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Original poster

Is NHS underfunding actually at root of COVID restrictions?

72 replies

Sleepdeprived42long · 19/12/2021 22:41

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??

OP posts:
Bebedoogoogle · 19/12/2021 23:28

@BungleandGeorge One company having the monopoly for the whole of the NHS is a terrible idea! Hell, why not just let the whole contract to Amazon! The NHS spent a lot of money on developing their own system 20 years ago and it was an absolute disaster.

The inefficiencies issue is now resolved. A lot of work has gone into what’s called ‘interoperability‘ and shared care records so not inefficient these days. Ie if you enter clinical data onto one system, it pulls together centrally and is available to view on another system.

Original poster
Sleepdeprived42long · 19/12/2021 23:29

I think one of my biggest concerns is that this feels like it could be the beginning of the end for the NHS as a public service Sad

OP posts:
BungleandGeorge · 19/12/2021 23:31

[quote Bebedoogoogle]@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).[/quote]
Yes I have a pretty good understanding of how the NHS works.
My response was directly to your appraisal of emisweb as you used that as an example. Your answer doesn’t seem to be about the points I raised?

Mouseonmychair · 19/12/2021 23:32

What about the German and Dutch health service are they underfunded too? They also have restrictions.

Bebedoogoogle · 19/12/2021 23:35

@BungleandGeorge I covered your point about Emis two posts above. It’s a moot point - as I explained the interoperability issue is being actively resolved across the system. Shared care records coming in soon (or already implemented). Of course there will still be gaps between systems but I think this issue will be sorted in 2-3 years.

Chessie678 · 19/12/2021 23:36

@vdbfamily
I think your post is helpful in understanding some of the issues but a lot of these problems sound solvable with sufficient resource or different choices. To lockdown the whole country because it's preferable to only have 4 patients to a bay seems crazy to me (appreciating that the staff don't have control over this). Equally, if we can put in place the logistics and funding required to move most of the economy and public services online, set up furlough, set up complicated and fast changing covid systems and rules, implement the vaccination programme etc, we should be able to set up some kind of temporary care system to discharge people to. I realise that the alternatives to the current system may not be easy or ideal but it has to be balanced with the harm of lockdowns.

vdbfamily · 19/12/2021 23:42

In our hospital/s, we don't need more beds, we need more staff to make all the beds useable. I am not sure how common this is. The problem with extra staff is what you do with them all when we don't have a pandemic with a large proportion of the workforce isolating. Assuming at some stage we get back to some sort of normal and stop all the testing of general population and staffing levels improve, yes we need some more staff but not as many as current absences. I manage a smallish team( about 20) and do not have any vacancies but on any one day would have several absences either Covid, track and traced, awaiting PCR results for runny nose, on top of general sick leave, training, holiday, emergencies etc. I don't need more staff but I do need those I have to be at work!!

BungleandGeorge · 19/12/2021 23:42

[quote Bebedoogoogle]@BungleandGeorge One company having the monopoly for the whole of the NHS is a terrible idea! Hell, why not just let the whole contract to Amazon! The NHS spent a lot of money on developing their own system 20 years ago and it was an absolute disaster.

The inefficiencies issue is now resolved. A lot of work has gone into what’s called ‘interoperability‘ and shared care records so not inefficient these days. Ie if you enter clinical data onto one system, it pulls together centrally and is available to view on another system.[/quote]
Doesn’t have to be a private contract does it?
The two systems have different functionality. Are you saying that when the patient notes are moved onto a different operating system you can view everything? That’s not actually the case… and still doesn’t resolve the issue of staff having to learn to use multiple systems.
Are you talking about the NHS solutions which were contracted out to private companies who then withdrew and were in breach of their contracts?

Bebedoogoogle · 19/12/2021 23:43

@Chessie678 Yep that’s what is happening right now - it’s called the Discharge to Assess programme. Running now across the country and undergoing evaluation. However problem arises when patients are too poorly to discharge and social care packages are not available (largely due to lack of resource).

Dr friend in hospital is getting pressure to discharge 3 patients a day, but all far too ill to leave. She has to constantly justify why they are still in a bed. They’re way too poorly to be leaving hospital.

BoredZelda · 19/12/2021 23:44

What does it matter? We are where we are with the NHS. We need to deal with it here and now.

BungleandGeorge · 19/12/2021 23:48

[quote Bebedoogoogle]@BungleandGeorge I covered your point about Emis two posts above. It’s a moot point - as I explained the interoperability issue is being actively resolved across the system. Shared care records coming in soon (or already implemented). Of course there will still be gaps between systems but I think this issue will be sorted in 2-3 years.[/quote]
Well it’s being resolved incredibly slowly. I’m not sure what you mean by ‘shares care records’? Shared by who? What part of the NHS has fully shared care records? Summary care records are shared widely yes but that’s a tiny fraction of the information held on all the different operating systems in pharmacies, hospitals, primary care. Are you saying in 2 years there will be one record fully accessed in all those settings?

Bebedoogoogle · 19/12/2021 23:50

@BungleandGeorge Not sure what point you’re trying to make about private sector? Any job these days you have to use multiple systems - that’s pretty normal! Modern workforce is expected to get to grips with different systems and training includes online/ practical peer support from colleagues.

It’s multiagency working which can be particularly challenging, when service users are logged across different systems. Ie coordinating info across NHS and LA systems, which don’t talk to each other.

Bebedoogoogle · 19/12/2021 23:53

^ for @BungleandGeorge for you to get up to speed on what’s happening Smile

MrsPsmalls · 19/12/2021 23:57

It is not just this tho. It's the number of staff of sick with covid and that number is doubling each day in my trust.

Definitelymaybenot · 20/12/2021 00:15

@MrsPsmalls Yes same in my Trust. We’re so worried about whole teams going down.

Staff told on Friday they don’t have to isolate if child/spouse has Covid. They come to work, wear a visor and mask. LFT daily.

We’re sending non clinical staff out as vaccinators (obviously they are being trained).

I think that tells you all you need to know about the situation.

It ain’t much to do with the structural issues which have been well explained by previous posters, or underfunding, which were being addressed until Covid took over. A lot of staff working on transformation projects, which will make the changes needed, have been redeployed to work on Covid projects over the past 2 years. Meaning we’re even further behind on sorting out the structural issues.

Come March, staff will be exhausted and the road to recovery will be a long one.

MrsPsmalls · 20/12/2021 01:17

Exactly. Just like our post isn't being delivered as so many posties are off sick, ambulance services are not able to staff shifts because staff have covid. This will get much worse over the next few weeks. If you need health care for whatever reason it will not be up to standard if staff are not available. The problem isn't so much patient admissions as staff away with covid.

BungleandGeorge · 20/12/2021 01:21

@Bebedoogoogle

^ for *@BungleandGeorge* for you to get up to speed on what’s happening Smile
Ok most of that was waffle but it appears that the areas for interoperability are nhs number, staff ID, medications messages (what even are medication messages?), appointment dates, basic observations, basic pathology, coding. Do you think that is all that is included in patient notes? This appears to be a slightly expanded version of a summary care record? So different organisations will be able to see a summary of some elements of care? This doesn’t allow one clinical system to map to another?
bumbleymummy · 20/12/2021 01:47

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.

Completely agree with you on this. It’s shocking how much money has been spent on covid response and yet we haven’t managed to increase hospital capacity - which would be beneficial for us all even beyond covid - particularly when we’re trying to get through the backlog.

workwoes123 · 20/12/2021 05:35

To answer your question, I don’t think that the state of the NHS per se is the cause of the restrictions. I’m in France, we have great healthcare which is nothing like the NHS - and we still have restrictions. I don’t think there is a healthcare system anywhere that hasn’t had its capacity tested and exceeded by the pandemic.

One way out of this will be to massively increase healthcare capacity, whether it’s the NHS model, private or somewhere in between.

RichTeaRichTea · 20/12/2021 05:55

I think even without the NHS being so severely underfunded there would have been some restrictions. But there is a world of difference between lockdowns and varying degrees of restrictions, all of which have varying knock-on effects and in themselves can result in long-lasting increased pressure on other services (including areas of the NHS beyond emergency and acute hospital care). There is a range of options in terms of restrictions, some crueller than others, and proper financial support for the consequences of those restrictions would have been a start. It’s not just the underfunding of the NHS but also social care/services and community support, underfunding schools and so on - these are all interlinked especially when we are trying to implement meaningful infection control measures.

It is also unacceptable that governments have allowed (or encouraged even) a situation where essential services are being run on exhausted and stressed staff who are just about holding it together out of a sense of duty and goodwill.

Nat6999 · 20/12/2021 06:02

The NHS wasn't prepared for a global pandemic, they do mock exercises for stuff like bombs dropping & ebola breaking out in a limited area but they have never planned for anything like this. There should have been a plan well before this started. Imagine if WW2 broke out & nobody had any idea of what military forces we needed & how they would feed & care for civilians? No air raid shelters, ARP, fire service etc, it would have been carnage, this is the health equivalent & there was no plan.

Tillyvonpantsalo · 20/12/2021 06:23

@BoredZelda

What does it matter? We are where we are with the NHS. We need to deal with it here and now.
I think it matters because historically pandemics happen and this will happen again, albeit not likely in our lifetime.

Yes, if small local hospitals hadn't been closed, services cut and recruitment and retention of staff has been a priority I believe we would have been in a better position.

We also need to take more responsibility for our own health.

CovidCorvid · 20/12/2021 07:06

@Bebedoogoogle

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!

We’ve always filled the training courses. Encouraging new entrants isn’t the current main issue. Retaining qualified staff is the main issue.

OP- I agree with you. A better funded nhs would be coping better and therefore we wouldn’t need the restrictions. They’ve had 2 years to at least have made a start with this. And there’s a lot which could have been done. More nurse apprentice schemes, training hcsw up to nursing associates, expanding degree numbers.

OverTheRubicon · 20/12/2021 07:11

Like others have said, restrictions have made it much worse.

But even with good staffing levels normally, 2 years is never going to be enough to turn things around - can't train new nurses and doctors, overseas ones would be less keen to move during a pandemic (and it's highly morally dodgy to drain poorer countries of their staff at this time), and to be fully staffed for a pandemic you'd be way overstaffed for normal times, and the NHS would make up an even higher percentage of govt spend.