To ask what can be done immediately to take the pressure off the NHS?

[Twinklenoseblows]

I've been reading stories about people waiting 4 days in A&E, people being taken into A&E in the back of a van with a broken hip as there are no ambulances ,and doctors and nurses pleading for something to be done right now as lives are at risk. But what can be done that would make a difference within the next week or two?

Promises of more money and more staff will presumably take years to filter through and make a difference.

I guess what is worrying me beyond the immediate crisis is that some bright spark in government is going to say we need a circuit breaker lockdown to reduce flu and covid admissions for the next few months to take some immediate pressure off. The thought fills me with horror so I'm hoping there is something else.

E.g. as a very short term measure could some people be diverted to make use of any spare private GP capacity to try to reduce the number of people going to A&E who could instead be dealt with by a GP if only they could get an appointment. Or is that madness?

A paramedic has a thread on Twitter about the implausibility of the general public being expected to carry out effective triage on themselves and their loved ones from a standing start of no medical knowledge or training.

twitter.com/DCollingsHughes/status/1609569725566320641

The reason ivf was offered on the nhs in the first place was because there was a known link between serious MH difficulties/suicide/poor health outcomes and infertility. It is far cheaper to be proactive and offer ivf than then treat all the problems that result.

The reason ivf was offered on the nhs in the first place was because there was a known link between serious MH difficulties/suicide/poor health outcomes and infertility. It is far cheaper to be proactive and offer ivf than then treat all the problems that result.

It was made available on the NHS in 1983. In 40 years, have there been any changes in society and the status of women that might have altered associations with mental health difficulties?

It seems to be far more acceptable to be childless by choice than it was then.

I don't have an opinion about the wider field of reproductive justice as it's known but if we're having a think about what the NHS covers then it's interesting to go to first principles and ask why something is available.

We have a massive increase in people being seriously ill because lots of people did not seek medical care during the pandemic. And the large rise in covid, flu and scarlet fever. The NHS is actually treating more patients at the moment than it normally does.

The Council estate I grew up .... From 1997 the 2 North African families who lived there increased to become 95% of the whole block. Every time a non NA family moved out, they were replaced with a NA family.... the new residents did not work (neither mum nor dad) and had between 6-9 children per family.

I'm intrigued. What was the Labour immigration policy that explicitly encouraged/facilitated arrival of families from North Africa (from which country/ies ?). And how have Tories since dismantled that policy such that non-working North Africans no longer arrive since... 2011 or so? Presumably PP is saying they lived on benefits: which policy make that easy to do? Asylum obtainers? How did these families of 8-11 fit in flats that must have been just 2-3 beds usually? Are the kids mostly grown up now or still crammed, adults living in those too-small flats?

I live near small towns in rural east Anglia with huge amounts of housing trust properties... virtually all British born residents. Our foreign imports are ... from London. Seriously, they come here because of a "retirement by the sea" programme (we are > 5 miles from sea) to encourage older adults out of London council homes. They live in 1 bed terrace/semi-det bungalows. No apparent Africans here. We think a German is super exotic in this neck of the woods.

Completely agree.

You think volunteers would care for the elderly? Even at the level of care you describe (which is often less than they need).

I’ll answer to best of my ability:

I'm intrigued. What was the Labour immigration policy that explicitly encouraged/facilitated arrival of families from North Africa (from which country/ies ?).

www.gov.uk/government/publications/statement-of-changes-to-the-immigration-rules-hc26-june-1997

The immigration policy changed but I’m not sure why so many NAs took it up. Possibly the word went back home so more came over. I do know this to be the case with the families I knew. Most came from Morocco, then Algeria and then Tunisia.

And how have Tories since dismantled that policy such that non-working North Africans no longer arrive since... 2011 or so?

They haven’t, it simply continued. The block I speak of is part of the complex of which Grenfell Tower was a part. If you look at the names of the victims you can see they were largely of NA heritage. The surrounding blocks have since had upgrades and in bathrooms in particular they have installed special toilets which “wash” your bum because NA don’t simply “wipe” - they see it as unclean.

Presumably PP is saying they lived on benefits: which policy make that easy to do? Asylum obtainers?

They weren’t asylum obtainers as there was no conflict in Morocco at the time. They applied for benefits same as anyone else in this country can.

How did these families of 8-11 fit in flats that must have been just 2-3 beds usually?

The flats are a range of 1,2,3 and 4 beds. Most of them maisonettes. NAs were in the 3 and 4 beds which were extremely roomy - about 1,500sq ft. A few kids to each bedroom. I’ve only been into 2 beds in Grenfell Tower but they were huge, about 900sq feet. Not sure if it had 3 beds. That estate has very large flats, they don’t build them like that anymore, might be why large families were concentrated there. Plus, I’m sure they preferred to be with their own community.

Are the kids mostly grown up now or still crammed, adults living in those too-small flats?
Once they hit 18 they get their own flats. The girls have children (marry early) so get accommodated and the boys I’ve known of are able to get their own flat by claiming DV at home.

Happy to answer any other questions 😊

This made me smile @lljkk I'm in a very similar area and our town has an area of social housing (1 beds, as you describe) which has been (affectionately) known as "Little London" for years. The demographic is almost exclusively white British.

I would add that in my opinion, immigration is absolutely not the problem. I grew up in a major city many years ago which was very ethnically diverse. Things were not this bad. What we are dealing with now are the repercussions of Covid, many years of Government underfunding and neglect of essential services and the fact of a large aging population. There are other factors.

Yep to all of this.

And lest we forget one of the things that pushed the already teetering social care system over the cliff was the decision the Tories made in 2021 to require carers to have had the covid vaccine. They were told by the unions that this was a fucking stupid idea and would simply worsen the shortage in the sector, but they arrogantly went ahead and did it anyway, thousands left their jobs and now we all suffer because of it.

I'm not making a judgement call on what treatment should and shouldn't be provided and I certainly don't envy those that have to make those kinds of choices.

But I do think we cannot reasonably expect the NHS to cover absolutely everything that isn't a direct threat to life. Certainly not with out the kind of huge tax hikes no political party that wants a chance of being elected will ever propose.

I'm sure the impact on people who need things like IVF/gender reassignment/bariatric surgery etc etc is life changing. But from a financial perspective providing all that with no additional charge just doesn't add up without massive tax hikes.

It's not something that's nice to hear but that doesn't stop it being true.

Absolutely correct. Financial penalties for repeated abuse of the system would be a good way to go to stop those that don't appreciate things they don't have to directly pay for.

Of course we can expect the NHS to cover treatment that is not emergency healthcare.
Bariatric surgery is provided because it is cheaper than paying for the costs of morbid obesity healthcare, NICE looks into these issues. It is not about cosmetics and you have to very fat to qualify.

But the day the NHS only covers treatment to stop you dying in A and E is the day a lot of people in Britain get zero access to proper healthcare. We are not a desperately poor country, stop coming up with ideas that treat our country as if it is incredibly poor.

The plan seems to be for most British people to be reliant on a US style Medicare system.

Two tier healthcare, with most of us on the lower tier.

No one needs gender reassignment surgery

"Why can't we open up the equivalent of Nightingales to house the bed-blockers, staffed with a few qualified medics but mainly with volunteers. Bed-blockers only need basic care, washing, bathing, help with feeding etc."

I take it you have not done much elderly care. You have forgotten dealing with incontinence, catheters, using hoists, medication, dementia etc.

Well apparently they do or they will kill themselves 🙄

I’m 68, happily still active and in good health but I have no family other than DH. If DH dies before me (quite likely tbh) I will have nobody else to rely on, therefore I am very likely to become a dehumanised ‘bed blocker’.

I can’t tell you how terrified I am at the future that awaits.

Why doesn’t anyone ask us if we want to be pointlessly kept alive or whether we’d prefer to just be kept comfortable while nature takes it’s course. I’m sure that if we were able to make a decision at age 70 about what we want when the worse begins to happen then there would be far fewer of us clogging up the system.

Nobody wants to be old, in pain, confused and, let’s be honest, unwanted and a drain on society, so why not give us the choice to go with a little bit of dignity?

Much as it pains me to say so I do think maybe IVF on the NHS isn't worth the money. And I say that as someone who has had it. My experience at a London hospital has made me think that because its done in a completely half arsed way it's just set up to fail in most cases. After my 2 NHS funded rounds had both failed we paid for a round ourselves at the same hospital. The difference was huge. We had daily blood tests and scans on the days the blood results showed would be best and egg collection done at the optimal time rather than only on Tuesdays or Fridays or whatever the schedule was on the NHS. And it was all done at the same place with the same facilities and doctors but just much higher chance of success. Surely they should offer the best treatment or not bother?

Would you charge the old, unemployed, disabled etc? Or would they be exempt like they are for prescriptions, dental check ups, eye tests, etc? Unless you're going to charge everyone, it just becomes yet another tax on workers!

Agreed. Universal Credit would need to be a gateway to exemption given the number of workers who rely upon it to meet their outgoings.

There would be a relatively small number of people who would have to pay for these expenses. And I wonder how much this would disadvantage relatively low paid young people who are attempting to pay back student loans, save for rent deposits etc.

I'm sure the impact on people who need things like IVF/gender reassignment/bariatric surgery etc etc is life changing. But

I bet these are a tiddly little drip in the ocean compared to all the obstructive airway disease, heart disease, hip fractures, renal failure, triple bypasses, cancer of everything and anything ......... etc

If you have a long list of exemptions, all you do is disadvantage students and young workers who are disabled or have chronic health problems. If you exempt them, you will be left with only charging mainly people who rarely use the NHS.

The biggest users of the NHS are pregnant women, babies, disabled and elderly people. You can't charge without charging the biggest users. It just does not add up.

Countries that charge people for healthcare charge for childbirth, premature babies and most older people. And the result is that some people do not get the healthcare they need. The maternal rate of death in the US is high because lots of women have no pre or post natal healthcare. They get help giving birth and that is it. So illnesses like pre eclampsia are not detected until it is too late for many mothers.

Charging only works by rationing healthcare based on who can afford to pay. And given we have no private A and E, and private hospitals absent throughout parts of the country, charging only works by selling off the NHS (undoubtedly at a bargain) to private companies. That is why certain people are pushing this agenda.

Exactly! Rich people getting good healthcare and the rest of us getting emergency style care and not much else. And if we complain we will just be lectured about how people today expect to live for ever.

@LeccyBillShill ok so what happens when your private health care doesn't cover things like A/E care because it's just not lucrative enough ? What happens when there then becomes a two tier A/E system, basic care for the have-nots, far superior for the affluent ?
And at what point are people deemed too poor to pay insurance ? A joint house hold income of £30k ? 60k ? People are basically saying they are quite happy to pay more into a profit making business than a national free for all one....oh no we can't keep putting money into the NHS bottomless pit but desperate to line the murky coffers of Kaiser Permanente 🙄