[Closed] What to cut to fund the NHS?

now that will fix things, how drunk is drunk? Was it sitting in a pub and getting attacked?
Sorry to sound so negative about some of these ideas but I just got knocked back from my range of chocolate cookwear.
The police can fine people for their behaviour already.

IMO, three things need to happen:

1) The NHS needs to stop getting used as a political football that gets booted into different directions every election cycle. We need all parties to commit to a 20 year mission statement so that NHS Snr management aren't dealing with goalposts that shift every 5 minutes.

2) We need to invest in professional healthcare management for the future. People talk derogatorily about "managers" or "back room staff" within the NHS.... but what they are actually talking about is bad management. The NHS needs talented managers just like any other big organisation, so they need to define the roles and train for them at the higher education level.

3) We need to challenge the general public's perception of the NHS. People need to understand that it is NOT FREE, and if we want a world-class heathcare system.... we are going to need to pay for it.

Of the three, the third is probably the most tricky to achieve: We just haven't got the appetite for charging at the "point of delivery" in the UK (yet?). Imagine the uproar about the first little old lady that dies because she couldn't afford to pay for the ambulance/GP visit/A&E charge.

The Australian healthcare system is a complete mess too, but one thing that they get right is an additional tax that is levied (after you reach a certain earnings threshold) if you don't have private cover to a particular level.

The solutions are out there....

The Australian healthcare system is a complete mess too, but one thing that they get right is an additional tax that is levied (after you reach a certain earnings threshold) if you don't have private cover to a particular level.

Tom_W1987 - Member

Then the drugs that we do manage to get out there, get pissed up the wall by governments, clinical staff and the general public - through poor or over use - eg antibiotics - we even have people on here who demand extended treatment for lyme disease who cannot show any evidence of it's efficiacy and who don't mind that by using these drugs they are contributing to their eventual obsolesence. Whilst we have millions throughout the world who don't have access to good healthcare or antibiotics?

A bit of a false comparison there Tom?

As someone who has gone from being able to cycle 200miles a week six months ago to barely being able to get off the sofa because I was bitten by a tick on a cycle tour, I hope you're modest ego might take a second to consider that there's not much evidence out there to say that antibiotic treatment longer than the NHS's current advice of anything from 5-30 days (at varying dosages of varying antibiotics depending on the consultant) won't cure Lyme because frankly, the NHS and other medical research agencies simply haven't done the research yet.

What I can tell you is that the NHS's current position on it and their treatment is absolutely shocking, and it's placing people like me in a position where we're having to spend a great deal of time and money of our own to seek out treatment elsewhere where the medical community is a bit more open minded to the fact that there is still much that hasn't been researched or understood about the illness. As someone who pays tax like everyone else, leads a healthy lifestyle and enjoys my independence I find your comparison deeply insulting not to mention incredibly short sighted. There might be some out there gobbling antibiotics every time they get a cold, but if you're suffering increasingly pronounced and worrying neurological and physical effects and so-called experts are dismissing it as stress because NICE guidelines written ten years ago don't correspond to reality, then you'd probably suck bigfoot's cock for a cure before you listen to some disinterested Dr who surprisingly enough, doesn't actually have access to the research he needs to make that judgement.

I'd politely suggest you take a minute to educate yourself by either visiting the Lymeaid or caudwell-lyme websites before holding Lyme up as some kind of symbol of medical over-zealousness, or else put your money where your mouth is and take a cycle tour up in the Highlands for a week, get a tick bite and then go see for yourself how well your GP and local hospital acquit themselves.

@batfink, well said especially that the solutions are out there. We need a grown up conversation about material change. The idea of 20yr plan approved by all sides is great.

The Australian healthcare system is a complete mess too, but one thing that they get right is an additional tax that is levied (after you reach a certain earnings threshold) if you don't have private cover to a particular level.

Yes, but even that is still a political football, remember the MP who just couldn't believe the average GP visits in a year.
In many ways I like the Australian system but I'd hate it coming from a poor background. Not being able to afford decent insurance certainly limits options.

Quite. Like lots of things in Australia.... it's a great place to live if you have money!

I am a staunch supporter of a public healthcare service, mostly because anytime you add cost as a factor to the healthcare equation - the ethics gets very complicated. Charge for ambulances, and people will die at the roadside because they can't afford to call one. Charge for GP appointments and be prepared for a massive reduction in the proportion of cancers caught early.

I would rather 10 people go to their GP unnecessarily, that 1 who needs to go, but doesn't because they don't think they can afford it.

Obviously cost IS a factor in healthcare delivery, but we should seek to keep it as far away from clinical derision making as possible.

Absolutly Batfink, was a pleasure last year to be involved in some more forward thinking helth delivery moving away from the introverted fire fighting approach that happens in so many places. These threads with their "interesting" suggestions remind me why both the individual and the front line HC professionals are not the people to be making the decisons mostly due to having a very limited view of the overall process and system. Unfortunatly politicians are also not the most qualified as typified by the bragging rights as to who promised more at elections and the desire to bend the facts to suit your brag regardless of the impact that has.

Tom_W1987 - Member
I don't see why I should be paying for other peoples poor choices

It's not quite as clear cut as that. Some choices which help health - let's use the example of a physical activity like cycling, can also lead to injury. So do we support the activity or not?

bad genetics

I'm sorry Tom, but that is to say the least distasteful. Do you really want to effectively penalise people based on something they cannot change. Your situation at birth already has a huge influence on your opportunities. Do you really want to add health to that list any more than it already is...?

seeing as Britain has collectively decided to punish me and my wife financially because I married a foreigner. And I damn well don't see why I should be paying for hospital maternity bills if people argue it's because we increased the population of the UK.

Whilst disagreeing with the argument people use regarding population growth from immigration - this now sounds like sour grapes.

i am a regular user of the nhs my mrs works in the nhs. i see folk on a merry go round of been passed from one dr/consultant to another.. when in reality a frank conversation is needed..lose weight stop drinking start excercising and even.. stop wasting our time and yours.. there is not a cure for everything like my mates spotty face 6 years and dozens of hospital visits no change..

save the nhs for people that are ill and seeking a treatment that is available that will make a difference

the a&E issue is easily solved.. theres a big sign above the door giving a big clue.. its for accidents and life threatening emergencies end of.. there should be a triage at the door.. either a welcome mat or get to the gp, pharmacy mrs has hundreds of folk come to her pharmacy with issues she offers drug and they say.. oh i ll go to dr s or a and e and get a prescription..

we even have people on here who demand extended treatment for lyme disease who cannot show any evidence of it's efficiacy and who don't mind that by using these drugs they are contributing to their eventual obsolesence.

Who's that then Tom?

@chompy - good post with pertinent points, thanks for being so eloquent.

NHS's current advice of anything from 5-30 days (at varying dosages of varying antibiotics depending on the consultant) won't cure Lyme because frankly, the NHS and other medical research agencies simply haven't done the research yet

Yes. Yes there really is. This is like saying that there has been no research done into man made climate change.

It's not quite as clear cut as that. Some choices which help health - let's use the example of a physical activity like cycling, can also lead to injury. So do we support the activity or not

I don't think it would be too hard to look at the accident rates and then decide if cycling had enough of a public health benefit to be exempt from any risk calculation...

mikewsmith - Member
The ceo is one of the positions that I would really want some of the best in. It's the key leadership role of the organisation.
How are the supply chain ripping people off? Big paharma are not rolling in cash from drug development these days.

I agree you want good people running these facilities but do they need to be paid £400K plus? More than double the PM's salary?

Supply chain is a lot more than drugs/pharma. Stationary, definitely overcharged (and signed up to long contracts), cleaners, caterers, maintenance, logistics etc etc. In such a big organisation every small overspend ends up adding to a huge amount overall. Which is why I want a better performance from those managing the budgets.

1) The NHS needs to stop getting used as a political football that gets booted into different directions every election cycle. We need all parties to commit to a 20 year mission statement so that NHS Snr management aren't dealing with goalposts that shift every 5 minutes.

I think that this is probably the biggest thing that could change the NHS for the better.
Sadly, it'll never happen.

The NHS needs to stop getting used as a political football

I don't think you really understand what the term political football means, the NHS is not being used as a political football. When in opposition the Tories do not particularly attack Labour governments over their handling of the NHS.

In fact while in opposition the Tories made an electoral promise of [i]"No more pointless reorganisations"[/i] of the NHS, to quote David Cameron. Of course a Tory-led Government then went on to impose the biggest top-down reorganisation in NHS history.

The problem which has occurred is that, despite people not wanting to admit it, the Tories have progressively become more and more right-wing over the decades, as a consequence the NHS is now under threat like never before.

Today we have a Tory Health Secretary committed to dismantling the NHS as we know it and replacing it with profit driven providers. Is it really surprising that the NHS is in crises?

[url= http://www.independent.co.uk/news/uk/politics/jeremy-hunt-privatise-nhs-tories-privatising-private-insurance-market-replacement-direct-democracy-a6865306.html ]Jeremy Hunt co-authored book calling for NHS to be replaced with private insurance[/url]

[i][b] “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.”[/i][/b]

The Labour Party is attacking the Tories handling of the NHS not because they are using it as a political football, but because the NHS is under attack from the Tories like never before.

I don't see why I should be paying for other peoples poor choices or bad genetics, seeing as Britain has collectively decided to punish me and my wife financially because I married a foreigner.

That sort of bitter, I'm alright jack attitude is the opposite of what the NHS is. You have completely missed the point.

Count yourself luck to be genetically blessed...

Count yourself luck to be genetically blessed...

So far...

I knew someone who consistently argued the case Tom is arguing, till Parkinson's Disease manifested itself (not sure its something you catch). Remarkably he suddenly realised that poor health can be as much down to luck as poor choices

Tom you can't lump all cycling into the same bucket in terms of health risks

ernie your post is exactly why the NHS / Health provision is suffering from a woefull lack of funding, a situation which is getting and worse. The NHS was under funded under Labour and it's under funded under the Tories.

As soon as anyone mentions private contributions to healthcare we get a knee jerk reaction about "privatising the NHS"

As I posted before, people are selfish and will not pay the extra taxes requred to properly fund the NHS. As @batfink says the solutions are out there and we need to acknowledge we pay less per head on private healthcare than just about anyone. That's our issue the private contributions are not integrtaed into public provison as they are elsewhere.

[img] [/img]

As soon as anyone mentions private contributions to healthcare we get a knee jerk reaction about "privatising the NHS"

Yeah, every time someone talks about privatising we get a "knee jerk" reaction about privatisation of the NHS 🙄 Have you any idea how absurd your comment is?

.

ernie your post is exactly why the NHS / Health provision is suffering from a woefull lack of funding, a situation which is getting and worse. The NHS was under funded under Labour and it's under funded under the Tories.

Have you actually read my post? I don't mention anything about funding. What I do mention though is how Jeremy Hunt, the present Tory Health Secretary, has talked about "denationalising" the NHS.

Of course only a "knee jerk" reaction would cause someone to think that denationalisation means privatisation 🙄

More weasel words and less "knee jerk" reactions eh?

As I posted before, people are selfish and will not pay the extra taxes requred to properly fund the NHS. As @batfink says the solutions are out there and we need to acknowledge we pay less per head on private healthcare than just about anyone. That's our issue the private contributions are not integrtaed into public provison as they are elsewhere.

Tom_W1987 - Member
NHS's current advice of anything from 5-30 days (at varying dosages of varying antibiotics depending on the consultant) won't cure Lyme because frankly, the NHS and other medical research agencies simply haven't done the research yet
Yes. Yes there really is. This is like saying that there has been no research done into man made climate change.

Hi Tom,

again, we weren't talking about climate change: you made the assertion that there is no proof that courses of antibiotics longer than current NHS pot-luck guidelines have any effect on Lyme, and that their supposed over-use by these patients diminishes the overall effectiveness of these medicines.

Here is a list of 700 peer reviewed medical papers that all support the claim that tick-borne diseases can persist and survive short term antibiotic use, all state the need for further research and large-scale sample groups:

Please show me just one paper that states Lyme is comprehensively cured by a sub-30 day course of antibiotics, and can prove that longer term use is unnecessary. If you can't do that, perhaps better to wind your neck in when talking about a subject you appear to know very little about. Just goes to show, all you need is one shit in the wrong woodpile and the whole house starts to stink.

The public aren't aware that not all EBM sees the light of the day. All depends on who pays the piper ...

good god 6 pages! what have I started.

good god 6 pages! what have I started.

You used keywords such as:

Tories, NHS, Corbyn and Trident.

Guaranteed 10 page thread.

...and privatisation 😀

Corbyn

That's done it. Stand by for a flood of hilarious images grabbed from Life of Brian. Oh, my sides!!

I don't see why I should be paying for other peoples poor choices or bad genetics, seeing as Britain has collectively decided to punish me and my wife financially because I married a foreigner.

Let us have a look at Pharmaceutical companies and what they are charging for 'life saving' drugs......
things to consider -
1. How effective are they at curing people?? or is it that they just reduce symptoms?
2. How much do they actually cost to develop and produce?

I am not saying this is the best or only fix, but it needs major consideration.

Drug companies those outstanding humanitarians.

http://www.telegraph.co.uk/business/2016/12/16/drug-maker-overcharged-nhs-hiking-price-hydrocortisone-tablets/

The Competition and Markets Authority issued a statement of objections after it found Actavis UK put up the price of generic 10mg hydrocortisone tablets from 70p a pack in April 2008 to £88 per pack by March 2016.

VAT on all food except fresh fruit and veg (environmental and heath bonuses too)
Close corporate tax loopholes
Healthcare to age 70, beyond that it's private or if you have a serous illness you have the choice of euthanasia. Healthcare needs to be about quality of life not keeping people alive regardless. Better than the all most everyone has good health for 70 years than go back to people dying of preventable ailments when younger.
As far a poor choices are concerned, maybe there is a middle ground - 3 strikes and your out - [i]Mrs Smith you've not lost any weight despite you being warned and provided with a training so all healthcare charageable until you lose the weight[/i].

Mr CD you've fallen off your bike too many times, you will have to pay to fix you're broken collarbone.

Healthcare to age 70, beyond that it's private or if you have a serous illness you have the choice of euthanasia.

Another person to completely miss the point of the NHS.

So you can only get healthcare past 70 if you are rich, otherwise you may as well just kill yourself. Nice.

Count yourself luck to be genetically blessed...
So far...

I knew someone who consistently argued the case Tom is arguing, till Parkinson's Disease manifested itself (not sure its something you catch). Remarkably he suddenly realised that poor health can be as much down to luck as poor choices

Indeed I have heard (feel free to debunk) that one tobacco company was on the brink of sharing the fact that people who smoke die younger AND CHEAPER than those who don't as a lobbying tactic for governments though, a few years back.

So get smoking, proles.

So you can only get healthcare past 70 if you are rich, otherwise you may as well just kill yourself. Nice.

good god 6 pages! what have I started.

OP it's one of the better discussions on the topic, there have been a few. It's constructive.

Let us have a look at Pharmaceutical companies and what they are charging for 'life saving' drugs......
things to consider -
1. How effective are they at curing people?? or is it that they just reduce symptoms?
2. How much do they actually cost to develop and produce?

I am not saying this is the best or only fix, but it needs major consideration.

My may or may not realise this but Trump is very pro pharma and its not as if we buy them in $ so its not like there has been a price hike anyway 😯

https://www.ft.com/content/3e981008-a6cd-11e6-8b69-02899e8bd9d1

OK then, so where do you draw the line? As medical advances continue can you all the extra people surviving in to old age is not sustainable, what if we could keep people alive for ever. I'd rather everyone one had a great life for X (perhaps 70 is too young?) amount of years then let nature decide. If it helps we can man private treatment over that age too so all people regardless of wealth will die naturally after X. This isn't just an NHS thing, it's excepting that endless medical advances are not sustainable. We can't live forever.

That all depends on how many years at the end of your life are poor quality/plagues with illness.

For example;
Person A lives until 84. They become ill with a variety of problems from age 80
Person B lives until 64. They became ill with a variety of problems from age 60.

Both ill for 4 years before dying but you would only keep the 60 year old alive?

That all depends on how many years at the end of your life are poor quality/plagues with illness.

For example;
Person A lives until 84. They become ill with a variety of problems from age 80
Person B lives until 64. They became ill with a variety of problems from age 60.

Both ill for 4 years before dying but you would only keep the 60 year old alive?

Some fascinating posts. 😯

Now we are getting somewhere. Instead of looking at life expectancy, look at disability free life expectancy.
The thing that if you are born poor you are guaranteed to have less of. Regardless of your "choices"

I'll say it again.
Fairer society
Social determinants of health.

Listen to experts not politicians

I doubt any of this will happen.

With reference to the spmd graph - 45% of all spend on US healthcare goes on administration of billing, terrible system.

Th simple answer to what to fund is data is needed on quality outcomes versus cost of treatment. That data exists in a reliable format for very little - that should be the goal as allows genuine treat,ent comparisons.

**** the poor.

Am I right?

I think Tom calls them Northners but yes.

Yes but the 80 year old has had 20 more years to liver and make the most of a healthy life. Or are you proposing that people have a limit of one or two major medical treatments in a life time however long that may be?

I haven't proposed anything. You are the one proposing that only rich people can have some quality of life with an illness or that people should be killed!

I am happy with how it works now, access for all. Just needs more money because there are more people in an increasingly aging population.
Money is easy to get (increase tax to over 40% earners), just that nobody wants to do it.

Yes you can make the service more efficient, yes you can cut other things but ultimately that won't be enough so it needs more money.

Majority would be happy to pay more tax if it was all going direct to NHS. Or that's what they say until it hit's their wages...

Times investigation into drug prices:

http://imgur.com/a/U42vD

[url= http://www.bbc.co.uk/news/uk-politics-38547760 ]crisis[/url] what [url= http://www.bbc.co.uk/news/health-38570960 ]crisis[/url]

Indeed Cinnamon. Indeed..

Let us have a look at Pharmaceutical companies and what they are charging for 'life saving' drugs......

OK understood. Then stop buying them because it's decided they are making too much profit ? How long do you think a Government could keep that up for ? Patients dying in UK whilst being treated in Ireland or Spain with "expensive" medicines.

**** the poor. Am I right?

Seems to be the default answer regardless of whether it improves anything.

Oh dear the battlelines are drawn again too old **** off, too fat on your bike son, smoke yeah mate jog on, too rich do one. Yeah seems a recurring theme. We just need to get the list of exclusions right, preferably with more categories to please all the loonies 😀

Bring back hanging. What we need is a good war 😆

good god 6 pages! what have I started.

Has anyone mentioned immigrants yet, or does that come in later at about page 10?

Been done.

This is a very good question.
Really the answer comes in a few stages:
1- cut waste. Simple. Don't prescribe when you shouldn't, don't double-pay providers of services. Don't request needs you don't use.
2-stop services without evidence our clinical benefit. This may be unnecessary or 'little evidence'clinical treatments. Or services such as IVF.
3-change thresholds for proven treatments; you need to be in MORE pain for a knee replacement, your cataract needs to be really bad for an operation etc
4-reduce whole services -starting with those with the least impact.

There you go.
Sorted.

DrP

edit- it would be interesting for posters of the ideas above to consider what category they'd fit their suggestions into.
Not saying they are right or wrong, but makes you think...
Certainly over investigating and treating frail elderly would fall into category 2.

Interestingly,i heard of a ccg that wouldn't operate unless the patients gave up smoking. That's a double win!

4-reduce whole services -starting with those with the least impact.

Can you give more details? EG, start with those with the least impact and stop where?

Not sure if Dr P missed a smiley or not.

1 - cut waste;

If the NHS was Walmart there is no way it would pay what it does for software licences, or IT consultancy rates. Collectively the NHS is massive and should really have the clout to dictate what it will pay. Instead (as I understand it) each trust negotiates it's own purchases so lose the ability to collectively threaten to take [i]all[/i] the business elsewhere if a vendors prices are not keen enough.

I know that prior to 2010 the NHS in England & Wales did have a half-decent agreement with one large software vendor. Then a new government talked about making cuts to save money and got rid of whatever department a previous government had established to manage these kinds of things.

So a saving of some centralised salaries meant that some NHS Trusts faced massive software licence fees (well in £ millions) when the old centrally negotiated agreements that previously covered them expired.

Speaking of software one of the key reasons the massive-super-expensive-project got so super-expensive was that the vendors were trying to please each hospitals requirements. They were not dealing with a single customer so no surprises it completely failed - I went to a fascinating seminar on that.

I've been told it's not too dissimilar with how drugs are purchased and some are now a lot more expensive than in the past. I don't know if true but certainly sounds plausible.

Haven't read all the posts so shoot me if some else has said this but, sell the houses of parliament off instead of rebuilding it (approx 5billion cost to rebuild) Find an empty office block (doesn't really matter where, Its a connected world!) and move all muppets, sorry M.Ps and their staff out there and spend money saved, plus what we'd get for selling Westminster on NHS.
Its a start.

Get rid of the nukes, easy.

ps. haven't read the thread.

It seems that you haven't read the original post either 🙂

Get rid of Trident, would that be enough?

Ooops!!

Could anyone please give a rational justification for keeping Trident, i know brexiteers seem to think we are still some sort of imperial power, but really if it is just about job creation then at least be honest about it, rather than talk about unforseen threats.

PS. infact wholesale cuts to the military, why do we need such a large military anyway, i would like to see a defence force!

Erm, numerically our military is pretty small. There's not much left to cut if the government still wants to support international operations, and even then we have stepped back a lot in recent years whilst the focus has been on Afghan and Iraq.

The NHS and pension budgets also dwarf the defence budget. So yes it could help but given the way things work you soon be looking for something else and would have zero capability to do anything other than what the police and coastguard could manage.

Hi Tom,

again, we weren't talking about climate change: you made the assertion that there is no proof that courses of antibiotics longer than current NHS pot-luck guidelines have any effect on Lyme, and that their supposed over-use by these patients diminishes the overall effectiveness of these medicines.

Here is a list of 700 peer reviewed medical papers that all support the claim that tick-borne diseases can persist and survive short term antibiotic use, all state the need for further research and large-scale sample groups:

ILADS.ORG "http://www.ilads.org/ilads_news/wp-content/uploads/2015/09/EvidenceofPersistence-V2.pdf"

Please show me just one paper that states Lyme is comprehensively cured by a sub-30 day course of antibiotics, and can prove that longer term use is unnecessary. If you can't do that, perhaps better to wind your neck in when talking about a subject you appear to know very little about. Just goes to show, all you need is one shit in the wrong woodpile and the whole house starts to stink.

Bwhahahahahahah.

None, I repeat none of those papers support the CLINICAL effectiveness of long term antibiotic therapy in humans. These studies have been done.

eg 1200 patients, well designed study, published in the New England Journal of Medicine?

http://www.nejm.org/doi/full/10.1056/NEJMoa1505425#t=article

Hmmmmm. Who do I believe, biased lobbying group or a study in the NEJM? A bunch of papers indirectly supporting a treatment and a good clinical trial?

Well that is a myth, the fith largest spend in the world just behind Russia, having offensive capability has only made situations worse, Iraq, Afghanistan, libya are all operations that have caused a shit storm, destabilising the region has not helped.

IMHO we do not need to get involved in these foriegn adventures, if you are cutting public services you can not sustain a military that has historicaly been the backbone of an old imperial empire, something has to give.

@fergel our military has been cut savagely over the past 30 years.

The Trident argument is a red herring imo. The Tories have promised to deliver an extra £10bn pa that's double the Trident cost, yes "every bit helps" but Trident money isn't going to transform the NHS/Health provision.

The Tories have promised to deliver an extra £10bn pa that's

According to my recent tax statement, the amount we spend on "defence" is around 26% of the amount we currently spend on health. Looks to me that we could redirect some of that spending.

Health Care spending (blue) and Defence spending (red). Up until 1987 we spent more on defence than the NHS.

[img] [/img]

@scotroutes Germany will be increasing defence spending by 80% to meet the NATO target.

So do you accept that the 10bn figure is bollocks yet?
also nice graph, apat from the cost whats it telling me? Health Care spending is increasing. Nice to know, so long as the economy grows it's a good thing.
As defence spending is also steadily increasing despite moving from a very expensive cold war into more peaceful times can the UK cope with the role it wishes to play in the world.

Well that is a myth, the fith largest spend in the world just behind Russia, having offensive capability has only made situations worse, Iraq, Afghanistan, libya are all operations that have caused a shit storm, destabilising the region has not helped.

Great discussion, we really have a wealth of knowledge here. Some really interesting and insightful posts from people in the industry. The point from bigeared abdout IT and the fact that seperating the nhs into trusts, which was lauded as a progression to save money has actually ending up increasing costs. These are things which can be amended with correct governance.
What about in welfare, any cuts we can make there?
save pensions, pay people what they're owed after paying in all their lives I reckon.

Ooh, are we off posting meaningless graphs again?

Here's mine - it's from a BBC website :

[img] [/img]

And here's another one also from the BBC

[img] [/img]

What about in welfare, any cuts we can make there?
save pensions, pay people what they're owed after paying in all their lives I reckon.

jambalaya - Member

The Tories have promised to deliver an extra £10bn

What's the exchange rate between a promised pound and a delivered one?

Tom_W1987 - Member
Hi Tom,
again, we weren't talking about climate change: you made the assertion that there is no proof that courses of antibiotics longer than current NHS pot-luck guidelines have any effect on Lyme, and that their supposed over-use by these patients diminishes the overall effectiveness of these medicines.

Here is a list of 700 peer reviewed medical papers that all support the claim that tick-borne diseases can persist and survive short term antibiotic use, all state the need for further research and large-scale sample groups:

ILADS.ORG "http://www.ilads.org/ilads_news/wp-content/uploads/2015/09/EvidenceofPersistence-V2.pdf"

Please show me just one paper that states Lyme is comprehensively cured by a sub-30 day course of antibiotics, and can prove that longer term use is unnecessary. If you can't do that, perhaps better to wind your neck in when talking about a subject you appear to know very little about. Just goes to show, all you need is one shit in the wrong woodpile and the whole house starts to stink.

Bwhahahahahahah.

None, I repeat none of those papers support the CLINICAL effectiveness of long term antibiotic therapy in humans. These studies have been done.

eg 1200 patients, well designed study, published in the New England Journal of Medicine?

http://www.nejm.org/doi/full/10.1056/NEJMoa1505425#t=article

Hmmmmm. Who do I believe, biased lobbying group or a study in the NEJM? A bunch of papers indirectly supporting a treatment and a good clinical trial?

Tom, for all the bluster show, you're using one study that took 3 sample groups and treated them over 14 weeks. 3.5 months, using two antibiotics that have not and never have been proven to address persistent Lyme infection, and which doesn't mention patients possible coinfections with other tick-borne organisms such as Babesia or Bartonella, both of which impair the successful treatment of Lyme through the suppression of the immune system. Hardly conclusive proof of anything other than their inability to design a better trial.

That paper is so flawed it would be like me taking three faulty washing machines and trying to fix them using a random assortment of tools used to fix lawnmowers then saying "I couldn't do it in 30 minutes so they're obviously broken" Can you imagine anyone saying "I couldn't cure your HIV in 14 weeks with two drugs so sorry, there's just no benefit to treating you further or doing any more research'? It demands money that isn't being spent to establish why Lyme turns into a chronic illness in some people, and unfortunately there's too many over-opinionated assholes like you that either don't want or are unable to acknowledge the lack of science underpinning current policy and any emerging research that contradicts you.

If you cared to look at more recent articles on Lyme you'd see that even the man who designed current US Lyme treatment protocols admits he got it wrong on the bacteria being able to persist, and that their ability to alternate between blood-borne and cystic forms renders antibiotics between 60 to 1000 times less effective as a result. Does that mean long term antibiotic use is the solution? Perhaps not, but until actual research is done to establish what treatment is effective in chronic lyme cases then we won't know, will we?

This article-published today-sums up the bias of arrogant tools like you quite well, but don't let that stop you being a snarky **** whatever you do... Sincerely, my deepest hope for you is that you reap your own reward and get to deal with the kafkaesque process of being diagnosed and treated for Lyme-it might cultivate some humility alongside the bacteria.

http://www.huffingtonpost.com/entry/flunk-the-lyme-test-just-wait-and-get-sicker_us_5873ef2fe4b08052400ee537?

Tom_W1987 - Member

Bwhahahahahahah.

Actually, if you care to read the comments on your own cited paper-from an assortment of scientists and doctors around the globe-they spell out quite clearly the flaws in the study, from the failure to account for the morphological nature of the bacteria, co-infections and also, that their own results showed that despite improper administration of IV antibiotics for a period shorter than the life of the bacteria, that there was... a mean improvement in all test groups after the 14 weeks. Too bad they attribute that to a placebo effect.

http://www.nejm.org/doi/full/10.1056/NEJMoa1505425#t=comments

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Tom, for all the bluster show, you're using one study that took 3 sample groups and treated them over 14 weeks. 3.5 months, using two antibiotics that have not and never have been proven to address persistent Lyme infection, and which doesn't mention patients possible coinfections with other tick-borne organisms such as Babesia or Bartonella, both of which impair the successful treatment of Lyme through the suppression of the immune system. Hardly conclusive proof of anything other than their inability to design a better trial.

You do know that they wouldn't have done the study right, if someone had already proven that these drugs work for 'chronic lyme'. Don't you? 😀

A lot of those comments are from butt-hurt Lymie quacks. In fact, they seem so upset - I might just choose this as a PhD topic to troll the **** out of as many of them as possible.

Tom, for all the bluster show, you're using one study that took 3 sample groups and treated them over 14 weeks. 3.5 months, using two antibiotics that have not and never have been proven to address persistent Lyme infection,

You'd think that they'd start with the drugs that are used to tackle acute lymes though? Wouldn't you, drugs that have been proven to work in neurological lymes disease eg doxycycline. 😀

a mean improvement in all test groups after the 14 weeks.

Oh you mean like in the placebo group as well?

and which doesn't mention patients possible coinfections with other tick-borne organisms such as Babesia or Bartonella, both of which impair the successful treatment of Lyme through the suppression of the immune system. Hardly conclusive proof of anything other than their inability to design a better trial.

I'm sorry, but I really don't think coinfections would statistically alter this study at all - there should be a representitive sample of coinfections in both the placebo group and the treatment groups - these coinfections do not intereact with antibiotics do they - you state that they intereact with the immune system.

A lot of those comments are from butt-hurt Lymie quacks. In fact, they seem so upset - I might just choose this as a PhD topic to troll the **** out of as many of them as possible.

Wow, and you say you want to get into unbiased medical research? You have managed some fairly harsh comments in this thread so far. It makes me hope you never persue a career in the actual health service or in policy making where being judgemental over people really isn't helpful or welcome.

No Mike, the public needs to get a grip and start listening to what medical researchers are saying - instead of issuing them with death threats because they spoke out against things like Morgellons etc. The lyme literate doctors are nothing more than Byzantine Alchemists who make money from preying on people.

Is this your new topic of experitse? I'm not claiming it's mine but you are often very quick to dismiss out of hand stuff. This does seem to be an area where understanding is poor and more data is needed.
The public will never listen to medical reseachers, they actually shouldn't as most are not euipped to do a full study of all available, on the other hand the medical researchers are often too close to topics to speak on the subject broardly. The body of research needs bringing together into public policy and it also needs highlighting where research has gaps/holes or not enough data.

Myabe you just need to chill a bit.

Ernie... Can I give more details?
Well, NOT really..it's a process that many ccgs are going through.

If you Google 'ccg decommissioning plans' there's a few who have published theirs..knock yourself out.

Stopping services (as opposed to reducing them via thresholds changes) is clearly a last ditch attempt to save money.

The reality is the nhs cannot afford it's current level of activity.
And there lies the crunch ,, the vast majority of overspend is increase in activity, rather than significant waste. More things are happening.

Three kids cost more than two.

Two cars cost more than one....

We need to sensibly reduce activity.

DrP

Tom_W1987 - Member

You do know that they wouldn't have done the study right, if someone had already proven that these drugs work for 'chronic lyme'. Don't you?

[b]A lot o[/b]f those comments are from butt-hurt Lymie quacks. In fact, they seem so upset - I might just choose this as a PhD topic to troll the **** out of as many of them as possible

Why not? You're ambition seems to be acting like a Phd level troll on here. Or you could do something medically useful. Either way, they raise pertinent and informed questions about the quality of that study and unlike you many have a Phd. Internet troll vs Doctor?

[b]You'd think[/b] that they'd start with the drugs that are used to tackle acute lymes though? Wouldn't you, drugs that have been proven to work in neurological lymes disease eg doxycycline.

you would, wouldn't you? And yet, they are already shown to have improperly used IV ceftriaxone by using it for less than the lifespan of the borellia and it ignores current research regarding persistent or chronic Borellia infection that actually discuss in vitro and in vivo antibiotic efficacy in-depth. That would have been a better place to start, wouldn't it? Or from your lofty position of achievement do these scientists not meet your standards?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132871/#__ffn_sectitle

a mean improvement in all test groups after the 14 weeks.
Oh you mean like in the placebo group as well?

I'm sorry, but I really [b]don't think[/b] coinfections would statistically alter this study at all - there [b]should be[/b] a representitive sample of coinfections in both the placebo group and the treatment groups - [b]these coinfections do not intereact with antibiotics do they - you state that they intereact with the immune system.[/b][.

Yes, and if the study relies on measuring the production of antibodies in response to the treatment but the patient is immunosuppressed they won't get an accurate finding, will they? Again, did you actually read it?

You talk of Byzantine quackery that's been allowed to form in the vacuum of knowledge around this illness, but you're just the opposite side of the same coin, as opinionated as outspoken and half as informed as you'd like to believe. As mentioned up thread, you clearly have no interest in impartiality nor any empathy for the people the medical profession is supposed to treat with compassion. If you're real point of upset is patients arguing with doctors then I'm afraid you just need to get over the fact that illness is a subjective experience and patients are the ones that know how they feel better than anyone else. You don't know how much you don't know but you might at least try and be less unpleasant.

meanigless graphs time?

(sorry nabbed from a brexit page)

[img] [/img]

its not about just money though

public health is now the 'responsibility' of local councils who have seen theire biggest cuts to funding ever

acute staffing crisis aside its a huge factor into why hospitals and GPs are in crisis

I think describing the current situation as “a humanitarian crisis” is a bit over the top. The bigger question is that the demands of targets on individual trusts are probably – choosing my words carefully – leading to gaming. Equally we are all meant to have abandoned all elective surgery but there are strong suspicions that certain trusts are not following this; still doing certain surgery because they make so much money.

What we are seeing is a breakdown in the trust and cooperation between different parts of the NHS. So we have seen mental health almost withdrawing from the sustainability and transformation plan process. We have major acute hospitals trying to protect their pre-eminent position by being too important/big to work with others. We have clinical commissioning groups in denial about their total absence of any long-term future. We have NHS England shouting down the phone at hard-pressed managers. We have NHS Improvement texting chief executives on Saturday afternoons checking that they are on top of the situation and expecting them to be at work.

Not one of these actions is going to help a hard-pressed consultant with targets – or more critically the patient. Worse than that, the pressure from above is largely political because government ministers and MPs cannot accept the reality of the general slide to a service that doesn’t meet what the public expect.

https://www.theguardian.com/healthcare-network/2017/jan/11/our-nhs-trust-is-close-to-a-tipping-point-and-we-are-not-alone

DrP - Member

....the vast majority of overspend is increase in activity, rather than significant waste.

You say that as if it's not a self-evident fact!

And I totally reject the sentiment behind this comment : [i]The reality is the nhs cannot afford it's current level of activity".[/i] It is completely disingenuous as it suggests that the only solution is to cut the level of service rather than increase funding.

Healthcare is [i]always[/i] affordable, it is just dependent on commitment and priority.

No one, certainly no successful politician, would argue that due to increased costs of food some of the population should be allowed to go hungry or just simply starve. Or that due to increased costs of housing some of the population should be allowed to become homeless or just simply die of hypothermia.

So I see no reason why health should be treated any different or accept the suggestion that due to increased costs of healthcare some of the population should be allowed to become ill or just simply die.

Food and shelter has been a basic human need for hundreds of thousands of years, no one would argue with that, so also has physical and mental well-being.

If we as a society can afford cars, televisions, cinemas, chocolate, etc, we can afford to treat sick people.

It has been proven that by far the most efficient cost-effective provision of healthcare is a nationalised universal non-profit driven service. Therefore it is not a case of 'we can't afford the NHS' but that we can't afford not to have the NHS.

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BTW I wasn't sure if you were taking the piss DrP so I didn't comment too much on what appeared to be some of your ludicrous suggestions in your original post, but can you explain some of the thinking behind this :

3-change thresholds for proven treatments; you need to be in MORE pain for a knee replacement, your cataract needs to be really bad for an operation etc

How does that work since for example cataracts progressively deteriorate? Is the idea to put off cataract surgery for as long as possible in the hope that the sufferer might die before surgery (possibly as the result of walking out in front of a car which they hadn't seen) and therefore saving a few hundred pounds?

What do you think the total saving to the NHS of delaying cataract operations might come to?