NHS problems etc
rick_chasey
Posts: 70,612 Lives Here
Seems a big enough problem to separate it out from the Tory thread as it's not all on the Tories.
(though charts do point things get worse from exactly 2010 onwards, but anyway).
For those who are interested, yesterday's economist daily briefing podcast had the NHS as their main piece and it sounds miserable.
Firstly, they looked at the claims between the Royal College of Physicians that around 5,000 deaths a year were attributed specifically to the problems the NHS is having - Sunak countered that by saying their analysis wasn't right, so the Economist did their own evaluation and came to the same conclusion that the RCP did.
There's basically a correlation between waiting times and excess hospital deaths, which makes sense. Even more worrying was the stats only went up to June.
Then they looked at what they think is causing the post-covid spike in demand on the hospitals, and they seem to think the main cause is a vicious circle which is creating chronic shortage of GPs, who are either leaving entirely or rolling back their hours because it's so stressy because they're all overworked and can't handle the loads they get.
They spent some time with the GPs - the government advice is to not see more than 40 patients a day because beyond that they'll be too tired and frantic and make mistakes - most, especially in poorer areas, are seeing in excess of 60 and some as high as 90 patients a day.
One GP put it "either I break the guidelines or I send half of them straight to A&E" so he largely does the former but sometimes has to do the latter.
They also looked at post-covid trust rates with GPs and A&E attendances. Apparently 1/5 A&E attendees would have gone to their GP if they could have been seen/if they trusted them, and quite a few people also just don't go to the GP when they previously would. For most that's fine, but for a few that means a more serious illness that requires a hospital stay which could have been prevented.
Anyway, figured this topic needs its own thread.
(though charts do point things get worse from exactly 2010 onwards, but anyway).
For those who are interested, yesterday's economist daily briefing podcast had the NHS as their main piece and it sounds miserable.
Firstly, they looked at the claims between the Royal College of Physicians that around 5,000 deaths a year were attributed specifically to the problems the NHS is having - Sunak countered that by saying their analysis wasn't right, so the Economist did their own evaluation and came to the same conclusion that the RCP did.
There's basically a correlation between waiting times and excess hospital deaths, which makes sense. Even more worrying was the stats only went up to June.
Then they looked at what they think is causing the post-covid spike in demand on the hospitals, and they seem to think the main cause is a vicious circle which is creating chronic shortage of GPs, who are either leaving entirely or rolling back their hours because it's so stressy because they're all overworked and can't handle the loads they get.
They spent some time with the GPs - the government advice is to not see more than 40 patients a day because beyond that they'll be too tired and frantic and make mistakes - most, especially in poorer areas, are seeing in excess of 60 and some as high as 90 patients a day.
One GP put it "either I break the guidelines or I send half of them straight to A&E" so he largely does the former but sometimes has to do the latter.
They also looked at post-covid trust rates with GPs and A&E attendances. Apparently 1/5 A&E attendees would have gone to their GP if they could have been seen/if they trusted them, and quite a few people also just don't go to the GP when they previously would. For most that's fine, but for a few that means a more serious illness that requires a hospital stay which could have been prevented.
Anyway, figured this topic needs its own thread.
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Seeing as I can't be bothered, does anyone have any data to back this up?
Lower than some but not massively lower than countries like NED.
The suggestion is that those efforts may have gone too far, and that places like Germany and Italy genuinely have much more capacity/resilience, at more expense.
Meanwhile, I have a bunch of friends who are junior docs who do locum work 3 or 4 days a week and make 40-ish Gs off that which they are very pleased with. None of them want to full time or permanent because they'd have to deal with all the nonsense.
Oh, and we sent quite a few "back to where they came from". Yaaaay us!
Meanwhile, Ma raver who was/is a nurse - in all the classic vocational senses -can't/won't give up the job but is only willing to take a few private locums or jab primary school kids because she is treated so shoddily when she works in a hospital or practice.
Sis raver got a 1st in physio but never practiced a day in the NHS because she knew she would never make enough money to live in that London that way. She is now a rather apathetic accountant...
I don't think the causes of the issues are that unclear, really...
- @ddraver
If the NHS is adequately funded, which h the worldometer says it probably is, the problem doesn't seem to be more money, does it, but where it is spent.
Why us the NHS so dreadfully inefficient?
Essentially it gets down to whether you believe the market or Govt is better at allocating resources.
I have no soluton other than to suggest that it will take a decade for the market to adjust. Depending on when you see this as happening we could be half way there so only another 5 years of this censored before it starts improving
I ask this from the perspective of assessing the under reported sticking plaster of putting hospital discharge patients in hotels.
I think Covid, like in most industries, led to a huge number of people leaving the workforce, mainly through retiring, and I think that combined with the added pressure the post-covid world creates (illnesses caught later, flus more likely to send people to hospital), plus the macro factors of aging population, means we're in a much worse position.
If we can't recruit and retain the staff to work in the care sector due to bad pay and very poor conditions (most will earn more working in supermarkets with a lot less stress), then there is no hope of moving patients out of hospitals back to community or home care settings, or if they are moved to quickly without that care they will land back at hospital in a never ending cycle until they die.
Isn't it about time the UK holds it's hands up and begs to be let back into the EU?
Multiply this over the country and run all the patched up hospitals you do have at close to full capacity, with the cherry on the top being two decades of Westminster avoiding dealing with social care and it's no wonder that it is falling over.
Pinnacle Monzonite
Part of the anti-growth coalition
When one of my intellectually challenged neighbours mentions they finally found someone to fix the plumbing, with the extra bonus that they are local and not Polish, it is hard to resist the urge to say,
"Does that mean they won't turn up on time, do a full day, actually ever quite finish, tidy up when they leave or answer calls or emails? Will I also find out a lot about his Mum's health conditions and the mechanical condition of his van, during the period I can't flush my toilet?"
When it fails to meets those targets it fines it’s self.
The main prejudice I have is towards thick neighbours with faded 8 year old yes stickers on the front door. Yup, I'm totally prejudiced against thickos with strong uniformed views.
I am not sure. You have no chance.
GP on the radio this morning defending Rishi's right to chose. Guess what, about 1/3 NHS, 2/3 private.
(presumably reliable) data from ons, nhs etc. suggest total numbers involved are well into the millions, with a hefty top-up from long covid
even if skewed to the old, there'll still be a lot of 'working age' people who are working less or not at all, plus knock-on impact of family/others taking time out to support them
There are clearly far too few front line staff (and that's not just doctors and nurses, but I'd include roles like porters).
Some aspects need to be centralised - eg procurement of drugs and negotiating prices thereof, but other things need to done at a local level - eg cleaning, without 2 or 3 middlemen taking a cut.
Being able to return things like crutches for reuse in the system, another simple and logical fix.
There also needs to be a discussion around what services it should provide - IVF being an example of that.
Should we pay a nominal amount for a GP appointment which could then be offset against a prescription charge - might stop a load of the hypercondriac timewasters?
There needs to be more preventative stuff going on - eg proper health checks at various ages.
And then the social care side needs to be addressed. We need to get away from the idea that people shouldn't have to sell their homes to help pay for their care. Part of the social care side might include the need to build half way houses so hospital beds aren't blocked, but the hwh is used before people are fully fit to return home.
She works extrememly hard, often on her days off, in an attempt to catch up with the workload with understaffing being one of the main problems.
Coincidentally, she had an operation that required a stay in hosptital just before Christmas and, whilst I was visiting, my wife and I were chatting with one of the attendant nurses (who my wife sort of knew as she was in the hospital that she operates from)
When the issues of the NHS were raised, it was very evident that nurse had the same thoughts that my wife has experessed many times:
1) There appears to be enough money but it is not being spent efficiently - "too many chiefs and not enough indians"
2) There is a mind boggling amount of waste e.g. :
Single use transfer sheets at £10 a pop
Brand new un used, unopened drugs thrown away - lots of them
Heating cranked up to the max coupled with single glazed 1960s windows.
My wife's midwife clinic has been held in a 4 star hotel suite for the past 18 months
These are just a few that were discussed in their brief conversation.
3) Whilst recruitment is an issue, retention is a bigger issue than recruitment
4) Many staff on long-term sick leave
Being a community midwife, my wife has to travel around the town and various surrounding villages at all hours of the day and night for births, pre-birth and post-birth checks etc. in her own car lugging around a bootful of kit. There was no adjustment to the mileage allowance when the price of fuel went through the roof. No police officer would go alone to some of the places my wife is called out to in the early hours of the morning (eg traveller sites, known drug houses) and some of the anecdotes she has are truly heartbreaking - I honestly don't know how she does it.
There are many people like my wife in the NHS who's work is made harder by the system within which they work and I think few people outside of the NHS truly appreciate the dedication that some have to their vocation.
I think that the main problem with the NHS is that, whilst there are immediate issues that need addressing, no government ever sits down to make a policy on what we want the NHS to look like in 10, 15, 20 years and drafts a plan to get there. Sadly, it is simply not compatible with the election cycle.
Giving a payrise, building a new hospital, recruiting x thousand new staff are all positive things but all are short term, high optics stuff that are never going to solve the problems of the NHS.
Just need to pay better to recruit and retain more staff.
And she'd agree 100% with Laurentian, with the only exception being the hotel part.
I am not sure. You have no chance.
I also think that, when a Trust is approached to "make efficiency savings" the higher management making these savings are the turkeys most unlikely to vote for Christmas.
Most of it is time, and most of that is staff levels.
A 10-minute appointment is run on the basis that a 15-year-old girl is going to come into the room, sit down and say, "I want the pill please Doc/Nurse"
The doc will ask if she has a heart condition and a few other questions, print the 'script and that will be the end of it. Baddabing, baddaboom.
Now anyone who has ever met a teenage girl (and read the above closely) will know that the conversation is not actually going to go anything like that and 10 minutes is nowhere near long enough to deal with it.
Previous chats with Pa & Ma suggest that on Monday morning they're going to see at least 10 of those...
- @ddraver
This isn't an argument for fewer managers, it is for good management, who can effectively make it so that the front line can concentrate on doing what they are good at, and for the right people at the right time. There's no point in having lots of front line staff and terrible organisation and coordination meaning they are wasting their time.