How would you fix the NHS?

@ruethewhirl
I'm sorry I was a bit hard on you.

My DD has been involved in patient discharges across 3 trusts in the SW, the predominant block is Social Care and the roles around it.

Most patients are still ill, they need support, care packages, home adaptations, waiting for community services to assess need, mtce teams to facilitate this.

Bear in mind, time in hospital has been cut to bone, people are sent home that just a few years ago they would not have been, they need additional care... and families are often unable to do this.

For example, a friends mum was deemed fit to discharge, with a care package, none available, she cannot toilet her self without assistance, my friend didn't want to do this for her mum, Mum stays in hospital.

There are multiple reasons patients stay in district hospital when they should be either at home or in a community hospital.. or a Care home, something that is getting ever harder to get as more homes close of refuse none self funders....

On Pharmacies, if we have a shortage of dispensing chemists, what do we do?

Not everyone has nowhere to go after being discharged.

The majority of patients want to go home but are stuck waiting for the pharmacy.

Yes for charging but would the exemptions mean hardly any money is recovered?

Social Care needs funding but it also needs staff, where from? not everyone who is "apparently" scrounging on the dole, is suitable or even able to do SC, you need a clean DBS, be healthy and physically able, a car for most roles, empathy, a caring attitude and intelligence.

You're both only addressing half the issue... staffing who need finding and paying, an issue in itself...

The other half, neither of you have addressed... Discharge to where???

Easy answers, not even begun to be thought through, rarely are successful.

@TeenLifeMum I mean, the divisional nurses, deputy divisional nurses and all that type of management. The level above matrons. We seem to have loads of roles, that no one has any idea what they actually do.

Fuck yes.

Tax the bloody fried chicken joints.

NHS has proportionately less management than private business run with.

I’m an NHS manager who runs the website, patient information service (local leaflet development), trust intranet used by clinicians and deals with media requests. Do you think doctors and nurses want to do that? I, like many managers, work with front line clinical teams to find solutions and support their work. I’ve never felt anything but valued by my clinical colleagues. “Cut the managers” is just a lazy sound bite that shows a total lack of knowledge about how large businesses/organisations run.

1. Charge for GP appointments for the over 18s
2. Better fund elderly adult social care/ rehabilitation
3. Change our language around mental health and neurodiversity to better differentiate what needs actual formal diagnosis and what is just being slightly different and/or having slightly difficult feelings about normal life
4. Tax the absolute fuck out of cigarettes, alcohol and junk food. Make them a treat not a daily default.

Ooh, you stomping off

I said that by the looks of things, your thinking hadn't changed. And I consider that a valid comment considering the way you've been posting on this thread.

Your accusations are getting old now, though. That post from me might have been inflammatory, I get why it might have put your back up. You've refuted the accusations I made in that post and I've clarified that I actually agree with you on what seems to be your key point, but you still want to hurl more baseless accusations at me and I'm bored of it now. I'm off to enjoy the rest of my Saturday.

Ooh yes also agree cutting down on ‘management’

Charge a small fee for GP appointments, A&E attendance and clinic appointments (exemptions would apply). Charge for more prescriptions. Introduce some hybrid health insurance model to include elective surgery.

but the biggest thing is sort out social care and also inappropriate admissions.

Cut down on middle management, and have pharmacy with the same shifts as nurses. So patients seem on ward round at 8am don’t have to wait for the pharmacist to start at gone 9am. Or 10 at week ends. Freeing up beds quickly.

You said that I think elderly people all have dementia and are screaming in pain. This is a lie! You lied!
As for a tipping point, yes I do think there will be because of changing demographics. Have you seen the birthrate in places like South Korea? 50% of the population there will be over 65 soon. They will have to priorities the working population for healthcare and frankly I think they/we already should. Let's say you have a care worker who needs a new knee, can't walk or work without one. Now you might argue she/he should just take their place at the back of the list, behind the people she/he cares for, who also need a new knee. This might leave nobody left to care for them or make things very difficult. And that is a viewpoint worth discussing and not without value. I think care worker should be put at the front of the queue so they can get back to work ASAP. I don't think my argument is complete without merit or shows me to be a terrible person and not even worth considering because I clearly hate the elderly. You might disagree.

OK, we've cross-posted. Read my last post and then tell me if you still think I'm the scapegoat you so clearly need to point your finger at.

Show me one single lie I've told about you or what you think. You can't, can you.

And you're claiming I'm the one not capable of sensible discussion, when you've been name-calling and hurling insults at people who are simply trying to get you to clarify your views on other aspects of this debate besides how people with dementia are treated? Um, OK, then. 🤷‍♀️

Looking back over the earlier parts of this thread I think I can see where you might have got the impression I was arguing for elderly people to be treated regardless of dementia. To clear up any potential misunderstanding, if the dementia isn't yet severe or significantly detrimental to a person's quality of life, I do think they should still be treated. However, nowhere have I said that I think the lives of people with advanced dementia and no quality of life, who are suffering terribly, should be prolonged. Because, newsflash! - I agree with you. Of course they shouldn't.

But you have also stated 'I actually think there will be a tipping point soon (globally) were we have to start prioritising the working population over the elderly for healthcare', by which you presumably mean people without dementia as well as with it. So it's not really that outrageous, on a discussion forum as opposed to an echo chamber, that I wanted to know whether you agreed with elderly people without dementia being deprioritised for treatment.

You may feel people are trying to shut you down on the dementia angle, but don't project that on to me because it's not what I've been doing.

@ruethewhirl
I'm actually quite glad you've been posting because it's the perfect example of why we can't have these difficult and ethically challenging discussions. No politician would dare stand up in Parliament and ask if we are really acting in the best interests of our extremely elderly in very poor health giving them life extending treatments. The Daily Mail and a big chunk of the public would be screaming 'THEY WANT GRANNY DEAD!'
These are really important questions though and somebody should be brave enough to raise them. I think one way forward is to make sure people get their own house in order and speak to family and have paperwork in place well in advance stating what treatment we do or don't want for ourselves and in what circumstances. If that is every antibiotic going and kept alive as long as possible regardless of and level of suffering (as seems to be the default now) well so be it, people are free to make that choice.

And it is lies about me and what I think.
You could have just raised sensible and thoughtful points and the ethics of treatment or non treatment for elderly people with terrible and painful quality of life.
Actually, maybe you are not capable of such a discussion.

Yes, it is. And?

You didn't try to interrogate my views - this is what you said about me -

Thank you for finally answering on that point. I'd be interested to know where you think I've lied or accused anyone of wanting people dead though, because this is simply you incorrectly reading into my posts.

I also think it's rather ironic you're accusing me of trying to shut down discussion when you're using the word 'hysteria' (the age-old put-down used to try to shut women up) to describe the views of anyone who has the temerity to question or interrogate your views.

Of course I do think elderly people should be treated. Just not if it's only to extend pain and suffering and lengthen dying.

No sidestep from me, just another lie from you. In my posts I have described people suffering both dementia and terrible painful physical conditions. People without dementia, regardless of how much physical pain they're in or prognosis, are free to decide whatever they want for themselves. I believe some people with dementia actually live relatively happy lives, good for them. This idea, pushed by you, that I want them dead is nothing but a lie based on zero evidence. Then there are other people living in terrible distress with dementia, other painful conditions on top with zero chance of improvement. It is this group of people I think society needs to ask serious questions about if we are acting in their best interests, for example, treating with antibiotics if they get flu. Unfortunately, we can't have these important conversations because people like you try to shut them down with hysteria and lies.
To answer your question and make things absolutely clear for you, of course I do.

I'm not the poster you're referring to, but I'll give you my answer based on both my personal experience of dementia and additionally, care for a n aging family member WITHOUT the disease. Later stage dementia sufferers have absolutely no quality of life and also have no awareness that there is anything " wrong" with them, thus reject any support or help which could make their and their carers lives easier. infact, due to the muddled thinking they'll often turn it around so believe you're conspiring against them or trying to ruin their lives. Can you imagine the toll this takes? To desperately love someone but become powerless to help and to receive constant accusations and be shouted/ sworn at continually all whilst still providing care that they need, but deny they do. It's horrendous. So I completely agree that active treatment does more h arm than good. On the other hand, an elderly person with physical ailments but who doesn't lack mental capacity, has every chance of enjoying a good quality of life and should never be denied treatment on the basis of age. I don't think anyone would think differently.