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be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.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

@greencartbluecart Diabetes costs 10% of the NHS budget.

My neighbour has been diagnosed with type 2 diabetes recently, he is very overweight, late fifties. Well educated, has a decent well paid job. Pops off on cruises. My DH saw him a few roads away when he was popping in to a small corner shop. He was dumping loads of wine bottles in a public bin. I’m friendly with his wife he is obviously drinking behind her back making his condition worse. He isn’t stupid he knows full well what he is doing. I’m staying out of it.

I think you will find that things have changed in Spain in the last twenty years. Even in UK, the NHS was in a far better state than it is now.

My French friends tell me that their access to treatment has declined greatly in quality since Covid in particular.

One thing that I find particularly frustrating, is giving evidence based advice and a treatment plan, which the patient then refuses to engage with, resulting in often years of sub-optimal treatment at huge cost to the NHS.

I think prevention is often overlooked - I include the NHS in that. Infection control in hospitals, GPs etc is woeful, especially for airborne viruses. Patients shouldn’t be made more ill by attending healthcare, especially when there is little that is done for life changing impacts of poor infection control on them. Staff should have a safer workplace too.

I think many things take too long to diagnose or offer help with. How many posts on here do we see about people where it’s taken years to get a diagnosis for something that shouldn’t be that difficult. How many have had to fight for simple things like HRT or to have blood work properly looked at and responded to? One size fits all approach rather than looking at results that are abnormal for that individual. I’ve read posts of people desperate for mental health help too, but are offered little or nothing in between crisis mode and major crisis mode.
Patients with complex needs are often not looked at holistically.

Could I add that a lot of admin, hcas and portering staff will be earning under or around £13 an hour. Plus having parking costs deducted.

Oh God, not the parking costs again. As if no one else who works ever has to pay for parking.

No, it’s basically the NHS wasting money due to inefficiency and poor management. It needs reform.

Does it say P or POM on the box. If P you can buy if POM you can't.

The vast majority of people could buy ferrous sulphate, ferrous fumarate or ferrous gluconate at the pharmacy counter.

There are so many factors creating problems for the NHS Model: 1) aging population and underfunded social care (creates bed blocking as nowhere for the patients to go who aren't able to return to their homes); 2) Escalating costs of care with new medicines and machines, 3) Understaffing - Lack of places for newly qualified doctors, no longer bursaries for student nurses, Brexit meaning excellent healthcare staff from EU cannot help out; 4) Expectations and 5) difficulty in getting GP appointments mean people either rock up at A and E, or they leave the problem until it gets really bad and they need hospital. I don't believe health tourism is really an issue - it's a scapegoat created by the tabloid press.

I agree totally with your post 👏

I am 60 and healthwise not great but not bad . At this moment in time I have foot drop, unexplained weight loss (so seeing a Dietician now) and various other (non serious) issues.
I have always thought, from young, that those who are in pain, terminally Ill should be able to choose to be euthanised , as we would not let an animal suffer would we ? I still stick by that.
My own DM is 81 and fit as a fiddle, but she has always looked after herself..

I was just thinking about this while reading the thread. At the opposite end of the spectrum to the people living longer argument, very, very prem babies and those with multiple morbidities are now able to be kept alive due to huge advances in treatment. To support these children through life is hugely expensive and requires ongoing and permanent resources provided by the NHS and ancillary services. I believe that quality of life is paramount and wonder how this intensive support can be justified if the child has multiple disabilities, many of which are sensory and mean that said child has no awareness. Probably a very unpopular opinion on here but my own belief is that some babies are kept alive because they can be rather than that they should be.

I agree with this.
But the issue is, I suppose, how/who makes the decision if a life is worth fighting for?

Well I'm currently lounging in a private hospital, recovering from surgery by a high ranking private consultant, enjoying the privileges of a private room within said private hospital.

The NHS outsourced me to ease the waiting list, and they are footing the bill. I was waiting for 4.5yrs.

For me, I had to advocate strongly for myself against male GPs who noted that I'd had a child and so instantly wrote me off as just being postnatal. Which then meant I had to make more appointments for myself, taking up more time at my GP surgery, knowing that I had a problem, even though it wasn't being recognised, wasting their time and resources that could have been directed elsewhere and to other patients if I'd only just been respected enough to be listened to in the first place. The problem with the NHS isn't just at the very top, at management level.

There is an element of education, or lack thereof, down the line. There is gender stereotyping. There is an element of lack of staffing, recruitment and retention issues impacting on wait times and waiting lists. There is an element of Brexit contributing too is expect, and ridiculous expectations and data targets to meet.

I would argue it’s the minority of workers having their parking fees deducted from their already uncompetitive salaries.

People expect high levels of professionalism and efficiency from staff but when it comes down to paying fairly for it attitudes like yours are common.

People expect to much of the NHS and don't do enough for themselves. It shouldn't be providing weight loss meds/surgery or IVF. Those are your own problems. If it only treated chronic conditions and made people pay a few pounds to see a GP or clinician I think a lot of people will have far fewer health problems.
Mental health is also not under diagnosed....every adult that struggles with life suddenly has ADHD and wants to get onto a waiting list!

As medical advances at both beginning and end of life, now play a big part in NHS costs, I think financial contributions should be sought from Big Pharma and Big Medicaltech to help pay for them. Fat chance, I suppose.

If IVF is your own problem, does that mean any challenges or problems that arise from having children are also your own problem, along the same line of thinking?

My problem wasn't weightloss or IVF or cosmetic. Nor was it chronic. Mine was a problem that occurs naturally in both men and women, but in my case it was triggered by having a baby.

So we're back to that question - is it my responsibility because I chose to have children, even if it could have occured naturally as it does in so many others?

I think there is a very grey area here.

Why shouldnt they pay for an appointment cock up caused by them They are getting too much like the housing associations. No accountability.

Just because you dont want to believe the Broken Plate survey doesnt mean it isnt true.

if healthier food is cheaper why are hospitals and care homes serving UPF

Well it kinda does mean it isn't true. There are factually families up and down the country feeding their children healthy diets and spending nowhere near the amount that the Broken Plate report claims is required. Apparently their estimate is based on the government's Eat well Guide but this guide isn't prescriptive and doesn't state that fruits need to be expensive berries or that protein has to come from meat. The Broken Plate report has averaged food costs by category and then compared healthy and unhealthy food but it's obvious how this approach could skew the data. Lean mince costs more than full fat mince but if you have lentils or eggs instead of mince then that will be cheaper and fulfil the protein quota. A punnet of blueberries will be more expensive than a kitkat but a banana or apple will be cheaper. You certainly get less choice if you have less money but it absolutely doesn't have to cost 50% of your household income to eat healthily.

UPFs are generally cheaper, I never denied this but some non processed foods are super affordable. What is true though is that it often takes more effort to cook a healthy meal and this will be a massive factor for hospitals. They also have to cater for the masses and sadly most people eat processed diets whereas people will complain if you start giving them a quinoa salad even if it is cheaper to make than chicken nuggets at home, the cost of labour and people simply not liking the food needs to be factored in.

I do pay for my own weight loss meds and I am fine either way that. However, for someone who is developing health conditions because of their weight, weight loss meds may be the most cost effective option. If the weight loss meds lead to sufficient weight loss that diabetes and cardiovascular problems are substantially reduced that may save money. That’s the conclusion the NHS / NICE has come to.
Someone who is morbidly or severely obese maybe on diabetes medication, be vulnerable to sores and poor wound healing, have high blood pressure, sleep apnea, joint issues, circulation issues, fatty liver etc. The cost of having to treat that may be a lot more than weight loss meds especially over a few years.

It’s really is a complex picture.

That's not correct. The ones from supermarkets / health food shops are very low strength but you can buy prescription strength iron tablets from a pharmacy, either in store or online.

i see this a lot. And in theory you’re right, it should be achievable to eat healthily on a budget.

however. What a lot of people forget, and I didn’t realise until I was in that situation, is it’s not just about the food budget.

i had to move into a small apartment with my kids temporarily. Storage and cooking facilities have a massive impact.

no freezer, only an icebox in the fridge. Nowhere to store the affordable frozen veggies. Limited fridge and cupboard space, no where to store the big cheap bags of lentils and rice. Small preparation surface, no dishwasher. Cooker had one shelf. No ability to batch cook in large amounts, even if I had a freezer. If I got the slow cooker out there was no where to prepare the food. I had to do one thing, clean and wash up, rinse and repeat which meant I could never time dishes to be ready.

no transport to the supermarket. Which was useless anyway as nowhere to store a “big shop”. So it was pretty much daily trips to the Tesco extra. That’s not cheap. Add in the fact I worked full time meant we ate more takeaway than I’d have liked, but I could pick something up on the way home, no washing up and no trying to cook.

Apples do cost the same as a chocolate bar. But they go off relatively quickly. You can’t have a choice of fruit and veg lying around because there’s no fridge or counter space and it goes off. So again, it’s off to Tesco everyday for a couple of apples after a day at work. Chocolate is smaller and keeps for ages.

so yes, lentils and frozen veggies are cheap and nutritious. But if your budget is that low it’s likely you don’t have a big spacious kitchen and a chest freezer in your non existent garage.

People expect to much of the NHS and don't do enough for themselves.

@hellhavenofury35 I see this a lot with people who either don't wash and apply cream to their own legs or if they are unable to, won't pay for carers to do it.
So they develop new ulcers because of course they also won't elevate their legs or wear the hosiery provided by the NHS.
Each time they inevitably develop a new leg ulcer we have to go through the whole rigmarole of treating it for months on end, finally healing it and discharging them, only to know they will be back on the books in weeks because they refuse to follow the simple preventative advice.

It costs the NHS £3.1billion each year, just to treat leg ulcers.

It would help if their appointments weren't so scattergun. I'm undergoing a load of pre op stuff in a hospital 50 miles from me. The first one got cancelled at last minute (I was about to get on the train!) because of staff illness. Ok, can't be helped but I lost £25. Next day, consultant phones with, as it turns out, a very abbreviated version of what my op involved & gives me date for the op which involved me cancelling my holiday. On Monday, the physio rings me with a prewritten script about being as fit as poss for surgery - I am not the fat, kebab munching alcoholic she imagined me to be but my views were of no interest to her. She also said my op wouldn't be on the site where I might be expecting it to be.
Yesterday, I attended the rearranged pre op appointment & got told a whole load of slightly different things including the fact that the date I was given isn't likely to stick as it's only 'pencilled in'. Great.
Today, I get another pre op appointment for two weeks after the date I was given so now I don't know when I''m having the op. This is a cancer situation; what's the point of patting me on the head & telling me 'not to worry' & 'keep healthy, don't think of yourself as ill' while they appear to be going out of their way to make me feel as anxious as possible?
I had all this last year as well. I really don't think I'm being entitled or too demanding. I just want clarity.
Rant over.