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be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.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?

The NHS needs to focus on outcomes. We dont need to test and scan our elderly people for issues they won't be treated for. My MIL has yearly heart scans for a heart issue they will not operate on as she is so frail. She has scans for osteoporosis annually too - it seems the results tell her it's getting worse but there is nothing they can do as she is so frail. Last week she had two scans at two hospitals in a big city on the same day, she was transported by hospital transport from one hospital to the women's hospital for yet another scan. How much is this costing ? And more importantly why is she having scans only to be told there is nothing medically they can do as she is so frail.

1. Not enough money to fund a larger aging population when we have so many more treatments now - more money needs to be given to the NHS
2. People who don't look after their own health eg those who drink too much, smoke, take drugs, don't exercise or cause their own medical need on some other way eg choosing to do dangerous sports and getting injured or speeding and crashing their car and those who are obese massively increase demand - should they have to subsidise their treatment or perhaps pay for those issues directly resulting from their lifestyle?
3. Should treatment which isn't 'medically necessary' eg IVF, sex changes, cosmetic surgery etc be funded at the expense of necessary medical treatment to save lives eg cancer treatments?
4. Should the very elderly or infirm have surgery eg hip replacements or heart transplant when they are I likely to live more than a year?

It is the age of the population

Yup - all of the above. People have ridiculous expectations, and the sooner somevsort of charge is introduced, the better.

YABU because the biggest issue is the appalling IT structure.

We have to really think about the implications of an ageing population and the fact the lifespans are being extended in lengthy but not necessarily quality. The elderly present often with a number of co minorities and the NHS is essentially playing wack a mole as a patient sadly degenerates due to aging. One year is night be heart suevery, the next treatment for head and neck cancer then in a couple of years the impact of dementia . The economic and logistic stress on the BUS all adds up.

Those responsible diving the treatment ultimately say they have paid into the system and are entitled to treatment in their old age which is an entirely valid point but we are stretching lives thinly (and expensively) in the later years. There is also the moral case that all patients are treated equally leading to quite invasive procedures for the very trial elderly and I don't know ultimately how wise this is.

We are going to see more doctor strikes in the future and I do think this will precipitate some hard conversations in government in future in terms of having a truly free NHS.

Politicians like to tell us that the NHS is the “envy of the world”, but has anyone in the world tried to copy it? And the sacred NHS kept being sold as a reason for lockdown going on and on and on and on. “Protect the NHS.”

Add to that - no money, no staff, no time and ever increasing demand…it’s completely horrendous to work in at the moment

But all of those problems could be solved with proper management. That's the point of management, to deal effectively with whatever issues arise.

@OntheBorder1 of course not, I fully agree with doing everything possible to help premature babies, children, even adults when possible but what I don’t agree on is prolonging the life of a person (who has already lived a long and full life) at massive expense to the NHS.

I’m not in the UK but a family member who is in serious medical decline keeps receiving significant life saving treatments when in any other generation she would have died. She has had sepsis 4 times, from what starts as a very minor infection and declines rapidly, in the last 6 months. Her system is giving out and she will die but she is a very tough cookie so she responds to treatment each time.

Continuous treatment is definitely an expectation from some family members but it is with the medical team too. One doctor spoke of palliative care but the consultant overrode that.

To say her quality of life is atrocious doesn’t begin to describe the situation but on and on and on the merrigoround we go.

This modern obsession with extending life in the aged population without any thought for life quality is really bewildering from this experience. What is the point of it?

come back and say that when you are over 80

It works the other way too. Too many staff have the attitude that it's free so the patient's can go whistle if they don't like the crap service they get. My OH, who has cancer, has had that attitude numerous times when he's complained about his chemotherapy drugs not being ready for collection on the agreed date, or turning up for treatment appointments that have been cancelled without him being told - when he "dares" to make his displeasure known, he has sometimes had the "it's free so you can't complain" attitude thrown back in his face!

And how could managers deal with these problems? It requires more imput than just managers. It requires a full overhaul of social care, it requires more beds, which requires more space, which requires whole new purpose built hospitals. More staffing - theres recruitment freezes in most trusts as there simply isnt the funding for more staff, from porter and cleaners, right up to medics, they dont have the budget. It requires goverment level changes do deal with the current differences in population demographics which directly impact healthcare for all.

The nhs is totally unsustainable and the sooner people stop with the “save the nhs” bollocks the better. Move to a European system asap.

some of it definitely is useless management. Having worked a good chunk of time in lower tier nhs admin, can confirm that most of the upper-middle management were alarmingly, in fact frighteningly hard of thinking. Most of them were hugely self-interested, nepotistic, and concerned with handing blame for the awful shortage of everything down to the lower admin rather than actually trying to do anything about it. The Peter principle in the terrifying flesh

It's difficult with the elderly, I think people should take more responsibility for their health but obviously this is difficult with the elderly. My MIL came back from hospital recently after having a UTI which was entirely preventable through her not drinking enough water. We have bought special jugs and glasses but she's shoved them back into her cupboard. She's been given numerous hearing aids, inhalers, compression stocking and high protein shakes to try and keep her out of hospital. All are unused in her cupboards. After her last hospital visit she showed us all the pills she takes on a daily basis. She was taking medication for diahorrea as well as taking medication for constipation.

I also think there’s a large group of people who don’t take any responsibility for their own health (they smoke, drink too much, eat too much of the wrong thing etc), then expect to be fixed when it goes wrong and they get ill.

I’m approaching my sixties, and I really can’t see how Millennials and Gen Z can be expected to finance the NHS for Boomers or my Generation who might averagely live into our nineties. It’s not fair on them. Too many of us are living too long. There won’t be sufficient numbers of younger taxpayers (or health workers) to support us. Not without massive immigration anyway…

Poverty A previous poster talked about poverty. Poverty causes early deaths. If you are poor, your life expectancy is shorter than another person. So I support free healthcare rather than see poverty health inequity get much worse.

Managers Bravo Labour for tackling the bureacratic bloated organisation that NHSE is. The managers at the coal face often work really hard. NHSE management... we wouldn't miss 75% of them. Healthcare would till be delivered

Patient lifestyles some people escape the consequences of their lifestyle. Others develop type 2 diabetes, COPD, cardiovascular disease and cancers earlier linked to their smoking eating etc. However we all die of something one day.

Age The amount of healthcare cost increases as you get older. ....I hope no one would dream of having an age cut off! However we do give very expensive and often futile treatments for people with significant morbidity. I'd like to see the discussion around quality of life vs quantity better. Its not about not bothering because you're 80, it's about getting 2 extra years but enduring surgery and medication side effects for those, living in pain and restricted.

DNA not attending or cancelling apps last minute. You pay for the next one.

You can't penalise DNA in the current system where often you're not told of an appointment nor can you get through to cancel it!

Issue is from when I was there is that any £££ is spent on looking for ways to make the existing system “more efficient”. How can we make what we’ve got, same number of beds, same number of staff, see more patients in the same amount of hours.

never going to work. They design computer programmes aimed at saving dr’s admin time. We used to pick up the phone in pharmacy and advise HCP’s on what drugs to give and when. Now they have a computer system that medics are supposed to consult so they can cut pharmacy staff. Algorithms aren’t fail safe and depend on the quality of the user, so often then HCP misreads and gets the wrong “advice” and we have to fix it later, or ends up calling us anyway. So twice the time and effort on less staff.

it’s like 111 was designed to direct people to the appropriate service and take pressure off overused a&e. But the HCP’s aren’t allowed to use their own judgement so we end up with ambulances and A&e visits for indigestion.

there was once a study that the fastest and cheapest way of reducing a&e wait times was stick a consultant on triage. Someone with the authority to send people away and admit only those who need seeing immediately.

my local hospital has a 24 hr GP service attached. All non immediate cases are sent. Sprains, infections, headaches. Sent for x-ray, prescriptions written from there. Does reduce the pressure on a&e.

it doesn’t occur to them that more efficient= spend on staff.

The income level of the 80 year olds is highly relevant I think. Not all 80-somethings are equal!

True. Prior to a recent emergency admission in France, we had to show ID (passport) and travel insurance / GHIC / method of payment. On discharge, we had to go to the payment admin counter, prominently located in the hospital entrance. An invoice was produced and we were asked pay the outstanding balance not covered by the GHIC.

Yes but they can’t actually say that because the pensioners will have a melt down.

We are having to provide care for often multiple conditions for a huge period of time - a decade or more at the end of life.

I have no idea what the solution is to it however.