Addressing the elephant in the room; people abusing NHS, health and social care.

I agree with you OP to a point. I've worked in the NHS for 45 years and I'm staggered by some of the nonsense that goes on.
People who miss 3 or 4 45 minute appointments for no reason and then expect a new one at their convenience whether we have a slot or not. We are a massively busy and acute department with a long waiting list.
Well off people who insist on being prescribed paracetamol and cheap creams when it costs pennies in the pharmacy. People insisting on home visits when they are not housebound.
That's just the tip of the iceberg.
The vast number of PIP claimants who are not genuine. They boast about it.
Makes me wonder what all this nonsense is costing the NHS.
Many quiet and unassuming people don't get anything because they don't ask for it.

This used to be a thing, none acute cottage hospitals. I think there's a case for bringing some back to reduce the impact of bed blocking and to enable more long-term care of patients who are difficult to discharge.

No, she was offered 1 option only and as is her right, she raised the concern that the 1 option offered was to a place that she has distressing memories of as bad things happened to her there. Our rights have been eroded, you used to be able to have a choice of a few options, then it was right to reject first two options, now it’s you get 1 option and you have no choice- take it or die on the streets homeless. I am sure this is in preparation for go where we say or it’s straight to the euthanasia clinic.

I'm not sure you are googling like for like - NHS price list has as little as 49p, depending on brand, pack size and dosage

bnf.nice.org.uk/drugs/levothyroxine-sodium/medicinal-forms/

So how are this older cohort failing to take on personal responsibility in your view?

Or is the issue actually simply one of the current demographics we have, and not one about personal responsibility at all?

Well it is because if there is a problem with taking on personal responsibility it can only be a real structural / strategic problem for an organisation the size of the nhs at volume.

We all know the woman who lived in a bed for 18 months is not causing organisational level risks or costs.

for personal responsibility to be an issue it has to be at volume and scale- a significant number of patients.

And with the largest number of patients being older that would mean the volume would have to sit with them.

These are patients that don’t need the acute setting of a hospital, but aren’t well enough to go home. They should be resting and recuperating so I don’t understand what is wrong with a minority of patients:
“staying in bed all morning, watching TV all day in their rooms, Refusing to join in group exercise classes, chatting on their mobiles. Socialising with their visitors for hours on end.”

the in group exercise classes might not even be appropriate for this minority of patients. Not everyone is going to be at the same level of fitness.

There are many reasons the NHS is in the situation it is, far too many layers of management who have little or no patient contact, whole departments dedicated to equality/ diversity and target chasing(Donald may have the right idea about those), before you even get to the problems of a/e, not helped by the decision many years ago to close what seemed like every other a/e to consolidate into centres of excellence which they certainly aren’t, then post a/ e it’s the issue with beds which is massively compounded by a broken social care system which means people wait weeks or months while medically fit awaiting resources to ensure they can be looked after in the community. Is the current government addressing those issues, well it’s having yet another review to tell it what every clinician can already tell them if they bothered to ask, other than that, no.

Thank you!
This woman wasn’t abusing the NHS. She was badly let down by social care.

Sure, but needing healthcare in the last few years of life is not the same as the point you were making earlier about not wanting to take personal responsibility

Having such contempt for your patients must make it difficult to perform or enjoy your job. Perhaps it is time for a career change.

In the facility I worked at, lack of motivation was expected from every patient who came through. It's a known symptom of the conditions that brought the patients in.

I can only speak about the particular setting I worked in, but it did include contracts agreed between the patients and lead therapist on admission. Individual schedules were discussed every morning on a one-to-one basis as well.

It isn't easy for the patients and it isn't easy for the staff finding the right approach for each person that helps them get through a challenging process. I have no doubt that it was a negative experience for some of the people on the programme, but for others I know it was the best thing that could have happened.

Examples in the press are likely to be exceptions to the norm.

we use something like 90% of our lifetime medical costs in the last 4 years of our lives. Hospitals, rehabs and clinics will of course contains a disproportionate number of older people

Many of these rehab hospitals are for people who have had strokes. They are left exhausted and probably don’t want to be up early, dressed and doing activities! They need rehab of course, but also their bodies need to heal. You wouldn’t expect that of a middle aged person, but with older people we expect them to comply as though they were toddlers… only they haven’t got the energy.

A lot of the examples we see in the press aren’t in that age group. The woman who has been clogging up the NHS bed for 18 months is 35.

This was my thought too.

Also, people need to be motivated to engage with rehab. It’s hard work and requires discipline. If there is no assessment to check if someone has the motivation to engage, you can’t really be surprised if a cohort of your parents don’t engage. That’s a system fail, not an individual fail.

This is a horrible thing to say but I think longer term- within 20 years- this will diminish as the generation who were told they would be looked after cradle to grave die out. Many of them have lived their lives with this expectation (understandable) and are not set to take personal responsibility. They are also the source of much of the pressure on the nhs currently

It really depends on what a person is in hospital for. For things like infection, a week in bed might be what's needed and there's little risk of a person becoming permanently disabled by doing that. But those patients won't be discharged into a a rehabilitation program.

For other conditions like major joint replacement, stroke, brain or cardiac injury, bed rest might make things worse.

Rehabilitation or Re-enablement placements are there to get people back on their feet and functioning as independently as possible so that they can actually go home. The alternative is often full time care. So support staff, physios and OTs are on hand with a specific program designed to get a person as well as possible.

Patients are given information about the programs before they go there and again when they arrive.

For every responder who says you're cruel and heartless OP, there will be 100 people reading who agree with you, silently.

We've lost sight of so many things in this country, one of which is taking personal responsibility and not expecting everything for free.

I wonder - what’s the admission process like?

Does anyone sit down with them when they arrive / before they arrive and spell
out the expectations and the commitments expected for their stay there? From what I’ve come across that’s not the case.

I compare that to my grandfathers stay in a rehab facility in Switzerland post heart surgery. There was a contract he committed to on admission, and it required participation in the rehab program, honouring quiet hours, visiting times, meals, respect for staff etc.

There’s no reason that couldn’t be done in UK council run facilities, but there seems to be a reluctance to set and hold
people to standards.

Well she didn’t have a home (despite being offered some choices) so she was there to sleep and get food, which as a homeless person wasn’t a given for her.

I believe she has NPD and was extremely difficult to deal with

As well as a lady forcibly being evicted for overstaying at hospital

A young woman staying in a hospital bed for 18 months clearly has some complex needs - I don't even have to read the article to know that. Hospital isn't the right place for her, but it doesn't sound like home is either. No one in their 30s (or any age really) would just choose to chill out in a hospital for 18 months.

You’re talking big society though, which nhs is only a small part of. I agree with the poster above- we need a national conversation about what the nhs is for.

when you’ve cured or prevented, or made easily treatable the awful disease and illnesses that took people in their childhood or prime- polio, measles, scurvy, birth defects, infection etc…. When you have hugely reduced heart disease due to healthier diet, when you have hugely reduced smoking related disease by reducing smoking, when you have reduced workplace accidents to a minimum through health and safety, when you have high driving and road safety standards reducing road deaths….

the hard truth is we will be left with a disproportionate number of people with “self induced” disease, or crippling social problems, poor mental health, or the pressure to treat complex “luxuries”- 25 week old babies, IVF, in utero surgery- things that simply would’ve have happened in the 1950s- and we need a conversation about how much of that our society is willing to support.

There are two real elephants in the room regarding the NHS but I don’t think the behaviour of individual patients is the issue- one ‘elephant’ is huge social inequality and the other is the way that- in large (but not total) part as a result of this inequality- people care for themselves so badly, often due to factors such as…..

• lack of/ lack of cheap and easy access to sport and fitness facilities, green spaces etc
• shift work/ long hours/ lack of time
• inadequate housing with damp etc
• food deserts and supermarkets stocked with cheap shit food that is quick and easy
• whatever on earth has happened to gp and dentistry services over the last few years

“Costs the nhs” very likely isn’t the direct costs of the drug- in fact your comparison proves it isn’t, of course the nhs don’t pay the manufacturer £2k for something the Portuguese get for £8.

“the cost to the the nhs” is the whole supply chain of patient contact to drug delivery. The staffing, premises, logistics, operations.