To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

[NaiceBlueSquid]

People often blame NHS management for its ongoing crises but isn’t the real issue much deeper? An ageing population, increasing patient expectations that can’t realistically be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.

AIBU to think that while NHS management could probably be improved, it’s nowhere near the biggest problem the system faces?

This!
Plus my generation (I'm 72) smoked & drank as a default. Most have now given up the fags (can't speak for the drink!) but are likely to be living with the fallout. The next gen & their children are far less likely to be smokers but, by golly, they're plump so I think obesity will replace smoking as the major health issue. People are comfort eating like billyoh!

I don’t think it’s just the older generation whose expectations are too hIgh think it’s across the board.

I think it’s younger generations tend to take less responsibility for their heath I’m in my 50’s and have had a lifetime of being told about the negative impacts of smoking, drinking, poor diet, not engaging in exercise yet my age group there is a huge issue with obesity related illnesses, alcohol related issues and smoking

my sons generation many seem so different rather than going to pubs they are at the gym (of course there are negatives to this)

There is a general lack of taking responsibility for our health in this country I think there are a number of factors but that has to change healthcare will have to change and the government (and following governments) have to be more honest with the public

The appointment system is incredibly chaotic! I don't know how the NHS runs at all based on how their appointments are dished out. They bear no relation to reality.
And getting to these appointments is expensive - I'll need my WFA to cover the costs of this latest debacle.

Yep, last year I was sent to a hospital miles from where I live for a pre op appointment. This consisted of a height/weight check, a blood test, blood pressure check & ecg. Why on earth did I have to travel 30 miles to have something done that could have been done in the hospital across the road from me??

Exactly. I spend £25 on train tickets to go to an appointment, only to have it cancelled just as the train pulled up. It was because of staff sickness. I'm 25 quid down & my future appointments have been thrown into chaos. I can't make any plans for myself for the foreseeable future & I've had to spend £95 on rescheduling my holiday which I could have gone on as it turns out. Who do I bill?

I would be happy if the NHS would just do what it says it's going to do. I don't go to the very often but if they ask me to go to a screening, I go. What is the point if they then proceed at a leisurely pace when they find something? 15 months it's been going on now & my 'urgent operation' is as far away as ever. I have spent the last 20 years keeping myself as fit as possible & actually feel fine but I am acutely anxious that, during the last 15 months, that Ii'l cancer is turning into big cancer. Please don't tell me that I'm over using the NHS or that I shouldn't expect so much.

It's not just "comfort eating" - it's the sheer amount of processed "foods" that are more chemical than raw foodstuffs. Tinned this, packet that, all full of additives, colourings and preservatives. Often the ultra processed stuff is far cheaper and easier than "proper" foods. Alongside busy lifestyles, it's just a lot easier to have a "meal deal" lunch from a supermarket or a "pinged" evening ready meal. The US owned food companies have a lot to answer for, i.e. crisps, fizzy drinks, chocolate bars, etc - all highly processed crap, cheap to manufacture in virtually fully automated factories and then "packaged" up into meal deals to make customers think they're getting a good deal. We desperately need some new big food companies to disrupt the market and challenge the small number of US owned "mega" food companies that dominate the supermarket shelves.

We're avoiding difficult conversations and decisions. The 'from cradle to grave, free at the point of contact' is obviously unrealistic especially with the ever expanding list of potential assessments, treatments and services. Opening each new service increases the demand for it - and my experience of NHS targets is similar, set one up to improve the service and you can be sure you'll never achieve it

We need less, not more. Fewer services but better staffed and funded. Fewer free treatment and more co funding options. Is it better to fund more autism assessments or to create a support programme for schools? To employ 3 physician's associates or one specialist doctor with small caseload?

Quality over quantity.

I need annual diabetic eye tests (diabetes now under control for a decade after lifestyle changes!). They used to be done during my normal annual eye test by my optician. About 15 years or so ago, they changed the system so that "normal" opticians are no longer able to do them. So now I have two annual eye tests, one at the opticians and another at various health centres/hospitals that change every sodding year.

How can it be cheaper for the NHS to pay for two different eye tests using different people and different equipment than just doing it all in one go with a slightly longer appointment like it always used to be? My optician has all the equipment, i.e. the camera etc and does the diabetic eye tests privately, but apparently the NHS won't fund a longer appointment for him to do them under the NHS!

Not only that, but the diabetic eye tests are obviously "under contract" which is why the health trust doing them changes every few years. It's been our area ambulance trust, our own hospital trust, the hospital trust of our adjoining county, and now the hospital trust of a city 50 miles away in the same county. Just why? The costs of admin and management of the changes every few years must be enormous, plus staff being recruited by the "new" trust and redundancies/terminations for the staff of the "old" outgoing trust. Then organising and presumably "renting" treatment rooms in different places when the contract changes. I must have been to over a dozen different places, granted, all within reasonable distance of where I live, but it's somewhere different every 2/3 years, sometimes it's been my own GP surgery, sometimes the nearest health centre, sometimes a health centre or GP surgery in the next nearest town, sometimes in our local small hospital, sometimes in our nearest city big hospital - it's utterly bonkers.

I have to agree with "quality over quantity". Both OH and I have ongoing health conditions and have often said exactly the same thing that there are simply far too many people involved, which is where the mistakes, inefficiencies and incompetence creep in. When you finally get to the right place, it's usually pretty good, but getting there is an absolute nightmare as you're passed from pillar to post throughout the system. At each point/contact, that's NHS staff time being taken up and 9 times out of 10, it's the wrong person who can't actually do what needs to be done at that time, whether a receptionist, administrator, HCA, nurse, doctor, etc and you just get passed on/referred to someone else.

Take my OH with his cancer. Whenever he has a complication, i.e. a new side effect, or a reaction to his chemotherapy, etc., he has to go through a long protracted system to get any advice, starting with the "on call" cancer nurses who he phones, but it's always answerphone and they generally take 2/3 days to call him back. He goes through it with them, but they generally can't give him any advice, so they "ping" the oncologists, and then he gets another call back in a week or so, from the nurses who've received a ping back from a junior/registrar in the oncology dept who can't really answer the question or give advice, and basically say either wait until the next monthly oncologist review appointment or go to A&E! He's had that numerous times over the 8/9 years he's been on long term drug chemotherapy! That's taken up a specialist cancer nurse appointment twice and taken time of the registrar/junior, none of whom could actually give any advice. He doesn't bother anymore and now makes up his own mind/decision and just tends to make a list of things to discuss at his oncologists review consultation - but she often bats things back by asking whether he phoned the cancer nurses about it - he tells her every time she says that they couldn't help him and told him to ask her! He's basically in limbo between consultant appointments as no one else is willing nor able to give any advice. Doesn't help that he never gets the same cancer nurses twice - it's like a revolving door of different staff constantly. Even when he goes into the oncology department, the staff are always different, from receptionists to the nurses, etc - very rare to see a familiar face, and the place is full of staff - there's no shortage at all, yet, it's nigh on impossible to actually see or speak to someone who actually knows what they're doing and can give proper advice - except for the consultant herself who is impossible to contact between pre-booked appointments.

Then they wonder why people turn up at A&E!

"An ageing population, increasing patient expectations that can’t realistically be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems."

An ageing population? The NHS - or rather the politicians who decide what to fund and by how much - has had since 1955 to estimate how many people there would be over the age of 70. And half a century to estimate how many over-50s there would be. Likewise planning for the number of clinical staff likely to be required, and the facilities and equipment that would also be required.

Little or none of which took place because politicians would rather wave the carrot of tax cuts than invest in public healthcare, and the section of society that would be most affected by increased taxes (which includes the politicians themselves) would rather pay an extra £150 or so a month to ensure that they benefit from access to better healthcare than pay £150 a month more in tax so that everyone could enjoy better heathcare.

Agree.

We're talking about well functioning Human beings who still can contribute to society.

So let me get this straight… people in their 40s and 50s are suggesting that older people should have popped off years ago to ‘ease the burden’ on the NHS? Erm, do they realise they would’ve been out of the game themselves by that logic?

If we're playing ‘survival of the cheapest’, then what’s the cut-off—30? 25?

Shall we start handing out leaflets titled “Thanks for your taxes, now kindly die” once people hit their 60s?

It’s beyond bleak.

We’ve got folks saying older people should just accept their fate, as if they haven’t paid into the NHS their whole lives, raised families, worked hard, and built the society we all benefit from. But sure—let’s call them the problem.

In the Middle Ages, yes, people died in their 20s—but we’ve also moved on from using leeches and thinking bathing was a sin. Maybe, just maybe, we should be grateful people are living longer and healthier, instead of pretending that compassion is a limited resource we have to ration like wartime butter.

This idea that the NHS can only function if people start quietly disappearing once they’re deemed ‘past their prime’ is deeply dystopian.

It’s not a slippery slope. It’s a bloody ski jump.

An autism support programme in schools would be funded by the DofE and how is that going to help NHS staff provide better treatment for autistic patients? Are we going to do that with all disabilities- just stop diagnoses and fund school
support programmes instead ? Many severe problems as a result of autism occur in adulthood too anyway. Why is it always autism that is seemed to be a waste of money on MN and not the more visible disabilities?

Why is 'from cradle to grave, free at the point of contact' obviously unrealistic?
It is the norm in almost every advanced country on the planet - with the notable exception of the USA, where healthcare is big business and which is the model that American companies have been attempting to implement in the UK, helped by the Conservatives who have starved the NHS of resources and sent those who can afford it, and many who cannot, into the arms of the private healthcare providers.

As for needing less, not more healthcare investment - this is nonsense as the UK already lags far behind many peer countries. Austria has twice as many doctors per capita as the UK, and more beds, more other medical staff and more elderly-care facilities. People don't wait weeks to see a GP, or months for a hospital appointment or for an operation. Germany invests 30% more in healthcare per capita each year than the UK does. Every 3 years, the UK falls behind Germany by an entire year's worth of investment - billions of pounds of investment shortfall that translates into the UK being short of doctors, nurses, modern facilities and equipment. Over 10% of the population in England is currently waiting for a hospital appointment - a situation that would never have been allowed to occur in most other countries, where any politician who allowed anything approaching this would have been kicked out of office. Instead, Andrew Lansley now sits in the House of Lords and Sir Jeremy Hunt continues to spout bollocks in the House of Commons.

UK NHS managers spend much of their time "managing the day-to-day crisis" instead of managing the service - they spend hours managing waiting lists and bed shortages; problems that healthcare managers in many other countries don't have.

I agree, the UK has for years been "avoiding difficult conversations and decisions" - but the difficult conversation is "how much more tax are you willing to pay (or more accurately, how do you want tax revenue to be re-allocated) in order to bring the service up to the same standards as in most other developed countries" rather than "by how much can the NHS be cut back." People need to realise that the right to decent healthcare is been stolen from them and handed over to profit-hungry corporations - and those who cannot afford to pay will quite literally be expected to just fuck off and die.

My experience is that pre operative nurses assume that you are a fat, lazy, mcdonalds munching alcoholic. You can tell them that you are a vegan who runs 10 k every other day & only drinks at weekends & they will look at you with glazed eyes & still gives you the script they've been given. It makes you feel like a liar.

This is true. A friend of mine, 7½ stone wringing wet, was diagnosed with type 2 diabetes & was given a lecture about losing weight, denying the evidence of their own eyes. She was dead skinny!

Well said.

Oh goody, another thread blaming our felling NHS on the users. Other countries seem to manage to deliver free health services to a better standard than we do so i think your reasoning is flawed. We just haven’t updated our model to keep up with an aging population and advances in medical care. We have also underfunded NHS services for years while the tories have been busy trying to privatise it by stealth rather than actually put in place a better system.

And it’s not a coincidence that ALL our services have gone to shit at the same time. Or do you think that’s the fault of the general populace as well?

Not wanting to veer into an assisted dying debate but my aunt is currently in a specialist care home with advanced dementia age70. She lies/sits there all day, can’t feed/dress/wash herself and doesn’t recognise anyone. She doesn’t speak or show any emotion. The cost of keeping her alive is huge for both social care and nhs but her quality of life is very low- not a quality I would want to have.

By contrast my great aunt is 93 and generally ok but has lots of chronic conditions. However she still has a good quality of life and I would hate her to think that she isn’t wanted or a burden.

I cost the NHS a huge amount as I have several autoimmune diseases and take very expensive biologics. However by taking them I’m working in my job in finance and contribute to society by paying tax at a higher rate (there are of course other ways to contribute but by spending £10k on my drugs means I am able to earn and contribute).

Perosnally I would love online booking- my hospital does it for blood tests and it’s great.

My Grandpa (soldier ww2) smoked 60 a day until approx 1955, died aged 92 in his sleep, he’d had a small stroke a couple of years previously, had a minor heart attack in hospital, which we only found out about by reading his notes, he also drank like a fish until he died. Granny 91 died from cancer, no other problems neither of them bled the nhs dry, both ate well fresh food cooked from scratch.

my mum worked as a nurse for about 50 years, was treated like 💩 by the nurses who were looking after her when she was dying, until we realised they nearly poisoned her, then they couldn’t do enough , the best nurse she had by a long shot was an auxiliary, she actually cared about the patients,

my mum always said nursing was a vocation and it was being ruined by people who were degree nurses on paper but who didn’t have a caring bone in their bodies

I know of at least 2/3 people who’ve died (in the last 2 years )under the age of 35 from being dismissed by gps

The nhs is like the bucket with a hole, no amount of money is enough

Yes, they closed all the cottage hospitals and then wonder why there aren’t enough beds. Social care is really NHS care for many elderly frail with the NHS is not paying for.

Not just cottage hospitals, but all the convalescence/oap/mental health hospitals too. Fair enough, most were Victorian and needed massive upgrades, but instead of that, they brought in "care in the community", private care homes expanded instead, etc., and now hospitals don't have the same discharge options.

My elderly dad is at the doctor's all the time. As a younger man he was always very healthy but now, in his eighties he uses a lot of resource. I suspect that ageing is something that wasn't factored into the original NHS model. Something does have to give, I think that if people can afford it there should be some sort of self contribution to costs, so a fixed fee for doctors appointments perhaps. My dad could absolutely contribute something towards his care, but his expectation is that the NHS will provide. Again perhaps our attitudes towards healthcare have to change.

I think management is an issue but yes, the biggest challenges are the ageing population (not much to be done so has to be dealt with) expectations.

I think we've really changed our idea of what "health" is and what kids of things publicly funded care is meant to cover. It was far less, much more acute or immediate needs when the service was founded.

I think there would probably be benefit to people thinking very clearly about how much it is worth having major health interventions in the elderly (say, 75 +) Not to restrict them, but people need to understand for themselves how much these are likely to give them more time with good quality of life. because often they don't. People are living 10 years longer but that's not typically a particularly good ten years. My mother, for example, is 73, and had a long career as a nurse. She does not plan to do much if, for example, she is diagnosed with cancer. Things that will improve QOL are a go, but not so much to extend years she will be ill. In order to approach things that way we will have to become more comfortable with the fact that death is a non-preventable end to life.

But also we probably need to take a hard look at what treatments are covered by the sate. I would not include fertility treatments for example.

I also think a European model is going to be the way forward.

Which ones are you thinking about?