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

age is a red herrring

What's the purpose of pretending we don't have an ageing population and that they impact social care & healthcare costs?

I’ve said this before but the biggest problem for the NHS is Type 2 diabetes which 10% of the NHS budget is spent on. Science now tells us that 80-90% of diagnosed Type 2 diabetics can reverse this with diet and exercise and we could prevent nearly everyone from getting it in the first place just by changing diet and exercise. If we could reduce the workload and costs of the NHS why wouldn’t we?
(clue: big pharma would not be happy, ditto processed food manufacturers)

One in eight adults has Type 2 and the numbers are increasing at pace.

Young people need faster referrals and fast track as well. My young adult DD has cancer and we had to 6 weeks for a MRI for a suspected Sarcoma and diagnosis.
Every MRI we go for she is the youngest there by 40yrs.
Sadly we don't have enough resources for everyone, let the young at least have a chance at life.
My Dad who is 76 has been badly affected by it, he is on a 30 week wait for a heart scan and refuses to chase it saying someone like his granddaughter needs it more.

@Whitehorses67 great post.

This. And a European model. If we want world class services, we have to be prepared to pay more tax.

It's middle and lower earners who pay more in many European countries

What is most needed is some people taking responsibility for their own health.

But you can't ignore socio economic issues and their impact on health...

We need the European funding model. We should have to pay to access some services. Then appointments wouldn’t be wasted

How will people not working fund the above since it's like a NI tax in that employers pay in?

Management is an issue but nobody wants to acknowledge the pressures of an ageing population.

indeed but the poster was commenting on over 80's refusing to agree to DNR.

We all have to die. Obviously when we begin our ninth decade we're only too well aware that the bucket may not be waiting very long to be kicked and if we're fit and well at that age then of course we want our lives to continue as long as possible.

However, few people, I feel, would choose to be kept alive just for the sake of being alive, if that life had no quality. It would feel pointless. There comes a point when it's time to go.

Yes, that would require decently functioning admin systems and postal service. I would absolutely cause more expense challenging a fine for an appointment I'd not been notified of, and so would a lot of others.

Absolutely this.

Between parents and PILs we see this carousel of consultant appointments for no discernible purpose. Each involves pre-appointment blood tests, scans etc with hopelessly inefficient paper-based communication around scheduling.

There is no joining up between the various specialisms involved and there doesn’t seem to be any agreed purpose or output of any of the engagement.

it is eye watering inefficient, and being ruthlessly objective, all of this activity seems to add up to little more than the observation and documenting of decline

Yes but they can’t actually say that because the pensioners will have a melt down.

We are having to provide care for often multiple conditions for a huge period of time - a decade or more at the end of life.

I have no idea what the solution is to it however.

True. Prior to a recent emergency admission in France, we had to show ID (passport) and travel insurance / GHIC / method of payment. On discharge, we had to go to the payment admin counter, prominently located in the hospital entrance. An invoice was produced and we were asked pay the outstanding balance not covered by the GHIC.

The income level of the 80 year olds is highly relevant I think. Not all 80-somethings are equal!

Issue is from when I was there is that any £££ is spent on looking for ways to make the existing system “more efficient”. How can we make what we’ve got, same number of beds, same number of staff, see more patients in the same amount of hours.

never going to work. They design computer programmes aimed at saving dr’s admin time. We used to pick up the phone in pharmacy and advise HCP’s on what drugs to give and when. Now they have a computer system that medics are supposed to consult so they can cut pharmacy staff. Algorithms aren’t fail safe and depend on the quality of the user, so often then HCP misreads and gets the wrong “advice” and we have to fix it later, or ends up calling us anyway. So twice the time and effort on less staff.

it’s like 111 was designed to direct people to the appropriate service and take pressure off overused a&e. But the HCP’s aren’t allowed to use their own judgement so we end up with ambulances and A&e visits for indigestion.

there was once a study that the fastest and cheapest way of reducing a&e wait times was stick a consultant on triage. Someone with the authority to send people away and admit only those who need seeing immediately.

my local hospital has a 24 hr GP service attached. All non immediate cases are sent. Sprains, infections, headaches. Sent for x-ray, prescriptions written from there. Does reduce the pressure on a&e.

it doesn’t occur to them that more efficient= spend on staff.

You can't penalise DNA in the current system where often you're not told of an appointment nor can you get through to cancel it!

Poverty A previous poster talked about poverty. Poverty causes early deaths. If you are poor, your life expectancy is shorter than another person. So I support free healthcare rather than see poverty health inequity get much worse.

Managers Bravo Labour for tackling the bureacratic bloated organisation that NHSE is. The managers at the coal face often work really hard. NHSE management... we wouldn't miss 75% of them. Healthcare would till be delivered

Patient lifestyles some people escape the consequences of their lifestyle. Others develop type 2 diabetes, COPD, cardiovascular disease and cancers earlier linked to their smoking eating etc. However we all die of something one day.

Age The amount of healthcare cost increases as you get older. ....I hope no one would dream of having an age cut off! However we do give very expensive and often futile treatments for people with significant morbidity. I'd like to see the discussion around quality of life vs quantity better. Its not about not bothering because you're 80, it's about getting 2 extra years but enduring surgery and medication side effects for those, living in pain and restricted.

DNA not attending or cancelling apps last minute. You pay for the next one.

I’m approaching my sixties, and I really can’t see how Millennials and Gen Z can be expected to finance the NHS for Boomers or my Generation who might averagely live into our nineties. It’s not fair on them. Too many of us are living too long. There won’t be sufficient numbers of younger taxpayers (or health workers) to support us. Not without massive immigration anyway…

I also think there’s a large group of people who don’t take any responsibility for their own health (they smoke, drink too much, eat too much of the wrong thing etc), then expect to be fixed when it goes wrong and they get ill.

It's difficult with the elderly, I think people should take more responsibility for their health but obviously this is difficult with the elderly. My MIL came back from hospital recently after having a UTI which was entirely preventable through her not drinking enough water. We have bought special jugs and glasses but she's shoved them back into her cupboard. She's been given numerous hearing aids, inhalers, compression stocking and high protein shakes to try and keep her out of hospital. All are unused in her cupboards. After her last hospital visit she showed us all the pills she takes on a daily basis. She was taking medication for diahorrea as well as taking medication for constipation.

some of it definitely is useless management. Having worked a good chunk of time in lower tier nhs admin, can confirm that most of the upper-middle management were alarmingly, in fact frighteningly hard of thinking. Most of them were hugely self-interested, nepotistic, and concerned with handing blame for the awful shortage of everything down to the lower admin rather than actually trying to do anything about it. The Peter principle in the terrifying flesh

The nhs is totally unsustainable and the sooner people stop with the “save the nhs” bollocks the better. Move to a European system asap.

And how could managers deal with these problems? It requires more imput than just managers. It requires a full overhaul of social care, it requires more beds, which requires more space, which requires whole new purpose built hospitals. More staffing - theres recruitment freezes in most trusts as there simply isnt the funding for more staff, from porter and cleaners, right up to medics, they dont have the budget. It requires goverment level changes do deal with the current differences in population demographics which directly impact healthcare for all.

It works the other way too. Too many staff have the attitude that it's free so the patient's can go whistle if they don't like the crap service they get. My OH, who has cancer, has had that attitude numerous times when he's complained about his chemotherapy drugs not being ready for collection on the agreed date, or turning up for treatment appointments that have been cancelled without him being told - when he "dares" to make his displeasure known, he has sometimes had the "it's free so you can't complain" attitude thrown back in his face!