quickly becoming worse, but I know who I hold responsible; filthy, conniving Tories that want to nudge us all into the hands of private healthcare.
Breaking the service is only half the trick, they've been chipping away at it since getting back in in 2010, the other side to the coin is the narrative/propaganda bit and that was somewhat defeated by the Pandemic. The original expectation was probably that by the end of Boris' second term we'd all be demanding the end of a 'flawed' health service and begging the likes of Eli Lilly and UnitedHealth Group to take our money and cure our various ills.
Of course Covid happened and the NHS demonstrated it's value, those same Tory bastards had to rely on the thing they'd been actively trying to kill in a big way, and of course their narrative had to shift as well NHS workers got clapped an everything...
Fast forward to 23/24 and the current behaviour of the government sits in stark contrast to two years ago; screw down the wages of those working in a demonstrably essential service during a cost of living crisis, try to vilify them as being greedy against that same COL backdrop, try and coax NHS staff towards the private sector, and further cripple the NHS and care sector by waging another ideological war on the immigration needed to fill the staffing gaps.
The problem here is time, how much damage will they do before the Tories are gone?
How far will the service standards drop before (hopefully) Labour take up the task of rebuilding and reinvesting?
How many people will suffer sub-standard care (and potentially die) due to the wilful neglect of those in power?
I'll admit I've been eyeing up private health insurance for my family recently having seen the cluster my Parents/MIL/older relatives have endured after a lifetime of paying for the NHS. It's not the NHS staff's fault it's the bastards in charge, but that doesn't change my priorities if/when one of my family needs prompt access to good healthcare.
Which is of course the mindset the Tories want people like me in...
Privatisation isn't particularly the answer but neither is is specifically the problem IMO. Healthcare in Japan is private but it's also heavily managed by the govt (compulsory insurance schemes and price capping etc). I wouldn't care to say whether it is efficient or not, but it certainly worked well for us while we were there, with sophisticated and expensive services (for non-urgent issues) provided on a time scale that you wouldn't believe. The doctor apologised to me for having to wait *one day* for an MRI scan on chronic back pain. He was gobsmacked I hadn't come in earlier, it had been dragging on for months but I knew that the UK approach would be to have a few pain killers and see if it got better, so I'd already done that for a while.
One feature that I believe possibly helped was to have a small charge for most services (20% of a fee that was itself capped at a low level). This must surely discourage the time-wasters compared to the UK's "free at the point of delivery" while not really being a big problem for people who genuinely need care. But of course even discussing such an idea would be completely impossible in the UK with its infantile politics and toxic media.
Also worth stating that transfer of national assets to corporate custodians usually ends in the primary goal of the organisation being profit, secondary being service. The assets are usually leveraged (stripped). Look at rail/power/water. Just sayin'
A brief list of the problems with the NHS:
- Paying lip service to the fact that we should be a safety critical service
- Group think
- A blame culture that relies on personal responsibility
- Hierarchical management structures
- Too little professional management
- Management seen as a way out of front line service provision
- Constant re-organisation
- Secondary care centric
- Targets and inspections
- Opaque performance data
- Lack of staff
- Lack of infrastructure
The doctor apologised to me for having to wait *one day* for an MRI scan on chronic back pain.
For most back pain, MRI scans are pointless.
In fact I'd go so far as to say that this is a classic example of wasteful over-diagnosis that plagues private healthcare systems.
Healthcare in Japan is private but it’s also heavily managed by the govt (compulsory insurance schemes and price capping etc). I wouldn’t care to say whether it is efficient or not, but it certainly worked well for us while we were there, with sophisticated and expensive services (for non-urgent issues) provided on a time scale that you wouldn’t believe.
Japan has one of the lowest obesity levels in the western world and a lot of "free" in work access to fitness regimes, gyms, pools etc and compulsory fitness/weight levels expected of the work force. All this helps in when it comes to the sharp end @ the hospitals. This sort of thing is rare in this country as the middle classes don't like the poor getting things for free that they have to pay for.
As far as I can see the nhs was largely privatised already over the last few decades. Its a tangled Web of private company surgeries
It pretty much always has been from the get-go. Your occasional reminder that more or less every GP practice, high street pharmacist, optician and dentist is a 'for profit' privately run business.
A large part of the problem that all healthcare systems face, is that what lay-people's perception of what a good service is, and what actually is a good service are two entirely different things.
It's a classic asymmetric market, which is why free market measures and things that focus on patient experience don't work.
One feature that I believe possibly helped was to have a small charge for most services (20% of a fee that was itself capped at a low level). This must surely discourage the time-wasters compared to the UK’s “free at the point of delivery” while not really being a big problem for people who genuinely need care.
Really? When people can't afford to eat or heat their homes, you want to charge them to see a doctor?
Privatisation isn’t particularly the answer but neither is is specifically the problem IMO. Healthcare in Japan is private but it’s also heavily managed by the govt (compulsory insurance schemes and price capping etc).
Companies run to derive a profit for shareholders must inherently be more expensive than a public service, introducing profit seeking into healthcare does not benefit those needing healthcare. I just can't square that circle TBH, not after the whole ethos of a general taxation funded health service having worked for 50 odd years. If capitalism ends up damaging peoples health how can the solution be more capitalism?
One feature that I believe possibly helped was to have a small charge for most services (20% of a fee that was itself capped at a low level). This must surely discourage the time-wasters compared to the UK’s “free at the point of delivery” while not really being a big problem for people who genuinely need care. But of course even discussing such an idea would be completely impossible in the UK with its infantile politics and toxic media.
We already have capped charges for prescription medicines (with sensible exemptions) I can't help worrying that charging for access to GPs would just result in more conditions remaining undetected for longer, ultimately resulting in greater costs and resource requirements and poorer outcomes... I'd rather see investment in GPs surgeries, community nursing and health screening initiatives pitched towards earlier interventions and prevention, but that's really a discussion for the next government, and maybe not even until their second term(?)
A brief list of the problems with the NHS:
Paying lip service to the fact that we should be a safety critical service
Group think
A blame culture that relies on personal responsibility
Hierarchical management structures
Too little professional management
Management seen as a way out of front line service provision
Constant re-organisation
Secondary care centric
Targets and inspections
Opaque performance data
Lack of staff
Lack of infrastructure
I'd agree reforms are needed alongside investment.
Many of those issues exist in other workplaces in both the public and private sectors.
The people with the greatest need for NHS services tend to be the people with the least resources to access it.
I've always felt that the current de-facto system whereby the people with the most time on their hands are most likely to be able to access the system is as fair as any for managing demand, but you'll never find a politician willing to say that.
is that what lay-people’s perception of what a good service is, and what actually is a good service are two entirely different things.
OMG this.. at my practice we triage every patient request, TBF this drives nearly every patient potty becasue they "feel" they should be able to ring and book an appointment with a GP. When you explain to them that our triage system means they'll get seen more quickly by an appropriate clinician rather than suffer for 2 more weeks while they wait for an appointment that may not have to be with a GP anyway; they often either just straight up don't understand or don't believe you.
Also the Friends and Family test can get in the sea. [irony] Are you better? Who cares, whether you liked the doctor is much more important [/irony]
One of the unfortunate things about the UK is how little people look at other countries’ experiences and reflect on them. In France I have had absolutely excellent healthcare mainly funded by taxes (it’s a little bit complicated but basically emergency care and long term health conditions are entirely funded, the rest is 80% funded unless you are on benefits).
However the health and social care component of taxes are a flat 23% of everything I earn. The annual income only adds a few percentage points but it does mean that overall I pay more tax here than I did in the UK. NI is tiny in comparison.
The UK has got more (ok a lot) for less out of the NHS for decades and somehow doesn’t seem to appreciate it.
In France I have had absolutely excellent healthcare
Most people who I've known who've visited doctors in France have been absolutely delighted with the number of unnecessary and ineffective treatments that the doctor has given them.
taxes? someone in HMRC has the temerity to suggest that tax evasion is tightened a little and STW massive have a meltdown in case the sale of their bike has a tax implication (clue for the h.o.t. - unless you 'sell bikes', probably not)
i met an 81y.o. yesterday who had recently had an incident with a dog walker (6 dogs) - one of the dogs bit him. ouch. He went to A&E and sat there for 4 hours before being sent away to Minor Injuries for a tetnus shot. Its ok tho, cos he knew the recetionist who managed to grab him a packed lunch bag, because otherwise he might have been really hungry........ i give up.
selfish, fudging, idiots, everywhere.
<br />100% behind the current strikes.
On management.
Estate management is utterly shocking, I did a PSSR course recently and every single bad example bar one or two came from hospitals. Stuff that would get anywhere else shut down immediately.
Why? The NHS run the hospital but the PFI company own it, neither wants to take responsibility (or understands because it's "just" a heating system) so it gets left to rot and get bodged along by janitors who don't understand or care either.
It's not a case of if, it's when one of these fails catastrophically.
Reading through all of this and in the cold light of day - waiting 30 mins for an ambulance to be dispatched seems quick compared to what others have gone through - but it is wholly depressing.
At the time I posted, it was a few hours after and I was shaken by the experience which doesn't generally happen easily.
These posts show we really do need change at a mammoth level to support the NHS as a whole.
A couple of things came into my head this morning (out biking on my own). I went through the person's wallet and found his driving licence - so his daughter was quickly on the scene with family care and knowledge of medical history. The other is that he didn't have emergency contacts on his phone and attempts to unlock it were unsuccessful.
I know it is a bit stupid but going through his wallet was really uncomfortable. I'm sharing that because it was important to push past the thought!
Thanks for sharing thoughts and experience. While it paints a hellish picture it has helped my understanding. I'll be looking carefully at political promises come election time but that is clearly no silver bullet.
Another part of the problem is that for healthcare systems to be the most effective, for any given level of resources, those resources should be targeted at the poorer sections of society, to the expense of those who are more well off.
This, we are all selfish and really only care about ourselves and our loved ones. Why should I pay more tax to treat the drug users and smokers? Or those idiots who ride bikes off road and crash into things. So break the system and introduce private healthcare for the people who can afford it. The rest can just fight it out in the wastelands of the north.
Or at least I think this is the approach we are going for.
absolutely db, i love the idea of a national health system, but everyone wants to pick apart what it will and wont treat (to suit their own personal ends, rather than those of the, er, nation...)<br />this extrapolates up to the political level where it competes with the rest of public spending and can then be split up and sold to the highest biddder, or the lowest bidder with the best kick backs.
I’d agree reforms are needed alongside investment.
Constant reform has been pretty disastrous for the NHS over the past three decades. They are running out of acronyms for all the bodies they've created and then scrapped.
And none of these reforms stood any chance, because reform in the NHS is a multi-decade project, and incoming governments just reflexively tinker with everything, or just rip it up and start again.
A true enemy of the NHS is the five-year electoral cycle.
For most back pain, MRI scans are pointless.
In fact I’d go so far as to say that this is a classic example of wasteful over-diagnosis that plagues private healthcare systems.
Nice try but this was after about 6 months of pain and with a view to the possibility of surgery. I know surgery isn't aways (or even usually) the best approach but it wasn't being suggested as a first resort.