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

Agree.

We're talking about well functioning Human beings who still can contribute to society.

So let me get this straight… people in their 40s and 50s are suggesting that older people should have popped off years ago to ‘ease the burden’ on the NHS? Erm, do they realise they would’ve been out of the game themselves by that logic?

If we're playing ‘survival of the cheapest’, then what’s the cut-off—30? 25?

Shall we start handing out leaflets titled “Thanks for your taxes, now kindly die” once people hit their 60s?

It’s beyond bleak.

We’ve got folks saying older people should just accept their fate, as if they haven’t paid into the NHS their whole lives, raised families, worked hard, and built the society we all benefit from. But sure—let’s call them the problem.

In the Middle Ages, yes, people died in their 20s—but we’ve also moved on from using leeches and thinking bathing was a sin. Maybe, just maybe, we should be grateful people are living longer and healthier, instead of pretending that compassion is a limited resource we have to ration like wartime butter.

This idea that the NHS can only function if people start quietly disappearing once they’re deemed ‘past their prime’ is deeply dystopian.

It’s not a slippery slope. It’s a bloody ski jump.

"An ageing population, increasing patient expectations that can’t realistically be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems."

An ageing population? The NHS - or rather the politicians who decide what to fund and by how much - has had since 1955 to estimate how many people there would be over the age of 70. And half a century to estimate how many over-50s there would be. Likewise planning for the number of clinical staff likely to be required, and the facilities and equipment that would also be required.

Little or none of which took place because politicians would rather wave the carrot of tax cuts than invest in public healthcare, and the section of society that would be most affected by increased taxes (which includes the politicians themselves) would rather pay an extra £150 or so a month to ensure that they benefit from access to better healthcare than pay £150 a month more in tax so that everyone could enjoy better heathcare.

I have to agree with "quality over quantity". Both OH and I have ongoing health conditions and have often said exactly the same thing that there are simply far too many people involved, which is where the mistakes, inefficiencies and incompetence creep in. When you finally get to the right place, it's usually pretty good, but getting there is an absolute nightmare as you're passed from pillar to post throughout the system. At each point/contact, that's NHS staff time being taken up and 9 times out of 10, it's the wrong person who can't actually do what needs to be done at that time, whether a receptionist, administrator, HCA, nurse, doctor, etc and you just get passed on/referred to someone else.

Take my OH with his cancer. Whenever he has a complication, i.e. a new side effect, or a reaction to his chemotherapy, etc., he has to go through a long protracted system to get any advice, starting with the "on call" cancer nurses who he phones, but it's always answerphone and they generally take 2/3 days to call him back. He goes through it with them, but they generally can't give him any advice, so they "ping" the oncologists, and then he gets another call back in a week or so, from the nurses who've received a ping back from a junior/registrar in the oncology dept who can't really answer the question or give advice, and basically say either wait until the next monthly oncologist review appointment or go to A&E! He's had that numerous times over the 8/9 years he's been on long term drug chemotherapy! That's taken up a specialist cancer nurse appointment twice and taken time of the registrar/junior, none of whom could actually give any advice. He doesn't bother anymore and now makes up his own mind/decision and just tends to make a list of things to discuss at his oncologists review consultation - but she often bats things back by asking whether he phoned the cancer nurses about it - he tells her every time she says that they couldn't help him and told him to ask her! He's basically in limbo between consultant appointments as no one else is willing nor able to give any advice. Doesn't help that he never gets the same cancer nurses twice - it's like a revolving door of different staff constantly. Even when he goes into the oncology department, the staff are always different, from receptionists to the nurses, etc - very rare to see a familiar face, and the place is full of staff - there's no shortage at all, yet, it's nigh on impossible to actually see or speak to someone who actually knows what they're doing and can give proper advice - except for the consultant herself who is impossible to contact between pre-booked appointments.

Then they wonder why people turn up at A&E!

I need annual diabetic eye tests (diabetes now under control for a decade after lifestyle changes!). They used to be done during my normal annual eye test by my optician. About 15 years or so ago, they changed the system so that "normal" opticians are no longer able to do them. So now I have two annual eye tests, one at the opticians and another at various health centres/hospitals that change every sodding year.

How can it be cheaper for the NHS to pay for two different eye tests using different people and different equipment than just doing it all in one go with a slightly longer appointment like it always used to be? My optician has all the equipment, i.e. the camera etc and does the diabetic eye tests privately, but apparently the NHS won't fund a longer appointment for him to do them under the NHS!

Not only that, but the diabetic eye tests are obviously "under contract" which is why the health trust doing them changes every few years. It's been our area ambulance trust, our own hospital trust, the hospital trust of our adjoining county, and now the hospital trust of a city 50 miles away in the same county. Just why? The costs of admin and management of the changes every few years must be enormous, plus staff being recruited by the "new" trust and redundancies/terminations for the staff of the "old" outgoing trust. Then organising and presumably "renting" treatment rooms in different places when the contract changes. I must have been to over a dozen different places, granted, all within reasonable distance of where I live, but it's somewhere different every 2/3 years, sometimes it's been my own GP surgery, sometimes the nearest health centre, sometimes a health centre or GP surgery in the next nearest town, sometimes in our local small hospital, sometimes in our nearest city big hospital - it's utterly bonkers.

We're avoiding difficult conversations and decisions. The 'from cradle to grave, free at the point of contact' is obviously unrealistic especially with the ever expanding list of potential assessments, treatments and services. Opening each new service increases the demand for it - and my experience of NHS targets is similar, set one up to improve the service and you can be sure you'll never achieve it

We need less, not more. Fewer services but better staffed and funded. Fewer free treatment and more co funding options. Is it better to fund more autism assessments or to create a support programme for schools? To employ 3 physician's associates or one specialist doctor with small caseload?

Quality over quantity.

It's not just "comfort eating" - it's the sheer amount of processed "foods" that are more chemical than raw foodstuffs. Tinned this, packet that, all full of additives, colourings and preservatives. Often the ultra processed stuff is far cheaper and easier than "proper" foods. Alongside busy lifestyles, it's just a lot easier to have a "meal deal" lunch from a supermarket or a "pinged" evening ready meal. The US owned food companies have a lot to answer for, i.e. crisps, fizzy drinks, chocolate bars, etc - all highly processed crap, cheap to manufacture in virtually fully automated factories and then "packaged" up into meal deals to make customers think they're getting a good deal. We desperately need some new big food companies to disrupt the market and challenge the small number of US owned "mega" food companies that dominate the supermarket shelves.

I would be happy if the NHS would just do what it says it's going to do. I don't go to the very often but if they ask me to go to a screening, I go. What is the point if they then proceed at a leisurely pace when they find something? 15 months it's been going on now & my 'urgent operation' is as far away as ever. I have spent the last 20 years keeping myself as fit as possible & actually feel fine but I am acutely anxious that, during the last 15 months, that Ii'l cancer is turning into big cancer. Please don't tell me that I'm over using the NHS or that I shouldn't expect so much.

Exactly. I spend £25 on train tickets to go to an appointment, only to have it cancelled just as the train pulled up. It was because of staff sickness. I'm 25 quid down & my future appointments have been thrown into chaos. I can't make any plans for myself for the foreseeable future & I've had to spend £95 on rescheduling my holiday which I could have gone on as it turns out. Who do I bill?

Yep, last year I was sent to a hospital miles from where I live for a pre op appointment. This consisted of a height/weight check, a blood test, blood pressure check & ecg. Why on earth did I have to travel 30 miles to have something done that could have been done in the hospital across the road from me??

The appointment system is incredibly chaotic! I don't know how the NHS runs at all based on how their appointments are dished out. They bear no relation to reality.
And getting to these appointments is expensive - I'll need my WFA to cover the costs of this latest debacle.

I don’t think it’s just the older generation whose expectations are too hIgh think it’s across the board.

I think it’s younger generations tend to take less responsibility for their heath I’m in my 50’s and have had a lifetime of being told about the negative impacts of smoking, drinking, poor diet, not engaging in exercise yet my age group there is a huge issue with obesity related illnesses, alcohol related issues and smoking

my sons generation many seem so different rather than going to pubs they are at the gym (of course there are negatives to this)

There is a general lack of taking responsibility for our health in this country I think there are a number of factors but that has to change healthcare will have to change and the government (and following governments) have to be more honest with the public

This!
Plus my generation (I'm 72) smoked & drank as a default. Most have now given up the fags (can't speak for the drink!) but are likely to be living with the fallout. The next gen & their children are far less likely to be smokers but, by golly, they're plump so I think obesity will replace smoking as the major health issue. People are comfort eating like billyoh!

Quite. Covid infections also increase risk of getting diabetes for both children and adults.

Same! My dad will make a GP's appointment because he's not sleeping well (somehow always manages to get seen the same day!). The GP tells him to stop drinking strong coffee late at night 🤦‍♀️ which he'll do for a few months. Then he sleeps better so starts drinking coffee before bed again and then goes back to the GP because he's not sleeping well. But apparently the NHS is really inefficient and we were all sitting on our arses in ICU during covid.

nope no it isn't ALWAYS a lifestyle choice. Plenty of people with T2 have led healthy active lives.

Lack of preventative medicine and health issues not being caught early enough. Also the postcode lottery, my advanced cancer would have been caught last year if I'd lived in a neighbouring county, now I'm costing the NHS a fortune for the sake of a cheap test (which if I'd known about it, I'd have bought the test myself!).
The amount of people I talk to in the oncology waiting room, who have visited their GPs countless times, yet have been fobbed off. So many people aren't diagnosed until things are serious and then they need expensive and extensive treatment.

I spent 35 years attending hospital appointments with my parents after my mum had a life changing stroke, and as they both aged. My dad was a doctor and my granddad was one of the first NHS GPs

1. Medicine is now a career not a vocation
2. Medicine is very disease focused rather than patient focused. This isn’t helped by specialisation to the extent that has happened
3. wholly degree led nursing has changed the make-up of nursing and also reduced the vocational element
4. no-one is willing to have difficult conversations with patients about their treatment options
5. quantity of life over quality of life is very problematic and linked to 2
6. growing isolation of elderly people leads to a sort of healthcare as a hobby approach which is not always conscious
7. there is very little effective mental healthcare for elderly people
8. just because something is medically possible doesn’t mean it’s the right thing to do
9. we need to all have adult conversations about our healthcare choices and what we would want to happen in certain circumstances
10. social care is utterly fucked at all levels and causing massive issues

Wes Streeting has acknowledged that there are too many people who just aren't getting the support they need and has highlighted the government's pledge to recruit 8,500 more mental health staff to cut waiting lists.

Untreated MH does not go away it causes worse more chronic conditions. You reap what you sow.
Undiagnosed ND does not get people into work and well. The right treatment, medication and support does.

My previous post was in reply to this truly ignorant post.

Absolute and complete utter rubbish. It’s nigh on impossible to get autism and adhd diagnoses on the NHS, ditto any mental health treatments under CAMHS or adult. The lack of care in CAMHs then causes a bottle neck in adult services with treatable MH conditions turning into chronic MH conditions. We’re talking young people who SH, try to take their own life several times, suffer from severe trauma etc. Transition between the two is dire. Patients are held by inexperienced and low qualified staff and access to expertise is very hard to get. Inpatient beds are often non existent with young people being sent across the country, young people lurch from one Crisis to the next getting worse……

As a parent who has witnessed this and frustrated NHS staff who feel like shit because they can’t provide what’s needed I can most definitely say a lot is down to poor management and severe short sighted underfunding.

The problem with the NHS is lack of funding and that they've managed to convince people that it is inefficient when it is not. I'm not sure what the European model is as every country does it differently, I'd go for the European models that have everything free for everyone and WAY more funding, beds and doctors. I'd also make medical training free.

I do think that our retired population have too high expectations of our NHS. I don’t know why or how that happened.

Take my dad for example. He goes to the doctor for everything. He needs blood thinners but he is the fittest, healthiest 80+ I know. He has 2 hospitals on the go for a knee operation. They are both doing tests and physio, and he is waiting to see who offers first. Except they have offered, and he’s put it off and put it off and it miraculously gets better every time they try to book in the op. So, he’s had 3 years of appointments. Then he went as he felt low (due to knee pain) and they offered him counselling and meds to lift his mood but he refused to take the meds. He’ll also call them up for appointments for a headache, sore shoulder ( after lifting something too heavy) and anything else.

My in-laws are the same. In fact my MIL’s GP has told her she should find another doctor’s surgery to go to.

If I want an urgent doctor’s appointment for me or my DC I have to pay for it.

I agree with a PP about the impact of housing and related amenities on health and wellbeing. I work in a food bank that runs a supermarket model, so people choose for themselves what they’d like. We hear a lot of “I’m sorry, I don’t have a cooker / my cooker is broken”, “I don’t have a fridge” and so on. Apples are sometimes a no-go because of poor dental health. We used to receive really lovely bread from a local baker but had to ask them if they minded giving us softer loaves instead, which more people can chew. And frankly when life is difficult and your nerves are frayed you are very likely to reach for your vice or treat of choice, whether chocolate, alcohol or whatever.

I have a (touch wood) secure job, an equipped kitchen, a car, a high level of education - when I needed to feed my family with just a kettle for prep we were fine and ate well. Doesn’t mean my medal is on its way.

I know many examples just from my own acquaintances and friendship group.

Plus over-complicated systems that waste time. First time I got a coil fitted, about 8 years ago, I had a brief appointment with my GP, who had my records in front of them, booked me in and then fitted it a couple of weeks later. The last time, it took a few phonecalls to be given the details of the separate clinic who now fits them, then days trying to contact said clinic, then two phone calls from them, one from an administrator taking personal details and then an hour-long phonecall with a nurse asking about my entire medical history, as they didn’t have my records. Then I saw someone different at the clinic, which was also a longer appointment as they also wanted to ask questions about my medical history. I’ve been waiting a year to see a specialist about something else, because their systems wouldn’t let one consultant refer me to another in the same hospital department, it had to go back to the GP who I had to have another appointment with and then they had to write a new referral and start at the bottom of the waiting list again etc etc. There’s a heck of a lot of inefficiency.