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?

Rowthe

“It's easy blaming people for getting ill when the blame lies in one place.“

No it doesn’t. Our Government is a shambolic, incompetent, self-interested embarrassment.
The great British public does itself no favours whatsoever, though. Too many people eat too much, drink too much alcohol, don’t exercise enough and, still, smoke. Personal responsibility seems to be a thing of the past.

Coming back to this thread raises some interesting ideas- wouldn’t it be great if Rishi read it 🙄

I had to come back to offer a glimpse into one of the big issues ; today I went, on 999 calls/blue lights, to 6 patients. 5 in care homes, one in sheltered accommodation. Ages of 90, 93, 94, 2 patients of 88 yrs old and finally a 95 year old lady.

All 6 people ended up going in. This is pretty rare tbh. This isn’t intended to be an agist post, merely an insight. 2 of these patients had complex and life threatening problems (very rapid heart rate and sepsis), quite rightly required treatment in hospital. The other 4 patients invoked lengthy phone calls to GP’s, OOH’s…. The result being that the tunnel visioned risk averse culture we exist in removed all common sense. In they went. Not necessarily the fault of the other HCP’s/GP’s I spoke too- more that short term risk trumps the long term risks that we all know about, but no-one can quantify those so in they go.

The risk to the individual patient at that exact time trumped the huge extended risk to them in terms of a lengthy hospital stay, the inevitable 15 hr wait on the corridor, the huge slump in mobility once in hospital, the risk of acquiring HAP, covid, you name it, the big risk of not making it out. So the 94 year old with dementia who may have had a stroke at some point in the night, so way out of any treatment window, was sent in by the GP, from a comfy bed, in her care home, with carers who maybe even have time to feed/toilet her, to a hospital corridor for an 18 hour wait, to (fingers crossed) end up on a stroke ward, to be eventually discharged a shell of her former self.

We- families, partners, children of the elderly, HCP’s, need to wise up to the fact that sending our elderly relatives to hospital ‘to be checked on’ is sometimes the worst possible decision. We need a huge education campaign. Sending people to hospital should have a definite aim- not just be the default position to shift risk to someone else. The vision of distressed elderly people, languishing on the corridors of my A and E, is an imagine that chills me to my soul.

Individuals don’t pay the full costs of obesity in the US; insurers do, which is spread among their entire client base.

The poor don’t pay at all so they have few constraints in that sense.

The larger issue (ahem) is that it’s really too late to do anything anyway by the time it affects your health so badly you have to see doctors and be on medication

Looks like some people are under the impression that misogyny will save the NHS

If you are a smoker/ heavy drinker/ obese then you have to start paying into an insurance scheme to gain full access to NHS services.

I'm obese. I put on weight because of poorly treated medical issues. I've managed not to gain more, but it's extremely difficult to lose any, in spite of exercise, teetotalism and lots of fruit and veg.

On the other hand, I've saved the country a fortune by giving up five years of my life to care for my terminally ill and very disabled mother, and I now give several hours a week to carrying for elderly relatives, friends and neighbours.

To afford insurance I'd have to give up those hours to earn extra money, which would actually cost the country more money.

mrsnoodle55
I absolutely agree that we have lost all sense of rationality trying to save 94 year olds with dementia. You just can't save everyone all the time and whilst beds are occupied by 90yr olds they will be turning away 40yr olds at the front door.
My gorgeous mum died recently at 88. We had to plead with the (wonderful) paramedics, not to take her into hospital as she wanted to die at home. She had full capacity and as an ex nurse was fully aware of how awful being on a chaotic ward would be.
The GP was another matter and practically accused us of trying to murder her.

Glitter trauma is quite right above. Well said! But most of the structural changes and advances in drugs and procedures were foreseeable. A government that cares about health care would have taken effective action. Instead we have had 12 years of Tory incompetence and carelessness, abetted by the Lib Dems in the coalition years. It will take years for Labour to improve the situation and because people have short memories the Tories will get back in and mess it up again.

If you are a smoker/ heavy drinker/ obese then you have to start paying into an insurance scheme to gain full access to NHS services.

Wouldn't it make more sense to tax unhealthy foods; subsidize healthier foods; and increase taxes on cigarettes and alcohol, and put resulting revenue into the NHS, rather than discriminating against people for health services? And where does it end -do you also charge patients for health services if they take part in dangerous sports; go to crowded parties in wintertime (thereby risking flu and other infections); live with a family member who smokes; aren't up to date with their vaccinations; etc.?

If you are a smoker/ heavy drinker/ obese then you have to start paying into an insurance scheme to gain full access to NHS services

Mobid obesity is an eating disorder that’s totally ignored. It’s not as glamorous as anorexia.

And those on psychiatric drugs which increase appetite tremendously. Do they pay into an insurance scene?

When I asked if antibiotics was the right thing for my family member with Parkinsons andDementia the doctor said even if there is only a 10% chance of saving him she must give them and quicklly. So he is alive and bed bound, can't speak, can only just swallow.

. It will take years for Labour to improve the situation and because people have short memories the Tories will get back in and mess it up again.
Is that the same Labour Party that tied the NHS into expensive PFI deals that we're still paying for?

You could say the same at end of last Labour govs too 70s and after the crash

Tbh I don't believe any government can deal with this.
The NHS is attempting to deal with the problems of a society that didn't exist when it was created. We might as well sit down, decide what the NHS can realistically do, and move on. It's harsh, but the only realistic solution.
It's effectively already happened with dentistry.

Totally agree.

Yes I agree too. We have to have an adult conversation about what the nhs can realistically do and what it can’t

dont get me wrong, I think this particular Tory government has been fucking appalling and doesn’t want to do some pretty obvious things like investing proper money & thinking in social care

but the challenges the nhs faces now are not what existed in 1948

Yes it’s painful to see the HoC just yelling at each other and we get the pantomime without discussion of options

Tbh I don't believe any government can deal with this.
The NHS is attempting to deal with the problems of a society that didn't exist when it was created. We might as well sit down, decide what the NHS can realistically do, and move on. It's harsh, but the only realistic solution.
It's effectively already happened with dentistry.

I think this is the situation - Is Labour claiming they can fix it all? Do they come up with ideas? As far as I can see it's NO.

They are happy to slam the Tories for destroying the NHS but don't have solutions either.

Having said the above you'd think the parties could come together and try to find the best option.

Imo, the tories aren't going to attempt anything radical at what will probably be the end of their tenure.
And Labour either haven't got the capacity to think outside the box, or don't want to frighten the horses by discussing it. Who knows what they think?

Sausagenbacon has summed it up well, but until the political parties agree that the NHS needs its remit redefining for the present day's medical possibilities and society, then it will continue to be a toxic football.

"The NHS is attempting to deal with the problems of a society that didn't exist when it was created. We might as well sit down, decide what the NHS can realistically do, and move on. It's harsh, but the only realistic solution."

So what should it stop doing? This is where the problem is. Of course nobody wants it to be what they need that's stopped. I do think 1 easy thing should be stopping free prescriptions to everyone except under 18s unless they are on universal credit / pension credit. Not sure that would save very much though. Would it?

@Sausagenbacon Maybe Sir Keir will start to answer the questions in today's big speech. "We will open a national debate on the future of the NHS, including working with our political rivals, to determine what NHS and social care provision should be in future" would be the bravest thing he could say, imo.

Andy burnham, Andrew Lansley & Norman lamb held very constructive cross party talks back in 09/10 around funding social care

then the election was called and all of a sudden it was “death tax!!”

it is the only way forward imo tho - has to be cross party discussions

I can’t imagine it would save very much at all, and it would only take one person not taking necessary medication and ending up in hospital as a result to wipe out the savings from many hundreds of people.

I just googled and read that it would save around 600mln a year. Apparently 90% of prescriptions are dispensed for free
I'm actually shocked at that statistic.
Why are all over 60s free? What's the logo there? Retirement age is 67. And the list of which illnesses are covered and which are not is weird and not at all obvious as far as I can see. For example, thyroid conditions = covered. Asthma not. Why is that?