Everyone was worried about the Tories and the NHS

[Puzzlemad]

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

It absolutely does need more funding. Reform is expensive in itself. When the NHS was properly funded there was sufficient capacity for efficiency. When it’s overloaded it becomes less efficient - for example cancelling elective procedures to deal with overcrowded A&E.

Another issue is that the “publicly provided” is missing - private sector provision in the NHS is poisonous.

The reforms seem reasonable, but are not feasible without extra funding.

As always lots of talk about prevention - but it’s easy for politicians to say that. Reality on the ground is that it’s the first thing to go.

take falls prevention. The best thing to reduce falls in ppl over 65 is exercise - it’s been researched & evidenced globally. The other things that contribute are - regular sight tests ( lots of older ppl fall because they have poor sight), regular medication reviews so that medicines aren’t causing dizziness, home adaptations - rails, handles

where I work, the wonderful falls prevention classes have all been cut because the ICB has a budget deficit & when push comes to shove the ICB will prioritise carrying out hip replacements rather than preventing hip fractures

the only way to do it is to double run both until the prevention has time to have impact. That will take years, be very expensive and therefore will never happen and so we’ll carry on repairing broken hips rather preventing them

NHS workforce has grown 30% but is this headcount or WTE? There are loads of part time NHS staff now inc doctors . They have to do same training/ supervision etc but less clinical hours

reform sounds great and is long overdue.

however “prevent” concerns me because of the above. I remember at one point there was a suggestion of poly pills for over 50s. FFS let me die of something. I fear ending up with the massive longevity problem of my ancestors (mostly).

if they want me to sign something, fine. As it is, I live alone and if I had a heart attack I don’t think I’d call an ambulance.

im quite scared of doctors now after being massively targeted for totally unnecessary investigations. I think it’s only when that happens that you see how much the money go round is fuelled by claims of “prevention”.

but reform and finding solutions to the gravy train - agree. It is hard to picture a Labour government making those redundancies though. Entire procurement teams might have to go for example. I just don’t see that happening and I’m sorry for anyone who loses their job but there are so many governments of all types who added to the bureaucracy. It’s got to stop somewhere.

@Destiny123 im not denying efficiencies can be carried out. I am denying efficiency is the whole source of the problem. Every politician finds it convenient to say that it is. We are comparatively extremely badly funded per capita. Politicians-and civil servants-don’t spend anything central well.

People will say next that the private sector is more efficient, and I can assure you that is pure bollocks. I’ve interviewed dozens of them and they will say the same.

I'm actually impressed her had to balls to address this. Labour's usual stance is to just chuck more money into the black pit we call the NHS.

it's FTE.

it's 1.3m FTE NHS headcount for 68m population

no way it needs more money. It does need different process and very different culture

The one good idea is to merge health and social care. It can’t come quick enough and they’ve avoided it for 30 years, mainly for political reasons (with a small or large P).

Well everyone knows that the Tories could not do anything without an uproar. Labour would do as they please and would be backed up. Excused and applauded by the rather annoying loud minorities that want them in power. Before you say they won by a huge majority get the facts right.

Most people here saying more money is not needed don’t know one end of an NHS budget plan from another, let’s be honest 🤣

I had thought greater population health and tech were the way to go and had said as much a few times, plus social care improvement

The hard part is making the population healthier and how to do anything if money is scarce

I do find the slight rebranding from 'underfunded' apparently to reform without extra money an interesting spin

I don’t know how we merge one service - the nhs which is open access and free at the point of delivery with the other social care which is limited by criteria, means tested and controlled by local authorities. Only way i can see would be to make social care operate on the same lines as nhs which would cost millions - and the government has said there’s no more money

I agree and patients should be fined £50 for first missed appointment and £100 for a second missed appointment and if necessary blacklisted if they consistently do not attend appointments.

Yes. Can't have a dxa scan until after you have had a fracture. Can't have IV osteoporosis meds until after you have developed a gastric ulcer from the tablets. Can't have HRT until you have really suffered for long enough. Can't have endometriosis investigated until you have had severe pain for years. So much time wasted.

I dont know where people are getting the idea that the Conservatives did a good job with the NHS based on the Darzi report -

"Darzi’s report criticises decision-making under the Tories and the coalition government, ­including the impact of austerity and the reorganisation of the NHS under Andrew Lansley, then the health secretary, in 2012.

In his report, Lord Darzi said the “Health and Social Care Act of 2012 was a calamity without international precedent. It proved disastrous.” He added: “In the last 15 years, the NHS was hit by three shocks — ­austerity and starvation of investment, confusion caused by top-down ­reorganisation, and then the pandemic, which came with resilience at an all-time low. Two out of three of those shocks were choices made in West­minster.

Darzi said the 2012 reforms represented a “scorched-earth approach to health reform” as it dissolved NHS management structures in a “uniquely complicated piece of legislation”. The reforms established more than 300 new NHS organisations, which led to “institutional confusion”, from which the NHS was still recovering."

As regards the failure to increase productivity -

"The report said that the hospital workforce had risen by 17 per cent between 2019 and last year. Yet output has not risen at nearly the same rate, leading to a large “productivity gap”, which means waiting lists remain stubbornly high. Darzi said the “central problem” was that the increase in staff had not been accompanied by upgrading infrastructure, such as diagnostic scanners or operating theatres. There is no point hiring more surgeons if they do not also have more equipment and space to work with."

And -

"The NHS was “still in the foothills” of the digital revolution, the report found. Technology that has been used in the private sector for 15 years has still not been introduced in the NHS, worsening waiting lists."

There is also the issue of the NHS estate -

"The NHS was “starved of investment” in new buildings and technology as a result of austerity, the report said. Darzi said the 2010s were “the most austere decade” since the NHS was founded in 1948, with spending flatlining in real-terms until 2018.

As a result, buildings have been allowed to crumble into a state of disrepair as the capital budget was repeatedly raided to plug holes in day-to-day spending. Compared with similar nations, the NHS has been “starved” of £37 billion in capital ­investment. "

www.thetimes.com/uk/healthcare/article/lord-darzi-report-nhs-review-6td77lqdw

@Theeyeballsinthesky A merger can happen without them needing to share budgets. We need to get away from h and s care ping pong, with each blaming the other. That IS wasteful, and I've seen a ton of it, at it happens at every single level. It's endemic.

Most people on here saying that the NHS should be given more money have given no explanation of exactly where this money is going to come from.

Amen.

Today, in my NHS clinic I spent NINETY minutes trying to print 12 blood forms on a printer that is so advanced it could probably fly the space shuttle. Unfortunately I was sending forms from a Dell that is older than my teenage DC.

My patients could not have their operations without having those bloods taken. And the bloods cannot be taken without the accompanying paperwork.

Oh god. I could talk all day, all week about this sort of nonsense. The fact is, my local takeaway is more digitised than most of the NHS. Digitising has also killed off teaching within the clinical environment where I work. Different thread though.

I feel it’s positive. A move towards a German style of healthcare, as opposed to an American once, which was the direction we were heading.

Why do you say this

What is it in the proposals that's more like the German system?

My neighbour had type 2 diabetes. He was sent on course after course on what to eat and how to improve his condition. He used to go on the courses then buy a take away on the way home. He thought it was hilarious. He was given a mobility scooter so he inevitably got even larger. Then gangrene started. Treatment after treatment couldn't get on top of it . He had toes removed, then his foot, then his leg below the knee. During the hospital stay after the final operation he died. His son was his only kin and refused to have anything to do with the body so he was kept in the hospital morgue for 10 weeks before the council gave up trying to find any money in his estate and cremated him 'on the parish'. Just that man alone would have cost stare services thousands and thousands. He had no intention of ever taking responsibility for any part if his life.

Addressing the issue rather than racking up waiting times and forcing people to go to extremely expensive private options?

Maybe you cold ask the OP, or even the media? They seem to have more facts than I do. Or do they?

My DIL works in an admin department of our local hospital. She deals with booking appointments for cancer treatments. There are 2 things that drive her round the bend.

1. Consultants deciding to work different hours to the hours logged on the system ( which requires an IT person to change). She is told to book Mr X in for a procedure at 8.45 on Friday but she can't do that because the consultants time is registered as 9 to 12 so the computer can't accept the booking. Consultant is god so doesn't want to know about that or to stick to the set hours so the poor patient can just get the treatment. It causes huge hassles and hours of her time wasted in trying to sort it out.
2. The patient needs a relatively simple procedure in order to facilitate the next stage of treatment. The doctor is there, the patient is there, there is time available. But the doctor feels they are far too senior to do that procedure so the patient will have to go home and then return for another appointment, on a different day, with a different ( more junior) doctor. The waste of time and money is incredible.