Suggestions for an ailing NHS?

[WideWebWitch]

OK, following on from the state vs private health thread and the 'solving the crisis in state education' thread I thought I'd start a similar 'solving the crisis' thread for health, since Woozle asked me to.

I can see why people are seduced by private health care when the NHS service is terrible and treatment often depends on postcodes. For example, I couldn't have an NHS nuchal fold scan here but could have had I lived 50 miles away in the next health authority. As has been said elsewhere, the NHS doesn't have the facility to take money to perform this scan, had I wanted to pay them rather than a private clinic, so I paid a private clinic. I know, ideally I wouldn't have to pay anyone, I do agree. (Gilli, I did take your point on the other thread too, thanks for that).

So, any suggestions for improving the NHS? This isn't meant to be a thread for arguing about private vs NHS though - for that see the other thread under Health.

Hope you don't mind if I correct some inaccuracies about nurse education.
Nursing is not a degree level only entry profession. You study to diploma or degree level.
The basic educational requirements to get on a nursing course are 5 GCSEs. Obviously, if a college has more applicants than places they probably take those with more than the basic requirements.

For the last 15 or so years students have been supernumary so more students does not equal more staff on the ward.

Ooh, I've got no suggestions, but wanted to say something about preventative healthcare (which Lucy123 claims costs money in the long run). Most US health insurance companies believe it saves money in the long run. For mine, all well-being (ie just going into the doctor once a year for a quick look, pap smear, blood work-up and whatever else) visits are covered at 100%. This includes all of my sons' visits, also, according to the recommendations of the American Academy of Pediatrics. My dental insurance starts not covering things if I don't go to the dentist for a check-up and cleaning regularly. My mom had colon cancer, picked up during a regular check and had surgery -- but didn't need to have chemo/radiation therapy (v expensive) because they had caught it so early. And Group B Strep was picked up during a routine check while I was pregnant with my first son, so action was taken there. (If he had gotten it, it would have cost them a lot of money.) Anyway, I'm not trying to argue about the UK vs US, just wanted to point out that preventative health care can save money in the long run.

Suedonim, that's so funny about your son and I've heard other Brits who go to the US say it as well. The American expats I've known don't like the NHS. My working theory is that the system you're used to dealing with (especially its failures, eg I'm confident dealing with recalcitrant insurance companies, but the receptionist at the local NHS clinic nearly had me in tears) is the system you're most comfortable with. Y'know what I mean?

That's what I mean verona- student nurses aren't on the wards very often now- and when they are they are doing things like case studies. Pre project 2000 the training was mainly ward bases so there were more on the wards.

Have to disagree with you jimjams. Students spend a good part of their training in placements. Being supernumary means they can't be included in the numbers which protects them from being used as slave labour.
I can't recall doing case studies personally

Yes, Ikwym, JJ! I think DS was smarting at the time from having to fork out $25 to get an eye infection treated.

Also his MIL works for a charity and has dealt with cases where she's had to try to find free cancer treatment for patients because they have no other access to medical care. But then, is that any worse than waiting 18 weeks for NHS treatment, by which time it's too late anyway? I guess it boils down to 'better the devil you know'.

JJ I did say that preventative healthcare saves money, but I wasn't aware that US insurers were so pro-active in this area.

Shame not everyone has health insurance - and for the uninsured, preventative healthcare is less easy to come by in a private/insurance system.

(the comment was actually based on UK dentists. Some do a lot of preventative work on children, but others don't and why should they? they'll be losing out on lots of nice paid treatment in the long run).

lucy123, I am the queen of misreading things. You think I'd have learned the proper way by now but noooo..... Sorry about that. Yes, private health insurers are very pro-active (at least from what I've seen) in the preventative medicine department. It's in their best financial interest! And finances are what matter. (You'll have to imagine me writing that in a very cynical tone...)

Anyway, yes, the US system, as a whole, has a grand total of no safety net. A huge amount of people have no insurance and therefore effectively no healthcare. I'm not arguing for it. I was just trying to push the preventative healthcare idea.

Now I've got all these ideas for healthcare in the US...

Just a quick (and controversial) contribution to the debate.

There are a lot of procedures undertaken now that are, strictly speaking, unnecessary. I think these should be paid for. (or part paid for, according to circumstances).

Examples - (I am ducking now - in fact I've disappeared altogether) IVF, sex changes, cosmetic surgery (except when necessitated by accidents etc.).

Also, appreciating the fact that surgeons need to perform new procedures etc. in order to improve their skills and understand if a certain procedure is going to prove a success, I think expensive solutions to problems which can already be to some degree solved, should be limited.

And also (I'm never coming back you know!) expensive operations should not be performed on people with limited life expectancy.

ho ho - stunned you all into submission; actually first of all I thought tech must have deleted my post because of the lack of reponse. Or am I being shunned because of my smelly children

Isn't a lot of cosmetic surgery done privately anyway?

how could u put sex changes in the same bracket as cosmetic surgery? its not exactly for social reasons but gender reassignment is a complex psychological and surgical series not undertaken lightly. Cosmetic surgery is rarely free, plastic surgery may be obtained on the NHs under strictly defined protocols. And as part of an infertile couple, why is contraception free and IVF charged for?

judetheobscure I agree with some of the points you raised.
sex changes- It is there choice to change sexes so I think it should be means tested where they can contribute to the cost of the hormones and ops.
cosmetic surgery-as carriemac said it is done under strict criteria
IVF-I do not agree. I believe that is every human beings right to have a child(except for child molesters/child murderers just before any one mentions it)It is not that persons fault if they are infertile or having probs conceiving. This treatment should be free and readily available.
limited life expectancy-to a point.I feel ,that it is unfair to give an alcoholic a new liver, a smoker new lungs to keep them alive when they are just going to carry on, if there was effort of quitting before ops then I feel it necessary to operate.(I am a smoker myself)
My ds2 had a limited life expectancy at birth he has had 1 op so he can be fed.He is 6 now and proved them wrong so on this point regarding children I feel they deserve every opportunity to live life to its fullest.
I have never heard OAP's getting operations so I cant comment on that point.

Other people points I would like to mention, I totally agree with Zoe. the missed appts etc costs money. The basic self help too. My friend makes an appt at the docs for the slightest sneeze and I am not joking. Her youngest is 14.To me that is a total waste where genuinely sick people have to wait up to 3 days for an appointment. i do all of the care for my son. I have been offered respite, social worker etc My reply is that he is my son I will look after him.
reversals- I would just like to say that I think these should be paid for by the patient as it shouldnt be down to the tax payer if they want more children.
budget- I thought gordon brown was off his head when saying that OAP's would still be entitled to their benefits up to one year staying in hospital.Before you all get on my back I know they deserve their pensions but they will in effect be living keep free.This will take up alot of beds as they wont want to go home. Nice little savings at the end of a hospital stay aswell.

Anyone got any opinions!!!!!!!!!

Re IVF: I don't think it is everyone's "right" to have children. I would like the money spent on IVF to be channelled into caring for neglected children - giving all those children in "care" a proper home. I think IVF has unfortunately reduced the numbers of prospective adopters.

Re sex changes and cosmetic surgery: yes of course these are very complex issues. However, I don't think they are conditions for which expensive surgical procedures are the solution.

The trouble is people know these solutions are available and expect to be given them.

hmmm. Think I would be the complete opposite to you, Doormat.

I don't think IVF should be free on the NHS for the same reasons as judetheobscure - why should public money be spent on helping couples determined to have their own children when there is so little help available for many existing children? Everybody should have the right to IVF, but they should pay for it (after all, it's quite a small cost compared to the total cost of bringing up a child).

Cosmetic surgery should also not be free except in special circumstances. As far as I am aware, though it isn't free in the vast majority of cases.

Sex changes, though, are another thing. People do not have sex changes on a whim as if it were any other "choice". I do think that the condition of being the wrong sex is real and the success rate for sex change operations would bear that out - it's over 90%. You would think that if it were simply a psychological oddity, far more than 10% would change their minds/ find something else to be miserable about. So I think the basic operation should be free, but not any extra cosmetic parts of it (i.e. breast enhancement etc.). No-one has sex change surgery on the NHS without years of psychological treatment beforehand.

And carriemac - the availability of contraception has clear benefits for the whole of society (and it's relatively cheap). IVF has great benefits for the couple involved (if it works) but few benefits for society (none if it doesn't work) and is expensive - that's the difference. Less expensive fertility treatements are and should be available free on the NHS, but frankly, any couple who cannot conceive without IVF, and cannot afford IVF should adopt. The rules for who can adopt should also be relaxed, but that's another thing.

I'm amazed Lucy. We should adopt if we need IVF to concieve!! Why?
We had IVF with my DH's frozen sperm, frozen before his chemo for cancer.. I'm fertile. We have 3 beautiful kids. we're lucky, we could afford it. we could also afford contraception, If I had free contraception over my fertile lifetime, the cost would more than cover the 2 cycle of IVF we had. So why is one free and not the other?

I didn't say you should adopt if you can't conceive naturally - I said couples who need IVF but can't afford it should adopt. I didn't put it very well really.

For one thing IVF has a very low success rate and many couples need more than 2 cycles. Not very many other treatments with success rates as low as that of IVF are available on the NHS. While I appreciate that it must be very upsetting to be infertile, it is one of the few conditions for which an alternative option is available - adoption. Also, as with many new treatements these days, IVF is demanded by people who don't need it (obviously not including you in that) - and also provides false hope to some of those that do. If it was much more effective, I'd have to think about my position, but as it is I really believe it should not be available on the NHS.

Contraception on the other hand has a high, though not perfect, success rate. Statistically, the cost of contraception is worth paying because it saves money elsewhere (remember how many extra NHS abortions took place during the last pill scare? plus there's child benefit, other benefits to poorer mothers, care for unwanted children etc etc). Although most IVF-conceieved children do go on to benefit society, the cost-benefit ratio overall is much lower.

Use purchasing power of one national organisation to get best prices from suppliers instead of every tinpot hospital negotiating own prices

We need a national fix on the top agency rates of pay for theatre nurses (ODPs) which the NHS is allowed to pay
eg anaesthetic skilled theatre nurses cost twice normal rates. The nurses and their agencies are earning super profits, demotivating other NHS nurses.
There is a national agreement on nurse salaries in the NHS but not on agency nurse salaries. This is costing hundreds of millions every year. Lining the pockets of agency nurses and their agencies, devastating morale of regular nurses.
We need to be spending that cash on patient care. What on earth is the government thinking of?

I think lucy has summed up what is wrong with the NHS. It is so obsessed with cost cutting and balancing budgets it has no humanity left in it.

"Infertile because of cancer treatment? Tough, we could try and treat you if we wanted but the chances of it working are too low so go and waste your own money. Can't afford it? Oh well no children for you then."

"Autistic child has a separate speech problem? Well no point treating him is there because he'll never be able to talk properly anyway. It would make his quality of life better but it wouldn't be cost effective you see".

"Down's syndrome with a heart problem- you can't seriously think people with Down's are worth treating"

It is wrong wrong wrong. At the moment there isn't a decent insurance alternative. This is why there needs to be a radical shake up so that everyone can receive the best treatment available. Maybe then patients will actually be treated as human again rather than figures that need to be balanced on a budget sheet.

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but robinw the problem is so many people are now left out- and usually it's the most vulnerable. Anyone with a complex condition (in which I include the elderly) is seen as being difficult and too costly. And so many decisions are having to be made now along cost lines that all humanity has gone.

that's why something major needs to change- it's too far gone to be patched up and repaired.

Of course one BIG problem is that a lot of money goes into fulfilling political targets rather than meeting clinical need.

Jimjams I agree with your comment about humanity. I had an interesting conversation with my sister the other day where she admitted that she's thinking (reluctantly) about buying private health care. Her view has always been the same as mine but one of the things that's making her think about it is the wish for dignity should she be ill. She's just read a true story called wrong rooms (I think) about a man's fight to get care for his partner who was dying of cancer, aged 32. Apparently it was all very reminiscent of our experience with the NHS when our dad was dying. In our case, the staff were rude, drugs were lost (morphine, mind you, essential), with staff refusing to even try to find them until we got stroppy and the whole experience was very dehumanising and even more upsetting than it was always going to be.

It only improved (and we're only talking 3 weeks from diagnosis to death here) when we hand delivered a strongly worded letter to the chief exec of the nhs trust threatening all sorts of action if things didn't change. For example, prior to this we had a porter screaming at my dad that he had better get in the wheelchair NOW and so what that he hadn't brought any oxygen with the wheelchair, dad could jolly well manage without it, couldn't he? Err, no, he couldn't have actually and without oxygen he would have died before he made it to the lifts, let alone the xray room (maybe it was a tactic? would have saved money ) and this is not even taking into consideration the fact that my dad could NOT stand on his own to get into the wheelchair, let alone get a move on! We weren't even asking for extra treatment of any kind since there was none, we were asking for basic dignity and courtesy.

I really, really dread to think how it would have been without us 3 daughters there all the time, asking questions, complaining when things were really awful and generally trying to take some of the strain away from an intelligent, fully compos mentis, desperately sad, shocked, dying man. I so pity anyone having to go through this without an advocate of some kind, but one shouldn't be necessary.

I have to say that despite my years of principles on the subject I am seriously considering the same if I get a job which offers private health care. And I really never thought I'd hear myself say that. Even though good manners and treating people with dignity costs nothing these basics are often not provided in the NHS IME, presumably because staff are under such incredible pressure.

Robinw, your mum had every right to be treated imo and I'm glad she was since it was what she (and you) wanted. Sorry this turned into such a rant but I've surprised myself with these thoughts really. I am furious with successive governments for cocking up the NHS so comprehensively but I don't know what the answer is.

And the worst thing www? I have heard so many stories like yours that I'm not even shocked anymore. A sense of sadness and the inevitable comes over me. As you said just how do the people without advocates cope? I can't even bear to think what their treatment would be. I agree it needs sorting out, but I don't see how we can get from the current chaos and mess to a decent healthcare system.

As soon as you enter a hospital you have to leave your dignity outside.

Another story- this is nowhere near as bad as yours www- but just from my own experience.

I had ds2 by c-section - it hadn't quite gone as planned as I had a lot of adhesions from the section I had with ds1. This meant I had a drain and catheter left in for 3 days. On day 2 (first morning after the op) I was allowed breakfast in bed. The next day a healthcare worker came in and said "it's your second morning so you have to get up for breakfast". This was round the corner at a communal table. I pointed out that it wouldn't be very pleasant for the others to be sat next to me carrying a bag of bloodstained urine and a bottle of blood. So they sighed deeply, said I could have breakfast in bed and then didn't bother to bring any. I sent dh out to Sainsbury's when he arrived. Dh also spent quite a bit of time mopping up my urine and blood which was spilt every time the catheter bag was emptied. The floors were not cleaned once during my stay- and newborn babies were being wheeled in to this. It is revolting! When I went for a shower the drains were blocked and overflowing and I had to mop the floor, and attempt to clean up blood with paper towels having just had a section. Now I'm a big strong woman in the prime of my years. But it made me realise why elderly people are starving to death on hospital wards.

The major problem with the NHS is the lack of humanity- the cause of this? I'm not sure- lack of money and resources certainly, shortage of staff -definitely, but I suspect the rot goes deeper.

ok,there are so,so many things wrong in the NHS,i myself,friends and family as users have all encountered problems big and small,but to say there is no humanity left,well,you are wrong,myself and most(obviously not all,as we are humans not robots)of the colleagues i have ever worked with give so much of ourselves physically,mentally,spiritually,we work our hours and then some,i cannot count the times i have ,of my own accord gone so far above the call of duty,how many times i have wept when i have come home for the death of a patient who i have cared for as though they were my own grandparent,parent,sibling,partner,i feel so hurt that anyone could say there is no humanity left in the nhs.

Yoko- I'm not talking about the people who work in it as such. I am talking about it as an organisation. So for example there are doctors who want to operate on a seriously ill patient, but have to operate on a non-urgent case instead to meet government guidelines. In the same way a decsion has been made somewhere not to give my son speech therapy because as an autistic child he isn't worth it. However the SALT that we have access to is lovely and is very helpful. The humnaity has gone from the NHS because of underfunding, the way in which it is managed and its organisational structure. In the same way as blood wasn't mopped form the floor, I didn't get any food, and www's father receievd such appalling treatment due probably to staff shortages. The staff working on the postnatal ward were doing thier best but they were flooded.

My Mum is a nurse and I know she works in very difficult situations, she also cares deeply about her patients (she works in the community so some she sees for many years). Of course she isn't inhumane, but the system she works within is. I remember several years ago when targets were introduced so patients were only meant to be on the books for so long. She thought this was ridiculous- the length of time a patient reamins on the community books depends on their needs, and their condition. It is this sort of ridiculous politicising which makes the NHS inhumane, not the staff. I know my son is seen as being too expensive which is why he doesn't receive treatment- his needs have been ignored as the cost is too great- that is a failure of the organisation - not a failure of individual staff. The staff are like anywhere- some are good some are bad, but it hard for even the good staff to give a patient what they need now.