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 )

Exactly. People don’t want to care for relatives themselves any more. But equally they don’t want to pay for others to do it! They want to pocket the inheritance without doing any care.

I don’t think it’s all like that. So many more elderly people have dementia and a family (once it reaches a certain point) would not be able to safely care for that person in their own home or even if they went to live in their child’s home.

Many stroke patients need specialist lifting equipment and full on nursing care that people just aren’t equipped to do at home.

I really don’t think it’s because don’t want to do it; mostly that they don’t have the necessary skills or facilities available in their homes.

It’s not just women working that has made it harder to care for older relatives: there have been other major demographic changes.

Although, as I posted above, living longer does not mean more years being dependent on family (on average), the age at which it happens has shifted. In the past, people typically had kids in their early to mid 20s and died in their early 70s. So adult kids, caring for parents, would have been late 40s/early 50s.

The generation who are now in late old age and living into their 80s/90s also typically had kids quite young, so their adult children are in their 60s or 70s themselves. If they are retired and in good health, this can actually work out well, but they are not necessarily fit enough to do the hard physical graft that caring can involve.

I've no issue paying or helping others to pay. But I cannot see the government even acknowledging there's issues here - including carer pay.

I would go back to social care, I did go back during the pandemic, but I left again because despite the promises of more funding and improvements from the NI increases, things were just getting worse and worse, costs were being cut and I think if I'd heard the phrase 'needs of the business' once more there would have been bloodshed, I'm not interested in the needs of the fucking business making someone else rich, I'm interested in the needs of the people I'm looking after.
It wore me down and I burned out - the job itself is hard enough, but it's pretty much impossible when you add all the crappy money making and cost cutting, no support available from the NHS services and the public perception and attitude towards the job.
I'd go back for a wage I could realistically live on, without worrying about putting my heating on, and that doesn't have to be a massive amount. But they could pay me all the money in the world and I wouldn't go back until conditions improved, until there were penalties for providers running shifts short, until there was more comprehensive training and support, until profit came second and the people being looked after came first - I have made my peace with the fact I won't be going back to social care through choice because not enough people care enough, and certainly not the government, for anything to be done about it, which on a personal level is sad because the actual job I enjoyed, got a lot out of it, and there's obviously so many who feel like me or we wouldn't have this problem.

I think everyone, and I mean everyone, should write to their MP asking what the government plan to do about this mess. Unfortunately there are still a lot of people who get very arsey about any criticism of the health service and all compete to say how wonderful it is and rant at anyone who says otherwise, which doesn’t help in getting anything to change.

People saying the NHS has always been like this, when in 2010 the FT reviewed all global systems and concluded the NHS was the best system in the world when considering access, efficiency (yes really, insurance balloons costs) and outcomes - this is why we are stuck in this mess.

It used to be considered outrageous if an ambulance took over an hour.

It is interesting that people feel voting Labour is going to provide a magic wand for the NHS it is quite literally fairytale thinking. You are not going to solve the NHS collapse with a Labour vote or any other for that matter.

This is Wes Streeting, the shadow health secretary no less on the NHS a few days ago:

“I’m not going to pretend that the NHS is currently the envy of the world,” said Wes Streeting, shadow health secretary, at an event hosted by Policy Exchange yesterday. He went further, picking his words carefully: “The NHS is in an existential crisis … It is failing patients on a daily basis.”

He even admitted that in debates about the NHS’s future, it is usually the interests of its staff that come first, while “[the] patient voice is often the quietest voice in the room”. Exhibit A: the nurses’ strike. We are again talking about the interests of producers, not the patients they serve.

The problem with the NHS, however, is not just that its funding demands are outstripping the economy’s ability to supply them. It is systemically flawed. This week, the Institute for Fiscal Studies published analysis showing that the NHS has more staff per patient than ever and yet the number of patients it is treating has actually gone down

In my view the time has now arrived when we need an all party solution to tackle the NHS and social care, and an open debate about how people wish to reform. Because reform is coming believe me. This has gone well beyond party politics. People are dying every day because we can not find our backbone to face this crisis head on.

www.telegraph.co.uk/news/2022/12/16/even-labour-knows-nhs-failing-why-will-no-one-admit-need-new/

www.mirror.co.uk/news/politics/labours-wes-streeting-says-nhs-28747686

Good post. The idea that there’s an easy fix coming is problematic

My DD sees this everyday... they simply cannot get patients out of hospital & its no rehab available e.g for amputee, neuro & no care in the community, either to a Care home or home support.

The reform will be the better off moving across to to private health.. with everyone else stuck with whats left.

Labour are correct in their assessment, takes years to train staff, build and equip, i believe Blair, despite trebling funding, took 7 years before we saw improvements... that was also after years of the Tories.

Yes there is more staff on the pay role BUT so many are part time.

From 2010.

Of the 12 NHS organisations providing ambulance services, 7 met or exceeded the 75 per cent standard for 8 minute response times. Of the remaining 5 trusts, 4 exceeded 73 per cent with the other trust exceeding 72 per cent.

digital.nhs.uk/data-and-information/publications/statistical/ambulance-services/ambulance-services-england-2010-11

That seems pretty good service to me.

Tories.

That’s literally it. There are complex, detailed (correct) answers regarding under funding, staffing issues, aging population etc etc.

But the crux of it is that the above issues could be solved, but there is no political will to do so.

It’s Tories.

in 2010 the FT reviewed all global systems

What about people's real life experience? A 'global system' means nothing unless it is backed up by the end users.

@Alexandra2001 The reform will be the better off moving across to to private health.. with everyone else stuck with whats left.

Quite right, it is already true in practice. People on low incomes with long-term conditions will be the biggest losers from all this.

My Mum had a stoke several years ago, Ambulance arrived, treatment hospitalisation, community hospital.

Again, a few years ago, i broke my hip and femur, ambulance with 15mins, AE and on a ward inside two hours from when paramedics arrived.

.... nhs can and did work but Austerity.. firefighting... funding and failure to deal with staff shortages since 2010 has run down the service.

The Cons also stopped bursaries... why would do that if you wanted to deal with staffing issues....?

The lack of mental health services, community care, social care - all of it lies at the Tories door.

There's a shortage of around 80 000 staff in social care, since Brexit no one earning an average carers wage (ie fuck all) has been eligible for a visa to work here.

It's all ideological. They're duping people into turning to private insurance in desperation. If you think the NHS is bureaucratic wait until you're dealing with layers of insurance bureaucracy all taking their slice.

Lower-income people
in many countries in Europe and Australia seem to do better than they do in the NHS, though. And many of them use insurance schemes, supplemented by state schemes. Does ideology outweigh outcomes?

The nhs is an insurance scheme

It's just not managed for profit

Have you ever cared for a relative with dementia, or an adult with incontinence and mobility issues?

This.

And we're not paying enough into it. We compare ourselves to Germany and France but pay in significantly less as a country

@tulips27 ‘How can this be possible in our country? Can anyone offer any insight?’

The Tories have been deliberately starving the NHS of money and resources for over a decade, is the short answer.

Well quite - so we know what to do at the next election. "Service" is not a word in their vocabulary.

Part of this is a numbers game. The post war baby boom generation (1945 - 1965) are now moving in to old age and ill health. This generational bulge is enormous compared to the generations before and after it. We also have the technology to keep people a live a lot longer.

The dependency ratio (the amount of working people supporting non working people) is going to get pretty hairy in the next decade or so as Gens X and Y (those born between 1965 and 1996) are literally smaller that the baby boom generation - specially Gen X as the birth rate dropped A LOT in the late sixties to late eighties.

Finally the way the NHS was set up assumed a much smaller retired generation than the working one (after all many people never made it to pension age - we lost a lot of people in the two wars and many would die in their sixties and early seventies) and also it assumed home care would be carried out privately (wealthier families would hire private nurses or pay for private convalescent homes) and less well off families would rely on women giving care for free.

Also in pre NHS (and even post) times dementia absolutely did exist but it was often seen as a mental health issue not a medical issue. There are heartbreaking archives of asylums where it is clear than many of the older inmates simply have dementia.

I think the only way to fix this is to create something like NI that pays for care that everyone has to contribute to - pool the risk rather than the current situation of people trying to avoid paying care home fees or people using all their savings to pay for care where as others pay nothing. Where the unfairness comes in is people often look at raising NI or income tax to fund this (see the recent but now withdrawn NI increase). To me it has to be an asset tax, it is deeply unfair to add more tax burden on the incomes of the working population to enable wealthier retirees to preserve their property wealth.

Given the choice I would either introduce CGT for primary residences or tax inheritance as income (with carve outs for people inheriting all or part of their residence - so partners or dependent children).

Because usually they are slagging the nurses off and HCA. Rather than the bosses at the TOP!

You can see the public are clueless..... leaving work to collect your poorly elderly parent, I've heard it all now.

Someone mentioned writing to their local MP - sorry for the bits that might be irrelevant.

I wrote to mine last week about these strikes - Tory - but we have had some useful correspondence over the years and he's been great with local stuff.

My email was, I thought, perfectly polite. But he has said some odd things in his reply letter and I wonder if I have touched a nerve?

he says is "there is no bottomless pit of money", giving all the figures they have given it.

I didn't say the NHS needed more money. I did say it needed reform.

He also effectively said he felt I was being rude.

I get the sense of a man at the end of his tether. I really don't think I said anything rude.

I don't think I will reply, though I think he might want an apology.