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?

Capelin what do you suggest then, bearing in mind that one day you will be part of that ageing population yourself (if you are lucky)? There is currently probably a 'bulge' because of the baby boomers, but it's really not going go get any better.

Between 2001 and 2011 census the population aged 65+ grew by 1 million. Most will be on some medication for the remainder of their lives eg for diabetes, joint pain, high cholesterol, high blood pressure. I'm all in favour of these ! Who doesn't want quality of life? There is a cost though so more money needs to be unfeasibly large amounts of money if no-one will debate which services could be cut.

I don't think any political party has a robust plan and worked in the NHS when Labour introduced privatisation (with Virgin) so trying to score points off either party isn't going to further finding a way forward.

The main thing is that we need more money - as the Kings Fund says, around £43 billion a year more - to get on a level with the rest of the EU. The aging population is not unique to the UK, but we've been very backwards about finding funding for it.

Unfortunately, we do have to deal with the fact that the average age is going up while the age of the working, tax paying population is staying the same.

That may mean that we have to work and pay tax longer, and pay more tax. As a payback for this though, we'll have a working NHS which will treat us properly as we get older, and a longer and more productive life.

I'm one of the few people in favour of higher taxes and a longer working life though I think!

NHS staff also leave to join agencies because of how they are treated by the NHS, it is not just pay. My sister is a nurse and supports the NHS, but was constantly expected to do unpaid overtime and treated terribly. As an agency worker she is treated differently.
Basically if you want good staff you need to treat them well and pay them decently. Skilled staff have a choice about where they work and they will walk if you don't do this. The NHS spends a fortune on agency workers that it does not need to if this was sorted out.

In the private sector if there are not enough people attracted to a job, the pay and/or benefits increases to attract them. This does not happen in the NHS.

There was a thread started on a similar vein in Chat yesterday in case people want to compare notes

www.mumsnet.com/Talk/_chat/3128318-Winter-Crisis-in-the-NHS

Lack of hospital beds and equipment
Lack of staff
Lack of community care / services
Lack of respect for the NHS (and it’s staff) from Government

That’s it in a nutshell really. If we want things to improve we need to accept that we have to pay more, and if that means higher taxes then so be it. It’s all about priorities isn’t it? What’s more important than our health?

£2b is what it costs to run the nhs for 6 days... it’s about 0.8% of the entire nhs budget, it’s a tiny amount.

It’s not just an increasing aging population, we are also saving babies who previously would not have been saved, and the impact their care has as they grow up.

puzzledandpissed NICE makes such decisions about new drugs/treatments at a national level. At a local level it is much more down to clinical team and that is into medical ethics territory. So IME there was discussion around those thoughts for MIL who was very elderly and was thought would not survive the only reasonable surgical option. (She had diminished mental capacity due to dementia so family was consulted.) There might be a commissioning level (CCG which covers your geographic area) decision taken on say IVF funding.

Another interesting fact is that although in England we pay for prescriptions, in fact LESS THAN 10% OF PRESCRIPTIONS ISSUED ARE PAID FOR.

So why not just scrap payment altogether?

quirky that’s because the poorer or older you are, the more likely you are to need medicine...

@Puzzledandpissedoff, search for "QALY", also "DALY".
I think 1 QALY = £30k at present (approx).
It doesn't just apply to elderly. It's the rule of thumb for cost of funding care at all ages, in cases where no other policy applies (very often those other policies do apply & exist).

It's not my area, but my rough understanding (could be faulty):
If spending £28k gets a person one perfect whole QALY: fund it.
If spending £280k gets a person 10 perfect QALYS: fund it.

10 perfect QALYs: doesn't mean 10 perfect actual yrs, for instance could be 25 yrs more expected life, but with low burden of disease all the time.

If you need to spend £1.1million to only get 2 QALYs: don't fund it (cost of 550,000 per year >> £30k per 1 QALY).

£2bn certainly not going to fix the problem. But 6 days isn't nothing! It's almost a week of NHS care for the entire country. It's also almost certainly considerably more than £2bn.

However that isn't the point, or it isn't my point anyway. Whilst I think we should try to improve recovery along with some of the more important measures on this thread, it's not a daily mail "foreigners stealing our NHS!!!!" point.

It's about the entitled attitude that Britain gives away unlimited free healthcare to everyone that makes people abuse it, and that's what I think needs to change.

That attitude makes people phone 999 for dumbass reasons. It makes people turn up at a&e for nothing. It makes people skip appointments without bothering to cancel them. It makes people waste drugs or sell them on. There's a video link I posted on a different thread about a grossly overweight man who was costing the NHS a fortune whilst he waited for surgery - but who was ordering sweets and crisps from the trolley every single day. When challenged by the dr because he wasn't losing weight, he said, "not my money, not my problem."
The whole attitude to the NHS needs to change and people need to stop taking it for granted as much as they do.

THEN we might see some reduction in costs. It'll still only be a fraction, but every little helps.

This is the chap: m.youtube.com/watch?v=xPmtBg4wPH0

Thanks for the info, 321namechange - and yes, I too have experienced the sort of thing you mentioned with elderly parents. It's just that I got the impression there was an actual formula available for use in making such decisions, rather than it being left purely to each clinician, IYSWIM

Very possibly I was wrong, though ...

I cross posted with you, MedSchoolRat ... thanks for that, which sounds very much the sort of thing I was thinking of

Am off to spend some time googling ...

Lack of community care is a BIG problem. Local hospital places that often used to act as halfway houses between big treatment hospitals and home have been cut. This means that there are a lot of beds taken up by people who are not that ill but are in recovery and need help before they can go back to their homes - where carers and support systems are also desperately needed.

I'm a manager in the private sector. I have been dealing with NHS issues for the past two years as my father has prostate cancer. The issues I see are:

Lack of staff. There are just not enough doctors. My father had his operation rescheduled 3 times because the surgeon was doing emergency operations the night before. How the heck can you not have back up?

All front line staff are expected to work overtime unpaid with no thank you. Guess what? Unsurprisingly the workforce are demotivated. Give people consistent shifts. Allow them to take requested time off.

Finally patients need to be much more willing to pay for healthcare. We need an insurance card system like the majority of other countries have. There should be a charge to see the doctor if you can afford it.

GP surgeries need to be 8-8, 7 days a week to reduce the ridiculous 2-3 week waiting times to see patients, which is what is causing problems with 111 sending people to A&E and people rocking up to A&E. It would reduce the impact elsewhere in the NHS.

Better community care on top of this.

NHS needs, I'm afraid, to focus solely on life-limiting and life-threatening surgeries. It's doing things it was never designed to do, nor should it, in my view. Sorry, unpopular as it is, treating life-threatening illnesses or conditions which have serious day to day impact on leading a normal life outweigh things like elective surgery and IVF (which is already treated differently by different trusts). The population is now too big and too aged.

5% of the nation's employees work for the NHS. It is the fifth largest employer in the world. It had 300,000 more staff in 2015 than it did in 2010. It's unsustainable but no government will bite the bullet and really sort out the sacred cow.

The only way we could afford for the NHS to do all the majority want it to do, would be to increase national insurance to the extent of adding a MINIMUM of 5 p on the basic rate of income tax. It's probably more. But that would have a knock on elsewhere.

Why do people say "throw money at" like spending money must be a bad thing

It's not necessarily a bad thing, but we need to remember that the NHS is an enormous burden to the tax payer and this is only going to get worse as the working population decreases. I don't think we should commit to a funding model that gives the NHS more and more every passing year without scrutinising whether that's the best use of funds.

I think we need to spend some time thinking about what nhs role should be - and working out a funding model off the back of that.

For example, I'd be interested in exploring a model whereby the NHS covers all critical care, funded by the tax payer, but non critical type treatment that impacts on lifestyle (say hip replacements for the sake of argument) are funded by a personal health insurance pot. I'm not saying that's the answer, just one of many options to consider.

We do need to pay more for our healthcare, but there are different ways of doing that.
I honestly think a charge to see a GP would lead to greater costs as people put off seeing a GP until their illness has got worse.

Finally patients need to be much more willing to pay for healthcare. We need an insurance card system like the majority of other countries have. There should be a charge to see the doctor if you can afford it.

No we don’t. That will not solve anything.

I've said this before on another thread. One of my DCs is an a&e doctor married to a paramedic. They both say that if alcohol became as socially unacceptable as smoking it would solve many problems in the NHS. They are both threatened and dealing with violence on a regular basis by drunk patients, especially during the past few weeks. Not all NHS problems are caused by lack of money (although I agree that much of it is).

The old cradle to grave concept has rather changed. It now costs money from pre conception (IVF and other fertility treatments) scans in pregnancy, premature birth and hugely expensive care from around 23 weeks gestation (many survivors then have complex needs and thus=huge costs). The introduction of intensive care, cancer treatments and huge advances in drugs and surgical interventions even full resuscitation have come along since the NHS started.
We treat 90+ year olds with full ( very expensive ) intensive care. People live way beyond natural life span and with increasing complex needs ie home ventilation, artificial feeding etc etc all need expensive care packages. Even the children’s hospices have had to now include adolescent and young adult hospices due to increasing life expectancy of complex needs children ( I know hospices are not nhs but it does demonstrate the problem) they all need nhs care.

An entitled population who call amblences when not needed, turn up to A&E drunk, take drugs and smoke. Liver transplants for alcoholism?
Change sex if you fancy?, Over eat have a gastric band? Have ivf abroad so have triplets or quads then have prem birth back in U.K. = 3 or 4 neonatal icu cots? These are just a few things that people will get very upset over if we point out the problem they all cost money and it adds up! We do not have a responsible population.

Yep health torisum exists some areas see it a lot ( certain part of west London I used to work in) other areas will not.

Not enough staff and often poorly paid for skills required thus can’t be kept. An icu nurse is a very different and highly trained nurse from the image of a 1950’s nurse. No wonder expensive agency staff have to be paid. Training is expensive.

Money is waisted on management, refurbishment then closing of areas happens alot also.

The nhs will never have the money it really needs as the amount will keep increasing as medicine constantly advances.
A brave government will be the one that tackles this problem.