A question for NHS staff

[Glowinginthedark]

AIBU to think that no amount of money throw at the NHS in it current state will fix the issues? What is the real problem? Lack of funds or people completely abusing and misusing A&E or both?

Not in the NHS but am an economist.

Actually if you look at the stats for spend and capacity utilisation for the NHS vs. other developed countries, the NHS does brilliantly with very few resources.

And in years/areas where the resources are even close to comparable to those of other countries they significantly outperform.

So in fact throwing a lot more money at the NHS will fix most of the issues.

What it will not do, is reverse the trend that means that everywhere that can afford it healthcare is becoming a bigger and bigger cost, which have nothing to do with the NHS and everything to do with an ageing population, increasingly unhealthy lifestyles, and the very expensive treatment of intractable diseases/conditions which would once just have gone untreated.

www.insidehousing.co.uk/news/housing-associations-found-inadequate-by-nhs-regulator-53725

I would happily pay more tax for a decent social care system - elderly looked after, well trained staff, decent service. I don't just want to pay for my own healthcare via private health insurance, I want the other people in my society to be taken care of too.

HelenaDove Wed 03-Jan-18 20:28:34
www.telegraph.co.uk/news/2017/12/24/great-granny-trapped-flat-seven-months-waiting-lift-fixed/

Add message | Report | Message poster HelenaDove Wed 03-Jan-18 20:29:50
Bernice Grant, 81, has left her fourth floor home just once since May when the elevator in her block stopped working. The housing association, which runs the flats and whose chief executive was paid £375,000 last year, has failed to fix it in the intervening period.

Mrs Grant, a retired lab technician, said: “I feel like a prisoner in my own home. I am trapped. I can’t go anywhere. I can’t manage the stairs.”

Mrs Grant, who has four children, five grandchildren and one great grandchild, can negotiate the two-bedroom using a walking frame but needs a wheelchair to go farther afield.

The four flights of stairs needed to reach her flat, which she shares with her daughter, are well beyond her.

Mrs Grant has been taken outside once when an ambulance crew carried her down the stairs after a medical emergency that required hospital treatment. Otherwise every appointment has been cancelled, including regular Sunday trips to church, to the doctor’s and to the day centre where she used to meet her friends

Lots of people say that Sandy

But the reality is to get a good healthcare and social care system it would have to be at least 5% on basic income tax that a lot and once tax goes up other costs start to rise to compensate

Many people simply can’t afford the extra costs and there isn’t a party brave enough to increase tax at such a rate

Liara you are a breath of fresh air

I do wonder now that life expectancy has plateaued , and that generally speaking the population is less healthy whether encouraging people to be healthier is actually a good idea ? From a bean counter perspective , someone who leads an unhealthy lifestyle will according to the matrix used by GP's die fairly early , do they then cost the NHS and local council social care providers more or less than someone who is studiously healthy but then develops dementia ? Or who has a family history that means they are far more at risk of developing certain cancers or degenerative diseases ?

Personally I think the NHS is pretty bloody amazing considering the almost constant onslaught it has had to endure over the last 20 years by various governments . Is it perfect ? Hell no , can politicians fix it ? Hell no ! This , along with education need to taken right out of the hands of people who can only see as far as their time in office . This is far more important than a few peoples careers .

I have only read the first 5 pages, but I think it would really help if we could somehow stop the quasi-religious veneration of the NHS and have a honest discussion of the main options there are. It's not NHS or US-style private insurance: there are other options. I think last time I went to a presentation on healthcare economics the countries that were doing best were Switzerland and one of the Nordic ones. It wasn't just that they were spending more but that they were organising the system differently. There are social insurance systems as well as private insurance systems. Some other countries are spending less but have much better (e.g.) outcomes for cancer treatment.

Universal coverage isn't much cop when you can't actually access treatment for many things (I'm always struck, as someone who paid for all my IVF treatment out of my own pocket, by the insistence that somehow IVF is the problem as I. it is a tiny proportion of the NHS budget; 2. the majority of infertile couples pay for their own treatment; and 3. it is the only treatment that creates future tax payers!) For a more everyday example, more availability of physio would head off a lot of later problems.

I should have said that I worked for the NHS for five or six years and I saw some amazing services and staff, along with some really poor practice, wastage and inefficiency. It's so massive, unwieldy and politicised that it's hard to generalise.

If we are to believe that the NHS is broken in so many ways, and more recently this week we have the usual media reports of Winter crisis,big queues, caretakers and cleaners being called in to do surgery etc etc then how come the NHS was deemed to be the best over 11 Euro nations?

If ours is the best, god help the rest.

I have experience of the Spanish health service and ound it excellent.
www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey

Addictedtocustardcreams that was my ten months ago except I didn't manage to see GP. They were doing triage by phone so when I spoke to GP I explained this pain and heavy feeling in my chest, I was feeling fine but had a bad night. She said I must go straight to A & E and she would contact them. So I got there and went straight in for an ECG and then through to a cubicle. A specialist nurse arrived from the Cardiac unit, I was laughing and saying I was fine but she said she thought I was being admitted and would see me on the ward. I was telling my husband they were just being careful. So doctor arrives and says I am going to ward as the ECG was way off, they won't even move me to the ward without wiring me up to a machine to check my heart and jump start it if it stopped.

I had 3 days in hospital and yes the angioplasty. All very impressive, fantastic care, wonderful ward with the loveliest nurses and doctors. OK my consultant's English was hard to follow at times but hey he did the job.

All my gratitude to people like you and your husband.

I agree with you frumpety "This , along with education need to taken right out of the hands of people who can only see as far as their time in office . This is far more important than a few peoples careers."

enthusiasm I really wish they would put taxes up to cover it. Imagine the improvement in society if carers, nurses and orderlies were valued and paid enough. It could be that nursing would become the "new TA" job, where people retrained after having a family, because it was family friendly reasonably paid job. All of those elderly people looked after in proper cottage hospitals and not bed blocking.

YY liara.

Of course part of the reason why we're experiencing more problems in the past couple of years is because of what we're spending. The problem is that it's going to become harder to keep up current levels of NHS spending let alone increase them as the population changes.

Addictedtocustardcreams not sure if what I had was exactly the same as you referred to but you get my point.

You never hear of a young person who wants to become a nurse when they leave school

You do actually. DS2 went to uni straight after A levels to do nursing, he’s got 6 months left until he graduates. When he applied there were 16 applicants per place on his course. DS1 (23) went to school with 2 girls who are now nurses, and there were 3 girls in the year below DS2 who are at uni doing nursing.

How about a little test ? Go online and see how much it would cost you and all the members of your family , being completely honest , remember they will have access to all your medical records , for complete health insurance , that will cover you for everyday ill health and accidents , plus long term conditions and possible cancer treatment and care , chuck in a curve ball and include the possibility of MS or MND or Parkinson's or maybe something like Bell's palsy .

But remember that you need to be completely truthful , you may have forgotten that abnormal smear 15 years ago , but hey suddenly they wont cover you against any female gynae cancer , that abnormal smear that showed you to be HPV positive , oops that also stops you being covered from head/neck cancers , married at the time ? that discounts your DH too . You say you hardly drink ? Social media says otherwise , lets cross off a few more cancers there then . You say you only smoked for a few years at Uni , any proof you stopped ? nope , well sorry but that's the smoking related illness's not covered either . You get the general gist .....

I trained as an RGN in 1985. At the teaching hospital’s school of nursing there were 4 intakes per year so, a group every three months began the training which was 3yrs 8 months. There were 38 in our intake, which was considered to be a smaller group. I’m not sure of the intakes now but I’ll bet it’s considerably less.

The NHS will never be reformed whilst we still have many people claiming, you cant change that, it will play into the hands of those trying to dismantle it. Or you can't reform that its only a fraction of he overall budget. FFS

Another one that must really drain the NHS is doctors buggering off once they get fully qualified. I do not understand why they aren't obliged to work a minimum of 10-20 years in the NHS after being fully qualified or they should have to pay back the full cost of their training.

suki I trained in 1987 and nurse training was so popular I had to wait 18 months to start my course, as there was a waiting list of people who had been accepted!

@ShatnersWig
GPs are already available 24/7 - it's called an out of hour's service and if you NEED to see a GP you get to see one. You call 111 usually and they sort it.
Simple.
The biggest problem with suggesting your named GP work 7 days is that they physically cannot! Most part time GPs work 3 long 15 hour days. And the full time ones work 4 x 15 hr days. People with chronic diseases need continuity of care and are seen in routine appointment slots.

IMHO I would suggest businesses make it easier for staff to make GP apptmts from 8am to 6.30 pm (stsndard hours). Businesses need healthy staff so should foot the bill for staff absence for apptmts.

I agree we should pay more tax as we are living longer with multiple comorbidities.

@Quirkyturkey - I'm with you. It's going to take 9 yrs to train GPs but the extra GPs are simply not signing up anyway.

The irony is we will need more foreign born doctors to treat the Brexiteers...

Cutting nurse bursaries, training physicians assistants, pharmacists and paramedics to do the job of a GP.

Investment is required and all I see is funding cuts and money being taken and then given back as rebadged "new" funding.

The government wants to privatise the NHS to enable it's rich cronies to get richer.

Rant over.

There were 38 in our intake, which was considered to be a smaller group. I’m not sure of the intakes now but I’ll bet it’s considerably less.

It’s 350 adult nurses and 70 mental health nurses a year at my local uni.

The problem is that nurses are leaving in larger numbers than we are training.

Missy, that’s how it was then. I had to train at a hospital miles away. There was no way I wanted to wait for the local hospital... I was that keen! We got a salary then. But then, we had fewer periods of tutoring and more “hands on/on ward” experience. When you got to third year, before qualifying, you were often left in charge of the ward 😐.

But then, we had fewer periods of tutoring and more “hands on/on ward” experience. When you got to third year, before qualifying, you were often left in charge of the ward 😐.

Oh god here we go with the “too posh to wash” “my training was better in the good old days” nonsense. The expectations of newly qualified nurses back then was different to what it is now - I highly doubt you were left responsible for 500 prisoners on your own within 6 months of qualifying. I’m almost certain you wouldn’t have been expected to suture either.... training is more technical now because it needs to be. Why is there always this battle with nurses eating their young?

Julie most of them dont want to "bugger off" and wouldnt if conditions were better!

I agree with Liara.

I do work in the NHS (in Finance). A lot of the problems are funding related. We can't attract and retain talent. We put far less GDP into our health service than other nations but we have an ageing population and as a nation are pretty crap at preventative measures to keep ourselves healthy. I think it's insane we need a sugar tax, for example. We should be able to self moderate and get off our backsides and walk 10,000 steps a day, it's shocking how inactive many of us are.

Yes there are other problems, but more funding is required to ease the pressures we currently have. If we had more cash we could attract the best and keep them, that includes managers, doctors, nurses, scientists porters etc. We do very little to incentivise people to work in the NHS at the moment and the fact it is used as a political football disincentives others. I wouldn't work in a CCG for example, because most of us expect them to take a battering post Brexit. Everyone is so on Brexit at the moment that the NHS has slipped way down the priority list, ideal for Mr Hunt.

I have a friend quite high up in healthcare policy-making (can't be too specific but she's party-neutral). She says the major issues are underfunding, understaffing (including the reliance on external staffing services) and, to some extent, the ageing population (though this is true in many other countries as well and their health services function fine thanks to better funding). These problems will never be solved because any party who took steps to solve them (resulting in tax rises and higher levels of skilled immigration) would become unelectable, and the positive results wouldn't be seen quickly enough to save the party.

Everything else - health tourism, smoking, the obesity crisis, timewasters, mental health, supplier costs etc etc - are tiny drops in the ocean comparatively, but very convenient ones politically as it's a) easier to appear to be tackling and b) plays well in the media. (Although I disagree with her a little re: supplier costs as they are BONKERS and it does seem easily solved! But I'm not an expert whereas she really is.)

It's her life's work and I've seen her weeping with frustration over the misapprehensions and blatant propaganda that gets propagated in the media.