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

@Teajenny7 how much would not spending on plastic surgery save? And what about spending on those who speed and cause accidents or those who take drugs?

The carers my mum had were private carers, with public funding.

And the last time I was in hospital visiting a relative I helped feed other patients as they were left with food in front of them but couldn't manipulate spoons etc.

palliative care isn't just for those near the end of life...

One of my relatives wanted to die at home. The state provided carers were shocking, she was lucky she could afford private ones.

@spoonbillstretford free excellent palliative care?

Hmm, UK TFR fell below replacement in the 70s, ie when boomers were younger adults and teens.

https://www.statista.com/statistics/284042/fertility-rate-in-the-united-kingdom-uk/

After that it bounced around between fairly narrow parameters for about 40 years, until the mid 2010s. Birth rates dropping off a cliff happened in the last few years, and hasn't really had an impact on the health service yet because the relevant cohort are still children (this link only goes up to 2021 but we know what's happened since then).

What we are currently experiencing is something that we knew was coming decades ago. But yes, it would've been politically problematic to talk about this.

Of course you can get free palliative care, please don't spread dangerous nonsense.

My DM died at home of pancreatic cancer and had a hospital bed provided and carers coming in four times a day plus a district nurse giving medication. There was never a question of having to pay for any of it or means testing. She died very peacefully.

I would agree that there is unrealistic expectations on the NHS. It is not just the elderly who have these expectations.

Had this discussion with a group of medics who I graduated with.
The concensus was to stop funding;
gender reassignment
IVF
Charge people who have private procedures abroad that go wrong (such as boob jobs, tummytucks)
Charge insurance companies or private hospitals for procedures that the NHS have to fix
Plastic surgery should be for the disfigured or disabled or rectifying after cancer treat not for body dismorphia

They were unhappy with the trend in people demanding diagnosis, for ADHD or Autism in later life. Who then go on to want PIP.
I work with SEND children and questioned the leading psychiatrist response was we are all neurodiverse. We all learn in different ways!

Suggestion on things to do
Charge for non attendance of appointments
Use more IT to monitor chronic conditions
Bring back 8 hour shifts for nurses on the ward.

Better education for health conditions
Educate people on what is necessary for A and E and what is time wasting

Full time mental health staff in all medical and educational establishments

Basic lessons in school to cover what to do if you cut your finger! I remember teaching this years ago.

Be honest with people and relatives and spell out the chance of survival, the quality of life of certain procedures

For the profession to remember just because can do it doesn't mean you should.

It was a rather interesting reunion weekend. We all were in Halls together as students.

I can't remember all of what they agreed on as the red wine flowed!

I am not saying these are all my views but it was really interesting discussions.

They surely aren't obligatory though. Why does she go at all?

You are right as is another poster who mentioned Amazon, Uber ect, also COVID has not helped either I think it's turned a lot of people into worry warts and it's no surprise the way the media were.

My wish is not to legalise euthanasia, but to ensure every person receives the dignity of excellent palliative care

That's not possible unless you can afford to pay privately. Haven't the government even said they can't afford assisted dying?

@Almostwelsh plenty of my older relatives are fighting fit according to their GP & they are in great shape. But they are all on a plethora of drugs!

@Bumpitybumper Our experiences and views clearly differ, except, it seems, on the agreement of "respecting people’s wishes." My wish is not to legalise euthanasia, but to ensure every person receives the dignity of excellent palliative care. Your wish, on the other hand, appears to disregard that entirely, favouring what is ultimately the quicker, cheaper, and more convenient option: ending life. To me, that is the very definition of throwing the baby out with the bathwater.

Yes, I acknowledge that your approach might save money. But let’s be honest - this is about budgets, spreadsheets, algorithms, and tick-boxes. Efficiency over empathy. Convenience over compassion. All of it dressed up as "choice," when in reality, it's life itself that's being devalued.

And even apparently fit healthy people over the age of about 80 usually do have several diagnosed conditions and medications.

I have a relative of 85 who lives independently and is active with a good quality of life, but they have medications for blood pressure, statins, osteoporosis, certain prescription strength supplements for a chronic condition. They have in the past few years had bone scans and orthopedic treatment for a fall.

This is a person who is remarked upon for how fit and healthy they appear and how much they can do for their age.

No matter how well you look after yourself, you probably will need quite a bit of medical help after 80.

I also have to take issue with the assumption all over this thread that if you take care of yourself you will not be frail in your old age.

@Katypp this is an odd new narrative. A lot also seem to think a healthy lifestyle means no cancer or chronic disease, unfortunately not.

This isn't strictly true. Whilst the old people have been alive a long time, it wasn't obvious when they were young adults that they essentially were going to be a huge bulge generation and that birth rates were going to drop off a cliff. What this meant is that baby boomers paid for the (much smaller) generation before them with their tax contributions. Easy peasy as there were lots more baby boomers than people in the Silent Generation etc so there was essentially a lot of people carrying a relatively small burden. Now the population pyramid is top heavy though and there is a huge burden placed on a shrinking working population. Really Baby Boomers should have paid more tax all along but this would have been a very bold move politically and you can't blame the old people themselves for not doing this.

I agree with this. A tagential issue is that I'm paying for pensions, for the current retirees, and I won't be able claim the same benefit. Ditto the services of the NHS.

It isn't throwing the baby out with the bath water. It's about respecting people's wishes. Some people view life and death very differently than others. I think it's totally possible for someone to feel that they've had a good innings but they want to stop now. That all that lies before then is pain, decline and ultimately a scary and largely uncontrolled road towards death. People want to skip that bit of life and that should be fine. I think of a condition like dementia and can honestly totally understand why people just don't want to go through it. To force someone to do so and fund this extremely expensive care with money that could be spent elsewhere on actually saving lives or even prolonging the life of someone that actually wants to live is bonkers.

If the NHS had the best management ever, we still wouldn't be able to afford to do everything that people feel the NHS should do. That is just the reality of running a healthcare system with increasingly expensive technology, drugs and skilled people and an ageing, sicker population. We can't have everything no matter how much you target management efficiencies. Something meaningful has to give. Keeping people alive against their will in this context is ethically and financially absurd.

What about rugby players and mountaineers ? They are making potentially life changing choices due to injury for a hobby ?

@Fortheloveofgodwhy most won't have paid even enough for their state pension. And that doesn't matter & is quite usual. The changing demographics make it a huge issue.

After nearly forty years my blood runs NHS blue, but whilst I am deeply loyal to it and skeptical of suggestions to follow some other models, we really do need to stop putting it on a pedestal. It’s a service that is funded by taxpayers and it either does less or we pay more.

However you are correct OP about managers.
Managers make up 2% of the NHS workforce.
Outside the NHS managers, directors and senior officials make up 9% of the workforce.
About a third of those managers are also clinicians, completing clinical sessions.

I lived in Spain for 7 years 2000-2007

Phenomenal healthcare over there, great system. Kids don’t even see GPs only Paediatricians.

Dentistry was another kettle of fish all
private- but health service was amazing.

• Don't blame the ageing population, they have been here 60/70 years and the NHS knew they were here and would age, the NHS never prepared many years ago as they should have. I't not fit for purpose and we need to change it to something like the rest of Europe.*

This makes no sense! Whether the gov did anything or not it's still due to an ageing population.

It’s not about blaming older people or wanting to bump them off. It’s about accepting that the aged body can’t do what it used to do, and not all ills are easily fixed. Two of my elderly relatives are very sensible and accepting. They pace themselves and know that some things are no longer manageable. The other three carry on to and fro the doctor, being investigated for all sorts of things, one refusing treatment because she doesn’t believe in it, another being in and out of hospital because of his own behaviour, but refusing residential care. None of them getting better because… old age.

The assisted dying bill suggests to me that half of us are determined to avoid all indignity and suffering, the other half determined to never let go no matter what!