Everyone was worried about the Tories and the NHS

[Puzzlemad]

https://www.bbc.co.uk/news/live/c0qejx03zjnt

One issue I see a lot of, is people refusing to adhere to a treatment plan and so the same problem occurs over and over and over again. Each visit is costly, resources are wasted, patient satisfaction is low and the issue has a knock on effect on their mobility/general physical health. I think really good patient education might help somewhat with this and would be a relatively cheap intervention. That is the sort of reform I could get behind

Of course it needs reform, but it's not going to be cheaper than what's there just now if you also want it to be better.

What we have now is "cheap" NHS.

You can slice and dice whatever way you like - run it "like a business", or bring in European style insurance with copays, or move care from one place to another place, or focus on preventative care (assuming you're not planning to let those who haven't managed to prevent up to this point whistle). All of this will cost an unholy fortune up front which governments hate.

Firing managers (and employing adminstrators to manage the new fee infrastructure...and more managers to manage them) won't touch the sides.

It can be good and quick and expensive.

Or good and slow and cheap(er).

Or bad and quick and cheap(er).

So which do we want? Bad or slow (Y no both??), because no-one's willing to pay Euro charges or set up costs and it would be suicide for any government that tried.

Why the delays to refer and treat? Because they don't have the staff or the money and if you can delay then you can hope it moves on to a different budget sheet, or maybe next year you don't have to commit to a 10% cut in your service.

All those middle managers and the top ones for that matter can go and get proper jobs while the medically trained and essential admin staff can get on with it with better funding after the formers' overinflated salaries are cur out. Absolutely sick of the number of organisations that have people working in frankly made up jobs for ridiculous pay.

There's loads of research on patient education interventions. The cheap kind don't work (have a leaflet! An app that sends you annoying messages until you uninstall it). The expensive kind (physio groups, face to face with a dietician over a long period of time) a bit better. Behaviour change is hard plus confounded by many other factors (all the inequalities you can think of basically).

The NHS can rarely fund the expensive kind and tbh the evidence base isn't really strong enough to justify it when so much else needs done.

Sick people don't tend to be from the groups in society that are easiest to reach.

Theatre efficiency is awful in most places. We have no porters after 11pm, if u send for a patient 20m before the current surgery is finished, still wait an hour before the next arrives. It drives me screwball as the anaesthetist in charge of the emergency theatres, I collect 70% of the patients in their beds personally ooh as can't be doing with the waits

Prevention is absolutely the best and ultimately cost-effective, but its gains are very long term, expensive to implement, and in the meantime the existing sick need treatment.

Big signs at A&E saying "If you're drunk or on drugs then piss off home again" wouldn't cost much though, would they? Would only take a couple of minutes with a piece of A4 and a marker pen.

Seriously though, people need to start taking responsibility for their addictions and terrible health decisions.

I completely agree that the system needs reforming re management and scans for serious illness. GPs are only any good if you know what you need and are prepared to fight for it.

The NHS apparently has a third of the number of managers that the rest of the economy does (by %).

I think that stat is from a study by a university, but I've not looked into it that much.

It makes a lot of sense to me. Big change is needed and there's no point at all throwing more money at it without it.

So you want idiot teenagers suffering alcohol poisoning or drug overdose to die on the streets undeserving of treatment?

@ditalini I am thinking of a specific area, patient education works well in this area in different Trusts, and it is well evidenced that it works well.

They realised there was no extra money?

As for the reforms I'll wait and see, maybe not the asked for ten years ;

But just generally how all these pledges pan out

Idiot people drinking themselves stupid and assaulting staff are a disgrace.

Charge them. They have beer money and shouldnt they be in the front of a queue to be seen. Perhaps if the knew the consequences of their action
s they might be more careful.

Most people think the NHS need reform and funding. They just don’t want it to be them. It’s for others to pay.

Well that's excellent. I hope the Trusts are carrying out robust evaluations and publishing (not just on bloody NHS sites where it gets buried) so we can all benefit.

One thing I think we need to do as a society is be less squeamish about death. The number of very elderly people I've seen living in extreme distress from dementia and with multiple other painful health conditions being pumped full of antibiotics to 'save' them from death from illnesses such as flu so they can live longer in terrible suffering. Its just plain cruel they way we try to extend these tortured life's for as long as possible. I suspect my generation, who have seen the generation above go through this, won't have it for themselves and will have paperwork in place to prevent it.

Agreed (solicitor who does and sees lots of NHS work).

Ken. Having both parents go through this. I think the medical profession are shit scared of being accused of not treating the very elderly the same as everyone else so they make unnecessary interventions and smugly discharge the very old back to care homes where somebody is making an awful lot of money from them.

Which ones specifically?

the nhs of course needs more money
as does social care
where does this stupid phrase Throwing Money
how about Investing in the NHS

Labour are now discovering for themselves the scale of the problems. It was not the evil Tories depriving the NHS of adequate funding (funding increased every year) but productivity is so poor, and has fallen. Hospital staff increased by 17% since 2019, but productivity has fallen 11.4% according to the Darzi report. That is fairly shocking. The figures are equally poor in general practice and community medical settings.

Surely there are some more pensioners left to be plucked.

We throw £165 billion (BILLION) at the NHS every year, and it has got worse. It does less each year, sees and treats fewer people. More people die every year (14,000 pa) in A&E than have died on active military duty since 1948.

Medical services are very easy to access.

There are thousands receiving treatment they aren't entitled to just because NHS staff are above vulgarities such as actually checking entitlement and payment.

throw again @Papyrophile
please stop with this attitude about Throwing

People have been saying for years that we have a fat unhealthy population, many of whom are now so fat and/or unhealthy they are unable to work.

A lot of the plans seem to focus on preventing people getting so fat and unhealthy (though I would like to see more focus on exercise and getting fit). The Telegraph unsurprisingly is howling about the nanny state.

Yes this will piss people off who have received the impression in the last 80 years that they are entitled to take zero responsibility for their own health and fitness but that the country will pick up the tab. It doesn't work any more - there are too many.

What would your plan be?

One thing I think we need to do as a society is be less squeamish about death. The number of very elderly people I've seen living in extreme distress from dementia and with multiple other painful health conditions being pumped full of antibiotics to 'save' them from death from illnesses such as flu so they can live longer in terrible suffering. Its just plain cruel they way we try to extend these tortured life's for as long as possible. I suspect my generation, who have seen the generation above go through this, won't have it for themselves and will have paperwork in place to prevent it.

And yes, I absolutely agree with this.

Would "shower" be more acceptable to you?