The NHS
Comments
-
I lived there for 8 years. The costs are astronomical, and insurance only covers about 80% of what theya gree to cover, and the list of exceptions is as long as your arm. Not a good system. The US Government actually spends more per capita on public health care than the UK, but if you make use of such service then you will be hounded by the legions of lawyers and beauracrats for the rest of your dyas, just in case you could actually pay for it......Rick Chasey wrote:Has anyone had any experience in a system with no public health care like the US?0 -
Ballsymate: i think the gist of that post is
Comapre the NHS of 1948 to the NHS of 2013
Comapre society of 1948 to 2013
Compare medical tretament between 1948 and 2013
Yet the promise of free care form cradle to grave has remained unchanged from 1948 to 2013
The bottom line is how much penercentage income tax raise are you personally prepared to pay "to improve it and keep that free/cradle to the grave ethos..forever?0 -
Gregger wrote:Ballsymate: i think the gist of that post is
Comapre the NHS of 1948 to the NHS of 2013
Comapre society of 1948 to 2013
Compare medical tretament between 1948 and 2013
Yet the promise of free care form cradle to grave has remained unchanged from 1948 to 2013
The bottom line is how much penercentage income tax raise are you personally prepared to pay "to improve it and keep that free/cradle to the grave ethos..forever?
I am fully aware that treatments and technologies have moved on at a considerable pace, but it was the last paragraph that got me.
'When you start prolonging the life of sick people.......' Bizarre!0 -
If we look at an example
If you developed heart failure, aged 75 in 1947 you'd probably be dead within 6 months
Now, few tweakings here and ther by these marvellous doctors andt thats 10 years. But that costs money. And in those 10 years you're gadaually worsening, oh you develop pneumonia (another £10K admission), oh you break your hip (another £10K admission), oh you go into a nursing home (£££).
So the acute slope to death is more gradual but hugely time consuming and expensive.
I think thats the point being made there
And at the other end have as many kids as you want
Something has to give?0 -
We all want a quality NHS but first you have to define quality. Most of the targets and standards we work to are about process not clinical care. So in A&E we are assessed about how quickly we deal with patients. Sorted within 4 hours? Fantastic, just ignore the incomplete diagnosis, deferred treatment and unnecessary admission. Properly diagnosed, treated and sent home with appropriate follow up after 5 hours? Failure, write an exception report and risk special measures.
What about mortality rates? You can look at these two ways. Death in hospital is a rare thing so being worse by 3-5% is probably meaningless. Standardised rates? Most doctors don't rate these stats. Alternatively all of my patients die eventually so which die earlier than they should have done? Outside of major errors (for which there are good mechanisms of follow up) I don't know how to identify them.
It is a highly complex multi-variable system that is close to impossible to analyse.
Is the NHS failing the population? Absolutely not! When I get cancer I will be eternally grateful I am in the UK. When I get creamed off my bike ditto.
Do individuals within the NHS get it wrong? Absolutely! I'm sorry but we are human and illness can be very complex. There are systems to minimise the risk but we will never eliminate it.
Is the NHS being at least partially dismantled? Absolutely! To be honest I think there are two reasons for this. One is about political philosophy. The other is that it is too expensive to continue to grow as it is.
So the public need to decide.
Do you want a fully inclusive NHS that will see anyone? Then you need to pay for it. If you want, for instance, seven day consultant presence then my department alone will cost you an additional £800k a year.
If you want to ration what the NHS provides from taxation and anything else has to be paid for privately then someone needs to decide where the line is drawn.
As a member of the public I would go for the latter and restrict NHS care to emergency care, cancer care, chronic illness management and preventive medicine (vaccines, screening etc).
Sorry for the length of the post but it is, as I said, very complex!0 -
"Why should we not expect first class treatment. It shouldn't just be reserved for the rich."
Care is required with terms like "first class treatment"; it cannot be read as an open ended approach to the cost of treatment. Cost has to be considered beside the likelihood of successful treatment, the benefit to the patient and the associated opportunity cost.
On a wider note I'm surprised that the NHS doesn't use its market position more aggressively; within the UK the health care market (by financial resources and even more so by quantity of resources consumed) is so utterly dominated by the NHS that they could, short of driving suppliers to loss, name their prices for materials and labour. The Japanese equivalent, does just this via a system of price control, if companies wish to supply them they miraculouly "find a way"; albeit they may well be drinking our milkshake as we (the US, Europe et al) end up paying all the R&D of drugs & equipment while sales to Japan simply occur to pick up margin on the additional sales volume.0 -
I wouldn't normally join in these never ending polarised debates, but just couldn't help myself as I happened to be reading the thread when my wife got home after a 13 hour shift in a neonatal intensive care unit.
Won't bother you with the (gut wrenching) details of her day, but it just reinforced my belief that we should all get down on our knees every day and thank f**k for the NHS and for the vast majority of good people that work in it for little reward.
We should also do everything we can to stop the asshole politicians and media types on all sides who seem to think they have the answers - they don't have a clue.0 -
oldhairylegs wrote:but it just reinforced my belief that we should all get down on our knees every day and thank f**k for the NHS and for the vast majority of good people that work in it for little reward.
We should also do everything we can to stop the asshole politicians and media types on all sides who seem to think they have the answers - they don't have a clue.
True, so true.0 -
My lovely Mother has been in there for the last week, with heart problems. They have been excellent, spotless clean, staff great, bright modern ward.
Thankyou, anybody who works in the NHS. A difficult time is being made much easier.0 -
oldhairylegs wrote:
We should also do everything we can to stop the asshole politicians and media types on all sides who seem to think they have the answers - they don't have a clue.
The only way to prevent this is to run for office yourself. And I don't mean that flippantly, it really is the case.0 -
DesB3rd wrote:"Why should we not expect first class treatment. It shouldn't just be reserved for the rich."
Care is required with terms like "first class treatment"; it cannot be read as an open ended approach to the cost of treatment. Cost has to be considered beside the likelihood of successful treatment, the benefit to the patient and the associated opportunity cost.
On a wider note I'm surprised that the NHS doesn't use its market position more aggressively; within the UK the health care market (by financial resources and even more so by quantity of resources consumed) is so utterly dominated by the NHS that they could, short of driving suppliers to loss, name their prices for materials and labour. The Japanese equivalent, does just this via a system of price control, if companies wish to supply them they miraculouly "find a way"; albeit they may well be drinking our milkshake as we (the US, Europe et al) end up paying all the R&D of drugs & equipment while sales to Japan simply occur to pick up margin on the additional sales volume.
Absolutely. I work as an independent contractor (most GPs, pharmacists, dentists etc are) and I'm also the adviser to my local NHS. We've been doing some work recently about integrating things better to take the pressure of the hospitals - and one thing I looked at was costs of drugs and other consumables. I wanted to see if we could get in to getting these from central supplies at cost - but it turns out that the NHS cost is more than I can buy them privately - because I get to shop around but they have to use their preferred supplier.
It's crazy but a bit like working for the council on a project - you are tied in to who you can use and then they've got you.I'm left handed, if that matters.0 -
private businesses use preferred suppliers too (we do, seemed like a great idea at the time). Once they have that nice long term contract gripping you by the short and curlies they start to make you pay. The NHS should get walmart to write the contracts, ours goes along the line of 'you will give walmart the cheapest price (that no one else gets) and if someone else gets a short term special price better than ours you must beat it for the period'
The NHS isn't alone in some short sighted decision making, the problem is it gets so much scrutiny from everyone.
As for cutting services as it's 'out of core' healthcare scope, if you believe that, I hope you never get in one of those boats. Those lists are usually put together by people who can't see themselves needing it (I don't have/want kids so fertility treatment is out but liposuction is in as I want to lose weight and my receding hairline says plugs are A-OK on the NHS etc).FCN 120 -
Where does one pick up the pieces in this thread. I'd almost forgotten about the thread completely.
There are some hard questions to be asked here. Topics which most people would find offensive and surely bitterly distasteful to discuss. We live in a society where brain-washing and a very narrow mode of thinking is promoted to its fullest extent as the only and just way things ought to be. Goes to show that populations in their entirety are merely flocks of sheep. Politicians' work is not easy either, and even they tend to be out of their depth almost all of the time. Answers are claimed with or no experiences to the problem. Problems are ever escalating.
On a separate issue. There are many private health services which operate in the UK, alongside the NHS. Clearly there's a requirement and indeed a market for such firms to co-exist and offer medical services to those who can afford it. The result is a catering for the very niche.
I shall say no more here before I inadvertently offend any tender or sensitive types on the board.0 -
skylark wrote:Where does one pick up the pieces in this thread. I'd almost forgotten about the thread completely.
There are some hard questions to be asked here. Topics which most people would find offensive and surely bitterly distasteful to discuss. We live in a society where brain-washing and a very narrow mode of thinking is promoted to its fullest extent as the only and just way things ought to be. Goes to show that populations in their entirety are merely flocks of sheep. Politicians' work is not easy either, and even they tend to be out of their depth almost all of the time. Answers are claimed with or no experiences to the problem. Problems are ever escalating.
On a separate issue. There are many private health services which operate in the UK, alongside the NHS. Clearly there's a requirement and indeed a market for such firms to co-exist and offer medical services to those who can afford it. The result is a catering for the very niche.
I shall say no more here before I inadvertently offend any tender or sensitive types on the board.
Don't leave it at that. Out with it ,man. We come here for a full and frank exchange of views. If people are offended it is their problem.
As regards expecting a first class service for all, I accept that the NHS has finite resources and will have parameters in what it can treat. Hence the controversy with NICE. But if you are treated by the NHS you should be able to expect the best medical care available. I am not talking private rooms or what amounts to room service in private hospitals, but medical care. If you aim low, you will achieve even lower.
Funding is an issue and will become an even bigger issue. There does need to be a rethink on how money is raise and spent as well as looking at partnerships with the private sector.0 -
For my sins I get to attend many clinical commissioning group meetings and it is with depressing regularity that the discussions around future commissioning intentions focus on the need to be saving money rather than the services required. Despite the former PCTs saving money over the last few years the figures for what has to be saved continues to rise (~£40m was the last figure mentioned for my county).Ballysmate wrote:Funding is an issue and will become an even bigger issue. There does need to be a rethink on how money is raise and spent as well as looking at partnerships with the private sector.
In terms of how money is to be spent and saved, there is a drive to move away from paying the health services for block contracts to payment by results. This should make health providers more accountable for the services they provide and stop the litigious private sector companies threatening to sue the CCGs should they end their contracts even when the private company has failed to perform.
From April next year there is the introduction of Personal Health Budgets for long term conditions that will give individuals the choice to hold part of the budget for their own healthcare. I'm certain the Daily Mail and Tax Payers Alliance will hate the idea but the national PHB pilot showed that giving people a budget for their own healthcare can lead to better outcomes at lower costs.
There's also individual packages of care where a person is sent out of county to a specialist provider that isn't available locally and therefore could set their own prices. Bringing people back in county has saved tens of millions over the last few years.
One area where more needs to be done to save money is for healthcare commissioning to develop how they commission for preventative healthcare so that people become less ill in the first place thereby avoiding their demands on high cost interventions. The mechanisms they use for commissioning services are focused on addressing clearly identifiable outputs and outcomes of identified health needs but commissioning has no mechanism for valuing preventative healthcare that can prevent people developing those identified needs. I hope that make sense.
We also shouldn't forget the burden of the PFI projects that were a necessary evil to repair the flagging hospital infrastructure.0 -
Some good points. Health Education should be promoted with much, much more rigour in schools. And also PE, there should be a class everyday. Not like when I had it twenty years ago, with only two hours of PE per week!! Imagine that, no wonder the nation is constantly teetering on perpetual sickness. A corresponding NHS can't cope.
I can't quite recall what I learnt at school, honestly. Most likely I learnt nothing. I've had to pick the pieces up myself and still the results are far from adequate. They teach such rubbish in schools. Education needs to be more relevant. Health Education and PE is a glaringly obvious start.
When you have unfit and sick children (young adults) leaving school, what are they going to do apart from propagate that sickness further. There is considerably more that I could elaborate on. But you get the idea.0 -
I'm not sure I entirely agree that the population in their entirety are merely flocks of sheep. I think that the general public are now deeply suspicious and hostile that politicians have the ability to understand and fix anything and that their dissing of it has a hidden political agenda. Even when they are telling the truth, which is rare then no one will believe them. My personal feeling is that the NHS is so big and complicated that it is beyond my intellectual capacity to understand it therefore I must accept it as it is and hope that it does the best for me when I need it.
A downside of encouraging activity and fitness is that the hospital is full up with young walking wounded have fallen off bikes or broken bones playing footie etc. I hardly appeared on the NHS radar for my first 62 years but certainly got my money's worth in the last 5 weeks. My ward was full of young cyclists with broken bones. So it can just kind of shift the focus. I had plenty of time while propped up in bed to identify areas where efficiencies could be made... There does seem to be a lot of folks engaged in admin duties frinstance and sometimes not so many to go round looking after the patients0 -
Personal spending funds have been in the care sector for a while now and do seem to have the effect of driving up standards. The two guys I support in the community would be perfectly entitled to take their funding to a different provider if I was not performing to standard. Which is quite motivating... I wonder whether the NHS gives the same opportunity of choice?0
-
Re: The NHS
by Mikey23 » Sat Aug 17, 2013 5:57 pm
I'm not sure I entirely agree that the population in their entirety are merely flocks of sheep. I think that the general public are now deeply suspicious and hostile that politicians have the ability to understand and fix anything and that their dissing of it has a hidden political agenda.
This is where the discussion kicked off, people asserting that it was an orchestrated campaign to discredit the Health Service to soften the people up for its privatisation.
But the stories that have been reported have emanated from patients and the public. It has taken years for people to be believed and have their complaints investigated. It is not politicians that are dissing the NHS, but Joe Public. He is asking what is going on.0 -
Mikey23, I read your post and my heart sank. Your response can best be summed up in two words; complacency, apathy, both of which could be applied to 99% of the UK population's view towards UK healthcare and the sheeple assumption that the best they can do is complain because of the false belief that they can't affect change in healthcare.Mikey23 wrote:I'm not sure I entirely agree that the population in their entirety are merely flocks of sheep. I think that the general public are now deeply suspicious and hostile that politicians have the ability to understand and fix anything and that their dissing of it has a hidden political agenda. Even when they are telling the truth, which is rare then no one will believe them. My personal feeling is that the NHS is so big and complicated that it is beyond my intellectual capacity to understand it therefore I must accept it as it is and hope that it does the best for me when I need it.
A downside of encouraging activity and fitness is that the hospital is full up with young walking wounded have fallen off bikes or broken bones playing footie etc. I hardly appeared on the NHS radar for my first 62 years but certainly got my money's worth in the last 5 weeks. My ward was full of young cyclists with broken bones. So it can just kind of shift the focus. I had plenty of time while propped up in bed to identify areas where efficiencies could be made... There does seem to be a lot of folks engaged in admin duties frinstance and sometimes not so many to go round looking after the patients
As a recipient of healthcare your view is invaluable to informing healthcare needs and how it could be improved, so my question to you is what are you going to do to improve the situation for all? Are you going to join your local PPG? Or LEG? Or Patient Congress? What about contacting your CCG or HealthWatch to see how you can get involved?
The public can affect change in healthcare but it can be bloody hard work.
PS. I should point out that older persons are the greatest recipients of hospital healthcare and not cyclists0 -
Yeah, and broken bones are cheap and relatively easy compared to heart disease and diabetes!I'm left handed, if that matters.0
-
I guess the people you're supporting receive budgets for social care. I'm glad to hear they appear to be working and I hope they're supporting you not only in providing support but also in meeting any training needs you have.Mikey23 wrote:Personal spending funds have been in the care sector for a while now and do seem to have the effect of driving up standards. The two guys I support in the community would be perfectly entitled to take their funding to a different provider if I was not performing to standard. Which is quite motivating... I wonder whether the NHS gives the same opportunity of choice?
Personal Health Budgets for healthcare are slightly different in that they are non-means tested and zero sum; any support provided must be at no greater cost than has been provided by healthcare services.0 -
I'm not sure what your point is but yes, every healthcare intervention has a price and whether it's through general or acute hospital, primary or secondary care or community health it all has to be accounted for.k-dog wrote:Yeah, and broken bones are cheap and relatively easy compared to heart disease and diabetes!
(I haven't included in that step up and step down costs or even cost transfers through referrals)0 -
@bm in particular and others. Yes I fully accept your observation but I wasn't trying to come across as complacent and apathetic. I think I was in a pretty good place because although I was physically busted, I was mentally sharp and able to pretty much direct and interact with my own treatment and convalescence. I suspect that those who lack capacity through their frailty and do not have friend or family to act as advocate have a much more difficult time.
I know this to be true because my in laws made a formal complaint about the treatment of my elderly father in law who despite the best efforts of the family became one who suffered dehydration and malnutrition but was fortunate to escape alive.
And yes, I could get further involved I agree... Any input as to how to do this in ways that actually make a difference and not just going to time consuming and pointless meetings. Thanks for the KUB!0 -
I don't understand any of the points being made in this post.Mikey23 wrote:I'm not sure I entirely agree that the population in their entirety are merely flocks of sheep. I think that the general public are now deeply suspicious and hostile that politicians have the ability to understand and fix anything and that their dissing of it has a hidden political agenda. Even when they are telling the truth, which is rare then no one will believe them. My personal feeling is that the NHS is so big and complicated that it is beyond my intellectual capacity to understand it therefore I must accept it as it is and hope that it does the best for me when I need it.
Which political agenda is it if not this?Mikey23 wrote:A downside of encouraging activity and fitness is that the hospital is full up with young walking wounded have fallen off bikes or broken bones playing footie etc. I hardly appeared on the NHS radar for my first 62 years but certainly got my money's worth in the last 5 weeks. My ward was full of young cyclists with broken bones. So it can just kind of shift the focus. I had plenty of time while propped up in bed to identify areas where efficiencies could be made... There does seem to be a lot of folks engaged in admin duties frinstance and sometimes not so many to go round looking after the patients
Downside? I guess we should all keep sitting on our fat-fat-fat arses then!0 -
No not saying that... Just that the NHS has to adapt to changes in society, more pro active than reactive. Attitude to it will vary from 'brill and sorted out my shoulder' to ' nearly killed my dad in law'. Based on nothing more scientific than personal experience. Am interested in learning from those who work in it0
-
Thread killer strikes again!0
-
Mikey23 wrote:Thread killer strikes again!
Don't worry.
I've been the Angel of Death to many a thread.
0 -
Tee hee... Just reading back over some of my responses and thinking what the flip am I on about and what point am I trying to make? Only excuse is I'm a cantankerous old git on medication!0
