To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

Do we differ between people who are fat with medical conditions and medications at our cutoff points for access to treatment?
So we have fat people, elderly, maybe disabled people too? FFS

It’s a tad ironic that with the millions already with deteriorating health due to covid infections, with pressures on nhs due to viral infections added to with covid, that some bright spark thought I know, let’s make it worse and ensure we don’t acknowledge airborne spread and also let our staff spread them around the hospital too!

Or possibly an overweight/obese population who are unable to regulate their own diets and are developing poor health as a result.

Roughly 25% of adults and 10% of chlldren are obese, which together is a larger number than the over 70s.

Perhaps we should blame the fat rather than the elderly. At least the elderly cannot help getting old !!!

I am English, but I live in Scotland. The hospitals up here are SO much better than down South. I've never had an issue.

But the English hospitals I've experienced have been dire :

I was hospitalised for a miscarriage and stayed in overnight. Didn't get fed once.

When I had my babies mistakes were made - a pair of scissors swaddled in with my daughter, for eg.

My uncle had a brain haemorrhage and was temporarily blind - they would put his food next to him and not tell him it was there - so my Dad had to go in at every meal time to feed him.

My Dad is always in and out of hospital with infections (he's elderly now) - his notes say which antibiotics he is resistant to, but they never read the notes and give him the wrong meds - EVERY SINGLE TIME.

Simple, common sense things, that a non medical person (like me) can see are wrong, and could so easily be rectified.

Also the system is so clunky, with Departments not talking to each other - for example, the Discharge team are supposed to connect with the Carers when my Dad goes home (to reinstate the care) - they never remember to do it. And then when the Ambulance driver delivers him home, they see there's no care and just dump him anyway - no water or phone given - just dumped in a chair and left.

In fairness, they have brought my Dad back from the brink many times, so there is that, but that really reinforces the ageing population theory, as he would be dead by now without medical intervention. Add to that, that his quality of life is rubbish, and you have to wonder whether that's a good thing. He would say so (of course), but my sibling and I are run ragged (and have been for 5 years now), with spinning all of the plates that are required to care for a fully grown man of 22 stone, who behaves like a toddler most of the time.

Nothing wrong with that - better to have quality of life rather than languishing on waiting lists if you have the money.

The more you spend on Private Health the less there is to pass on. A close relative has paid £20,000 for 2 hip replacements. Others thousands on knee replacements & cataract surgery.

Aren’t there quite a few services that used to be more easily available e.g. dentistry, ivf, ear syringing? Haven’t thresholds increased to access treatments too?

Sometimes when I hear about some people's mental health problems, I think 'you don't have a mental illness, you are having a legitimate reaction to a really shit circumstance or difficult life'.

I spent many years thinking I was a neurotic mess until I realised that just about anyone with the caring responsibilities I have would start to crack. So, I definitely agree with the over medicalisation of some mental health issues.

Why are you rattling on about 'inheritance seekers'?
My dad died at 89, my mil at 89. Neither had a fantastic quality of live for the last five years of their lives.
My FIL is 94 in a home. His quality of life is pretty poor too and some of his fellow residents literally don't know where they are. Are these lives worth saving? I think probably not. And inheritance does not come into it.

See if you feel the same when you’re ‘elderly’! It’s easy to offer opinions when you have no idea what it’s like to be ‘elderly’
Many of our relations are no longer willing to have NHS appointments constantly postponed or cancelled. Neither do they wish their quality of life to suffer with long waiting lists.
They quite happily pay for private treatment. The ‘elderly’ are still treated if they have funds to pay. Not good for inheritance seekers of course.

I work in adult social care and find myself increasingly exasperated at the amounts of medications prescribed to (very) elderly clients just to 'keep them going' regardless of their quality of life. This is not to say that I think treatment should be withheld on account of a person's age and medications should always be given to relieve pain, but at some point there needs to be some common sense applied. Also, the amount of medications that are prescribed and not taken because the client thinks it's pointless, doesn't like it, and the meds just end up being sent back to the pharmacy for destruction. Such a complete waste of money.

Yes, a jolly good idea! Let all over 75s remain untreated. Great for those waiting for their inheritances.
My cousin recently attended ten age 80 birthday celebrations. Sorry, they weren’t all lying about waiting to die. Some had treatable cancers, some arthritic issues, some completely well. Still alive & kicking.
Cutting out care for those of a certain age is not the answer.
I would advocate setting boundaries for under 75s, after all you haven’t paid in as
much, have you?!

I agree, I’ve worked for the nhs for nearly 25 years and patient expectations has increased year on year.

Some people think the nhs is there to solve absolutely every problem in their lives.

That said there are some areas that could be run more efficiently and with a lot less bureaucracy.

The nhs also needs a national records system , so that it doesn’t matter where in the country you are any dr you see can access your patients records. At the moment the system is very disjointed which creates confusion and delays.

Which ones are you thinking about?

I think management is an issue but yes, the biggest challenges are the ageing population (not much to be done so has to be dealt with) expectations.

I think we've really changed our idea of what "health" is and what kids of things publicly funded care is meant to cover. It was far less, much more acute or immediate needs when the service was founded.

I think there would probably be benefit to people thinking very clearly about how much it is worth having major health interventions in the elderly (say, 75 +) Not to restrict them, but people need to understand for themselves how much these are likely to give them more time with good quality of life. because often they don't. People are living 10 years longer but that's not typically a particularly good ten years. My mother, for example, is 73, and had a long career as a nurse. She does not plan to do much if, for example, she is diagnosed with cancer. Things that will improve QOL are a go, but not so much to extend years she will be ill. In order to approach things that way we will have to become more comfortable with the fact that death is a non-preventable end to life.

But also we probably need to take a hard look at what treatments are covered by the sate. I would not include fertility treatments for example.

I also think a European model is going to be the way forward.

My elderly dad is at the doctor's all the time. As a younger man he was always very healthy but now, in his eighties he uses a lot of resource. I suspect that ageing is something that wasn't factored into the original NHS model. Something does have to give, I think that if people can afford it there should be some sort of self contribution to costs, so a fixed fee for doctors appointments perhaps. My dad could absolutely contribute something towards his care, but his expectation is that the NHS will provide. Again perhaps our attitudes towards healthcare have to change.

Not just cottage hospitals, but all the convalescence/oap/mental health hospitals too. Fair enough, most were Victorian and needed massive upgrades, but instead of that, they brought in "care in the community", private care homes expanded instead, etc., and now hospitals don't have the same discharge options.

Yes, they closed all the cottage hospitals and then wonder why there aren’t enough beds. Social care is really NHS care for many elderly frail with the NHS is not paying for.

My Grandpa (soldier ww2) smoked 60 a day until approx 1955, died aged 92 in his sleep, he’d had a small stroke a couple of years previously, had a minor heart attack in hospital, which we only found out about by reading his notes, he also drank like a fish until he died. Granny 91 died from cancer, no other problems neither of them bled the nhs dry, both ate well fresh food cooked from scratch.

my mum worked as a nurse for about 50 years, was treated like 💩 by the nurses who were looking after her when she was dying, until we realised they nearly poisoned her, then they couldn’t do enough , the best nurse she had by a long shot was an auxiliary, she actually cared about the patients,

my mum always said nursing was a vocation and it was being ruined by people who were degree nurses on paper but who didn’t have a caring bone in their bodies

I know of at least 2/3 people who’ve died (in the last 2 years )under the age of 35 from being dismissed by gps

The nhs is like the bucket with a hole, no amount of money is enough

Not wanting to veer into an assisted dying debate but my aunt is currently in a specialist care home with advanced dementia age70. She lies/sits there all day, can’t feed/dress/wash herself and doesn’t recognise anyone. She doesn’t speak or show any emotion. The cost of keeping her alive is huge for both social care and nhs but her quality of life is very low- not a quality I would want to have.

By contrast my great aunt is 93 and generally ok but has lots of chronic conditions. However she still has a good quality of life and I would hate her to think that she isn’t wanted or a burden.

I cost the NHS a huge amount as I have several autoimmune diseases and take very expensive biologics. However by taking them I’m working in my job in finance and contribute to society by paying tax at a higher rate (there are of course other ways to contribute but by spending £10k on my drugs means I am able to earn and contribute).

Perosnally I would love online booking- my hospital does it for blood tests and it’s great.

Oh goody, another thread blaming our felling NHS on the users. Other countries seem to manage to deliver free health services to a better standard than we do so i think your reasoning is flawed. We just haven’t updated our model to keep up with an aging population and advances in medical care. We have also underfunded NHS services for years while the tories have been busy trying to privatise it by stealth rather than actually put in place a better system.

And it’s not a coincidence that ALL our services have gone to shit at the same time. Or do you think that’s the fault of the general populace as well?

Well said.

This is true. A friend of mine, 7½ stone wringing wet, was diagnosed with type 2 diabetes & was given a lecture about losing weight, denying the evidence of their own eyes. She was dead skinny!

My experience is that pre operative nurses assume that you are a fat, lazy, mcdonalds munching alcoholic. You can tell them that you are a vegan who runs 10 k every other day & only drinks at weekends & they will look at you with glazed eyes & still gives you the script they've been given. It makes you feel like a liar.

Why is 'from cradle to grave, free at the point of contact' obviously unrealistic?
It is the norm in almost every advanced country on the planet - with the notable exception of the USA, where healthcare is big business and which is the model that American companies have been attempting to implement in the UK, helped by the Conservatives who have starved the NHS of resources and sent those who can afford it, and many who cannot, into the arms of the private healthcare providers.

As for needing less, not more healthcare investment - this is nonsense as the UK already lags far behind many peer countries. Austria has twice as many doctors per capita as the UK, and more beds, more other medical staff and more elderly-care facilities. People don't wait weeks to see a GP, or months for a hospital appointment or for an operation. Germany invests 30% more in healthcare per capita each year than the UK does. Every 3 years, the UK falls behind Germany by an entire year's worth of investment - billions of pounds of investment shortfall that translates into the UK being short of doctors, nurses, modern facilities and equipment. Over 10% of the population in England is currently waiting for a hospital appointment - a situation that would never have been allowed to occur in most other countries, where any politician who allowed anything approaching this would have been kicked out of office. Instead, Andrew Lansley now sits in the House of Lords and Sir Jeremy Hunt continues to spout bollocks in the House of Commons.

UK NHS managers spend much of their time "managing the day-to-day crisis" instead of managing the service - they spend hours managing waiting lists and bed shortages; problems that healthcare managers in many other countries don't have.

I agree, the UK has for years been "avoiding difficult conversations and decisions" - but the difficult conversation is "how much more tax are you willing to pay (or more accurately, how do you want tax revenue to be re-allocated) in order to bring the service up to the same standards as in most other developed countries" rather than "by how much can the NHS be cut back." People need to realise that the right to decent healthcare is been stolen from them and handed over to profit-hungry corporations - and those who cannot afford to pay will quite literally be expected to just fuck off and die.

An autism support programme in schools would be funded by the DofE and how is that going to help NHS staff provide better treatment for autistic patients? Are we going to do that with all disabilities- just stop diagnoses and fund school
support programmes instead ? Many severe problems as a result of autism occur in adulthood too anyway. Why is it always autism that is seemed to be a waste of money on MN and not the more visible disabilities?