NHS

People keep talking about experiences with the NHS so here's the experience of my friend from South Africa were there is no NHS. My friend is very poor by our standards but not poor enough to receive medical help. To be poor enough for that you have to be virtually destitute.

She suffers from a variety of painful physical conditions and chronic depression. As she has to pay to see the doctor and for any prescription to be dispensed she has to make choices. Does she spend her money on food (and we're not talking extravagant food) or medical care? Well that's Hobson's Choice isn't it? Get the meds she needs and starve or eat but do without meds.

So how does she cope? Well she lives with the pain but the depression stops her from working. As there are no out of work benefits she has to work so whenever possible she buys underground Citalopram and prays it's the real thing or when she starts checking the train times (her plan is to lie under a train) she pays to see the doctor but has no food.

We take our NHS for granted because very few of us can remember a time when it wasn't there. Do we really want to return to a system where only the well off or those who can afford insurance get the treatment they need?

Do we want an NHS that keeps all the money (our taxes) in the system or gives some of it away to investors?

There is talk of making extra efficiencies. How would this happen and in what form would they take. Hasn't it been tightening it's belt since the eighties? How much tightening can take place before it ceases to be the NHS we know?

www.pulsetoday.co.uk/news/live-blogs/as-it-happened-lmcs-conference-2016/20031890.article

The GPs conference, showing a lot of very unhappy GPs, including one from Leicester.

"Dr Grant Ingrams, from the GPC and a GP near Leicester, said: ’GPC will follow the will of the conference, so we will ask the BMA to ballot and then it will depend upon the outcome of the ballot, as to what step is taken next.

‘At least we are at a position where everyone recognises that there is a crisis, and we are in a position where Simon Stevens is saying it is due to duff policy for the last decade, and everyone agrees the plan which has been put forward won’t deliver. So GPs need to do something. They need to take some form of action to protect their practices, to protect themselves.’ "

www.pulsetoday.co.uk/hot-topics/lmcs-conference-2016/gpc-could-ballot-gps-on-willingness-to-take-industrial-action-within-three-months/20031891.article

www.pulsetoday.co.uk/views/blogs/this-is-it-from-now-on-i-choose-life/20031893.blog

Read this, and the comments afterwards.
Sorry it's second hand, or third hand for you.

Actually read the whole of pulsetoday, to find out how many GPs are feeling and why they are leaving in droves.

Its all so open-ended. Constant improvements in treatments and availability of new medications etc leads inevitably to increased demand and thus provision by the increasingly stressed NHS. There will be a constantly increased escalation of demand and thus cost. How can this be addressed?

Let's look at the underlying assumption that a longer ambulance journey to A&E is necessarily a bad thing.
Ambulances are staffed by paramedics, not "mere"(sorry!) ambulance drivers and consequently triage, assessment and early treatment including ECG, CPR, if necessary, administration of oxygen or pain relief can be carried out either at the patient's home (or wherever they are called to) or in the ambulance , or both.
A first response paramedic may also often despatched in advance by car, not ambulance and one of their "calls" can be whether an ambulance or even air ambulance is necessary.
It is increasingly common for patients to be transported by air ambulance to a centre of excellence where specialist emergency treatment is available, rather than a local hospital A&E department which does not necessarily have specialist facilities.
So this emotive question referred to by OP "Has a hospital closed near you? You're being stomped (sic?) on" is perfectly valid but also misleading.
Yes, a longer journey to A&E is bad for the individual who takes themself there, but the provision of Out of hours/Urgent Care /Walk in centres can address the issue of lesser injuries. And before I am shot down by those who do not have those facilities, it does not invalidate the point.
Having had considerable experience at the receiving end over the last 8 years, I agree that personal experience is not a qualification for running the NHS but it is for expressing an opinion.

Good post GandTea.

As Alea says, our experiences are good indicators. I know that the people on the ground work their socks off, I'm married to one of them, but their efforts are very often thwarted by the layers of management that get in the way and cost large amounts of money that could be better spent on practitioners. If this is happening in our very small bit of the NHS it is going to be multiplied thousands of times in the rest of the NHS.

This is not hot air Eloethan and I object to my experiences being dismissed as such. I keep saying that I don't know the answers but I am entitled to put forward a point of view gained from current experience.

Of course we all are biased by our own experiences. My BC treatment was first class and swift. My GD, born with an horrendous cleft lip and palate has had 17 years of wonderful care and it is ongoing. I am on the waiting list for a TKR,I will comment on that when I have had it, but so far so good. My H's experience with Alzheimer's is almost non existent. CPN has discharged him to the care of the GP surgery and they do not want to know. So if that was my only experience it would not be good. The NHS is like the curate's egg.

Informed opinion in the media is certainly important in considering ones owns views.
But when it comes to "letters" I am very sceptical, complainers always (IMO) make more noise that those that are satisfied.
I have some close friends that complain about the local GP and hospital services. They also complain about the post office, shops, postwoman, dustmen (sorry,dust persons), foreigners, garages, broadband supplier (they have tried most of them), their neighbours, probably us, ete etc, and these are only the one I can remember recently, you get the picture.

Undoubtedly day to day experience colours our views about all sorts of experiences, and it is perfectly valid to bring it into a general but subjective discussion.
However, surely we must all agree that one cannot run an institution like the NHS or anything else on personal experience.
Objectivity and evidence can be the only key to any problem.

If all you go on is first hand experience of the NHS, you do not see what is happening over all
Maybe not, but perhaps it does give insight into a more complex situation than some entrenched opinions would have us believe.

Like grumppa I believe that "first hand experience" whether working in the NHS or being served by it plays an invaluable part in forming one's own opinion and is perfectly valid.
If we were only to go by the media, we would get a broad brush view , with varying degrees of accuracy and informed comment, depending on the source.
Yet again, personal discussion is being shot down in flames if it dares to veer from the received wisdom of the OP.
To ask "why are you bothering with this thread at all?" is hardly designed to encourage balanced discussion. .

Another significant fact is that Hospital beds have decreased by 51% since the 1990s. This is not as bad as it sounds as change in the way we treated the mentally ill etc meant fewer beds were required. However, I suspect that it was tempting to cut a tad more than necessary when the accountants were looking at the budget.

Not only will we have lost those beds but also the capacity to increase if necessary.

Perhaps we should have a question on the referendum slip asking if an extra 5pence on NI or income tax should be levied to go specifically to the NHS.

Yes, except that it doesn't feel like our choice even though "we" (enough of us anyhow) voted for the current government. We've only got ourselves to blame. That old saying strikes again: people get the government they deserve.

I think we just have to grin and bear it for the next few years. ??

Our choice then is to either increase spending or degrade the NHS.

From these figures then I think we can deduce that funding is the biggest source of the problems experienced by the NHS. Funding particularly in social care. To cut the budget just at the time when our generation was coming onstream seems highly significant, and to deny that it has any effect is not facing the facts.

Read a couple of articles this morning that were saying even management effficiency is hard to improve on without cuts to A&E and/or specialist units such as urology and rheumatology (e.g. that not every hospital will be able to continue providing these). The. trouble seems to be two-fold: we spend less of our GDP on our health service than comparable countries, and the rate of increase in the number of patients (partly because of the ageing population) has gone up quite dramatically.

It seems a lot of NHS hospitals in England (articles were only talking about England, though the nearest A&E to me in Scotland closed down a couple of years ago) are very much in deficit.

The Kings Fund has just published some figures which might help to settle some debate, particularly relating to A&E.
The A&E standard is 4 hrs. 95% of patients discharged or treated within that time.
2015/16 it failed to met this in every single month except July.
Q. Has the A%E number of patients increased?
Up to about 2010 the figure remained steady at about 14million.
By 2014/5 there had been an increase to 22.3million. Most of these were represented by less serious issues. But the extra pressure is largely from older folk and other emergencies.
13% of patients are discharged without an treatment.
35% just need guidance.
Q. Lack of GP appointments. 85% get a timely appointment down from 88% in 2010. There has therefore been no significant deterioration.
The removal of GP out of hours responsibility is not significant. Most people end up in A&E in working hours.

2014/5 356000 more admissions than in 2010. This has a clear knock on effect on waiting times due to waiting for hospital beds.
2014/5 A&E were operating at 85% bed occupancy rate, which means they will struggle to deal with demand.

Delays in discharge
Known as delays in transfer of care. This was stable until 2014/5. The delays increased by 33%. Proportion attributed to social care rose by 31% reflecting the LA budgetary cuts which were highly significant. Especially so in recent years.

Staff shortages.
50% of year 3/4 registrars resign. The Kings fund stated that there is a limit to the workload that the staff should be e pelted to undertake.

Funding.

No actual increase since 2009/10
All increase to 2020 will be mostly swallowed by inflation.
17% decrease in social care budget.
Since 2009 hospitals have been getting busier, but it has not increased at the rate of population increase. Older folk attribute most of all to increase.

There has only been one previous post that mentioned "incompetence", and the word was used twice. That doesn't seem to warrant the "lot of hot air" statement.

I have mentioned "inefficiency", that is by no means incompetence and I have never suggested such.. Efficiency can be improved as technology etc advances to allow systems to become more efficient and as management techniques improve.

I do have first hand experience of the care sector as I worked as a carer for 6 years prior to retiring.

Again, a lot of hot air about "incompetence" but no actual facts. Our medical and care staff - in the hospitals, surgeries, people's homes and in residential settings - are working themselves into the ground, with reduced numbers of staff - and people focus on incompetence.

Yes, there is bound to be some incompetence - as there is in any large organisation. You only have to read the consumer letters written to newspapers to see examples that. But why the public services alone should be singled out as being especially incompetent I don't know.

Yes excellent post Grumpa. I am convinced that management efficiency can provide the financial improvements that are essential if we do not wish to increase the tax bill to fund it.

So many of our posters are quoting third or fourth hand information, often from sources that have an axe to grind.
It used to be "heard it in the pub, so it must be true" nowadays it's "seen it on the internet, so it must be true". Anyone can post unsubstantiated rubbish about any subject they like on a web page, it's the modern day soap box. Yes, there are some good factual sources, but I'm sure for every one of those there are a dozen crap ones. I will find and read those I consider well informed and ignore the rest. I will not read links, just because someone thinks I should.

Good post grumppa.

Excellent link from OpenDemocracy, dj. Unfortunately, some people are so blinkered that they don't even want to find out what's going on.

grumppa, Maybe you would like to give some examples of 'management incompetence'. Durhamjen has just highlighted some examples which have resulted from the current government's reforms. One of my sisters was an NHS manager until redundancy and could give you a list of inefficient practice (not incompetncy), most of which have resulted from government 'reforms'.

Extra funding needs to come from tax.

" Of course the NHS could save money by ending the market in healthcare and stripping out the costs of lawyers, accountants and others whose job is simply to run the market. This would save an estimated between £4.5bn to £10bn a year if not more. But that’s something central government - both Labour and Tory – has repeatedly refused to look at."

Corbyn would do it if he was PM. Unfortunately by 2020, there will only be a rump of a HS left.