To think our obsession with the NHS has got out of hand?

[HFJ]

I think we’ve got to the stage of faux outrage, thinking that if the NHS did its job properly, old age would be cured and there’d be no deaths whatsoever.

This article caught my eye https://www.telegraph.co.uk/news/2024/06/20/ae-waits-cause-plane-load-of-deaths-every-week-doctors-say/

Essentially, according to the article, delays at A&E are causing 250 extra deaths a week. You’d expect these extra 250 people to show up in the national statistics. So I checked and found the answer here: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending7june2024

I attached the key image. It very much looks to me like deaths are lower than average.

My worry is that this outrage is just being used to prep us for huge increases in tax ‘for the NHS’ and this will be at the expense of spending that would benefit young people, young families who are really struggling right now.

I've been waiting for back surgery since 2019. Practically every appointment is cancelled or rescheduled. I've only had 2 face to face appointments since then. The rest were all telephone appointments.

I fear the NHS is so huge and unwieldy that it is very difficult for meaningful changes to be implemented. It’s all so huge and unwieldy. DH recently had blood tests, an ecg and ultrasound, and an X ray. He had to go to three different places, two hospitals and a clinic in different towns. Despite being on an ‘urgent pathway’ it took five months before he was seen by a consultant and he has just been informed that his next appt on this urgent pathway is in a year’s time.

I don’t think excess deaths in those under 70 years old is acceptable.

I think we should treat those over 70 separately and have a different stream for them entirely. I know it sounds harsh, but they need to treat the working age population first so they can then work and fund the over 70s.

So 1) pediatrics (outmost priority) 2) working age 18-70 (2nd priority) 3) geriatrics . And in the last category much more focus on quality of life over quantity and much more focus on end of life care and what patients actually want. Living wills etc the norm.

Missing the point of the thread but the NHS became so glorified over covid particularly, that the term “NHS worker” has become something people use and now expect adulation for. Whilst I massively value the NHS and its doctors, nurses, paramedics and other healthcare workers, the amount of people that seem to think they’re worthy of the same respect and thanks is definitely something I’ve noticed.
People will often phone into radio shows, for example, and proudly mention that they work for the NHS and the dj will fawn over them and thank them for a great job. The hardworking medical staff deserve this as they’re going above and beyond in a difficult job at all times of day or night and their skills are in shortage. The admin people - HR, finance, secretarial, managerial etc just don’t -they are just doing a typical 9-5 office/WFH job and can usually easily be replaced by others with the same skillsets.

I may have a fairly simplistic view, and I'm not trained in economics, but this is what I see.

A lack of social care means that today no longer in bed of acute care are kept in hospital, depleting bed availability.

This impacts not just emergency care, but planned procedures as not enough beds.

As a&e can't move people out of the department, there are longer waiting times and ambulances queuing outside.

Ambulances aren't able to reach people who could have initial emergency treatment at home, preventing the need to go to hospital in the first place.

A lot of these people who have had to call an ambulance haven't been able to access a GP to get medical care in the early stages of their condition.

We then have to look at why general health in society has fallen. Poverty, no access to places such as sure start facilities, which taught many about nutrition, recognised early intervention needs, and improved outcomes for a generation of children.

Poverty increases the risk of children falling behind, hopelessness and an increase in crime. It increases the risk of obesity, as it's cheaper to grab a bag of frozen chips and large pizza to feed the whole family than to provide a nutritious and healthy meal.

There are so many factors that need to be dealt with in order to improve the accessibility and efficiency of healthcare.

@Mabelface you have summed up the problems perfectly.
I would also add

• triage by non clinical staff at 111 using algorithms resulting in ambulances being sent to people who don't need them
• increasing pressure on consultants in hospitals meaning that GPs end up doing a huge amount of work for the hospital "ask your GP to" " I'll get your GP to" etc etc
• fear of missing something which means now everyone is consulting for advice and more and more tests are being done on everyone to avoid being that dr that missed a diagnosis in one person.
• and reduced (in real terms) funding on a background of an increasing population, who have more chronic illnesses, who are living longer and who have access to more and expensive treatments.

No amount of money would ever be enough for the NHS. It is a bottomless pit.

@ll09sm and so there needs to be some really tough decisions regarding rationing healthcare.
I regularly have conversations about rationing and the public expectation they can get everything on the nhs.
Some of the requests I have declined are

• something to stop my child biting their nails
• sudocrem for nappy rash
• regular paracetamol to have in, incase
• referral for removal of skin lesions that are cosmetic
• referral for fertility treatment when one of the couple has a child from a previous relationship
• many other examples

But funding for patients to see their GP as many times as they like (or can get an appointment) costs 30p a day. The same cost as insuring a rabbit with a vets. I have patients that come every week to see someone whether that is nurse, GP or pharmacist. Should we ration their care to only a few visits a year (currently funded for about 2.4) Should we ration A&E attendances?

Unfortunately it isn't until someone with clinical experience has assessed the patient can they confidently be told they don't need any medical intervention. But they already have.
So maybe co-pay will make people think twice whether they really need to go to A&E, call that ambulance, phone up their GP.
But some of my patients don't have £10 spare to pay for their prescription so how many will not attend and then die or present very late.

I don't know the answer, can only see the problem.

Oh rubbish

The nhs does rather well given it's relatively low finances

You can get the data about cost and performance by country through google .

The us does badly because it spends a high amount but gets less good a service than many European counties - that's because of its funding model , which is profit making , excludes many and over treats others. That's a better example of bottomless pit

Nhs did better when it had ( proportionally
Inflation adjusted ) more

But the way we look after our health ( weight , lack do exercise , poor diet) coupled with a reluctance to pay taxes ( partly caused by our lack of cash due to housing costs ) means we get the service we deserve

I can't believe what I'm reading. Disgusting ageism. What if I flipped it another way and said treat taxpayers first then everyone else. Should that be acceptable? - no, of course not. Or men first, then women? The whole point of the NHS is that it's free at the point of need for everyone. Once you move away from that then you might as well make it all about who can pay most.

Things I'd like to see in my simplistic view:

Children's clinics which include dentistry, paediatric care and disability support

Access to dentists

Early mental health intervention

Emergency mental health paramedics - right care, right time

Annual health check for all adults

Early access to treatments like physio and podiatry

School nurses

Sure start centres which include help for new parents with regard to post natal mental health care

Who would pay for this? Well, looking ahead, this preventative treatment would be a damn sight cheaper than the reactive, acute care.

I don't think anyone should be fawned over for working in the NHS.

But you're making common incorrect assumptions about the NHS and it's workers.

Many, many NHS medical and nursing staff work 9-5. On wards, in clinics, in offices and WFH.

Admin, reception and secretarial staff play vital roles and often under very difficult circumstances and with enormous amounts of stress and dealing with abuse from the public daily. And often can't easily be replaced because of all that.

@Byronada - you have spectacularly missed my point! The whole point is dedicated hospitals and facilities for the more elderly so they don’t end up dying on trolleys and waiting in A&E with zero dignity. To the point that they develop a hospital/medical phobia. Healthcare should be care foremost and there for people when they are at their most vulnerable. No elderly person should be stuck in A&E with drunk yobs on a Saturday.

And that underlines the problem with the NHS. It is not, and never has been, patient centric. It’s a state run and funded command and control organisation that sees its mere existence as its key purpose. And that we should be grateful for its existence. If the NHS model is so good, why has no other first world economy with above average performance on key health metrics got the same system. Perhaps it’s because it doesn’t work…

There would be something deeply unpleasant in a state that refuses to help those that wish to die, while at the same time imposing premature death on those who are not ready.

There are many ways of contributing which don't involve paid work. I recently read that 50% of families rely on grandparents for childcare. Most of the 70+ year olds I know are involved in voluntary work. And premature death is the tip of the iceberg - the same processes leading to premature death lead also to disability and additional burden on NHS and Social Services.

@Araminta1003 I completely agree with you about care for the elderly and treating them with dignity but I don't think you can put a number on it.
I went out with an elderly friend - she's 77 and regularly drives down to Cornwall. I have patients still working part time into their 70s. My dad is 88 and drives elderly patients to hospital appointments.
Conversely I have patients in their 40s/50s/60s with a host of chronic illnesses who have the medical records of an elderly person. Some of it lifestyle some of it just bad luck.

Its a system where we pay in as part of the social contract (well some of us do) and out of that, when entitled we are able to get health care, NHS dentistry to a certain level, benefits, pensions etc

It may have been sold that way but this isn't how it actually works, because as PPs have said very little is ringfenced and most of it's up for grabs for whatever headline grabbing political vanity project appeals at the time

Anything can be "proved" with stats, but fundamentally this is the reason why there's no point at all putting in more money without thorough structural reform, and we're unlikely to get that because the system suits those managing it just fine

Edited because I should have added that I thoroughly agree with your first sentence, OP: "I think we’ve got to the stage of faux outrage, thinking that if the NHS did its job properly, old age would be cured and there’d be no deaths whatsoever"

Unfortunately we've got to the point where many see death as a failure rather than a natural and inevitable process, and it really doesn't help

A lot of what you've said there is already available. At least in some if not many areas.

i know people reference Europe as having better healthcare systems…they probably do (I’ve had no experience in Europe and needing healthcare) but they also pay higher taxes for it, well at least the ones that are often referenced. People need to make a choice raise taxes and actually have a decent amount of funding or keep/lower taxes and have a lower quality public service but most likely privatised (US style - low tax country but with privatisation) . At the moment we are stuck in the middle with it just stagnating. I’d happy pay a bit more tax if I could see improvements

Really? Are you sure? Not from where I see it, and indeed my friends and family around the country. Can you evidence this?

But you did say the working population should be treated first. So you would prioritise them over disabled people unable to work, people caring for elderly relatives, people who choose not to work as they are looking after young children? It's a slippery slope.....

@Byronada - what I meant is they should be in different streams, like paediatrics is treated separately. Special hospitals/hospital wings and rehab centres for the elderly ideally. I think it is inhumane that an 80 plus year old has to wait in A&E for hours on end with everyone else.

For a start, school nurses already exist...

There's fewer than there used to be but they're definitely still there in most if not all areas. There were 2000 as of Jan 2023.

Where do you live? You might have access to them but just know about them as they're not always physically based in a school but the schools often have named school nurses attached to them. Google your area.

Here's an example.

School Nursing Service – Children and Young People’s Services (sirona-cic.org.uk

Same goes for early intervention in MH, particularly in schools - as you can see from that link, there are often lots of MH services available that provide early intervention. Google your area.

Same goes for 'mental health paramedics'...successful pilots already happening in some areas and being rolled out to further areas.

Here's an example:

Mental Health Integrated Access Partnership :: Avon and Wiltshire Mental Health Partnership NHS Trust (awp.nhs.uk)

2000 school nurses for the entire country. They have much less availability to children and families than they used to.

Early help mental health intervention services are a bit of an oxymoron, as the waiting lists are huge for them. Just look around the boards here for desperate parents trying to get help for their children.

Same with adults. Waiting lists for even the assigned 6 sessions of CBT can be 2 years or more. Also look at the length of the waiting lists to be assessed for neurodiversity, and the issues with medication supply for those with ADHD.

Pilots are all well and good, but they're not in place now.

I live in the north west, you've shown the south west. Funding most definitely varies from region to region.

What about all the other points I've raised?

Often its not available, or is virtually on paper only and not fit for purpose, inaccessible, big gaps in service due to lack of staffing or sickness. So no, its not avaiable. And much has been cut in many areas too