Catastrophic state of the ambulance service: what's behind it?

[tulips27]

Seeing the shocking and upsetting thread where the OP has been waiting for over 24 hours for an ambulance for her relative who has a broken hip I want to ask what has cause this state of affairs? How can this be possible in our country? Can anyone offer any insight?

(Link to the thread for those who have not seen it: www.mumsnet.com/talk/am_i_being_unreasonable/4701431-i-know-iabu-blatantly-using-this-for-traffic-emergency-situation-no-ambulance-still-and-need-advice )

I have to say it, as I've heard it so often from carers and nurses...so many left due to the vaccine mandate, or threat of. They won't come back. There's ads all over my local area with a one off payment to join as a carer. But as they keep saying, now they know they've been treated like shit, why would they come back?

No one things there's an easy fix!

I do think we need a change of govt to get the message across that this lot are a shambles.

This is modern excuses and hospitals ha e made everything far too fancy nowadays which is a huge issue.

Look round a nursing home...
Ask the staff the family can't be arsed to even visit their own family members.

Hospitals were putting signs up asking for family to bring in basics like soap and so on. Many don't even get clothes once a week. It's the culture here in UK.

Most of it is down to the "internal market" within the NHS where it's fragmented and run by different trusts. Each trust "wins" contracts based on performance and grant/funding applications. Trusts are given finance for doing specific things, specific treatments, achieving performance targets, etc. So, they won't do anything they don't get paid for or which doesn't help them "hit a target". It just causes conflict between trusts.

So, an A&E dept doesn't want to be seen to having exceptionally long waiting times (as it may affect performance targets, future funding etc), so they deliberately won't accept patients who have to stay outside (or in corridors) under the "care" of the ambulance trust. So that patient languishes in the ambulance trust's waiting time performance target etc. There's no "benefit" to the trust running the A&E to accept the patient handover earlier than they have to. The same principles flow throughout the NHS.

My OH is a classic case. He has cancer and needs chemo for the rest of his life. The oncology dept get funding for his "cancer" related care, i.e. the drugs they give him, etc. His GP surgery continue to get funding for his "normal" care. As a result, when he needs his blood tests (twice monthly), the GP surgery won't do them as they don't get funding for them. He has to go to the hospital who've been contracted by the oncology dept to do their blood tests! When his oncologist flags up that he has some deficiency, rather than prescribing, say, iron, calcium or Vit D tablets, they just tell him to go to the GP surgery, as supplements come out of the GP's funding budget, not the oncology dept's! That costs the NHS a lot more, of course, being OH then needs a GP appointment and a GP blood test before they'll prescribe, say, calcium tablets as they need to do their own consultation and do their own blood tests before they can prescribe! It'd be a hell of a lot cheaper for the oncologist to add Calcium tablets to his monthly bag of drugs they prescribe, but they don't have funding to do it (even though it's minimal). But at the same time, because oncology have "won" funding for OH's long term expensive chemo drugs, there's no benefit to them to stop prescribing the drugs he doesn't need - one of which is a weekly drug costing £2k per pill, they prescibe 3 per month, but he only takes 1 (only needs 1 per oncologist) yet they continue to prescribe all 3 (so £4k wasted every month) because it's easier to continue doing it (as they're allocated the funds anyway) rather than to bother changing the prescription down to just what he actually needs/takes.

This is what happens why you try to impose "real" business-style economics into a state controlled monopoly - it's a complete failure. They thought that it would create competition between trusts, etc to save money, but in reality, it just causes everyone a lot more work, increased admin/management costs, and in a lot of cases causes worse outcomes!

Yes, it's wrong, but when people are paying thousands per week for a care home, then there will inevitably be a high expectation for them to be properly cared for in all aspects!

£37bn spaffed on Track and Trace that didn’t work, billions on useless PPE….

@Badbadbunny what has that got to do with not visiting your own family in a care home/hospital? 😕

A carer can only do so much. Looking after 8 people is a demanding job, hence the poor staffing levels. Something has to give.

Yes. I can't apologise. He backed all of this.

I suspect his plea about NHS and money is deliberately ignoring my comments on reform. I realise he gets millions of letters and some will be about money, but I specifically said I think the NHS should stop doing certain things to save money. I definitely don't want more money going into the NHS.

I don't understand what you mean by "modern excuses", presumably for families being unable to care at home for people with dementia or who've had strokes.

My DM has been desperate to have my DF back in their own home, but it is simply not possible. He has advanced dementia and it takes a minimum of two people to reposition him on the bed (he cannot move himself), bathe and toilet him, and hoist him from bed to specially adapted chair.

My DM is 80 years old, DSis and I both work and live some distance away. With the best will in the world, even if there were family available round the clock, we are not able to care properly for my DF. At my DM's insistence he returned home from hospital this summer. He was at home, confined to bed for 5 weeks with a care package of 4 visits a day from 2 carers. He had urine infection, then chest infection, followed by thrush as a result of the antibiotics. A hospital bed was provided but he kept slipping down it. We couldn't reposition him properly. He lost a lot of weight because he couldn't sit up properly to eat or drink. He was extremely distressed and agitated all the time. My DM was making herself ill sitting in the bedroom with him all the time on an unsuitable chair.

DF ended up back in hospital and after 5 months, has now been discharged to a nursing home.

Oh, and as for taking clothes into hospital! My DM repeatedly took in clothes and shoes for my DF to wear in hospital - before he even wore them, they disappeared, never to be seen again! More recently he was wearing clothes which my DM was sure belonged to the man in the opposite bed.

Travelbud just think about it. How many posts do we see where fathers are having children in their 40s. So a man is 45 when he has a child, let’s say his partner is 39. They will both have to work until they are 67 before they can use their state pension.

When they become old and Ill - let’s say at 80, their child is 35 ish and probably has a baby of their own. They will also be working full time as will their partner ( if they are still together). They can’t look after their parents. I understand what you are saying about visiting and that isn’t right. But the fact is we no longer in the main live in a society where women have had their dcs by the age of 22. Where they stay with their one partner for life, where they have the luxury of not having to work full time at 65. Where one parent can stay at home, visiting elderly parents all day everyday. I myself work full time and so does dh. We cannot retire any time soon. We have elderly parents. If they need 4 visits a day we could not do it, we have to work. Gone are the days when men had a wifey at home doing the caring for her and his parents. Christ people still have their adult dcs living with them as they cannot afford to buy a house. It isn’t lazy when you have to work full time. It’s called reality.

Exactly. When my mum was in and out of hospital in the early stages of dementia I lived an hour and a half away, was working full time and looking after two small children. I just couldn't provide the support she needed.

No, its the other way round.. State scheme supplemented by private.

The French health care system is one of universal health care largely financed by government national health insurance.... through taxation of employers and employees

...they don't exclude pre existing either or cancer or chronic ... unlike UK.

We are also not talking about AXA levels of UK insurance costs either for the private schemes.

People read Europe has health insurance schemes but then never read beyond the headline....

I didn’t mention France?

You didn't mention any country in europe....

But the fact remains is that all comparable EU countries operate tax payer funded health models, private ins the top up.. not at all what you said.

Italy and Portugal very similar to UK.

Germany - Healthcare in Germany is funded by statutory contributions, ensuring free healthcare for all. In addition, you can also take out private health insurance (Private Krankenversicherung or PKV) to replace or top up state cover (gesetzliche Krankenkasse or GKV)

Perhaps you would like to say which European countries you were referring too that have PHI topped up by the state?

Only one i see heading that way is the UK....

Yes, state supplemented by insurance is the way I should have phrased it, apologies. But the point remains that state isn't expected to do the whole thing.

I was a bit confused when you added in the bit about France as I thought you were quoting me!

Another reason why there are more staff required is that if you have someone bed blocking in a ward, they need to be cared for during that time. If you could get them out the same day they became medically fit (either sent home with appropriate care, or sent to a step-down bed), then any nurses/HCAs etc looking after them would be freed up. As it is, with patients in hospital for longer, then for every patient there is a bigger call on staff than there ought to be. Hence needing more staff time per patient, because length of stay is higher than it needs to be.

Apologies' too!

Here is perhaps a system you might have been thinking off ?

www.commonwealthfund.org/international-health-policy-center/countries/germany

Role of public health insurance: In 2017, total health expenditures made up 11.5 percent of the gross domestic product (GDP). Of this health spending, 74 percent was publicly funded, and most of that spending (57% of total) went toward SHI
About 88 percent of the population receives primary coverage through sickness funds, and 11 percent through private insurance. There were 109 sickness funds in January 2019

Its not the norm in Europe though.

Of course not. Nobody can opt out of paying NI in UK. Some part time workers don't earn enough to pay Class 2 (which affects their state pension entitlement unless they opt in to paying Class 3). Self employed pay Class 1 (which doesn't get you a state pension) and can choose not to opt in to Class 3 if they prefer.

You can also purchase private medical care for diagnosis and then return to the NHS waiting list for treatment, effectively queue jumping (because the others needing treatment are still awaiting their NHS diagnosis and haven't even made it onto the waiting list for treatment yet). People with money or private health insurance do it all the time.

NI pays for way more than just NHS or just pension. If people were allowed to opt out of it because they wanted to sort those two things for themselves the whole country would probably collapse