NHS problems etc

rick_chasey

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.

First.Aspect

I heard a nursing union representative (who, unlike the rail bloke sounded intelligent and didn't make me want to immediately buy a car) say that NHS funding as a proportion of GDP has dropped in the last 12 years.

Seeing as I can't be bothered, does anyone have any data to back this up?

rick_chasey

First.Aspect said:

I heard a nursing union representative (who, unlike the rail bloke sounded intelligent and didn't make me want to immediately buy a car) say that NHS funding as a proportion of GDP has dropped in the last 12 years.

Seeing as I can't be bothered, does anyone have any data to back this up?

https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=GB-EU-DE-FR-NL

Lower than some but not massively lower than countries like NED.

rick_chasey

One of the suggestions in the podcast was that the NHS has always been focussed on throughput and efficiency and part of that is reducing the number of available "beds" so that their usage is as near to 100% as possible. An empty bed is inefficient.

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.

ddraver

Pa raver was a GP. His entire cohort all semi-retired at 55-60 and fully at 60.

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...

First.Aspect

So the unions lied on national radio then.

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?

surrey_commuter

ddraver said:

Pa raver was a GP. His entire cohort all semi-retired at 55-60 and fully at 60.

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...

I extrapolate what I see in the private sector and see this as the straw that broke the camels back. I see departments losing staff, failing to recruit and going into a death spiral as the remainder give up. I see no reason why this would not be happening in the NHS.

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 sh1t before it starts improving

First.Aspect

Does the worldomeyer have any data for social care, or is it all bundled together?

I ask this from the perspective of assessing the under reported sticking plaster of putting hospital discharge patients in hotels.

rick_chasey

First.Aspect said:

So the unions lied on national radio then.

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?

The figures are from 2019, as covid makes the figures almost unusable, and you'd have to break down how the money was spent.

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.

photonic69

Has anyone dared mention the Brexit word? Seems like an awful lot of staffing issues have arisen since then? When my MiL was alive a lot of her home careworkers were Polish. There were also a lot of Spanish careworkers in the home where she finally died. I recall pre-Brexit a lot were intending on returning home to find better work as they were treated badly and underpaid in their work here. If they thought that then God help us in recruiting British-born staff to work in that sector. The same is true of the institution where I work. Staffing levels are at an all time low especially in the hospitality sector. I have friends in the Hotel business and they say the same.

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?

First.Aspect

It is blasphemy to point out the Brexit has caused any problems at all, or that the government did nothing to prepare for any entirely foreseeable problems. It is an imprisonable offence to point out that control of our borders does not mean taking up a fanatical and almost fascist xenophobic opposition to making exceptions in industries with a desperate need for EU staff.

katani

photonic69 said:

"...they were treated badly and underpaid in their work here."
"bad pay and very poor conditions (most will earn more working in supermarkets with a lot less stress)

How's the above related to Brexit?

rjsterry

One thing that struck me as I have an example on my doorstep is chronic dithering and therefore failure to invest in health infrastructure. Our local hospital (St Helier) was built in the 30s and is now very tired, but is also dearly loved. For at least the last two decades various plans have been proposed, fought and then abandoned. The latest is a new hospital on a new site in Sutton, but anyone being actually treated in this hospital is still years away.

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.

photonic69

katani said:

photonic69 said:

"...they were treated badly and underpaid in their work here."
"bad pay and very poor conditions (most will earn more working in supermarkets with a lot less stress)

How's the above related to Brexit?

The people I know that employed EU workers would much rather employ EU workers than British-born workers are they were more productive and reliable. They are now stuck with a workforce that isn't and leave after a couple of months.

kingstongraham

This is a good thread with a bit more detail about the excess deaths in 2022. Lower than expected (given covid) deaths among over 65s, but higher than expected among under 65s.

https://twitter.com/Jean__Fisch/status/1613144419477196801

First.Aspect

The analogy is the Polish tradesman prejudice.

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?"

webboo

First.Aspect said:

So the unions lied on national radio then.

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?

Possibly because it spends a vast amount of its funding to check whether it met or failed to meet the targets that said funding was provided for.
When it fails to meets those targets it fines it’s self.

kingstongraham

First.Aspect said:

The analogy is the Polish tradesman prejudice.

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?"

Sounds like there's prejudice on both sides there.

First.Aspect

kingstongraham said:

First.Aspect said:

The analogy is the Polish tradesman prejudice.

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?"

Sounds like there's prejudice on both sides there.

Bitter experience. And no different from the general observation that the British workforce isn't all that.

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.

pblakeney

Going back to GPs, it's only second hand info but I've been told GPs are allocated 5 minutes per patient. If some take longer then you can see where the stress levels will rise.

First.Aspect

Thought it was 10.

GP on the radio this morning defending Rishi's right to chose. Guess what, about 1/3 NHS, 2/3 private.

sungod

aside from the human misery of increasing waiting/treatment/recovery times, chronic conditions and deaths, there's the economic impact

(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

Dorset_Boy

There are too many non-front line staff employed by the NHS - it is the largest employer in Europe and comfortably in the top 10 employers globally. There are inefficiencies throughout the system.
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.

laurentian

Whilst I'm no authority whatsoever on the NHS, I do kind of see it "close up" as my wife is an NHS Community Midwife.

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.

photonic69

pblakeney said:

Going back to GPs, it's only second hand info but I've been told GPs are allocated 5 minutes per patient. If some take longer then you can see where the stress levels will rise.

Going back to GP's - There is about a 2-3 week waiting list to see my a GP at my surgery. In that time people are usually better or they have got worse and gone to A&E. If I really need to see a GP (usually 3-4 times a year) then I need to call at 8am or 2pm for an urgent appointment slot. This takes about 25-30 minutes waiting on the phone to speak to reception. If I'm lucky I'll get a telephone appointment that day. If they need to see me they will call me in. I'm quite happy with the telephone appointment triage system and really most patients could be dealt with as such. They just need more. More receptionists. More nurses. More Doctors. When I do get to seem them I have always been happy with the service they have given me but I can see how much stress they are under. It doesn't help that patients are under stress too with worry about their own medical conditions and concerns. This rubs off on the doctors too.

Just need to pay better to recruit and retain more staff.

First.Aspect

I wonder how much stress and workload is caused by the army of administrators making decisions to help nurses, over their heads. One of the biggest contributors to any workplace stress is a lack of control, right?

pblakeney

First.Aspect said:

Thought it was 10.

GP on the radio this morning defending Rishi's right to chose. Guess what, about 1/3 NHS, 2/3 private.

Maybe prior to Covid? My wife is allocated 10 minutes to treat patients as a district nurse. Setting up a syringe driver can take an hour. That puts pressure elsewhere.

And she'd agree 100% with Laurentian, with the only exception being the hotel part.

laurentian

First.Aspect said:

I wonder how much stress and workload is caused by the army of administrators making decisions to help nurses, over their heads. One of the biggest contributors to any workplace stress is a lack of control, right?

Lots! In my wife's case, her immediate line manager is an absolutley wonderful person but a pretty mediocre manager.

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.

ddraver

Not a lot

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...

kingstongraham

laurentian said:

First.Aspect said:

I wonder how much stress and workload is caused by the army of administrators making decisions to help nurses, over their heads. One of the biggest contributors to any workplace stress is a lack of control, right?

Lots! In my wife's case, her immediate line manager is an absolutley wonderful person but a pretty mediocre manager.

Is the line manager also a healthcare professional?

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.

First.Aspect

I suspect lack of resolution in decision making and lack of time are interrelated.