To think that no politician should talk about health services without acknowledging that we’ve lost half our acute hospital beds and half our district nursing services in 30 years?

[PermanentTemporary]

Those things matter a lot more than the exact funding model. And they sure matter more than how many people come to live in the UK.

Theres also the fact that the number of people aged over 85 has quadrupled in the same period.

Im an NHS staffer, and I believe in the NHS public funding model because I think it’s efficient (to me, about the last thing we need is a whole load of new insurance gatekeeping admin around going to see a doctor). But where the money comes from hardly matters compared to having enough GPs, enough District Nurses visiting people at home to keep an eye on them for GPs, and having some actual beds available for those GPs to admit people to. That, of course, and community services to discharge people to, so that the acute beds stay open.

I agree, we now have a messy, inconsistent mush mash of services which is costly to fund and administer.

District nurses don’t just keep an eye on people for GPs. They’re practitioners in their own right - often prescribers themselves - and rarely actually contact GPs at all. They’re practitioners who provide care and treatment to enable people to remain at home and are employed by NHS and not by GP practices

The numbers are dwindling as it can be a thankless job. Many people think district nurses no longer exist……..until they’re needed.

They can’t say they’re full like a ward can - the referrals just keep coming and the caseloads get bigger. As more and more GPs hand back parts of the contract they’re picking up more tasks. Practice nurses aren’t trained to do certain tasks as the practices won’t pay for the training so again district nurses aren’t expected to pick up that additional work too.

There needs to be a way to figure out staffing for an every changing and over stretched service

No I’m sorry, I didn’t mean to say it like that but that’s exactly how it came out so you’re right to correct me. District Nurses are experts in their own right. It’s also true that one of the things they can do is call it when there are signs that more is needed.

Whilst I don't necessarily disagree with your sentiment, if you think the NHS is efficient then it has no chance. The NHS is the most inefficient organisation I have ever worked with. From NHSE to the trusts themselves, it is vastly inefficient. Until we get an acknowledgement of that by the NHS themselves, we will continue to lose services. We are wasting billions of pounds on painfully poor operations and systems that should be spent on exactly the services you rightly point out that we have lost.

I’m one cog in the system so I don’t necessarily see the inefficiencies. I also work in stroke care which I think is pretty good, because the entire pathway is funded based on how we perform against the clock - I’m in a team that picks people up within 24 hours of discharge from hospital and sees them at home. We do things that I’ve seen people insist the NHS doesn’t do (admittedly basic stuff like all referrals and communications are electronic, using the national NHS secure platform for a proportion of therapy sessions which is excellent and useable even by people with communication and cognitive disabilities, AI for notes and meetings, deeply integrated with third sector provision). I would defend our pathway in terms of efficiency against a hell of a lot of private sector organisations (what are you referring to? Evri? BT?) The reason we have what we have in stroke care is due to medical leadership and research evidence on the impact of time on outcomes and because of national structures like NICE and the medical training deaneries. One of the major reasons we have the NHS is because care before it was not necessarily poor - it was very good in some areas, usually major cities - but because care was nonexistent in huge areas of the country. One of the things we would lose with a more fragmented model is any semblance of ability to even out care nationally. And no, I’m not claiming that care is evenly good everywhere, it certainly isn’t. That wouldn’t improve by breaking it up.

Theres also the fact that the number of people aged over 85 has quadrupled in the same period

Isn't this the biggest issue though, the changing demographics and the associated costs?

Thanks for introducing some evidence OP. In spite of it all the NHS still function better than the newspapers wound have us believe.

To some extent its been a victim of its own success.

It's mad isn't it, from 300,000 beds down to 160,000 since 1980.

Meanwhile the population has increased from 56 million to 69 million over the same period.

It doesn’t function well in my area. No mental health unit for over 65’s and no beds elsewhere, people sent over 100 miles away or left to manage without proper care and treatment. A&E like a war zone with people in Ambulances for hours, once in, left to sit on chairs in pain, vomiting, dying as there are no beds. This in a hospital that sold half the site 25 years ago to build houses.

That’s great to hear about your NHS pathway OP. The NHS, like the rest of the public sector, is only ever attacked in the media with the successes and good practice never mentioned. I’ve been shocked when I’ve heard from friends working in the private sector to learn about the levels of inefficiency, lack of clear processes, safety concerns, terrible HR practises etc etc - and all the while they maintain that the NHS and the Civil Service are the worst offenders. They don’t have a clue.

This demographic certainly matters hugely. I’m saying that a politician that talks about (generally younger, healthier) immigrants as ‘the problem’ re the NHS is ignoring the actual important demographics.

Moving care out of hospitals isnt all bad - I would say that, being part of a community service, though in my particular team we are run by the acute trust. I’m not saying we should necessarily have the same number of acute beds as in 1980. But the true core of the NHS - fundamentally GPs, actually- must have services available to them to take action for patients - I agree including mental health services. Right now GPs are investigated by the funding authorities every time they refer to secondary care, and an ‘urgent’ referral may well be rejected, even though the entire service should prick up its ears if an experienced GP is smelling something isn’t right. The reason all that happens is because the service is run at 100% efficiency, which ironically ends up with inefficient bedlam at A&E and loss of public trust.