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be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.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

Absolutely this.

Between parents and PILs we see this carousel of consultant appointments for no discernible purpose. Each involves pre-appointment blood tests, scans etc with hopelessly inefficient paper-based communication around scheduling.

There is no joining up between the various specialisms involved and there doesn’t seem to be any agreed purpose or output of any of the engagement.

it is eye watering inefficient, and being ruthlessly objective, all of this activity seems to add up to little more than the observation and documenting of decline

Yes, that would require decently functioning admin systems and postal service. I would absolutely cause more expense challenging a fine for an appointment I'd not been notified of, and so would a lot of others.

We all have to die. Obviously when we begin our ninth decade we're only too well aware that the bucket may not be waiting very long to be kicked and if we're fit and well at that age then of course we want our lives to continue as long as possible.

However, few people, I feel, would choose to be kept alive just for the sake of being alive, if that life had no quality. It would feel pointless. There comes a point when it's time to go.

indeed but the poster was commenting on over 80's refusing to agree to DNR.

Management is an issue but nobody wants to acknowledge the pressures of an ageing population.

We need the European funding model. We should have to pay to access some services. Then appointments wouldn’t be wasted

How will people not working fund the above since it's like a NI tax in that employers pay in?

What is most needed is some people taking responsibility for their own health.

But you can't ignore socio economic issues and their impact on health...

This. And a European model. If we want world class services, we have to be prepared to pay more tax.

It's middle and lower earners who pay more in many European countries

@Whitehorses67 great post.

Young people need faster referrals and fast track as well. My young adult DD has cancer and we had to 6 weeks for a MRI for a suspected Sarcoma and diagnosis.
Every MRI we go for she is the youngest there by 40yrs.
Sadly we don't have enough resources for everyone, let the young at least have a chance at life.
My Dad who is 76 has been badly affected by it, he is on a 30 week wait for a heart scan and refuses to chase it saying someone like his granddaughter needs it more.

I’ve said this before but the biggest problem for the NHS is Type 2 diabetes which 10% of the NHS budget is spent on. Science now tells us that 80-90% of diagnosed Type 2 diabetics can reverse this with diet and exercise and we could prevent nearly everyone from getting it in the first place just by changing diet and exercise. If we could reduce the workload and costs of the NHS why wouldn’t we?
(clue: big pharma would not be happy, ditto processed food manufacturers)

One in eight adults has Type 2 and the numbers are increasing at pace.

age is a red herrring

What's the purpose of pretending we don't have an ageing population and that they impact social care & healthcare costs?

Also, I should add, the whole stay was astonishingly good, from the care at all levels, nutrition, physios, accommodation, facilities etc Had we not returned to the UK as planned, the aftercare would have been far better too (twice daily nurse visits, weekly Dr check up and repeat bloods after a month).

I would be more than happy to pay my 20% or mutuel for this level of care. I

The vast majority of patients I have seen who are overweight or smoke do so in large part because of enormous stresses and disadvantages in their lives.
Food or cigarettes are a (just about) affordable comfort when you are, for example, looking after your severely disabled child or elderly parent who has dementia. Or you have lost your job in your fifties and can’t find another one despite your best efforts. Or your husband has buggered off and left you with nothing. Or your childhood was an endurance test of abuse which left you chronic trauma and because therapy is unavailable you have to make do with chocolate.

Thank you for saying this @Whitehorses67

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…

There are already more over 65s than under 15 yr olds.
Immigration isn't particularly popular 😆

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

True

I have already made my wishes clear to loved ones that after 80 I only want pain relief. I’m looking into an advance directive although I think medical staff may be able to overide them…
see @YourAmusedTiger pp on her poor relatives suffering😢

Sadly we don't have enough resources for everyone, let the young at least have a chance at life.

It's inevitable that they are going to have to start prioritising by age surely?

This is not an emotional decision, no one is advocating some cull when you get over a certain age. One has to take the emotion out of it, everyone can't have everything for free and be kept alive. It's not nice of course.

On the subject of DNR, the doctor in charge of my dad one of the last times he went into hospital suggested to us that it would be very pointless and counterintuitive to try and revive him if he was dying as the force involved to resuscitate would break his ribs. "It's not like you see on the tv" - I did like the cut of her jib. So not all healthcare professionals are the same.

My Mil is a hypochondriac. Only this week she has had 1 brain scan and one coloscopy. Next week it's something else. She's 80 and doesn't have any major health problems except aching limbs/back that's age related.

The solution to that probably is Big Pharma, since we know diet and exercise don't work on a population level for people who are already overweight and obese. The fact that something would work if people continually did it is a very different point to whether they're actually going to.

I'm optimistic though. The price of MJ and the like is going to come down, and there's research on a pill form rather than injections, which will make it more acceptable to some.

No i disagree. The NHS is not fit for purpose and it has nothing to do with an aging population or people expecting too much.

Theres no set money allocation per trust so every trust can just spend whatever they want on supplies with huge discrepancies between them. They can also allocate treatment based on trust so one trust might offer ivf to certain people whilst a neighbouring trust can decline treatment to certain people. The same goes for diagnosis. Gestational diabetes for example. The criteria for testing, treatment and diagnosis varies from trust to trust. This should not be the way it should be a standard diagnosis across the board not that you are classed as diabetic in one trust but not in another.

The middle men and waiting is ridiculous. A personal example from this week alone, my midwife gave me a blood test. The lab identified anaemia. The results were sent to my midwife and the maternity hospital. The hospital then send me a letter and phone me to let me know i need to get in touch with my gp for medication. My gp takes nearly a week to respond to my online request. I then get my script to send to the pharmacy. Why was any of that waste of time necessary? Why can my midwife send tests for things and not allowed to just prescribe me the medicine straight away? Why did it then go through both the hospital and gp just to get iron tablets?

Being pushed from pillar to post, being told to make multiple appointments for even simple issues that could literally be sorted there and then. Another example, say you need to see a gp for a thyroid test and while there ask them to look at a painful cyst, they will say no you need to make a seperate appointment. Yet another waste of time and resources.

Its so badly run and managed its beyond a joke how they are still functioning.

I have made an advanced directive stating this and I'm 45. But depressed and wouldn't mind dying once my teens are independant. I really do not want to live a long time. If life is crap now I doubt it will be better at 65. (And yes I'm on meds that makes me fonction but I still find life utterly miserable)

What is the european model? Because I am from an european country and I find the system (from a patient perspective) quite similar to my country of origin

as some clever lady - i can't recall who it was said on the radio the other day. The problem is the post war generations feel they have paid for their cradle to grave care and are entitled to it, the issue is they have not paid enough. No one anticipated the advances in medical care, the long term conditions we now all live with, the age we can survive to with these interventions and often for 1/3rd of that lifetime (or more) not contributing to the system. If you worked and pay taxes from 15-65, but live to 80, you've paid in for only 5/8ths of your life.