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The NHS is not living with COVID, it's dying from it

118 replies

EmbarrassingHadrosaurus · 18/07/2022 13:26

Most people (including many in the NHS) are so tired of it that they are wilfully pushing it to the back of their minds, but now is the time to face the fact that the nation’s attempt to “live with covid” is the straw that is breaking the NHS’s back.

In 2020 and 2021 the NHS coped with pandemic peaks by stopping or slowing much of its routine work. 2022 was meant to be the year of full speed recovery, when we would build back better and fairer, when record waiting lists in elective care, cancer diagnosis and treatment, and mental health would begin to reduce, and the workload on primary care would begin to ease.

Above all, the government must stop gaslighting the public and be honest about the threat the pandemic still poses to them and the NHS. Being honest with the public will have two positive results, it will encourage the public to modify behaviour and, we hope, provoke urgent reflection about how the NHS is in such a mess so soon after the nation was applauding it on their doorsteps.

Joint editorial from major Health Services journal and the BMJ. Free to read: www.hsj.co.uk/coronavirus/the-nhs-is-not-living-with-covid-its-dying-from-it/7032824.article

What measures would you be prepared to support to get the NHS back to some form of functioning for everyone who needs it for non-COVID reasons?

OP posts:
Burnedoutdr · 18/07/2022 17:53

As for the argument that the NHS is on its knees because staff get paid sick leave... you have to be having a laugh?

Do you know how much it costs to replace knees worn out by arthritis, to manage a lifetime of type 2 diabetes with all associated needle and medications costs and appointments and associated heart/vessel disease +/- amputations?

The NHS is picking up after those who maintain unhealthy lifestyles yet staff are begrudged a paltry bit of sick leave.

MajorCarolDanvers · 18/07/2022 17:53

The socio-economic, physical, mental and emotional cost of pandemic restrictions can only be justified when the public health cost outweighs all of that.

Society was will to have curbs placed on civil rights and to incur these costs when people were being hospitalised and dying in significant numbers.

Things have moved on and people would just not accept a return to restrictions unless the virus changes again and deaths start to rise.

ApplesandBunions · 18/07/2022 17:57

MajorCarolDanvers · 18/07/2022 17:53

The socio-economic, physical, mental and emotional cost of pandemic restrictions can only be justified when the public health cost outweighs all of that.

Society was will to have curbs placed on civil rights and to incur these costs when people were being hospitalised and dying in significant numbers.

Things have moved on and people would just not accept a return to restrictions unless the virus changes again and deaths start to rise.

Even then, there'd still be the question of what could restrictions actually achieve. We have already seen mask laws, isolation laws and free universal testing fail to prevent an Omicron wave in England, and in Scotland even when restrictions persisted for longer. An increase in deaths doesn't automatically mean there's a restriction that can tackle it.

Tegelflughafen · 18/07/2022 17:58

@Icedbannoffee ah yes. The NHS has no trouble attracting decent staff because of the exceptional working conditions and benefits of service….

ILoveAllRainbowsx · 18/07/2022 18:03

We need to stop keeping people with no quality of life alive just because we can.

We need to only treat people over the age of 80 if they are otherwise fit.

lightand · 18/07/2022 18:03

"and be honest about the threat the pandemic still poses to them and the NHS"

I wish it would! But not in the way "they" mean!

IdiotCreatures · 18/07/2022 18:03

Allow those of us who want off this planet to have assisted deaths in nice surroundings with medical support. Would save thousands over our life span, in medications and therapy.

balalake · 18/07/2022 18:08

I would support the obligation to self-isolate if you have Covid (with proper sick pay), the return of free tests and restrictions on hospital visiting.

KnittingNeedles · 18/07/2022 18:09

Topgub · 18/07/2022 13:33

Massively increasing funding and staffing levels and pay.

Massively increasing funding for social care and staffing levels and pay for those in social care

That's what we need to fix the nhs.

The covid response exacerbated an existing problem.

Disagree. We have an unsustainable model which is not replicated by any other country in the world. We need a European model of insurance paid by employers or the state.

NHS Is not fit for purpose and hasn't been for a while.

Topgub · 18/07/2022 18:10

@balalake

Surely we have to learn from our mistakes by now?

Not keep wasting money repeating them?

Cornettoninja · 18/07/2022 18:20

ILoveAllRainbowsx · 18/07/2022 18:03

We need to stop keeping people with no quality of life alive just because we can.

We need to only treat people over the age of 80 if they are otherwise fit.

that largely happens anyway imhe. Of course even when people recognise that their time is almost done they still rarely wish to go out in pain and distress. Supporting that wish also has the side effect of prolonging lives in a high number of cases. Also I think you’d struggle to get staff working in conditions they were discouraged from providing that.

Then there’s a number of people, who naturally, would have died in the 60’s and 70’s if it wasn’t for medical intervention.

I’m all for seriously considering euthanasia but it really is multifaceted and I don’t think it would impact greatly on a population level.

ApplesandBunions · 18/07/2022 18:23

Topgub · 18/07/2022 18:10

@balalake

Surely we have to learn from our mistakes by now?

Not keep wasting money repeating them?

People advocating a return to isolation rules never seem to think about the negative impact of having a law on the books that millions of the population are simply not having and that can't possibly be enforced. It's bound to foster resentment.

I can see that there are people who would like to be able to isolate and are only prevented from doing so for financial reasons, but there are also a lot of us who are simply not going to engage with testing, reporting and enforcement now. There was a limited window during which probably the majority of people were willing, and it has passed.

maryso · 18/07/2022 18:24

The original question was how to avoid covid shouting out the non-covid hospital demands, not pandemic controls: Test every visitor, cancel covid positive electives, make them leave immediately, only treat covid emergencies in a controlled way. Thus capacity is preserved and lists will fall because covid negative patients get treated by uninfected HCPs. Longer term, someone has to get a grip on disincentives for overpopulation. Covid freedoms will accelerate mutations to a stable state, meanwhile lock out the infection in health care settings. Freedom loving patients have deliberately chosen a higher risk of non treatment, no need to damage other patients and HCPs.

The related point about relaxing covid restrictions in hospitals: Every consultant I know, and that's easily in three figures, would disagree, The only ones who do in-person nowadays are those who have to, i.e. surgeons. GPs don't do in-person except for secondary minor surgical consults and usually only by younger GPs, eg under 50s. Why put service capacity at risk when there are no benefits to anyone, patient or HCP? You may not get a cosy chat in-person with the HCP but your treatment is the same, and you avoid viral shedding in transit. These are GP practices that never did telephone, only personal, consults pre-covid. Comments on consultants "benefitting" from remote consults is typically unconstructive and nasty. The same work is being done, and less would be done if they exposed themselves in transit to the virus.

The calls to dispose of the NHS: Staff already do better now if they were to leave the UK, or switch to private work. Demand will stay, and access to treatment will become the patient's responsibility. A fundamental and good standard of national healthcare is no longer rare in the world now, so getting rid of ours would make us health pariahs, which is much less an issue than the consequences both health and social of such an extremist change.

Helpful suggestions to tweak out unnecessary demand eg perfunctory charges for access: These initially sensible changes have tended to morph into complex set-ups with more exceptions that standard users. However always worth a look.

The lack of ownership and misalignment of resources with outcomes, eg faulty equipment, pointless initiatives: This is about bad management not private v public. Bad management privately means you'll close, so that may tweak behaviour. I've seen and used very large private hospitals outside the UK that offer the breadth and depth of cutting edge practice, and they're successful because every thing is done well enough, even squeaks in beds are addressed because as the staff explained to the student, the squeak is a signal and if not put right, etc as in shoe horse kingdom etc. Every item is logged by every staff, eg you need a dressing, that's a pack charged to your account, and the pack belongs to you. Likewise bloods, scans, etc. Bills, statements on demand at any time, in as much detail, by specialty, activity, date, staff, etc Diagnostic kit and non-surgical treatments come to the bedside. Infection control sweeps on the hour. None of these staff are more skilled or caring than ours, just that culturally they own the problem and do not require corporate staff to make them feel better. It's still down to the patient to choose their specialty consultant from a massive line up. The best firms in the UK are run in the same way because the attitude comes from the top.

FunDragon · 18/07/2022 18:27

Burnedoutdr · 18/07/2022 17:48

A good start would be removing free prescriptions based on age alone and making it means tested.

If you're taking more than one medication you can get a pre pay certificate for around £11 a month, which is absolutely within budget for many over 60s.

A 60 year old will now potentially have 30 years of free prescriptions from the NHS. If they used a PPC that would be nearly £4k per person. Still massively less than it costs to prescribe 6 regular medications.

Anyone who's done a home visit and seen boxes and boxes and boxes of totally free medications in an elderly person's house because they just keep re-ordering them will see how much is wasted.

If people pay they assign more value to something.

Over 60s are the main users of the healthcare system yet get the most for free.

I read the other day that one in four baby boomers is a millionaire.

I’m not saying that an attempt to get people to start flinging generational insults around but it seems absolutely nuts to offer blanket free prescriptions (not means tested) to the generation who are, taken as a whole, the richest generation who’ve ever lived.

My parents could easily afford to pay for their prescriptions. They aren’t millionaires, but they own two homes for goodness’ sake, as do many of their friends. They would absolutely agree that they’re the last people who should be getting free prescriptions.

Grumpybutfunny · 18/07/2022 18:28

Where is the money coming from to fund it. We are in a deficit, a cost of living crisis, kids have years of education to catch up on thanks to saving the NHS. I think it's time we were honest about putting a ceiling of care on the NHS relative to what we as a country are willing to spend.

As science advances we could spend the entire countries income chasing what are now impossible cures that become feasible.

Personally as NHS staff I would like to see education prioritised and a limit of X % of GDP placed on the NHS. In the same breath I would like us to become more responsible for our own care and that of our relatives.

We seem to have forgot we can die of infectious diseases like COVID.

EmbarrassingHadrosaurus · 18/07/2022 19:04

I've seen the argument that it's cheaper to give a Winter Fuel Payment to everyone over a certain age than to means test it. Would people in favour of means testing expect this to not be true for health and social care or prescriptions?

There seem to be several people who are in favour of means-testing for access to primary care and prescriptions (if I understand this correctly).

Is it just primary care and prescriptions issued there? Or would you also want to see payments for outpatient referrals and any prescriptions issued there and in secondary care (that might be drug treatments for cancer or some of the newer ones for heart failure)?

Are there any groups you'd exempt, like children and young people? People with particular long-term conditions?

Would you cap how much people had to contribute to secondary care if you support paying for that?

NB: I still think it was a huge omission for the writers of the editorials not to consider the wide-ranging costs for people who need non-COVID treatment and not to provide links for evidence for their recommendations.

OP posts:
Kiwirose · 18/07/2022 20:02

Muminabun · 18/07/2022 16:14

A lot of nhs staff are poor performers but it is nigh on impossible to get rid of them. This means poor service and demoralised teams. Nhs staff get far too much sick leave fully paid which means too many of them use it and this leads to increased agency costs. Nhs pensions are huge which need to be funded. Staff are the biggest cost. There needs to be a brave shake up of nhs staff benefits and performance management. Sadly they are not all living saints.

I think it is a little unfair and inaccurate to say a lot pf NHS staff are poor performers. Of course there are a few as in all industries but the majority of staff are very caring and trying their best under very difficult circumstances.

Yes sick leave is high but we work with vulnerable patients. Covid is a massive problem were I work and we are not allowed back until we test negative for 2 days. In many other areas staff would be back after 5 days. Working in the NHS is hard graft physically, mentally and emotionally. There is a higher incidence of staff with mental heath issues too - probably because of their working conditions.

maryso · 18/07/2022 21:33

I still think it was a huge omission for the writers of the editorials not to consider the wide-ranging costs for people who need non-COVID treatment and not to provide links for evidence for their recommendations.

So they're no worse than everyone else who strangely can't quite cost up options for what must seem like simple decisions, especially if you have no constructive or practical options either, only at best partially informed basic level questions. Firstly they're not economists or accountants. Next editorials are primarily about balance, not persuasion. Moreover a complex and intertwined system means costing for decision making will have unintended consequences for apparently unrelated specialties because any apparently "low hanging fruit" for cuts may appear so because they're supporting other ecosystems that cannot be dispensed with. As old Mencken would put it, For every complex problem there is an answer that is clear, simple and wrong.

Despite all the modern market experiments thrown at the NHS since at least the 1970s, HCPs tend to cling onto extracting the best patient outcomes because they aren't confused about or distracted from the point of the "business". Any solutions that improve that "business" are always welcome. Nobody is working there for profit. As for the threats to close the NHS down, even the most anti-state Govt has enough brain material to get that that would hurt us and them much more than HCPs, who can't help that demand always exceeds supply, anywhere in the world. Suggestions on reducing overpopulation on this planet would be easier and more effective.

TheKeatingFive · 18/07/2022 21:51

Firstly they're not economists or accountants.

Well this is exactly the point.

They're not.

But they're asking for measures that will impact a wide range of businesses ability to function, require significant additional amounts of tax payers money beyond medical care, ask the impossible of workers with much worse employment rights than their own, impact people's ability to live their lives as they always have.

Massively overstepping their remit basically.

Unprecedented measures were taken in a global health emergency. These were acceptable to most in a short term situation. But as a semi permanent way of living, to hold up a service that wasn't fit for purpose to begin with. No goddamn way.

We do need to talk about the nhs. But in honest terms about what we can expect it to deliver for the funding we're prepared to put into it. It's there to serve the people, not the other way around.

maryso · 18/07/2022 22:09

Sure, you're asking for what they are, aren't you? To open up the box?

The NHS isn't there to cheat taxpayers, it serves using what it's given, and for most of us what it's not given, too. As long as it's understood that changes resulting can be less for more or the same for more and less for the same, and not just more for less/the same. We're already substituting shortage HCPs with nurse practitioners, AI, so change isn't new.

The real blockers for you are the paymasters, not the NHS. Get them to open up, and if you find that you can reduce service levels to match the funding you're prepared to put into it, that'd be a win all round. It does seem odd that repeated Govts some extremely keen to simply cut any part of the service possible find that options range from bad to fantasy. Shame they haven't got the Gov Econ Service or the Finance Service to work it out yet. Go for it!

endlesscraziness · 18/07/2022 22:20

We're in a weird no mans land at the moment where the rest of the country is pretending COVID is no longer here but the NHS has to test staff and patients and isolate both. In order for us to properly ignore it we would have to accept it's virus that isn't seasonal and mutates like a cold so is circulating perpetually. We would have to accept that patients will get sick and die from it but that's the cost of life returning to normal. Those dying are mostly sick with other things but probably would have had a while left.

TheKeatingFive · 18/07/2022 22:25

Sure, you're asking for what they are, aren't you? To open up the box?

Is that directed at me? I'm not quite sure what you mean if so.

maryso · 18/07/2022 22:32

You've summed it up @endlesscraziness All we can do is maintain infection control, by being extraordinarily rigorous about turning away covid positive electives, while the fires burn outside. There'll be many more of these with the transmission rates, however patients who have restricted themselves to lower their risk should get treatment they're due.

Reinfections occur every 3 months because up to 12 weeks they don't count as reinfections! With BA5's immune escape and replication, it's like measles plus morphed with the cold, so no immunity. Very helpful for people to accelerate mutations for the greater good, but I dread to think how many tiny clots are circulating in those who are unlucky enough to succumb. Still, they're happy with the trade-off, so fair enough.

maryso · 18/07/2022 22:39

We do need to talk about the nhs. But in honest terms about what we can expect it to deliver for the funding we're prepared to put into it.

Like you, the editors want an honest discussion about how to proceed in the current situation. Frankly their editorial is less likely to get a response than if you raised a campaign to review the NHS.

Tolerance has been beaten into HCPs, so pandemic controls or not, all we will do is to control hospital infection. Those who use public transport will have much higher risks, but once they're in we can control their infection risk better.

JohnPrescottsPyjamas · 18/07/2022 22:49

ILoveAllRainbowsx · 18/07/2022 18:03

We need to stop keeping people with no quality of life alive just because we can.

We need to only treat people over the age of 80 if they are otherwise fit.

Hasn't Covid sort of been doing this anyway? Don’t forget, at the beginning, there was a view that we had to save absolutely everybody - even if they were very, very poorly with major underlying conditions. Even if it meant putting them in total isolation from their families for their last few months, they had to be protected.

Yes, I agree with other posters; the NHS hasn’t been fit for purpose for years. We’ve been living with covid for nearly 2.5 years now so that’s no longer an excuse. It’s definitely a combination of many factors. If it’s free, so it’s open to abuse. We’re all living longer, so more of a burden on it. Mismanagement at the top. Poor cost control, money wasted on duff computer systems etc and dire record keeping. I’ve had several instances with both DH, DM and MIL where details of diagnosises/medications issued were not even on file which resulted in wasted resources and unnecessary retesting.