Why the NHS needs to change...

[CogitoErgoSometimes]

Basic care denied to elderly patients

Yet another story about the NHS failing to provide basic care to patients. The NHS, like the curates egg, is only 'good in parts' and given that it costs so much and given that we are meant to be a modern society that is an appalling state of affairs. What good is free healthcare if it means you are condemned to suffer malnutrition, lie in your own filth or need a doctor to prescribe water to you so that you're sure of getting a bloody drink?

There is a lot of knee-jerk 'hands off' opposition to the NHS reforms but how can anyone honestly defend a system that allows such laziness, complacency and neglect?

Hang on a second. Just what is the NHS for? I would suggest that it exists to provide healthcare to patients that is free at the point of use. How that healthcare is provided is a totally separate discussion to 'what should we do about X, Y and Z within the NHS?'

I believe that if the patient is given a voucher to 'buy' their treatment with(probably administered by their GP ala Lansley's plan), from any supplier of their choosing, it would encourage a market based approach where the patient can vote with their feet regarding which hospital they go to. As each hospital procedure is of a fixed cost to the NHS, the only way that Hospital A can attract more patients than Hospital B is to raise their game. Whether this is done by improving the nurse to patient ratio, improving cleanliness, reduced waiting times etc, it is all win-win for the patient.

Finally, I've heard some nonsense in my time but the comment about 'healthcare and profits shouldn't be mentioned in the same sentence' is the dumbest thing I've ever read on here. Do you think Elastoplast don't make profits when they sell you some plasters, or that Tesco don't make a couple of pence out of flogging you some headache pills? What about drug companies? Should they be researching and producing drugs just for the fun of it? Which is worse, a private model where multiple companies are in competition to provide a better service to the patient at a lower cost to the state, or a state run monolith where the costs of inefficiency can only be guessed at?

I say break the NHS up into dozens of smaller and more manageable lumps. Privatise the lot and use the sums raised to pay off a huge chunk of national debt. Legislate so that these lumps need a licence to operate as healthcare providers and can't own more than 25% of any given PCT (ensuring some degree of competition at a relatively local level). If any of the providers fail to meet minimum defined standards in areas like patient survivability, infection rates, standards of cleanliness, types of operations carried out (to stop cherry picking the easy cases) and probably half a hundred other clauses, they lose their operating licence and go out of business. Have these licenses renegotiable every couple of years so the government can revise minimum standards and apply more clauses if necessary, other than that, the government should get out of the way and let the system sort itself out.

Your posts are the only ones that really matter on this subject, I feel, Greenmonkies. Have you noticed how OP literally VANISHES once her flimsy arguments are shown up for what they are?

Far be it from me to be a paranoid android and I'm in no way accusing Cogito in particular but isn't it oh so curious that threads like these spring up just when the gov NEEDS to shape and deform public opinion to prepare the sheeple for the privatisation of our beloved NHS that they've been itching to do for years since Thatch onwards. I believe gov's are increasingly using internet forums to disseminate propaganda via trolls etc. We should use our critical faculties even more in the years to come. These are perilous times for our "democracies".

Let's not be swayed by faceless, interchangeable rightwing posters all singing from the same hymn sheet. Public opinion is much broader than that and cannot be suppressed by the ministry of information.

Of course the NHS needs to change.
You don't need legislation to do it. Or a massive top down reorganisation to do it. Why would that make sure that the elderly would be treated with dignity?

As for the profit argument - look at energy companies and how they've been making huge margins and we're still being ripped off.

They used to be public sector utilities. The NHS will go the same way - just look at dentistry.

The problem with privatising utilities was that without digging up half of the country and relaying new water and gas pipes or new electricity cables, there could never be true competition. It's the same with the railways - another government blunder. How the hell can the train from Southampton to London be considered as being in competition with the train from Newcastle to Sheffield in any meaningful way? The only thing that could ever be expected to happen would be a series of state sanctioned monopolies. It requires direct head-to-head rivalry to massively cut costs. Look to your supermarkets, airlines, mobile phone operators etc to see the blue prints of how the NHS should be organised.

Is low pay an excuse to do a bad job?

If all these workers are so overworked, underpaid and lost motivation, then why don't they do something else and leave the job to someone who cares and wants to work?

Also Glasnost, some of us actually agree with the OP and we have every right to do so. I appreciate that my views may vary from others but I respect other posters' views and do not feel the need to put others down.

I haven't vanished. The thread's quite lively and the conversation was flowing. I've said what I wanted to say already. No point repeating myself. BTW... I don't really understand the rather paranoid argument that someone who thinks the NHS needs to improve is automatically a government 'troll'.

I never said you were a troll Cogito. You wouldn't cut it as a ministry of informaton minion anyway. Read my post. Carefully. Noticed it's not de riguer anymore on MN to read posts/links through properly.

And the points I referred to weren't mine.

It's not just an Nhs issue in my opinion. It's about the nursing culture in this country My father had surgery at a private hospital a while ago. The surgery was delayed and he had been nil by mouth for the best part of 24 hours. He was parched. There was no water anywhere. I asked at the nurse's station. Three times with about 10 mins wait between each time. I was quite happy to get it myself but had no idea where to find a cup. And there was no canteen where I could even go and buy him some. My father was parched and couldn't speak easily during the limited visiting time.

Giving someone some water when they are (extremely) thirsty is nursing at its most basic. Yes I am sure they had other things to do, but ensuring basic levels of comfort should be a given.

I did wonder how long a patient without visitors would have had to wait for a drink.

I'm not that cynical or suspicious tbh. A message board thread is just that. Everyone has an opinion. I usually appear to be in the minority but such is life. If someone from the government or a lobby group wants to join in... what the heck?

I think the NHS needs to improve and I am a Nurse !
Totally agree with GreenMonkies that the funding needs to go to the right places .
I dont see people deliberately doing a bad job on a day to day basis I see them deperately trying to do an impossible job .Read my comments about Nurse /Patient ratios and then read the report .

Sorry to hear that eurochick -totally unacceptable.

MrPants I can't seriously compare a basic healthcare service to providing mobile phones. Sorry.

Private companies will always go for the profitable business. They'd be stupid not to.

As a user of the NHS, I don't want to be bombarded with choices, I just want decent healthcare. Choice means that the intelligent consumer gets the best deal. When you're ill, or your child is ill, the last thing I need is to have options. It's not like picking a mobile phone tariff

From the NHS, I want reliability, consistency and decent treatment. Not a lottery.

Give me the evidence that the private sector will be better. They're better at driving down costs to make money not to please the customer (they only please the customer because we give them money, lets not pretend otherwise). Some people spout about tescos etc etc. I've had plenty of bad service from bad companies who are accountable to their shareholders and noone else.

Are there really Hospital wards in this country where water is not provided
Water jugs are refreshed and given out 3 times a day and drinks -tea,coffee,juice,milk etc are provided on drinks rounds after every meal and also midmorning/afternoon/bedtime.

If there are wards not doing this then they should be shut !!

The NHS is a sea of mediocrity with a few islands of excellence within it. Anyone who believes otherwise is deluded. From my own family's experience:

My wife hospitalised with severe flu whilst 6.5 months pregnant and the foetus tachycardic. Hardly looked at overnight and only checked by an obstetrician after 24 hours because "the obstetrics department only like to make other ward rounds once a day".

Our baby admitted to PICU with breathing problems, then discharged onto the ward. PICU was amazing, I was totally impressed and overwhelmed by not only the technology but also by the attitude of ALL the staff, both to the patients and the parents. On the other hand, once on the ward with my wife, checked 3-4 hourly at most. When alarms went off during the night, they were ignored totally.

2 NHS births....hmmm. Well they got both babies out well in the end and I guess all is well that ends well. However, everything before the last rather scary hours was a complete disaster. We were very very lucky to have had a private midwife as our advocate. And, before NHSers get all stroppy and say that the poor treatment was due to her being there, there is a protocol within the NHS that she is only allowed to be our advocate and we should have been treated exactly the same as any other patient. And, as for the post natal wards, the less said the better.

So, that is personal experience and, yes, anecdotal. However everything shown in the recent survey of old people is statistical and not anecdotal. The NHS is NOT the envy of the World and is nothing to be proud of. The attitude of a substantial number of people in it is completely wrong and they should not be in the "care" business at all. Most of the money pumped in by "Nu" Labour went into creating additional posts for bureaucrats and health inflation. As soon as people started becoming nurses as a stage towards being an overpaid NHS manager (read administrator, as they do not really "manage" in the true sense of the word), common sense and a decent approach to care went out the window.

We need a big rethink and to be prepared to slaughter some sacred cows.

Are there really hospital wards where water is not provided, yes there are.

If you want water you need to get a family member or visitor to go and get it for you. You could ask the staff but you are likely to have a long wait. Also no point in putting a jug of water in front of someone if the patient is not able to drink without help, which is not usual in some older patients.

Would the private sector do better? I can only say that every time I have used a private hospital I got brilliant care, clean hospital and nice food. In the beginning of the year I also had the pleasure of spending 2 days in an NHS hospital because ambulance admissions have to go to the NHS. In one of the beds on the ward there was a woman who was in so much pain that she was screaming day and night. Only to be told by the nurses to stop screaming, people did not eat the food and nobody questioned why plates went back to the trolley without being touched. I ended up having to get water for some of the older ladies on the ward because they could not get out of bed to get it themselves. After one night I checked myself out, there was no way I was going to stay in that place. If this happened to someone in a private hospital you would simply check out and go to another one.

Iggly

MrPants I can't seriously compare a basic healthcare service to providing mobile phones. Sorry.

What I meant was that there can be no denying that quality and capability has shot up whilst price has gone down - the cut-throat nature of competition between the main providers has created this and we, as the customer, have benefited. This has all been achieved despite the main phone providers making a handsome profit.

As a user of the NHS, I don't want to be bombarded with choices, I just want decent healthcare. Do you use that strategy when doing your weekly shopping or choosing where to go on holiday too I wonder?

Choice means that the intelligent consumer gets the best deal. As opposed to everyone regardless of intelligence getting a crap service, yes, you're really making sense so far.

From the NHS, I want reliability, consistency and decent treatment. Not a lottery. What we have at the moment is a lottery. I don't see how doing more of what we are doing will change that.

They're better at driving down costs to make money not to please the customer (they only please the customer because we give them money, lets not pretend otherwise). So they do please the customer then - What does it matter what their motivation is?

Some people spout about tescos etc etc. I've had plenty of bad service from bad companies who are accountable to their shareholders and noone else. Fine, boycott them. If Tesco's have upset you so much, why not never use them again? You do have plenty of choices. If the NHS upsets you though, who are you going to use? There is no competition and no incentive for them to raise their game.

MrPants;

"I believe that if the patient is given a voucher to 'buy' their treatment with(probably administered by their GP ala Lansley's plan), from any supplier of their choosing, it would encourage a market based approach where the patient can vote with their feet regarding which hospital they go to."

You can choose which hospital you go to, you can even choose which consultant you want to look after you. You tell the Dr that is referring you which consultant you want to see, and which hospital you want to go to, and the referral goes where you want it to.

Sadly LarryGrylls is right; The NHS is a sea of mediocrity with a few islands of excellence within it.

How do you propose to sort this LarryGrylls?

Jinx;

"Is low pay an excuse to do a bad job?

If all these workers are so overworked, underpaid and lost motivation, then why don't they do something else and leave the job to someone who cares and wants to work? "

No one wants to do these jobs for this money. Most healthcare assistants are on a very low wage, have you noticed how many of our nurses and healthcare assistants are from developing countries? People who are prepared to work long, anti-social hours, for pitiful wages. Would you wipe shitty arses, empty catheter bags filled with piss and wash filthy patients for £14k for a 37.5 hour week? There are lots of people who genuinely care, but they can't maintain the level of commitment and emotional investment that is required. These committed caring staff either burn out and leave, or desensitise and start to behave in the manner that is described in these NHS horror stories.

And Jinx; "Would the private sector do better?" Not on the budget and with the treatment targets we work with, no.

Constructive criticism is fine, but unless you can see the big picture, in all it's gory details, I suggest you stay quiet.

MrPants, I'm on my phone so cannot reply fully.

I will say - healthcare is not like buying a loaf of bread. When I was rushed into hospital for blood loss, I don't want to have to choose which hospital to go to. When I've called an ambulance for my choking son, I dont want to be asked whether I'd like to use x/y/z. When I'm thinking about giving birth in December, I don't want to choose a hospital - I want my nearest hospital to offer a high standard of service.

And mobile phone providers have us stitched up - locked into 12-18 month contracts, I can't move providers without incurring huge cost and the tariffs are so similar you can't tell the difference and it can be bloody confusing. As for my supermarket - logically I should shop for the cheapest deal - I don't. I just use the nearest one as it is convenient - important as I didn't drive until recently. Im not tempted to try any others (nothing to do with it being a waitrose )

greenmonkies and kittycatlove and anyone who I haven't thanked while being absolutely terrified about DD on the ward or in the clinic, thank you for the kindnesses, large and small (esp for keeping an eye on the docs)

"I believe that if the patient is given a voucher to 'buy' their treatment "

It would create another huge level of bureaucracy administering the vouchers.

No part of this restructuring proposal will reduce bureaucracy. It just moves the bureacracy out of the integrated public service into the hands of profit-making "professional services companies" ? for whom more paperwork will mean greater profit. It also creates whole new layers of bureaucracy, lawyering and accountancy handling the transactions between all the micro-providers.

GreenMonkies,

Who are you to say I should stay quiet. I can see the big picture thank you very much. I agree it much has to do with budgets but is also about employing people who care. It doesn't cost anything to smile be friendly and treat others with respect.

You are a great example of an NHS worker. You are told something you don't like and you tell people to stay quiet and you can not cope with working more than 3 days a week... Yes that sounds about right.

I'm sure that there are unemployed people out there who would do a lot worse jobs for 14k so they can feed their families. If you don't like the job description for the money on offer then why go in to to nursing. Surely when someone decides to become a nurse they are aware what the job involves and what the rates of pay are.

Jinx1906
Green Monkies might work 3 days a week for lots of reasons- childare,study,caring for a relative -and is PAID for working 3 days a week . She/he has been honest about the emotional impact of her/his job.

As for people queing up to do this work -HCas -most decide they are better off on benefits or after a while decide to go back to working in Tescos . The ones that stay do it because they like their work/patients.

The standard of care you describe is the standard of care you would receive on the ward where I work - it is spotless,the staff are dedicated and work themselves into the ground. Become seriously ill in a private hospital and guess where you will end up -yep being blue lighted back to an NHS ICU because there are no specialist teams or any staff that can cope with anything other than routine surgery. Nice carpets though

I think GreenMonkies is a great example of an NHS worker

iggly I?m sorry to hear about your blood loss and your son's choking emergencies. In emergency circumstances it will usually make sense to head for the nearest A&E but what about all those other routine operations which happen every day? You yourself say 'When I'm thinking about giving birth in December, I don't want to choose a hospital - I want my nearest hospital to offer a high standard of service.' but what if there isn't a high standard of service in your nearest hospital compared to the one on the other side of town? Would you always chose the nearest?

With regards to your supermarket comment, you are perfectly happy to use Waitrose (my favourite too) but in that case you have chosen to pay a premium over (for example) Aldi and in return get a better shopping experience. Competition allows that to happen. Waitrose compete on product quality and customer service, Aldi compete on price. There is room in the market for both.

Getting back to the point I originally made, if the NHS buys a service in from a privatised hospital the service remains free at the point of use for the patient and the hospitals get a fixed price for a given procedure. To compete for customers the hospitals have to raise their standards. They can only compete with each other on product quality and customer service. In other words, make the NHS the purchaser of services, privatise the hospitals (building in as much competition as possible) and instead of a low cost, low quality 'Aldi' healthcare system, we will get the patient focussed 'Waitrose' system.

Tianc the bureaucracy already exists to work out finances. There is a system by which all treatments are costed which could easily form the backbone of a private business model. There is no need to reinvent the wheel on this one.

Also, I totally agree that bureaucracy exists only for its own ends - not sure if that was what you meant but that sort of thing usually elicits a harumph out of me! For that reason, rather than have the NHS pay all the costs of that bureaucracy, throw it over to private companies. It's amazing how little burocarcy big companies really need when the cost of it is coming out of the bottom line!