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be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.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

What is the European model?

Even better would be the ability to self-refer directly to physio when it's blatantly obvious that it's the right treatment for a shoulder pain in the first instance. Why waste GP time. We don't need a GP referral for spectacles or dentists.

Because in the time the patient is sitting there leafing through their diary and then calling their friend to see whether they can give them a lift that day, the GP could have seen another patient or two!

There may be a more efficient system than the current one but to change it to something better will require investment ie Money!

True I think you can self refer actually in some trusts. It was an example but I think there would be better ones I could have used. The gist is there though... Ha!

Amen to this.

Don’t get me wrong I know that poverty drives many bad choices - although not everyone who is poor and stressed makes those choices

i am more mad at a society that leads people to those choices

and I am very mad at people who “blame” older people and bring out hateful remarks because old people can’t help being old either but that’s ok to hate them and it seems people would like them Al to kill tejmselves rather than be a burden - so that other people can be a burdon

rhe focus should be on stopping anyone drom
being a burden and not picking on the old - my mother costs the nhs a lot less than many people half her age

I don't agree. Of course life isn't equal. Even someone sat in a lovely home in a leafy idyll can be going through hell. The assumption that money is the great divider is wrong. Trauma and hardship doesn't discriminate. Money can take the edge of some things but so can having a great support network or experiencing a stable childhood that has equipped you well for adult life. We are all dealt different hands.

It is completely wrong though to lean into the victim mentality associated with this. Just because someone is poor it doesn't mean they have to smoke an expensive cigarette to feel better. I come from a deprived area and yes there were more unhealthy choices being made but there were also people doing the opposite. It is totally possible. My mum would give us an apple instead of a cheap chocolate bar but we seldom had expensive fruit. We would have veg with every meal etc. It really really is possible!

And don’t get me started on the international students who sign up for mickey mouse degrees only to rock up to the NHS with a new diagnosis of a certain disease that needs expensive treatment like cancer etc.

Not to mention the bed blockers who “won’t budge” from their hospital bed as during their admission they have become homeless. The homelessness then becomes the NHS’ problem
to find them a lovely new flat in an expensive part of central London.

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@Bumpitybumper I would never make light of your experience. It's hard and you have my empathy, but none of us can speak for a.n.other (unless there is no capacity). Just because there is a severe lack in excellent, caring, empathetic palliative care, too many folk want to throw the baby out with the bath water.

However, I wasn't being sarcastic. It's the potential towards I can foresee things going if we were to follow the thinking of the opening poster. I would be being wryly cynical if I were to say one easy quick-win way of dealing with the expense of piss-poor self-serving expensive managers would be to save money by killing off the elderly, infirm, disabled ... rather than deal with the real issues.

https://news.sky.com/story/poorest-fifth-of-uk-would-need-to-spend-45-of-disposable-income-to-afford-healthy-diet-13298853

The poorest fifth of the UK would need to spend almost half their disposable income on food to achieve the government's recommended healthy diet, a new report has found.
It comes alongside a warning that healthier food is getting more expensive at twice the rate of less healthy options, with food that is lower in fat, salt and sugar now twice as expensive per calorie as its less nutritious counterparts.

It means the most deprived fifth of the population would need to spend 45% of their disposable income on food to achieve a government-recommended healthy diet.
This rose to 70% of disposable income for those in households with children.

Yes, we know the situation with the cost of healthier food, now. What someone's parents did decades ago tells us nothing at all about 2025.

Don't blame the ageing population, they have been here 60/70 years and the NHS knew they were here and would age, the NHS never prepared many years ago as they should have.
I't not fit for purpose and we need to change it to something like the rest of Europe.

It’s not about blaming older people or wanting to bump them off. It’s about accepting that the aged body can’t do what it used to do, and not all ills are easily fixed. Two of my elderly relatives are very sensible and accepting. They pace themselves and know that some things are no longer manageable. The other three carry on to and fro the doctor, being investigated for all sorts of things, one refusing treatment because she doesn’t believe in it, another being in and out of hospital because of his own behaviour, but refusing residential care. None of them getting better because… old age.

The assisted dying bill suggests to me that half of us are determined to avoid all indignity and suffering, the other half determined to never let go no matter what!

• Don't blame the ageing population, they have been here 60/70 years and the NHS knew they were here and would age, the NHS never prepared many years ago as they should have. I't not fit for purpose and we need to change it to something like the rest of Europe.*

This makes no sense! Whether the gov did anything or not it's still due to an ageing population.

I lived in Spain for 7 years 2000-2007

Phenomenal healthcare over there, great system. Kids don’t even see GPs only Paediatricians.

Dentistry was another kettle of fish all
private- but health service was amazing.

After nearly forty years my blood runs NHS blue, but whilst I am deeply loyal to it and skeptical of suggestions to follow some other models, we really do need to stop putting it on a pedestal. It’s a service that is funded by taxpayers and it either does less or we pay more.

However you are correct OP about managers.
Managers make up 2% of the NHS workforce.
Outside the NHS managers, directors and senior officials make up 9% of the workforce.
About a third of those managers are also clinicians, completing clinical sessions.

@Fortheloveofgodwhy most won't have paid even enough for their state pension. And that doesn't matter & is quite usual. The changing demographics make it a huge issue.

What about rugby players and mountaineers ? They are making potentially life changing choices due to injury for a hobby ?

It isn't throwing the baby out with the bath water. It's about respecting people's wishes. Some people view life and death very differently than others. I think it's totally possible for someone to feel that they've had a good innings but they want to stop now. That all that lies before then is pain, decline and ultimately a scary and largely uncontrolled road towards death. People want to skip that bit of life and that should be fine. I think of a condition like dementia and can honestly totally understand why people just don't want to go through it. To force someone to do so and fund this extremely expensive care with money that could be spent elsewhere on actually saving lives or even prolonging the life of someone that actually wants to live is bonkers.

If the NHS had the best management ever, we still wouldn't be able to afford to do everything that people feel the NHS should do. That is just the reality of running a healthcare system with increasingly expensive technology, drugs and skilled people and an ageing, sicker population. We can't have everything no matter how much you target management efficiencies. Something meaningful has to give. Keeping people alive against their will in this context is ethically and financially absurd.

I agree with this. A tagential issue is that I'm paying for pensions, for the current retirees, and I won't be able claim the same benefit. Ditto the services of the NHS.

This isn't strictly true. Whilst the old people have been alive a long time, it wasn't obvious when they were young adults that they essentially were going to be a huge bulge generation and that birth rates were going to drop off a cliff. What this meant is that baby boomers paid for the (much smaller) generation before them with their tax contributions. Easy peasy as there were lots more baby boomers than people in the Silent Generation etc so there was essentially a lot of people carrying a relatively small burden. Now the population pyramid is top heavy though and there is a huge burden placed on a shrinking working population. Really Baby Boomers should have paid more tax all along but this would have been a very bold move politically and you can't blame the old people themselves for not doing this.

I also have to take issue with the assumption all over this thread that if you take care of yourself you will not be frail in your old age.

@Katypp this is an odd new narrative. A lot also seem to think a healthy lifestyle means no cancer or chronic disease, unfortunately not.

And even apparently fit healthy people over the age of about 80 usually do have several diagnosed conditions and medications.

I have a relative of 85 who lives independently and is active with a good quality of life, but they have medications for blood pressure, statins, osteoporosis, certain prescription strength supplements for a chronic condition. They have in the past few years had bone scans and orthopedic treatment for a fall.

This is a person who is remarked upon for how fit and healthy they appear and how much they can do for their age.

No matter how well you look after yourself, you probably will need quite a bit of medical help after 80.

@Bumpitybumper Our experiences and views clearly differ, except, it seems, on the agreement of "respecting people’s wishes." My wish is not to legalise euthanasia, but to ensure every person receives the dignity of excellent palliative care. Your wish, on the other hand, appears to disregard that entirely, favouring what is ultimately the quicker, cheaper, and more convenient option: ending life. To me, that is the very definition of throwing the baby out with the bathwater.

Yes, I acknowledge that your approach might save money. But let’s be honest - this is about budgets, spreadsheets, algorithms, and tick-boxes. Efficiency over empathy. Convenience over compassion. All of it dressed up as "choice," when in reality, it's life itself that's being devalued.

@Almostwelsh plenty of my older relatives are fighting fit according to their GP & they are in great shape. But they are all on a plethora of drugs!