Crisis in the NHS

[Parafox]

And it's all our fault... apparently.

 

We are told constantly that there are people going to A&E who don't need to be there and to some extent that's true. However figures show that there's a percentage increase of those that attend A&E that then go on to be admitted. So therefore, it's not purely down to increased or unnecessary attendance at A&E, it's equally, if not more so, that more people are waiting for beds and cannot be moved from A&E.

 

Those who attend with treatable conditions or who can be dealt with on the day, i.e. a need for an x-ray on an injury that couldn't be done elsewhere, are discharged quickly and do not clog the system unnecessarily.

 

Monday 27th Dec was the busiest day in the NHS and LRI was THE busiest in the UK. Guess what? It was a bank holiday and there were no GP services available, urgent care centres were on a minimum staffing level with (to the best of my knowledge) only one GP on duty at Loughborough. It was staffed mainly by 3 Emergency Care Practitioners. Without a doctor they are limited to what type of patient they can see so those outside that criteria get referred to A&E.

 

To me, the NHS is a victim of it's own success. We are able to treat conditions and illnesses that 50 years ago would have resulted in death. We are able to keep people living longer and the older we get the greater the likelihood of needing hospital admission, not to mention the dementia related conditions that occur most frequently in elderly people. All these people need medical care and treatment and we just don't have the money or resources at this time to manage the load.

 

There needs to be a shift away from centralising medical treatment away from big hospitals and back to community based centres that can offer reasonably comprehensive services, such as outpatient treatment, x-ray and minor ops, even keyhole surgery. Maybe bring back the convalescent homes, they could be privately run, maybe. That's how it used to be, but successive governments have centralised in order to save money. This has resulted in the situation we are experiencing now. That and the cuts in social care funding have cause a logjam in hospitals.

 

Is the answer more money? Fewer patients? Better decision making by the public on when to attend hospital? Better social care? Would you pay for it?

[MPH]

It really needs to be funded better. Period. And the current funding needs to be better. Too many chiefs..

[Webbo]

I think certain procedures will have to be charged for the future. IVF springs to mind, not the full cost but a decent contribution.

[RobHawk]

Hospitals in general (not just A&E), how much better would it all be if we had a care system for the elderly that actually worked?

 

I also read an article earlier this week that the government are providing generous relocation packages to Dr's from Poland lithuania and other parts of the EU as we are struggling to fill all the gaps  the healthcare system. Not only is this quite ironic after Brexit but it suggests more Money should be provided to train more Doctors so we don't have to do this. The changes to student funding in Engalnd for courses such as Nursing could also have a major knock on effect a few years down the line!

 

The NHS is a great institution of the UK but is a political football that has been kicked a few too many times and until politicians realise this, we will just keep going round in circles with this debate. 

[Parafox]

5 minutes ago, MPH said:

It really needs to be funded better. Period. And the current funding needs to be better. Too many chiefs..

Interesting that you say "funded better". Do you mean more funding or better use of the limited pot they have?

 

Politicians talk about this billions of pounds extra funding they are providing but this is being drip fed over 4 years. The Dept of Health has stated in the last few days that they will NOT be providing any additional money to the NHS.

[bovril]

It doesn't help that we are incredibly unhealthy nation.

[RobHawk]

1 minute ago, Webbo said:

I think certain procedures will have to be charged for the future. IVF springs to mind, not the full cost but a decent contribution.

If a person is struggling to have children, for reasons that cannot be helped, why shouldn't they be entitled to NHS help? 

 

Rather that than gastric bands for people who can't stop putting food in their faces! 

[Parafox]

1 minute ago, bovril said:

It doesn't help that we are incredibly unhealthy nation.

That has an effect I agree, but we are more an aging nation

[Webbo]

1 minute ago, RobHawk said:

If a person is struggling to have children, for reasons that cannot be helped, why shouldn't they be entitled to NHS help? 

 

Rather that than gastric bands for people who can't stop putting food in their faces! 

They would be, they'd just have to make of a contribution to the cost. As for gastric bands, possibly but then if they didn't have one and then needed treatment because of their weight would it end up costing more? There aren't any easy answers.

[Guest MattP]

10 minutes ago, Parafox said:

Is the answer more money? Fewer patients? Better decision making by the public on when to attend hospital? Better social care? Would you pay for it?

Probably a combination of the lot. If the answer was just throwing money it at the problems would have gone a long time ago, the cock ups appear to be from everyone, no government seems to know how to handle the NHS, even the chief exec Simon Stephens doesn't seem to know the funding he needs, it lunged from crisis after crisis and it will only get worse with a lack of money being raised combined with an exploding and ageing population.

 

I wouldn't want to pay more in tax though, we can divert funds from elsewhere because we go to that, we spent 5 million on the Ethiopian spice girls, we dumped 2 billion in the World Bank because of Cameron's brainless 0.7% foreign aid commitment, you can spend that before the government starts picking more money out of our pockets..

[Alf Bentley]

 

I'd imagine that better social care is the most important response that is needed.

 

I'm sure more money is needed, given our expanding and ageing population - and improvements in treatment. Yes, I would pay for that (well, some of it!), though there are limits and hard decisions will still have to be taken.

 

Other factors come into it: poor public health / misuse by public, and particularly an over-rigid focus on systems and procedures, rather than care (from bitter personal experience).

 

However, social care is falling apart. Local government funding has been declining for years (it may be worse under the Tories, but was happening under Labour, too).

That is insane when we have a rapidly aging population. At a time when hospital beds are at a premium, particularly in winter, more and more are being blocked by elderly people who need care, not hospital treatment.

 

My uncle has been in hospital for 3-4 weeks. No treatment is pending (awaiting test results that could take 2 weeks). He just needs care - but there's nowhere for him to go, so he's been kept in hospital. 

Similar things happened during my Dad's decline. At one point, he was discharged from hospital with care promised. They then decided that he didn't qualify for NHS care, but didn't arrange anything else. I was able to arrange self-funded care for him (private contract with a care agency) but many people wouldn't be in that position - in which case they'd end up straight back in A&E, either taken there by relatives who couldn't cope or after suffering an accident at home. It's bonkers - and all so that governments (of whichever persuasion) can tell the public that they are "the party of low tax and good public services" (social care being the responsibility of local govt, so the central govt has someone else for the public to blame).

[lgfualol]

Feel sorry for NHS workers. 

 

The whole thing will be made private soon anyway so let's see how that works. 

[RobHawk]

4 minutes ago, Webbo said:

They would be, they'd just have to make of a contribution to the cost. As for gastric bands, possibly but then if they didn't have one and then needed treatment because of their weight would it end up costing more? There aren't any easy answers.

I understand there are no easy answers, but i get frustrated by the attack on IVF. Me and my wife have been through it ourselves (not on the NHS) and the emotional and mental strain it can put upon you means its not an easy answer for those struggling to have children. I am lucky that i could afford to go private, we decided to do this because we were told the NHs waiting list was around 2 years and we had already been under a consultant for a year. From a moral point of view, i think those in need of IVF are more deserving of help than those who have inflicted their health condition upon themselves (people who eat too much). On a financial point of view, i understand that gastric bands save the NHS more money in the long run but should money always be the deciding factor when looking at who we can and cant provide support for (or conditions).

[Webbo]

1 minute ago, RobHawk said:

I understand there are no easy answers, but i get frustrated by the attack on IVF. Me and my wife have been through it ourselves (not on the NHS) and the emotional and mental strain it can put upon you means its not an easy answer for those struggling to have children. I am lucky that i could afford to go private, we decided to do this because we were told the NHs waiting list was around 2 years and we had already been under a consultant for a year. From a moral point of view, i think those in need of IVF are more deserving of help than those who have inflicted their health condition upon themselves (people who eat too much). On a financial point of view, i understand that gastric bands save the NHS more money in the long run but should money always be the deciding factor when looking at who we can and cant provide support for (or conditions).

I'm knocking anyone who needs IVF. I understand it's around £2k for a round of IVF, if you get it done on the NHS for say £500, wouldn't that be better?

[yorkie1999]

Had an ear infection just before christmas, 1st time for about 15 years i wanted to see a doctor, and was told, with what sounded like a hint of humor in the receptions voice, that the next available appointment was in February and to go to something called newdoc. So i left it and now my ear's fell off, cured itself.

[Parafox]

20 minutes ago, RobHawk said:

If a person is struggling to have children, for reasons that cannot be helped, why shouldn't they be entitled to NHS help? 

 

Rather that than gastric bands for people who can't stop putting food in their faces! 

This is a different issue TBF. These procedures in themselves don't contribute to this crisis per se. They don't create bed blockages and don't need social care beds.

[RobHawk]

1 minute ago, Webbo said:

I'm knocking anyone who needs IVF. I understand it's around £2k for a round of IVF, if you get it done on the NHS for say £500, wouldn't that be better?

I'm not saying you are knocking those who need IVF, but why should people pay for that when other treatments are free? My issue with IVF in this conversation is it always the first thing brought up that should be cut when issues with the NHS are discussed - on the news, in the papers and even in this thread. 

 

Can't we charge £500 for gastric bands or other treatments - what about alot of the cosmetic type surgeries that still get done on the NHS? I'm not saying any treatment is more or less deserving than IVF from a financial point of view, but why specifically would be charge for that 1, even if it is alot cheaper than going through a private provider?

 

[RobHawk]

6 minutes ago, Parafox said:

This is a different issue TBF. These procedures in themselves don't contribute to this crisis per se. They don't create bed blockages and don't need social care beds.

True, but in a discussion of resource its often discussed as somewhere money could be saved. 

 

[Webbo]

5 minutes ago, RobHawk said:

I'm not saying you are knocking those who need IVF, but why should people pay for that when other treatments are free? My issue with IVF in this conversation is it always the first thing brought up that should be cut when issues with the NHS are discussed - on the news, in the papers and even in this thread. 

 

Can't we charge £500 for gastric bands or other treatments - what about alot of the cosmetic type surgeries that still get done on the NHS? I'm not saying any treatment is more or less deserving than IVF from a financial point of view, but why specifically would be charge for that 1, even if it is alot cheaper than going through a private provider?

 

I agree with you about cosmetic surgery, boob jobs on the NHS? But what if someone is born with a cleft lip or some other disfigurement?

[Parafox]

8 minutes ago, yorkie1999 said:

Had an ear infection just before christmas, 1st time for about 15 years i wanted to see a doctor, and was told, with what sounded like a hint of humor in the receptions voice, that the next available appointment was in February and to go to something called newdoc. So i left it and now my ear's fell off, cured itself.

You make light of it but that is an inherent problem and a reason why people pitch up at A&E. If you have an acute minor illness you want to see a doctor AT THE TIME IT'S MAKING YOU UNWELL. not two weeks down the line, so what do people do... 

 

Incidentally Newdoc is a GP led service that takes patients out of hours, I guess they see the overflow that GP's can't manage. I think its locally in Nuneaton.

[Parafox]

5 minutes ago, RobHawk said:

True, but in a discussion of resource its often discussed as somewhere money could be saved. 

 

Yes but my OP was really about the current crisis and the one that will happen next year and so on. Taking resources from elective procedures won't help in the short term and particularly in the case of gastric banding, could ultimately result in an A&E visit because obesity leads to other complications that can become an emergency.

 

Cosmetic enhancement surgery shouldn't be done on the NHS. Cosmetic surgery to correct a life-damaging disfigurement should.

[Bryn]

"Entitlement to treatment" is a complex ethical debate. I doubt the founders of the NHS envisaged even half of what the NHS does today. 

 

Perhaps if politicians cared less about getting elected and more about honest debate perhaps this something that could be addressed. Any organisation has to have objectives and I don't think the NHS even has that. 

 

I'm not going to disclose my own personal views on what treatments I think should and shouldn't be funded, but what if there was broad consensus on the objectives the NHS should strive to achieve free of cost? If perhaps everyone agreed that  "The NHS will provide emergency treatment for the preservation of life and limb,  free at the point of care"? That covers your acute critical illness, trauma, obstetric emergencies but also probably acute mental health crises where there is a risk of harm to the individual or others. And then the government could identify the cost of that and ensure its provision. Perhaps second would be "The NHS will provide interventions for the preservation of public health for free". This would include screening programs and vaccinations, amongst other things. Eventually it start to get more complex and things might have more debatable priority to some than others. But at least there'd be a conversation. The consensus might be in favour of "The NHS will provide interventions for the diagnosis and treatment of cancer for free" as an objective but also that "Routine appointments for the assessment of minor symptoms will not be provided for free". Under that system "cough" could be declared a minor symptom and the appointment for a cough might incur a fee of say,  £50. With a two day history of cough, runny nose and fever with no other adverse signs or symptoms, you'd be sent away with a fifty quid bill and advice to rest. With a three month history of cough and weight loss in a long term smoker, you'd proceed to the diagnosis and treatment of cancer pathway and your xrays and specialist consultations etc. would be free. A decision could be taken on whether or not that £50 would charged or waived; I think the fairest and simplest thing is to not waive it as the subsequent treatment is all free but there'd need to be discussion. 

 

It would of course get complex the further you discussed. IVF as an example would be contentious,  as you can argue that infertility does not cause further physical health problems in itself. But of course the psychological and ethical arguments go much deeper. But at least you'd have some transparency and understanding of what is and isn't free. The key principles could be enshrined in an NHS "constitution" and the public made aware of how much it costs to provide the most important aspects, and how much extra is needed for extra. 

[MPH]

1 hour ago, Parafox said:

Interesting that you say "funded better". Do you mean more funding or better use of the limited pot they have?

 

Politicians talk about this billions of pounds extra funding they are providing but this is being drip fed over 4 years. The Dept of Health has stated in the last few days that they will NOT be providing any additional money to the NHS.

 

 

Think i covered both of those in my post?

[Footballwipe]

I think another fundamental crisis is GP surgeries. I know my local surgery is going to pieces at the moment. Just two full time doctors, the rest are locums and they close the place on Thursday afternoons. It doesn't seem to pay to be a full time GP anymore.

 

I used to work for one of the commissioning units for the NHS, they supply CCGs with services etc. The word "manager" in job titles was thrown about like it was in vogue. I dealt with no less than 10 in my one role, it was ridiculous, chaotic and very haphazard with barely any order it seemed.

 

The NHS has helped me, from cleaning up my disgusting-looking face as a teenager to using the "Let's Talk" service during a huge bout of hypochondria. I feel desperately sad at the whole thing. People are right, money isn't the answer. Clean up and clean out up top. If my brief experience is to go by the bureaucracy at all levels is desperately disruptive. It's like a gravy train for some. 

[Manwell Pablo]

1 hour ago, Parafox said:

And it's all our fault... apparently.

 

We are told constantly that there are people going to A&E who don't need to be there and to some extent that's true. However figures show that there's a percentage increase of those that attend A&E that then go on to be admitted. So therefore, it's not purely down to increased or unnecessary attendance at A&E, it's equally, if not more so, that more people are waiting for beds and cannot be moved from A&E.

 

Those who attend with treatable conditions or who can be dealt with on the day, i.e. a need for an x-ray on an injury that couldn't be done elsewhere, are discharged quickly and do not clog the system unnecessarily.

 

Monday 27th Dec was the busiest day in the NHS and LRI was THE busiest in the UK. Guess what? It was a bank holiday and there were no GP services available, urgent care centres were on a minimum staffing level with (to the best of my knowledge) only one GP on duty at Loughborough. It was staffed mainly by 3 Emergency Care Practitioners. Without a doctor they are limited to what type of patient they can see so those outside that criteria get referred to A&E.

 

To me, the NHS is a victim of it's own success. We are able to treat conditions and illnesses that 50 years ago would have resulted in death. We are able to keep people living longer and the older we get the greater the likelihood of needing hospital admission, not to mention the dementia related conditions that occur most frequently in elderly people. All these people need medical care and treatment and we just don't have the money or resources at this time to manage the load.

 

There needs to be a shift away from centralising medical treatment away from big hospitals and back to community based centres that can offer reasonably comprehensive services, such as outpatient treatment, x-ray and minor ops, even keyhole surgery. Maybe bring back the convalescent homes, they could be privately run, maybe. That's how it used to be, but successive governments have centralised in order to save money. This has resulted in the situation we are experiencing now. That and the cuts in social care funding have cause a logjam in hospitals.

 

Is the answer more money? Fewer patients? Better decision making by the public on when to attend hospital? Better social care? Would you pay for it?

 

Well, that's not true, so perhaps UHL should be asking Derbyshire Health Care United how busy there Out Of Hours GP Service was as it if wasn't bursting at the seams somethings gone very wrong.

 

On the subject of which I will be in utter amazement if that is true,  but if it is then that is not good enough. But then you can't blame the NHS for a single thing that happens at Loughborough Urgent Care Centre as it is actually run by, again, Derbyshire Health Care United, who are private and only contract managed by the NHS. 

 

As for your last question I am afraid the answer is all of them and a few more besides.