NHS is finished

[Tulipsroses]

My experience with NHS is patchy. The maternity hospitals were good but some diagnostics I had to do were a nightmare. At one point I found it easier to fly abroad to do a biopsy because NHS would not do it and private clinic would charge a fortune.

I read about NHS horror stories and I can't stop thinking why on earth it's not abolished by now. It is clearly not sustainable. It's a black hole where you damp more money every year and the outcome is predictably worse.

If I was to design a health service I would have diagnostics and general health completely private with set maximum prices and no barrier to competition. I would subsidize medical degrees to make them free and remove the number limits on them so there are more doctors trained.
I would encourage people to have as many early diagnostics as possible.
What's your thoughts?

Has everyone forgotten covid. Waiting lists exploded directly after lockdowns because routine health care was suspended and it was a covid only service.

All of you lot were happy as you got a chance to be furloughed and bake banana bread.

This is the result.

We were the only country to suspend routine health care and I'm not sure what you all thought would happen. Not so dramatic as the country declining- you close essential services then there is a backlog on top of those coming now.

Most people get unwell in their 70s. Even people who aren’t obese. In fact population studies suggest it’s better to be upper end and slightly overweight in terms of BMI if you want to love a long time. But still expect 10-20 years of I’ll health

Most people get unwell in their 70s. Even people who aren’t obese. In fact population studies suggest it’s better to be upper end and slightly overweight in terms of BMI if you want to love a long time. But still expect 10-20 years of I’ll health

Depends how you define ill health. I'm 70 next year, on medication for high BP (under control) and a blood cancer (also under control). I see the practice nurse once a year to check the former and my oncologist every 3 months to check the medication is working as they want. I haven't seen a GP since 2018 because apart from the foregoing, I've no issues apart from sinusitis. There are plenty of MNetters who post about their fit as a fiddle parents in their 70s and 80s, as well. I not going to be sitting around expecting ill health as inevitable.

Nominal charge for all prescriptions despite job status/health stays/disability etc.. something like £2.

Charge for missed GP/ hospital appointments, no exceptions.

Self help education in community groups/colleges/churches etc

Free education for nurses and doctors and other AHPs

DS has just had a shoulder repair - privately. He was not in pain or debilitated by the problem but it was causing problems when playing sport. Longterm it would have deteriorated and probably he would have developed arthritic damage and needed a shoulder replacement in his 40d or 50s.
Fortunately we had the funds to go privately and going forward I will pay for health insurance for him until he finishes uni when he can pay for cover himself.

Having worked for the NHS for 35+ years we have seen this coming. I have always had a health savings account. Money stashed away for health issues. In the old days professional courtesy meant that as a front line worker you were bumped up waiting lists. It makes sense to treat HCP quickly since it costs the NHS a lot of money to cover longterm sickness.

Unfortunately all procedures are now coded and consultants no longer have any control over their own lists. I now work in the private side so I’m able to clinically prioritise based on common sense rather than managerial protocol.

As we have discovered during Covid the GPs are key to access. They effectively closed down over the pandemic and have adopted an online/telephone system of medicine. You cannot replace hands-on, face to face medicine. When someone rings up with back pain it could be a twinge or full on disabling acute pain. Pain is subjective and the twinge patient may describe their pain as much more severe than the patient who has a serious disc problem. Both patients may end up with the same pathway, the twinge patient being referred for MRI and orthopaedic consult when a course of anti inflammatories would have been more appropriate. The only way to see which patients needs the referral is to examine them.

Both DH and I have had the best treatment from secondary NHS (hospital) but the follow up from primary care has been scant and frankly negligent at times. DH had a stroke 18mnths ago. He has had no interaction with his GP since his discharge. He has a yearly check now he is on blood pressure drugs but no follow up with regard to his stroke since the stroke unit discharged him. Fortunately, as an HCP I can check his blood pressure and monitor his general health but I’m no expert with post stroke victims.

I don’t blame the GPs they are working in a system where maintaining a relationship with their patients is strongly discouraged. Many younger GPs haven’t grown up in the old system of cradle to grave so are unaware of how useful it is to “know” your patients. I work in dentistry where some of my patients have been seeing me since I started in practice. You instinctively pick up on changes to their health when you see them every 6 months. With the current GP model you rarely see the same GP twice so it can be frustrating when you have to explain your full history each time. In addition the process you have to go through puts people off, if they are trying to book an appointment with a random GP it is easier and quicker to go to A&E.

Wes Streeting was in Australia this week. They spend LESS per person than the UK, and have better outcomes. Their new Labour government had to force through measures, against their BMA equivalent, to improve the service, and it has. I wonder whether Wes will have the balls to do the same here. Interestingly, clinical hubs was an idea tested by our own previous Labour government way back when, along with the proposed increase of medical places, both of which were stopped by the BMA. We would have been in a much better place now, if those reforms had been implemented.

Exactly, how did people think ill people would get treatment when hospitals etc were basically closed to anything but covid? It was inevitable that the waiting lists would double or treble. Add in to that the people who "could" have been treated more easily/cheaply had they had access to medical care sooner, whose conditions ended up more seriously and requiring longer hospital stays, more drugs, more operations, etc.

What an absolute load of shit.

Like the way the BMA voted against increasing the number of medical students and against the opening of new medical schools!

@Angrymum22

I don’t blame the GPs they are working in a system where maintaining a relationship with their patients is strongly discouraged.

I agree about lack of longer term relationships, but GP surgeries are usually owned by GPs so they have the power to decide whether to use the model of a different HCP each visit or try to provide continuity.

I've had T2 diabetes for 25 years. For the first 10 years or so, I had continuity from specialist diabetic nurses for several years at a time. That included "face to face" appointments and the continuity helped me to control levels etc. For the next 10 years, it's someone different every year, ask the same questions but don't seem to listen to the answers except for tapping away in the computer, and offer no real advice and just regularly increasing the drug dose.

Covid made it worse. Never "see" anyone anymore. Called in for blood test with a random HCA. A few days later, get a text saying something like "bloods were OK, just carry on", and that's it. Saw a real GP in person a few weeks ago for something else, and I asked for the HBA1C readings as I've not been told for 5 years. He looked them up on the computer, and gave me the readings, which were very high, far higher than I was used to and far higher than recommended levels. He said it needed urgent attention and he'd get "a colleague" to contact me. That "colleague" is another random practice nurse (I asked, she's not a diabetic specialist), another phone consultation, who just glibly said to have 2 tablets in the morning instead of 1. I asked if they wanted another blood test (which is usual when drug doses are changed), but she said no. I asked about a follow up, and she just glibly said wait till the next annual review next Summer!

No one seems to care anymore, there's no continuity and the GPs are far too keen to fob you off, often to other practice staff who may or may not know what they're doing.

*Has everyone forgotten covid. Waiting lists exploded directly after lockdowns because routine health care was suspended and it was a covid only service.

All of you lot were happy as you got a chance to be furloughed and bake banana bread*

I was furloughed because due to WFH, wholly inadequate equipment and managers who were beyond useless my MH was taking a battering. And I haven't baked banana bread for years.

I'm a practice nurse. Our two diabetic specialist nurses retired. My PN colleague is going next year and myself the year after. We advertise but can't recruit anyone with any experience. We now have pharmacists doing asthma reviews after a one day online course. The last newcomer we planned to train up lasted six months.
The ticking time bomb in primary care is not just with GP's on countdown to go. People have no idea.

People take the piss out of anything they perceive as 'free' including the NHS. Nearly 8 million hospital appointments are missed each year at a cost of £30 each. As a nation 60% of people are fat/obese, generally massively unfit and aging to boot. Hardly surprising the whole system is under massive stress. Treating the NHS as a some sacred cow and the 'envy' of the world despite no other healthcare system adopting it is unhelpful as well. It needs reform but the usual suspects throw their toys out of the pram thinking the only alternative is a US style system as opposed to a French or German part public funding/insurance based system that has way better outcomes.

Nearly 8 million hospital appointments are missed each year at a cost of ....

is that really a fair description, though. Don't the staff take the chance to nip to the loo, get a cuppa, complete some paperwork, tidy a pile of equipment, call in the next patient who is already waiting, go home 5 minutes early from a day that is already exploitively too long. I don't think the staff sit around idly browsing Instagram on NHS pay. The admin side is so automated that there is very trivial waste there. So There is very little genuine waste of time or resources. Am I wrong?

Th French spend more per capita than the UK.

And anyway, there is no conversation happening - it’s not politically advantageous for any party.

The current lot are only interested in ushering in the US system, which can happen (and is happening) without them doing anything at all other than denigrating, starving and mis-managing the NHS.

But it’s not just delays in treatment people are unhappy with. It’s about the NHS generally. The care you get from your GP has nothing to do with Covid, other than GP’s enjoyed not actually having to see patients face to face, and many have continued with that. I don’t get that 30 years ago I could ring my GP, and get through straight away (no answerphone or recorded messages), whereas now I try to call, and am put in a queue, and still waiting on the phone an hour later. Hospitals are even worse. I didn’t used to have much of an opinion on it 2 years ago, as never really had to use it. However, in the last twelve months we have had three hospitalisations of family members, two resulting in death, and one where he is at home now, having had a stroke, and God knows what would have happened to him if he didn’t have family. Just absolutely chaotic treatment in hospital, and zero aftercare or follow up, which was promised before discharge. One of the deaths - elderly mil was on a trolley in A&E for five hours, and then moved to resuscitation room (she wasn’t for resus) where she died two hours later - couldn’t find a bed for her despite telling us she was going to die. We had to sit with her during her last hours with chaos around us. The NHS isn’t fit for use.

You are wrong as in it is 8 million appointments missed by the public, not staff.

I understood that. It's the public who didn't turn up.
Those 8 million patients who "missed" led to the staff catching up on their other work, is my suspicion. Not "the staff sat around doing nothing and no benefits happened to any other patients either". The staff are so overworked but conscientious (mostly, caring types do caring jobs) and the work is never ending, so the staff don't do "nothing". They don't scroll Instagram for 10 minutes because a patient didn't turn up.

If all 8 million had turned up the staff would be even more crazy overworked than they are. Those 8 million slots gave some breathing space to stop the staff burning out completely. I suspect. Would be interesting to hear someone clinically qualified comment.

There's net loss & waste in admin to make appointments happen that didn't happen, that's true. But I suspect with modern admin methods, that admin waste part is quite small.

I wonder how many of the "didn't turn up", escalate to a worse condition because they weren't seen the first time they had an appt. I bet it's unusual.

It's very tempting though. Our DD was suddenly taken very ill in Prague earlier this year. It was a Friday night but her ambulance arrived in 7 minutes. Within an hour of arriving at hospital she had been seen by a doctor & consultant and had an ultra sound scan + bloods. While waiting for results she was put to bed in an immaculately clean and quiet ward. One of the nurses even had time to sit with her and reassure her (DD only 19 and very stressed). Results came back within 2 hours, the doctor spoke to me on the phone and I flew out the next morning.

My flight cost £65 and DD's ambulance + hospital stay + tests came to £375. For the efficiency and level of care it would have been a bargain at three times the price.

For the efficiency and level of care it would have been a bargain at three times the price.

This. The European system gives those that can afford it the opportunity to access private-level care at affordable prices.

in France for 15 years, we haven’t really used the fully public service (ie pretty much free at delivery) at all. But the semi-private services we have used are nothing like the cost of private in the UK. It’s an absolute bargain. DH had an elective op recently, not a hip replacement but similar, with a 4 night stay in hospital. He had:

Private surgeon to do the diagnosis, operate and follow up. All rdv at mutually convenient time (booked online) and no waiting time. When they decided to do the op, he and the surgeon basically got their diaries out and chose a date a couple of months away that was mutually convenient, and fitted around DHs work. If he’d wanted, DH could have had the op within a couple of weeks.

Choice of hospital: private hospital literally round the corner from us in the city centre
Private room for 4 nights, including all meals, care, private bathroom etc.
General anaesthetic.
Ambulance taxi to bring him home and get him settled.
Once home: all pain relief and medical supplies delivered directly to our home. 3 weeks of follow-up nurses visiting up to three times a day to give pain relief, check the wound and change dressings etc.

In total we were probably about €800 out of pocket for all of the above, with all the other costs being reimbursed. This was an absolute bargain for the level of service, convenience, level of care that he received.

Meanwhile my dad is in the UK, where he’s now been waiting more than two years for a knee replacement. Sitting there, waiting for letters / appointments to eventually arrive, getting less and less mobile. If he wanted to go private he’d be looking at £15,000, no reimbursement.

Funnily enough, that $800EUR is almost exactly the amount that France spends more, per person, per year, than the UK.

I'll keep repeating it over and over.

We don't spend very much on health in tis country. Our outcomes are in line with the amount we spend. We can afford to spend more.