Is NHS underfunding actually at root of COVID restrictions?

[Sleepdeprived42long]

From what I can gather, appears new variants are leading to less serious outcomes (inc death) than previous but the number of people infected is much greater due to increase in transmissibility. So seems to me the concern is the increase in number with COVID might lead to more hospitalisations, which might overwhelm the NHS.

The NHS is a public body. It can only provide what it is given funds to do. If the NHS cannot provide a service, it is because it has not been given adequate funds to do so. Perhaps the millions that were spent on furlough when infection numbers were low would have been better spent making sure that our rates of pay for NHS staff were competitive (to attract more staff and retain current) and making sure we had hospital facilities that could cope with an increase in demand, rather than only just manage (and many weren’t even able to do that) which I think is where many health trusts/boards were pre-COVID.

To be very clear, this is not a bashing of the NHS thread, the opposite in fact. Nor is it a political one. I’m just really struggling to see how we have ended up in this position where we seem to be facing more restrictions in due course, although we have had almost 2 years to properly prepare our NHS not to be overwhelmed??? Just me??

In the first lockdown we didn't know much about the virus and it was genuinely likely the NHS would be massively overwhelmed.

Right now if the talk is "even if omicron is really mild, the NHS could still be overwhelmed" which I think means we are going to be locked down because of ten years of chronic underfunding, and I'm not really into it

I agree with a lot of what you say, but it is a political issue - the Tories have been running the NHS into the ground by not funding it properly for years. So that when it all falls apart it can be sold off to the highest bidders in private healthcare - Virgin, Ramsay, Care UK etc, and American firms.

@HalfPastThree yeah that’s exactly how I feel. I mean first two lockdowns were somewhat understandable. We didn’t have the vaccine so the individual risk was greater. Now we have that, we literally have nothing else to defend ourselves with. We can’t restrict people’s liberties again for the sake of something (the NHS) which we should have been properly funding for years, and especially the last 2 years, for this exact eventually!

No, it’s not. You’re thinking of winter pressures.

The NHS needs wholesale transformation, which is well underway. See the Long term plan and integrated care systems if you’re interested. Digital health care is part of the solution, which will involve the NHS buying from the private sector.

Actually quite a bit of private contracts are coming back into the NHS. Very ill-informed to say it’s being run into the ground to be sold off. Not saying privatisation won’t happen but there is not a grand plan to run it into the ground. It’s creaking because it’s been bolted onto over the years and is being transformed- which is underway but will take years to reap the benefits.

@HDready I live in Scotland and I think our NHS boards are funded from the Scottish Govt (SNP). So I’m not sure if it’s quite as simple as being a political/Tory issue. Maybe a balance sheet problem-government have chosen to spend public funds elsewhere and now we’re seeing the consequences?!?

Ps there are a huge number of job vacancies across the NHS. That’s where a lot of pressure is coming from. Doesn’t help with finances as tend of rely on bank staff which is expensive.

So what we need is to train up and encourage new entrants into NHS. That’s a huge challenge and more solutions are needed.

The pandemic has actually attracted nurses- more people are training to be nurses than ever before which is great news!

@Bebedoogoogle your post worries me tbh because it suggests we haven’t learned from the often negative results of bringing private companies in to provide what was previously a public service. Private companies exist to be profitable. Public services do not have that bias.

Well, it clearly isn’t solely about NHS overcrowding, as the UK isn’t the only country imposing restrictions and lockdowns. Virtually no healthcare system out there is able to cope with thousands of daily admissions of an illness which takes a relatively long time to progress to death, meaning ill people block beds for longer.

*NHS underfunding, that should read.

@ComtesseDeSpair and yet I used to think of our NHS as being world leading, rather than world following!

Yes, we are being threatened with another lockdown because the tories have underfunded the NHS for the past ten years and it is more easily overwhelmed when inadequately resourced

@HalfPastThree

In the first lockdown we didn't know much about the virus and it was genuinely likely the NHS would be massively overwhelmed.

Right now if the talk is "even if omicron is really mild, the NHS could still be overwhelmed" which I think means we are going to be locked down because of ten years of chronic underfunding, and I'm not really into it

This with bells on. Almost everyone I know is vaccinated, many already boostered. We’ve never dropped our mask mandate here in Scotland and where I live compliance with it still appears high. Nobody I know is taking the piss. And yet we’re looking at another fucking lockdown.

@Sleepdeprived42long Well the NHS has let contracts to the private sector for decades. Along with charities, local government and a host of NHS organisations. The commissioning is pretty complex.

I think you’re oversimplifying things you don’t really know much about, saying you’re worried about digital activities being contracted out. The NHS would not be able to create what they need in house- they’re not a tech company they’re a healthcare system! Private sector already embedded with loads of IT. Always been like this and it’s not a bad thing.

Take Emis (the most widely used clinical / online consult system) which was actually started by NHS GPs and is a private company. They’re a very good and well run company. Not sure what the issue is? It’s heavily regulated and contracts are pored over (forget about all the Covid contracts, that is NOT normal).

Regardless, the NHS is one of the largest employers in the whole world. I don’t believe that will change in our lifetime.

Perhaps the millions that were spent on furlough when infection numbers were low would have been better spent making sure that our rates of pay for NHS staff were competitive (to attract more staff and retain current) and making sure we had hospital facilities that could cope with an increase in demand, rather than only just manage (and many weren’t even able to do that) which I think is where many health trusts/boards were pre-COVID.

This is exactly what I've been saying for ages, in theory - the only problem is, all that would take a fairly long time (time we didn't have). I do feel the government should have learned from it though, and done more than give nurses that measly pay rise last year. They need to make working in the nhs an attractive prospect by paying them well, and make it easy for overseas staff to come and work here so it isn't understaffed.
We have a hospital near us with facilities and wards that aren't being used, which seems ridiculous.
And what happened to that bloody extra 350 million quid on the side of the brexit bus?!

It’s not only about the NHS, having a lot of sick people at the same time would stop our society from functioning. From emergency services to shops, to bankers, to IT, to utilities, to haulage the list goes on. Too few workers able to work would have a major impact on everyone. Not to mention a lot are interrelated and can’t function without the others. We’ve had a taste of shortages and lack of power etc and it would be a lot worse..

If money wasn’t poured into furlough, the economy would have gone down the tubes. Whereas that money would have been quickly swallowed up by the healthcare system. Given the challenges in recruiting (which brexit has not helped) money will make very little difference right now.

Primary care (GPs)has been given lots of money, but it doesn’t help them meet demand as locums are thin on the ground.

It seems like the NHS is overwhelmed right now but there aren't actually all that many covid patients in hospital. There are 7,611 by the latest count and around 800 on ventilators. Now clearly that could go up very substantially over the next few weeks but we are currently talking about a tiny percentage of the population in hospital with covid and a small percentage of overall hospital beds. Just a few thousand extra beds would likely make a significant difference to our ability to deal with covid. I refuse to believe that given the huge human and economic cost of the alternative (lockdown), we couldn't have increased capacity by those few thousand beds in the last two years. Perhaps it would have been too difficult to find the staff but it's the fact that there doesn't even seem to have been a genuine attempt to do so which really bothers me. There are plenty of nurses not currently working in nursing or people from allied professions who might have been tempted back or being capable of being trained to be helpful if enough resource had been put into this. We could have taken staff from abroad with a sufficiently lucrative offer and attractive visa regime (though the ethics of that would be dubious right now). We could have made sure that patients who were ready to be discharged but had no care in place had that care available (that alone could have freed up 10% of beds at some points this year). There are loads of possibilities which could have been explored with sufficient political will and funding which may have helped at least a bit - but all the political will and funding has gone into locking the whole population up so that the NHS has these extra few thousand beds available. The government has been willing to spend billions on covid related policies but relatively tiny amounts on the NHS.

The NHS seems to be treated as fixed in its current capacity and structure. In future, the issue may not even be covid but an aging population who need more healthcare than they used to (which is increasingly likely the more we put our population through lockdowns in which their physical and mental health suffers).

We seem to be in a position where the price for often inadequate healthcare is giving up social interaction, education, hospitality, entertainment etc.

I should say that my experience of NHS staff has always been very positive but you can't have a health service which requires the whole population to live under lockdown in order to function (ironically becoming increasingly less healthy).

The problem with the NHS is more logistics with Covid. Patients need to be further assist so 6 bedded bays become 4 bedded if possible. In a normal bay of 6, if one tests positive for Covid, the other 5 have to be treated as if they might have Covid. If a patient comes in with Covid, or catches it in hospital, they cannot be discharged until they have finished isolating unless they are going home to live alone independently as care agencies will not support and cannot go to a care home or home to a vulnerable partner. This means many people are well enough to leave and cannot.
Now you add in the fact that staff are testing positive, or have children who are positive, or have been in contact with people and track and traced. Even if vaccinated and boostered, NHS staff still have to isolate, as to community carers and care home staff. So yes .. there was a shortage before but now the problem is greater as staff absences are very high. The staff who are not off are asked to work extra bank shifts, sometimes incentivised by bonus payments, but these staff will then be getting exhausted and more prone to catching bugs and the cycle continues.
The lack of staff in the community means that patients needing to leave hospital with support our needing rehab or a shirt stay residential need cannot leave as no staff in community either.
I am not convinced extra finding would exactly help much. We survive by cancelling elective surgery and using those wards and staff for other patients. Out -patient staff are redeployed to wards too.
So the hospital's are not full of very poorly Covid patients. Last week we had 2 Covid ITU patients across 2 hospitals plus a couple of wards of less poorly Covid patients, however, we had a pile up of patients in A&E corridor as no one can move out of hospital at present unless they are independent or have families who can care for them and that is not often the case, especially at Christmas when people have more important plans!!

@BungleandGeorge but these are the people that would be told to continue functioning because they meet the key worker category? Also many key workers I know, because of their job, have now already had COVID. And what about the impact of people not being able to go anywhere/do anything/ have children at home while also trying to work-that also has a huge impact on workplaces and the economy!

@Bebedoogoogle
Is it the most efficient option to have more than one clinical system used? Which aren’t particularly compatible with each other? And have to train all staff who work in different surgeries to use more than one system? Whilst the thing in the NHS is to have private companies bid for contracts is that truly the most efficient option?

@BungleandGeorge

What they said ^

That’s the point. This is crisis . Whereas the challenges the NHS faces are structural. Yep they don’t help. But they are not the root cause of this crisis... Covid is.

Structural issues are well known. We know what to do (again, read the Long term plan). Plans and actions are being worked on by an army of NHS managers and progress is being made. But it is long and slow because the NHS is a huge behemoth! Besides the money, it’s about getting the system right and we’ve a good idea of how to do that.

If you’re interested in truly understanding the challenges and solutions being worked on right now, I’d recommend heading over to the Heath Foundation and Kings Fund (start with the video explaining how the NHS works as it’s very complex and you need to understand that first).

@Bebedoogoogle - private sector isn’t always brilliant. PFI is v expensive in the long term. Now different hospital trusts have different e records systems: epic, lorenzo. No reason why nhs cannot employ IT and software developers who have worked in private/public sector. Some other public bodies have good IT interfaces - DVLA, .gov website.

[quote Sleepdeprived42long]@BungleandGeorge but these are the people that would be told to continue functioning because they meet the key worker category? Also many key workers I know, because of their job, have now already had COVID. And what about the impact of people not being able to go anywhere/do anything/ have children at home while also trying to work-that also has a huge impact on workplaces and the economy![/quote]
If people are unwell or have dependents unwell they can’t go out to work whether you designate them a keyworker or not. That’s the issue and you can get covid multiple times. It doesn’t take that many people to be off work to disrupt services.

You’re not wrong OP.

The NHS was routinely underfunded for decades. Over the same time, its scope got way too big, widening to include everything from orthodontics, counselling, sex change operations, mental health and weight loss etc etc. It didn’t have the money or staff to meet the demands on it. Even before covid I know someone who had to wait 18 months for urgent heart surgery (only receiving it when their category changed from ‘urgent’ to ‘emergency’).

We knew a pandemic was coming, it was well overdue. The NHS was not funded, or properly managed, to be in any shape to meet it.

The restrictions are also partly from government mismanagement of the crisis though. Compare Australia’s decision to close borders early and clear messaging about face masks, America’s early decision to vaccinate teens to stop spread at schools and hey even China’s willingness to lockdown properly instead of the half-assed lockdowns we have where half of society carries on as normal (our school was open at half capacity throughout all lockdowns).

Watch this space for the Government wriggling around to find a way to tell people it’s our fault when they lockdown… Despite the scientists saying that the population’s behaviour has been way better than they hoped for…

Anyway. Decades of terrible politicians = mismanagement as standard = a country and health service on their knees.

@vdbfamily I appreciate it’s not quite as simple, but none of the things you’ve mentioned there were unpredictable given what we already knew about COVID sup until this point and which we could have taken action (by funding ) to try to avoid? You know like attracting staff back, increasing bed capacity, improving post-hospital care provision etc