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Really? When people can’t afford to eat or heat their homes, you want to charge them to see a doctor?
Yes, so long as there is a safety net for those who can't afford it. Currently there's a substantial cost of accessing basic healthcare for someone in work due to the time and energy it takes to negotiate the system and the lost productivity due to untreated sickness and injury. Whereas the unemployed and retired can toddle along to their GP for the price of a (possibly free) bus fare and sit in a warm waiting room for a couple of hours so they have someone to chat to. Anything that discourages them from wasting everyone else's time can only be a good thing.
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.
Agreed, it's cultural reform that's needed not organisational reform. Unfortunately cultural reform starts from the top down.
Anything that discourages them from wasting everyone else’s time can only be a good thing.
Leaving aside the rather odd idea the unemployed and oaps use the doctors surgery as a social club the problem with making people pay is you make it more likely people will put off going until their condition has worsened significantly.
Not only does this give worse probable results for them but can cost the NHS more as well since treating something early is often more cost effectively than trying to treat it later.
You are also, of course, adding additional costs to those people in work and making it less likely they will be taking that time off.
Yes, so long as there is a safety net for those who can’t afford it. Currently there’s a substantial cost of accessing basic healthcare for someone in work due to the time and energy it takes to negotiate the system and the lost productivity due to untreated sickness and injury. Whereas the unemployed and retired can toddle along to their GP for the price of a (possibly free) bus fare and sit in a warm waiting room for a couple of hours so they have someone to chat to. Anything that discourages them from wasting everyone else’s time can only be a good thing.
- The people most likely to benefit from health care are the ones who do have the time, please see my earlier post on this.
- Most of those people would be picked up by your safety net anyway, so wouldn't be charged.
I cannot stress this enough. Ill health is extremely strongly associated with poverty.
I think that this thread illustrates nicely the problem with uninformed people's perceptions of what the problems with and solutions are to providing effective healthcare:
- Being happy because "something has been done" for them.
- Being unhappy with "nothing being done", even though often it is the better course of action.
- Various tired old tropes about private sector & NHS efficiency.
- Stop those people from wasting precious NHS resources so that I can get better access.
Stop those people from wasting precious NHS resources so that I can get better access.
This one worries me the most. Trying to price off old or vulnerable people from accessing healthcare seems an odd motivation, these are the people that need help most, and it wouldn't work anyway. If charges came in, it will be working busy people paying them, in the main, and older and unable to work people not being asked to pay.
Even if old people are toodling down to sit in a warm waiting room, (which I doubt) that points to a societal issue that needs fixing outside the NHS, not within it.
Disincentivising people to visit their GP would be the same as making it tougher to get free prescriptions - people would die as a result.
People who miss appointments and timewasters have been present in the NHS since its inception. The difference is that successive falls in funding and staffing mean that this annoying but unavoidable part of the job has become something that is harming access for people who actually might have stuff wrong with them.
The question is, do you think free-at-the-point-of-need healthcare (such as it is), is worth fighting for, is it a social good?
And when you look at those clamouring loudest for extra charges, and private sector involvement, do you see people who are trying to make things better for everyone, or mostly a collection of Right Wing Think Tank shills who just see opportunity for them and their mates?
Anything that discourages them from wasting everyone else’s time can only be a good thing.
Here's a thing that will surprise you...We (the folks in primary healthcare) can spot timewasters, and we have ways of dealing with it. We don't need (or largely want) any additional bureaucratic* tools to help with that.
* As GPs (where the payment would no doubt be taken) we're entirely not set up to take money from patients routinely. That's not to say we don't do it currently, we do, but it's once or twice a day, I can think of any other patient facing activates I'd rather my admin staff did for patient healthcare than deal with all the issues that having to take payments off people would cause.
Oh yes, the other amazing thing in France is the sheer number of people devoted to healthcare admin. Because it’s free but run on an insurance basis there are immense amounts of paperwork and you get to see what your broken ankle (to give a pertinent recent example) would have cost if social care hadn’t picked up the bill. I am totally not sure about whether this is an unnecessary waste that contributes to the higher social care levy here but it’s interesting.
Whereas the unemployed and retired can toddle along to their GP for the price of a (possibly free) bus fare and sit in a warm waiting room for a couple of hours so they have someone to chat to. Anything that discourages them from wasting everyone else’s time can only be a good thing.
How big an issue is this? Do you have any statistics?
Yes.
Literally today my wife has been refused a consultation due to "capacity issues". She'll now attempt the morning internet trial that is a Dr's appointment. She has a Thyroid issue, and on the last two occasions the GP was in shock and manipulated an appointment on the basis my wife is "...at serious risk of a heart attack..." The reason she is calling is her resting HR is up to 90bpm and other symptoms put her levels at risk. A 12hr wait in A&E won't help.
Gov.UK doesn't give a shit about the proles dying as long as they make their money.
<br />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. <br /><br />
I agree. You only need to look at how Circle health ran Hinchingbrooke hospital to see how much better things would be.
Or Serco’s butchery of Suffolk Community Services. They under-bid the NHS providers by £22m and then lost £22m trying and failing to run it. And that was a fairly straightforward set of services. They ****ed it so badly that they haven’t bid for a clinical service since. <br /><br />
The answer is not privatisation, it’s acknowledging that in a civilised but aging society we’ve all got to pay a bit more tax.
Really? When people can’t afford to eat or heat their homes, you want to charge them to see a doctor?
Plus adding in a load of admin to charge/collect fees along with shipping out debt-recovery from those who's cheques bounced etc or weren't actually allowed not to pay.
Any healthcare system that 'decides' who will be treated and to what level has a far larger admin overhead than one that doesn't. Most of the NHS admin is related to staffing, buildings, logistics & procurement plus managing the constant Govt changes (waiting lists and the like) - not payables, invoicing, recovery etc etc.
One of the reasons the USA has a healthcare problem is folk don't go until it's really serious, even those with good insurance - check out "healthcare deductible".
The NHS needs root and branch reform before more money is chucked at it. Should still be free at the point of use for those who cannot afford to pay, but surely some sort of health insurance based type system, like in most of Europe (where healthcare outcomes are generally better) would be far preferable to the shitshow we currently have which seems to serve no-one very well?
The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories. I am not excusing the Tories as they are utterly shit too, but just saying that the problems clearly run much deeper than whichever political party is in power.
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 have no idea but I do know that their grandparents were likely to have asked their GP for a home visit if they were feeling poorly and had a bit of a temperature.
I also know that back in the day their grandparents could pop down to see their GP on a whim, they didn't even need an appointment - they could just turn up any weekday and expect to be seen!
I also remember a time when a GP would sometimes ask you to come back after completing a course of treatment to see how you were. Imagine that, a GP having the time to see someone with a cured medical complaint!
The NHS needs root and branch reform before more money is chucked at it.
Yay, more reform.
some sort of health insurance based type system, like in most of Europe (where healthcare outcomes are generally better)
Where they also spend more of their GDP on healthcare you mean?
Yay, more reform.
It is one thing the various governments have been competent at with regards to the NHS.
Shouting loudly about "sacred cows" and "cant criticise the NHS" and "needs reform" to cover up all of them have been buggering around with it since about the year dot never allowing anything to settle in before they dive into their own personal dream of how to "improve" it.
I kind of think that @Kramer (et al) has summed things up and made much of this thread superfluous… including the stuff I have written below.
As users of the system each of us who expresses an opinion here is doing so on the basis of anecdotal evidence; gained from our experiences and those of people we know. The people we should listen to are those that understand and work in the system.
I can cite examples of things where I think the system didn’t work as it should… but in many cases the outcome would have been the same if things had been done differently.
In the end I feel we need to pay more to the system as a whole and invest in primary care and prevention. At the moment too many NHS users let themselves get unhealthy, moan about tax and then moan about how long an ambulance takes to turn up. On top of that they moan about immigration whilst relying on an immigrant for their healthcare and so on… all the time they are subject to the drip drip gaslighting of the billionaire press and think tanks so they vote for parties who perpetuate the situation we have.
note sure this'll work
https://twitter.com/gloshospitals/status/1742584102694350864
When you have the NHS telling people to stay away you aren't in a good place.
Just don't go stuffing yourself into trees or on rocks for the next week.
I was well looked after as an in patient for 6 weeks after breaking my spine, express delivery through A&E straight into resus.
That was a while ago.
The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.
I wonder why a Tory government might act in a way to make a labour government look worse?
Charge to be seen? I can't even get seen.
My local practice regularly has people calling over 100 times to get through. They don't allow walk in appointments and have a couple of phone operators if you're lucky.
They used to run e-consult which was great, fling in symptoms, bish bash bosh, wait to get triaged and they would contact you for an appointment. Then they made it run during opening hours only. Then they scrapped it entirely.
So if you have an urgent medical issue how do you get seen? Or an issue that's not that urgent but you don't want to take half a day off work to sit on the phone hoping you get through. ****ed if I or anyone else knows, it's an utter shit show.
@kramer I doubt you mean it but you are coming across as quite dismissive and arrogant regarding other countries medical services. If there's one thing I've learned it's that we always have something to learn from our peers and there is always room for improvement.
I had cause to pop into minor injuries last week.
Angle grinder spark in my eye.
Walk in , 4 people waiting. Booked in within a minute.
Fab .
Triage within 5 mins , usual " are you an athlete?" HR around 60 , BP 105/67.
Back out to waiting room for 10mins, then called to see eye specialist.
Just a burn and no debris so ointment for a week and don't be a dickhead with an angle grinder chat.
Out the door within 30 mins. So , in this instance on a sample of 1 , amazing service from the NHS .
Queue was more or less the same when I left ,
The NHS in Wales (where my brother lives) and run by Labour, has for a long time now been far worse than the NHS in England under the Tories.
How do you know it’s worse? If it is, how do you know if the reason is due to the Welsh Govt and not other variables? Are any differences significant when corrected for population and other regional variables?
Don’t forget how desperate the current UK govt is to show Labour in Wales as failing. I’m not saying WG or its institutions are perfect and beyond reproach but the current UK govt works hard to shaft the WG whilst making it look like they are trying oh so hard to do the opposite.
Then they made it run during opening hours only. Then they scrapped it entirely.
I know its frustrating, but I know why GPs do this. Web based triage systems are like building an extra lane on the motorway, for a bit they divert people from walk in or the phone, like the extra lane makes traffic move faster for a bit... But soon patients overwhelm them as they think they'll get seen quicker, and they still rely on GPs to triage them, if I divert a GP to look at those, that's a GP who's not seeing patients. If I left our web-system on 24/7 we'd never get through it ever, and we'd be back to square one. It might be boring and a bit beyond scope of the thread, but GPs pay contracts are based around seeing a number of patients each year "at the expense" of other patients on the register who never really come in. I don't know of many GP practices who're are within hat contract ratio anymore, and we haven't been for a while now.
edited to make more sense and typos.
@kramerI doubt you mean it but you are coming across as quite dismissive and arrogant regarding other countries medical services. If there’s one thing I’ve learned it’s that we always have something to learn from our peers and there is always room for improvement.
I refer you back to my point about "something was done" therefore people judging it as being good when in fact it isn't.
Overtreatment and over diagnosis is a massive issue in health care systems, especially insurance based ones.
The NHS isn't brilliant, but most other countries that we're comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.
Something to consider, when the system is short of frontline staff, and we're not talking one or two, but 10's thousands there will be an impact. To train a nurse is going to take 5+ years, a doctor a decade. Throw in an aging population, decades of underfunding, not exactly great conditions, staffing is going to be an ongoing issue.
Privatisation isn't going to fix anything when the staff don't exist. Remember the farce of the nightingale photo ops. no staff to populate the buildings.
Spending money on consolations and reorganisations is easy, getting staff when you tell all the foreigners to f*** off less so.
To see how well privatisation works, take a look at dentistry.
I work for the NHS (Mental Health, and I'm a MSc Student Dietitian, so partly funded via the NHS) what I see from a work point of view and from the other side of the coin is completely different, mental health, bloated mess, no discharges, bed blocking, huge buildings and wards for 45 patients, managers for managers, 90% of discharges into private residential, at huge cost
however, on a couple of occasions in the last month I've been on the other side of the coin
1st, had a kid, waters went a month early, 5 day stay for baby mama, discharged with a plan, went back in, augmented, baby safe, flawless, couldn't ask for more (ok maybe a bit quicker from you're getting discharged, to you can go, but it is what it is), baby readmitted 8 days later, phone call at 8pm after blood results were back for 24 hours due to jaundice and feeding issues, bit of a staffing issues and access to a machine but it was 9pm new years day, they were understaffed, he wasn't a priority
2nd, friends partner hung himself, arse end of nowhere in Lincolnshire, took me 40 minutes to get there, by the time we had, there was already 2x police, and an ambulance, he'd been resused and worked on for a good couple of hours before the ambulance left for the hospital, unfortunately he died a couple of days later having never regained consciousness however, you literally couldn't have asked for more
lots of other stuff like missed appointments, and other stuff, but when you need it sometimes, it's still good
How do you know it’s worse? If it is, how do you know if the reason is due to the Welsh Govt and not other variables? Are any differences significant when corrected for population and other regional variables?
I'm not sure of the politics, but my brother has been waiting 2.5 years to see a dermatologist in Wales for a fairly unpleasant and progressive skin disorder. Still no joy to see anyone despite his GP trying to expedite his referral - twice. His next door neighbour has just had both knees done as she was getting to the stage where she was unable to go to work with it. She paid and went private in the end as the wait for her operations on the Welsh NHS was 5 years. 5 years - just let that sink in for someone of working age who is struggling to stay mobile.
So pretty ****ing sh*t I would say.
Yeah Scotland and Northern Ireland aren’t great either.
@mrmo dentistry, well that’s a whole separate thread but the death of nhs dentistry is already a foregone conclusion & broadly speaking it’s the result of massive under investment going back to the last labour government and includes both parties ignoring the profession telling them what was going to happen about 20 years ago.
The dentists themselves would tell you that privatisation has not massively increased incomes compared to the heyday of the nhs but it has eased workloads to under burnout levels and has allowed clinicians to practice the dentistry they were taught to do not some speeded up bargain basement version that doesn’t really help the patient or the dentist in the long run. So it has worked just not on a whole population level.
ever wonder why dentists were in the top three of professions that committed suicide?
anyway carry on.
@ceepers I think it started even longer than 20 years ago. I remember my father stopping being an NHS dentist ~35 years ago because they brought in a new contract that made it (in his eyes) unviable to continue as a dentist.
@kramer yep that was the first nail for sure and it’s only got worse.
Back then it became unviable to practice really high standard dentistry. Now it’s pretty much unviable no matter how many corners you are prepared to cut & nhs dentistry only really exists wheee a business has a private side to subsidise it!
as a business owner I am increasingly wondering why my personal finances are subsidising a health service provision that the government won’t fund properly and yet we and many others continue do So as far as we can because it’s “the right thing to do” as healthcare professionals
I’m not sure of the politics, but my brother has been waiting 2.5 years to see a dermatologist in Wales for a fairly unpleasant and progressive skin disorder. Still no joy to see anyone despite his GP trying to expedite his referral – twice. His next door neighbour has just had both knees done as she was getting to the stage where she was unable to go to work with it. She paid and went private in the end as the wait for her operations on the Welsh NHS was 5 years. 5 years – just let that sink in for someone of working age who is struggling to stay mobile.
So pretty ****ing sh*t I would say.<br /><br /><br />
That sounds crap and indefensible… but you can find similar counter claims the other way. A friend who went private in England for an op that another friend had done on the NHS in no time in Wales. Other people I know who have all kinds of issues in Cumbria with geriatric care that I haven’t had here with my folks. My brother was an audiologist in England and his service got privatised… he came home. Wales does have some significant problems I know. But my point is
1. Our observations are anecdotal and not the whole picture. <br />2. If Wales is worse then it isn’t an order of magnitude worse; it’s in the same ballpark.<br />3. That Wales is screwed over by the current government; they have the magic money tree but WG doesn’t. It simply hasn’t got a tree to shake. <br />4. Wales lacks the economy of scale in all kinds of public sector services that England relies on. <br /><br />But again this is kind of by the by. The issues stem from a Govt and its support systems/influencers (press, think tanks, the USA corporate lobbyists, the Brexit lobby) that have not looked after us and our public services.
The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.<br /><br />
Exactly… yet the Govt(s) and wannabe govt as well as the likes of Kelvin MacKenzie will have you believe the opposite. The comments you hear from them on issues such as NHS pay are reprehensible to put it politely.
@nickc but now nobody can be seen at all unless they have the spare time to phone 100odd times before they get through.
I appreciate your explanation, I just think there's a sensible middle ground somewhere. Have the e-consult for those that can use it and leave the phones free for those who can't or urgently need an appointment.
The NHS isn’t brilliant, but most other countries that we’re comparing ourselves to have better funding. Better funding has improved NHS outcomes in the past. Comparing ourselves to countries that are better funded than ours, but organised in a different fashion, and thinking that the difference is down to organisation rather than funding is likely to be wishful thinking IMO.
@kramer That makes more sense, cheers.
Or you could just have the right number of gps for the population they are expected to see.
But there’s a crisis in recruiting GP’s and more leaving the country / taking early retirement than are being replaced.
which is back to pay & conditions and lack of investment in primary care instead of secondary services as mentioned above...
they have the magic money tree
Don't they just. Apparently even though we are now the 6th biggest economy in the world, we can't afford to fund a decent level of healthcare for our population, or decent social care for those who need it most. Or train sufficient numbers of doctors or nurses or ambulance drivers.
But there is always plenty enough money to bail out the bankers, fight or fund wars in foreign countries, give it to our mates for dodgy PPE, fritter it away on a useless HS2 vanity project, or in Wales case, change all the 30mph road signs to 20mph at a cost of £32 million.
Did you know our response to Covid cost somewhere between £310 and £410 billion pounds. That is nearly three times the entire annual budget of the NHS!
Public spending during the Covid-19 pandemic
And what exactly did we get for that money and where has it all gone? Ask yourself are we healthier now as a nation after all of that spending? Have our NHS waiting lists gone down? Did we save loads of lives and was it all worth it? Or have peoples lives got worse?
It is our hard earned money that the Tories have pissed up the wall (and given to their mates). Money that we will all be paying back for years and at the expense of the vital services we rely on. During the last financial year, the government spent £111 billion on debt interest alone. That's more than the entire annual spend on education! Practically criminal levels of mis-management from our government.
And what have Labour done to oppose any of the above? What have they done to hold the Tories feet to the fire?
**** all, that's what!
Meanwhile, just another £1.1 billion of taxpayers money down the drain by June.
No biggie though, eh?
Yeah but
Lifting the lifetime cap on pension payments so alot of GPs who were effectively working for free due to punitive tax regulations might be return or not leave reducing natural wastage over time
@singletrackmind that’s definitely going to help a small amount with hospital consultants but it’s not a big factor for GP’s using medics I know as a guide.
seems to be more about volume of workload / stress and General practice (especially in rural areas ) seeming less glamorous to the type of person now qualifying.
others can perhaps comment more learnedly
EDIT: As i understand it, the pension thing is about making it more attractive to do "extra" hours - not everyone is going to be willing or able to do "overtime" longterm
fwiw, i know quite a few GP's. They all work very hard, have lots of work stress. One just moved himself and his Dr wife to New Zwealand for a better work / life balance. Another has been telling me about the looming recruitment crisis for the whole time i've known him ( 10 years).
The fundamental problem with NHS is the lack of understanding or acceptance of just how expensive running a comprehensive health system is.
Small real terms increases doesn't come close to meeting the growth in demand, or the rate of growth in cost of drug/treatment/technology advances.
The same for all public services. The fundamental problem is not starting with the question about how much does it cost to have a service at the level we really want (staff, drugs, equipment, estate) and then deciding how to shape society to afford it. Honesty about the trade off between tax and public services.
The £1.5billion that Labour have promised above whatever's the Tories have said - to address waiting times - I reckon is maybe 10% of what is needed as a starter - and I do have a lot of experience in this area at a national level.
It's depressing really, and the NHS is in a better position than most public services. Many local Authorities are on the verge of collapse, justice/prison service is dysfunctional, care services problems are so difficult nobody even talks about it etc etc
Meanwhile, just another £1.1 billion of taxpayers money down the drain by June.
"Paxlovid – an antiviral developed by Pfizer and designed to be used shortly after people test positive for Covid-19 – was approved across Britain in 2021 after trial results found it reduced the risk of severe illness by almost 90 per cent."
Presumably there are at risk people with access to this, who are also testing to catch things early enough to then be given the drug if needed? Is this a success (those people aren't testing positive, so don't need the drug) or a failure (not enough people who could benefit have been given access to testing and the drug)?
The same for all public services. The fundamental problem is not starting with the question about how much does it cost to have a service at the level we really want (staff, drugs, equipment, estate) and then deciding how to shape society to afford it. Honesty about the trade off between tax and public services.
The problem currently is that you can't fix the NHS without fixing the care system and council budgets. Everything along the pathway, from pre-hospital prevention/education, through to primary care, diagnostics, acute treatment and post-discharge care is dysfunctional, creaking, or virtually non-existent.
Labour in the late 90s was the last government to attempt the semblance of a plan on how to start improving things, starting with stuff like SureStart to help set a foundation of better health in infancy, and then investing to reduce waiting times for diagnosis and treatment, and moves towards a National Care Service. But the scale of the problem was vast, and even the substantial funding provided then was not able to achieve all these aims. And obviously, the government which followed ended up reversing much of this or just starved it of resources.
I have not seen anything from the current Labour Party with the same level of ambition, but then economically we are hamstrung.
And what exactly did we get for that money and where has it all gone? Ask yourself are we healthier now as a nation after all of that spending? Have our NHS waiting lists gone down? Did we save loads of lives and was it all worth it? Or have peoples lives got worse?
It is our hard earned money that the Tories have pissed up the wall (and given to their mates). Money that we will all be paying back for years and at the expense of the vital services we rely on. During the last financial year, the government spent £111 billion on debt interest alone. That’s more than the entire annual spend on education! Practically criminal levels of mis-management from our government.
I'm a bit confused. Are you complaining because labour are not challenging the tory's narrative that there is not enough money for public services, or are you complaining because our govt borrows too much? You're right that the current govt gives public money to their mates for very little return. That's what the tories always do, it's their raison d'etre. You're wrong though that borrowing or the national debt is a problem. We should be 'borrowing'* and spending much, much more than we currently are to fund public services. Where labour are getting it wrong is accepting the tory narrative that the country doesn't have the money to fund public services. It does many times over, but it needs politicians willing to speak the truth and challenge the myth of austerity.
*It doesn't need borrowing or taxes, the govt can just spend what it wants.
but then economically we are hamstrung.
Are we? Please explain.
It's all linked (as has been said)..NHS health care...social care..schooling etc etc
In our area (West-ish Sussex) there's been reviews done (by teams that sort of transcend social/health care) on the impact that stopping food economics in school will have.
Not today, not tomorrow, but in a generation's time. Yes, money will be saved today, but the impact on the health of a nation will be huge. Mainly from poorer diet education leading to worse health leading to needing more health input.
The main issues really are managing the frail and ageing population properly (I'm sure i've raised this before..).
We've more 85+ years olds than ever. And the average age will continue to grow. And we simply can't treat them the same as the 'average 55 year old' - not because of the desire to discriminate, or save money by "not treating old people", but because they don't respond the same.
Peopls simply don't live forever, and EVERYONE dies. Unfortunately, death is still seen as a failure..as if something has gone wrong.
The mindset of the natin needs to be changed, so that accepting that a 96 year old, bed bound patient needing 100% of their care to be met by carers, SHOULD be allowed to die in their nursning home.. and NOT ring 999 when they "become a bit more drowsy"..
because 999 will take them to hospital, and hospital will "think they need to do something"... when really they jsut need care and family around them.
I feel massively that we (i'll say it) mistreat our frail and elderly, by forcing them to endure medical treatments and such, purely because we're (family, doctors, nursing homes) too stubborn to let people die nicely..
DrP
too stubborn to let people die nicely..
Oh absolutely. It is human nature to 'fight against the dying of the light', but we need to embrace the concept of a 'good death' - and devote our efforts to improving the quality of those last weeks or months, rather than just desperately trying to add a couple more to the tally.
But again, this is partly due to failures across the NHS and care systems. I have a relative who may be approaching this shortly, and the absence of any communication between the various clinical and care teams, when they should be moving to set a decent palliative plan in place, is very frustrating.
A member of our family recently popped off at 96. He'd had a week in a care home for respite but in doing so he lost his ability to walk around the house. He had a 'good death' though and aged disgracefully, regular trips to the pub and surprising stuff on his computer, the old dog.
The mindset of the natin needs to be changed,
And not just with attitudes to dying, but with their attitudes to taking responsibility about their own health. Generation X is getting on to being wildly unhealthy. They may not smoke as much as their parents did, but their diets and lifestyles are way poorer, and their children are now leaving school obese. Its GPs who're shouldering the burden of that.
Now I get that its a wider societal issue and as a nation we have to have a proper conversation about the "food" that we have surrounded ourselves with, but we have a major political party who think that any sort of intervention is "The Nanny State" and a current health minister (Victoria Atkins) who's married to a CEO of one of the worlds largest sugar manufacturer [apparently that's not a conflict of interest] , and her solution is diet advice, which we know doesn't work.
Quite agree about intervention when someone is at end of life. Really should have stopped intervention at least twice on MIL - final time this ended up with her 'hanging on' for another week because a relative and staff decided to intervene as she arrived in hospital, rather than accepting the inevitable (which family decided 24 hours later).
Prior to that was probably a year before - again at death's door, too much intervention and she was 'around' another year. She didn't want to be.
The system is broken with the bed blocking - we do need more care units for elderly, rather than them filling A&E and high intensity wards, just because we can't get them out without a decent care package'.
I literally heard someone in the office mention an elderly relative wouldn't take paracetamol to manage a high temperature, because this person preferred to be in hospital being looked after !
The issues with the NHS is certainly making me think about going for a routine check up - I'm fine, but going in for blood tests etc (supposed to be every year), taking up the practice's time (when it's next to impossible to get an urgent appointment) means I just don't bother. I had a nasty cut from a bike crash a year ago - really should have gone in for it to be stitched, but I just patched it up and carried on - thankfully it didn't get infected, but I have a nasty scar.
The problem currently is that you can’t fix the NHS without fixing the care system and council budgets.
As I see it, you can't fix the NHS and the care system without fixing society in general.
People need to take some responsibility for their own personal health and help unwell family members. All of the things that point to poor health outcomes and higher mortality like poor education, poverty and lack of opportunity all need fixed.
As someone alluded to earlier in the thread, it's like the current shit roads we have, you can patch them up all you want but it's only a temporary fix as they actually need resurfaced or to be built properly in the first place. The health and care system feels like this, lots of sticking plasters being applied without addressing the underlying injury.
My mrs pal has been suffering with sciatica for the past few months. Over the past few years she's also been treated for breast cancer. All on the NHS
The sciatica has been causing huge problems for her to the point she's on the verge of a mental breakdown. Her parents paid for a private consultation for her yesterday at a dedicated private hospital. The consultant there was absolutely horrified by the lack of care from the NHS consultant. Essentially it was "you've got sciatica, here are some painkillers, go away". No MRI, no tie in with her previous cancer diagnosis, no treatment plan other than the painkillers.
Years ago my mother experienced some migraines. She went to the NHS, they did a scan, told her she had lesions on her brain and she likely had MS and sent her on her way. Nothing further offered. Naturally my mother was devastated so she went for a private consultation and a battery of diagnostic tests and a fully in depth discussion with the consultant. The result of which was reassurance that those lesions were perfectly normal for someone of her age, she didnt have MS and advice and guidance on what to do going forward.
Yes, it's broken.
Perhaps the government needs to look at fixing the demand side issue. Chronic conditions such as obesity and type 2 diabetes (and all the associated health problems) are due to skyrocket due to poor lifestyle choices and lack of education. Diets full of processed crap are now the norm. And, if you follow the latest scientific research, the NHS's heavy focus on cholesterol and low fat is now woefully outdated as a predictor of heart disease, dietary health etc.
We have been told for years that a low fat, high carb, low cholestrol diet is healthy by the NHS etc. But just look at what has happened during that time. Obesity is now out of control, and the number of people living with serious life-limiting chronic health conditions is at levels never seen before. So something about this approach is clearly not working.
GP's (if you can actually get to see one), seem really only there these days as the gateway to book hospital appointments, or as dishers out of pharmaceutical products. Pharmaceutical products that mask a patients symptoms rather than address a patients underlying issues (there is no money in this).
My guess is that most GP's know very little about the latest research in diet, nutrition etc. and what a huge role this plays in health outcomes. They are stuck with the outdated dietary advise promoted by the NHS and entrenched in a cycle of prescribing endless pharmaceuticals with often very limited efficacy and frequent side effects. Statins for example.
To prove this you only need to look at the US, where the use of pharmaceutical products per head is the highest in the world. Yet they also now have the biggest chronic disease burden in the world, and the most metabolically unhealthy population. It wasn't always this way. To see for yourself tale a look at some Woodstock photos from the 60's. See how slim and healthy everyone looked. Compare these photos to the overweight and unhealthy young people all around you these days and you will see that something has changed.
But it feels almost like the huge food industry and the pharmaceutical industry wants it to be this way. After all there in nothing so profitable as a repeat customer. A customer addicted to processed food full of sugar and seed oils to make them unhealthy, and then requiring expensive medication to address the symptoms - for life. Ozempic is the latest profitable wheeze. An expensive and regular treatment to address an issue that could, in most cases, simply be managed through a better diet.
So it might surprise you that almost all members of the US Congress on both sides of the house receive lobbying money from the Pharmaceutical industry. I expect it is similar in the UK and I am aware that 86% of the Medicines and Healthcare Products Regulatory Agency (MHRA)'s budget is derived from the drug industry. Look it up, and then maybe the penny will drop as to why we are in this mess without seemingly a will from the top to change things.
Remember, without an unhealthy population, the pharmaceutical industry makes no money. He who pays the piper and all that.
To affect the demand side through public health you really need to look at what worked for smoking. Huge and hard hitting public health campaigns and rapidly escalating taxation.
Be brave Government that did either as the criticism from the libertarian sections of society of nanny stateism. Can you imagine if a freddo was £2?
That would also only work on the food side - getting people to do something ie exercise would be even harder to lever.
most GP’s know very little about the latest research in diet, nutrition etc. and what a huge role this plays in health outcomes.
Go on?
Go on?
From the US:
an average of 11 hours of nutrition training throughout an entire medical program
How much nutrition training do doctors get
And from the UK:
We learn nothing about nutrition, claim medical students
Doctors know little about nutrition or excersize
And this is just the established (and now somewhat out of date) basics that they know little about, let alone the recent developments in nutrition research, which as ever take quite some time to filter down to education programmes.
I know this because my wife is a qualified and practicing nutritionist, so she, and I to some extent are aware of how much things have evolved, and how much we now understand about how nutrition, and the very closely linked metabolic/gut health, impacts a whole range of health outcomes.
Poor nutrition and other lifestyle factors such as sleep, excersize etc. have now been identified as the single biggest predictor of a whole range of diseases and health issues, with genetics being less important than it was previously believed to be. We really are what we eat.
But your average GP in the UK knows seemingly very little about any of this. So can you see the problem?
People need to take some responsibility for their own personal health and help unwell family members.
I am not a GP, or a consultant (or a nutritionist for that matter). We need professionals, and to have access to them, and pay them well for their learning and application so that they'll keep at it.
And from the UK:
One of those articles is 5 years old and the other is 8 years old...D'you not think things might've progressed at all?
IMV as a GP, the relentless push to make us more "efficient" is killing the golden goose.
A GP used to be about twice as cost-effective (on average) as a hospital doctor. This meant that a pound of NHS money spent on primary care (GPs) gave you about twice the benefit of a pound spent on secondary care (hospitals).
That wasn't because we're in some way better, but a lot to do with the fact that we could get to the low hanging fruit in health benefits.
The main way that we achieve that is through continuity of care, which means that we know our patients, they know us, and we tend to have a good working relationship.
To have continuity of care, when demand is variable, you need to have spare appointments. This is inefficient.
You also need your GP to be reasonably rested. GPs are mostly spotting needles in haystacks, it's nye on impossible to do this if we're fatigued.
The other part of what we do is take shortcuts based on our clinical experience. No other clinicians in the NHS see the number and variety of patients that we do. This makes us pretty good at using our spider sense to diagnose things (and know when there's not likely to be much wrong) very quickly. Again it's nye on impossible to do this when we're fatigued.
Our final secret source is our consultation and communication skills. This is what we specialize in. Yes we're not perfect, but on average we have more training in it than most other clinicians (other than therapists). Again it's very hard to communicate effectively when we're fatigued.
Rested GPs are inefficient, because if we're not tired to the point of exhaustion it means that there's unused capacity in the system.
If you have a rested GP with a reasonable amount of time on their hands who knows you, then in general we're pretty good at spotting and effectively treating things before they become serious much more cheaply than hospital doctors do.
However, everything that has been done to General Practice since I've been a GP has seemed to be with the aim that we should work more like hospital doctors with guidelines written by hospital doctors, targets devised by hospital doctors and the focus on patient access with no regard to continuity of care. At the same time we're being reorganised into structures that look a lot like community versions of hospital hierarchies. Our patients have been fragmented into seeing lots of different people for different things.
At the same time, over the past fifteen years, funding has actually been taken away from primary care and given to hospitals.
Crazy when you think about it. You have one service that is twice as effective as another. You respond by reorganising the more effective service to look more like the other one, whilst at the same time removing funding from it and giving it to the other one.
It's madness.
I am not a GP, or a consultant
Sure, but I wonder how many folks have read the NHS constitution, and particularly the first sentence of the patient responsibility section of it?
One of those articles is 5 years old and the other is 8 years old…D’you not think things might’ve progressed at all?
It is very slowly changing as people become aware, but still not a lot according to my wife. If anything, often views have become somewhat entrenched as there are many vested interests trying to ensure that medicine remains primarily a pharmacological and surgical based pursuit. Medics and scientists who fall outside of this, or who propose treatment protocols that rock the establishment boat are frequently labelled as cranks, or struggle to get adequate funding to support their research.
Meanwhile research for new pharmaceuticals is awash with cash - because huge financial returns can be made by corporations and their shareholders. And sponsorship of almost all major therapeutic areas, it's key opinion leaders, and their educational congresses is by the pharmaceutical industry. So it is not a level playing field.
Hence the growing prevalence of things like Ozempic which is supposed to help manage the symptoms of type 2 diabetes. But type 2 diabetes can in most cases also be perfectly adequately managed, or sent into remission, through improved nutrition and without the potential side effects of drugs like Ozempic.
But like I said before, there is not much money to be made from healthy eating.
Sure, but I wonder how many folks have read the NHS constitution, and particularly the first sentence of the patient responsibility section of it?
I think this sits nicely with the rights/responsibilities conversation.
When it comes to the issues with the NHS there isn't any human element involved that doesn't have a case to answer for making better choices.
As for the reform, the NHS is a franchise with many, many chiefs and reform is usually a one size fits none process. Look at the shitshow that has been the NHS Digital, Improvement, Leadership Academy absorption into NHSE, Haemorrhage many quality people due to the lack of competence of the leadership function compounded by the size and complexity of the task.
My experience thus far on some of the FTC's I've worked is there is a real lack of competence in leadership, this may in some part be down to choice (that in itself is a challenge the NHS is yet to crack), but more often than not it is down to a lack of time to devote towards growing competence and all that entails Vs the competing priorities people have to manage. It's quite sad to see close up the impact of that in human terms.
Medics and scientists who fall outside of this, or who propose treatment protocols that rock the establishment boat are frequently labelled as cranks, or struggle to get adequate funding to support their research.
I've had direct experience of this myself, where an ex-GP and a patient essentially drove our GPs to distraction with their insistence that only a particular diet would be acceptable as advice for T2D patients and that to show commitment to this, we (the practice staff) should all convert our own diets to align with their particular fetish. It was a short conversation after that. Cranks indeed.
I know this because my wife is a qualified and practicing nutritionist
Not to rock any boats . But Anyone is a nutritionist. It's not a title protected by law.
By this I mean, it's kinda just a made up title that doesn't have a legally qualified backing.
Not to say nutrition advice isn't of use. But the concept of a nutritionist (over, say, an actual dietician) is nothing short of faddy bs most of the time.
Tumeric anyone?
Sorry.
And I don't really get this adversity to pharmaceutical treatments.. yes, big pharma can often be terrible and expensive, but I. Reality it's the introduction of measured and tested drug treatment that had significantly prolonged life.
To take your example of ozempic... YES... of course patients with newly diagnosed type 2 DM can reverse their condition with weight loss (5-10% body weight loss). You don't need to adhere to nutritionist advice for this. You just need to eat less - salad, shakes, stir fry approach works! But people don't. (Well, some highly motivated people do.. And that self selecting audience is probably what your wife sees I guess). The rest can't just be left to rot. So what do we do...we treat with pharma and operations to make them drop the weight. Cos, shamefully, it works.
DrP
DrP
I'm afraid that there's a massive gap between the claims made for nutritional medicine and the actual evidence that shows those benefits.
I've read Tim Spector's books. They're very interesting, but the actionable advice that he gives can be summed up in a couple of pages, which, in fact, is what he does at the end of them.
The reason that there isn't much time spent on it at medical school is because in terms of practical advice it really isn't that complicated as per Tim Spector's couple of pages.
If we're going on about Big Pharma, then it's only fair to point out that Big Supplement is far worse and far less regulated.
And I don’t really get this adversity to pharmaceutical treatments
Because people are generally emotional and scientifically illiterate. 'Natural' remedies are seen as better cos they're er, natural and a bit magic. The fact the many pharmaceuticals are basically the active ingredients from natural remedies with the shit removed, active mechanism understood and the dosage carefully calibrated is way beyond peoples willingness to understand. They'd rather go with simple pseudo science than accept they are thick and don't understand real science. They often do their own research as well........being completely incapable of making any rationale judgements about what they find.
And I don’t really get this adversity to pharmaceutical treatments
Pharmaceutical treatments have their place, many are excellent, but many also come not only with significant costs, but also with potential risks too. Might I remind you that there have been some very significant criminal fines paid by the pharmaceutical industry for fraudulent, misleading and ethical behaviour relating to safety and usage:
These are just the ones we know about
Then there are also the absolute horror shows like Vioxx, and the lack of much real-world efficacy of things like Statins, but often considerable side effects.
There is also the correlation I mentioned before. By far the biggest consumer of prescription medication in the world per person is the USA. So they should be by far the healthiest population right? Wrong, they have some of the worse levels of serious chronic illness in the world. Sure, much of it is diet related, and some is probably due to the poorest not having the same level of access to healthcare as the more well off, but facts are facts, so perhaps ask yourself how is this the case with so much access to pharmaceutical treatments?
I’m afraid that there’s a massive gap between the claims made for nutritional medicine and the actual evidence that shows those benefits.
I'm not talking about popping a load of supplements and pills. That's a whole other minefield. I'm talking about what constitutes a basic and healthy diet and the latest research that shows that the previously recommended low-fat (high sugar), high carb, low cholesterol diet, is not no longer considered a very healthy option given what we now know.
Wrong, they have some of the worse levels of serious chronic illness in the world.
A majority of citizens are over 40, access to healthcare is sporadic and expensive for many, and the work culture and work place protection is poor.
There are very real problems of over prescription and consumption of many medical pharmaceuticals in the USA as well (not least opioids)... but "natural" alternatives wouldn't be any better for those effected if they were to be used instead.
After today's farce. Yes.
4 ambulances and a gp visit due to poor comms and absence of people commitment to a decision
And what have Labour done to oppose any of the above? What have they done to hold the Tories feet to the fire?
**** all, that’s what!
Alex
- which bit of the Tory's having a big majority in Parliament are you missing plus a client media?
- also, a key issue in the USA is the ability to obtain prescription drugs OTC and over-prescription of other drugs
which bit of the Tory’s having a big majority in Parliament are you missing
There has been an ongoing and unprecedented epidemic of excess deaths across all age ranges since 2021 and mostly it is not Covid related. So clearly there has been some significant mis-management happening under the Tories watch.
Some of it will be delayed care due to GP's not seeing patients face to face for a while combined with a huge backlog on NHS waiting lists. Some will be the collateral fall-out from lockdowns and the stress, poor mental health, loneliness and financial hardship that lockdowns created for many. Some will be due to lifestyle factors brought about by lockdown, e.g. increased drinking, less people playing sport etc. Some will be down to doctors strikes and staff/ambulance shortages. Some will be down to the general NHS problems already discussed in this thread. And some, (heaven help us), might be down to the introduction of a novel medication in early 2021 with no long term safety data.
It would be an easy win for Labour to hold the Tories responsible for this utter and ongoing shit-show. Yet Labour don't even seem interested to look into the excess death situation. Why is that? Is it perhaps because during the pandemic, all Labour seemed to want to do was to call for more, longer, harder, sooner of whatever it was the Tories were proposing?
It would be an easy win for Labour to hold the Tories responsible for this utter and ongoing shit-show.
Who else could be responsible if the Tories have been in charge for 13+ years?
You really are talking nonsense.
Who else could be responsible if the Tories have been in charge for 13+ years?
You really are talking nonsense.
I think you have missed the point, which was about excess deaths. Why would Labour seemingly not want to investigate the ongoing large number of excess deaths across all age groups, particularly when the outcome of such an investigation would no doubt mean the Tories were made to look even more awful than they currently look?
According to The Lancet, they state that: "in the period from week ending 3rd June 2022 to 30th June 2023, excess deaths for all causes were relatively greatest for 50–64 year olds (15% higher than expected), compared with 11% higher for 25–49 and < 25 year olds, and about 9% higher for over 65 year old groups".
They also state that: Deaths involving cardiovascular diseases were 33% higher than expected, while for specific cardiovascular diseases, deaths involving ischaemic heart diseases were 44% higher, cerebrovascular diseases 40% higher and heart failure 39% higher".
This likely equates to somewhere between 50,000 and 60,000 excess deaths more than would be expected during the June 2022 to June 2023 period. That's 1,050 extra deaths a week a week, 150 extra deaths each and every day (equivalent to a Boeing 737-700 aircraft full of passengers going down every single day). And the vast majority are not Covid related.
These numbers of deaths are a long, long way above normal parameters, and very unusual after a deadly pandemic where your would usually expect mortality rates to improve somewhat. Yet unlike the daily Covid death toll, we don't hear much about this on the news, and our MP's simply do not seem bothered enough to make it a priority to find out just what on earth is going on.
I have written to our Labour MP about this and was fobbed off by him. Seemingly he didn't even want to acknowledge that there could be a problem. And one thing he was sure of was that it couldn't be anything to do with the vaccines. So that's a relief!
So why on earth don't Labour want to shoot into an open goal?
the introduction of a novel medication in early 2021 with no long term safety data
There’s a long tail of damage from Covid, you wouldn’t expect excess deaths to be zero in this period we’re calling “post pandemic” which isn’t really “post” at all. And Labour have promised to investigate anything left outstanding from the already ongoing enquiry, and specifically how money was spent and who it went to. Now pull your anti-vax tinfoil hat on tighter and shut up now please, there’s a good fellow.