NHS

Good post, POGS

Kitty

No doubt we will be hung drawn and quartered as Leicester posters

Don;t worry POGS, the NHS will stitch you back together (probably)

Vampirequeen. A&E is often used inappropriately by people who have neither had an accident nor is their problem an emergency. Identifying why people go to A&E is important. Large numbers of cases are alcohol related. Why should NHS have to pick up the tab for this? Thinking laterally do drink manufacturers and sellers have any responsibility here? Should laws on sales of alcohol be tightened up? Should a percentage of alcohol profits be given to local NHS services? Where is the individual's responsibility in this?
That's just an example. Cut down on this sort of demand for A&E to enable those specialists to focus on the genuine accidents and emergencies.
Re organise GP services to make it easier for people with more routine problems to be seen more quickly and easily. Employ well trained triage staff as required. etc etc etc

Maybe the situation is very different in big urban areas, but in more rural areas with market towns, the situation is dire. Twenty or thirty years ago, there used to be numerous 'cottage hospitals' with a basic A & E and often convalescent wards, which acted as a halfway house. The A & E departments could do X rays and bandaging or plastering and could stitch up bad cuts, etc. These don't need a high-tech A & E, but can't be dealt with by GPs. They also used to have beds for people not quite ready to be discharged back to their own homes, who now block more expensive beds.

We don't have any walk-in centres for miles and public transport is so bad that it's not even possible for many people to reach a hospital and get back home within a day. If I were to break a leg, I would have no choice but to call an ambulance, because a taxi would be astronomically expensive and I don't know anybody who would take me. This seems a waste of a very expensive resource. There are virtually no district nurses, so I would have to stay in hospital until I could look after myself.

Mental health services have been decimated. The nearest appointments are 20 miles away and the waiting lists are months. Until last year, we had a small unit in my town, but I know of some people who now can't afford the bus fares and/or are too anxious to travel such a long distance. The actual treatment offered has also been cut. Mental health services for children are particularly bad.

Jane10 You say "just throwing money mindlessly won't necessarily lead to improvement".

As whitewave's earlier post indicated, The King's Fund research reported that there has been no actual increase in funding since 2009/10 and that all increases up to 2020 will be mostly swallowed by by inflation. Added to that, there has been a 17% decrease in the social care budget.

So, far from "throwing money" at the NHS, it is actually being starved of money.

POGS Do you really think that issues such as how the NHS is run, or indeed whether the NHS should exist at all, can be a politically neutral topic?

A few years ago, Douglas Carswell (now UKIP but formerly a Conservative) put together a book called "Direct Democracy", the contributors to which included Jeremy Hunt, Douglas Carswell and Michael Gove. It put forward, amongst other things, ideas for replacing the NHS with an insurance market system and called for the private sector to be brought in. Another contributor to the book, Conservative MEP Daniel Hannan appeared on Fox TV and said:

"Because you're our friends and if you see a friend about to make a terrible mistake [introduce Obamacare] you try and warn him. We have lived through this mistake [the NHS]. We have lived through this mistake for 60 years now.

"It began with the best of intentions. It began because people thought it was wrong for those who were not well off ... to be treated differently ... But the reality is it hasn't worked."

And yet, as I've said before, in 2014 a very reputable piece of research carried out by the Commonwealth Fund covering a period up to 2011 ranked the UK healthcare system in top place and the US healthcare system in bottom place, despite the fact that healthcare expenditure in the US is more than double that of the UK.

They will not believe you, Eloethan.

Bags, you have absolutely no idea what else I do apart from what I post on Gransnet.
So sorry, you are wrong that I do nothing about it. Unfortunately, what I do is not enough to get rid of the privateers.
What do you do? Or don't you care?

Apart from wanting to dismantle the NHS as we know it, what do Jeremy Hunt, Douglas Carswell, Michael Gove and Daniel Hannan have in common?

Who on earth believes that they would spend the alleged savings from leaving the EU on the NHS? Ha ha ha! :-(

As usual you have skewed what I said to make it say something you want it to say but which I didn't say, dj. I didn't say you did nothing except post stuff on Gransnet. I asked what your posts on Gransnet would change?

Sigh. Never mind.

I think jane10's post of 22:40:28 yesterday makes a valid point. We've all heard stories of people going to A&E over trivial matters that they really should have been able to deal with at home or at least which didn't need emergency treatment. I know it's Accident and Emergency but a good number of the accidents one hears about don't really need to be dealt with by medics.

I think there's a case for non-emergency treatment rooms/places if only to unclog A&E departments and to reserve them for serious accidents and actual emergencies. GP practices used to do minor stitchings up and bandaging of wounds, for instance. If GP practices can no longer do this sort of thing then we need some other way of covering such incidents that isn't as expensive to run as a hospital A&E.

Good post bags. I think there is also an argument for using pharmacies much more. And, surely, there must be a case for having a holistic 'geriatric' service rather than bitting and bobbing about between different disciplines.

As I keep on saying - a complete rethink is required.

We do have a walk in centre near the hospital that deals with minor injuries etc, not used it for a while, but it used to be staffed 24/7. Trouble is I'm sure people still go to A&E with minor complaints I did use our local A&E a while ago when I had a serious hand injury (which was referred on to surgery). I was lucky that I did it very early morning and I was seen quickly (the blood helps ) When I came out a couple of hours later it was heaving. .I was not convinced from visual appearances about the emergency nature of many of those waiting
I know other towns have similar walk-in centres as our daughter has used her local one with her boys.
How we tackle the mis-use of emergency services and ambulances , I'm not sure.

I do not know how people can be persuaded to deal with minor incidents themselves and not pile into A&E. My OH was a rural GP and the nonsense that used to come to us when he was on call at night and weekends beggars belief. All that stuff is now going to A&E as GP out-of-hours services have died the death. It is all very well saying educate the public about this, but to be honest so many of those who abused the out-of-hours were not of the brainiest. Very un-PC, but true.

I think that 111 has a lot to answer for in this regard. The people on the end of the phone are following an algorithm which errs on the safe side and many people are directed to A&E who might otherwise have waited for the GP surgery the next day.

Ditto A&E departments. Once you are through the doors, you have to be seen, even if the staff know it is nonsense. Once you are there and they register you they have to examine you to make sure nothing is being missed. They are understandably minding their backs.

I've looked back over the entire thread and there seem to be some things we all agree on.

I don't think any of us want to dismantle the NHS no matter what part of the political spectrum we come from.

No government regardless of the party in power has invested properly in the NHS for at least two decades.

There is, and will continue to be, greater demands made on the service as people live longer and new treatments are developed.

We are a rich country and can afford an excellent NHS.

There should be more doctors, nurses and other health professionals.

Doctors, nurses and other health professionals need to be listened to by those who make the decisions as they're the people working within the system.

A and E is misused. We need to increase the number of and promote the use of walk in and minor injury units. These also need to be open longer hours.

We need more GPs and better access to primary care.

Managers need to manage efficiently but also flexibly.

More money needs to be invested but it needs to be targeted. Perhaps it should be targeted even if this means some parts of the service have to wait for their share as long as every part gets what it needs eventually. This means that rather than spreading the cash thinly each part will get the lump sum it needs to sort itself out.

I think our differences are not really about dismantling the NHS but about how the service can be funded in the future. Some of us are adamant that it should totally be in public hands and funded directly by taxes. Others say that private companies can be part of the NHS and help it to be more efficient. Whilst others just don't know what but know something needs to be done.

And, I'm sure that many (note not all) of those complaining about having to wait for so long are the very ones blocking the system with minor problems.

Good summary vampirequeen!

Yes excellent post vq

Hear , hear, vamp. How nice to have a proper discussion of what people feel is needed rather than "pointless oppositionism".

You do realise what you've agreed to?
Vampire said it needs more money, more doctors, more nurses,and other health professionals, more GPs and better access to primary care, which is what some of us, including me, have been saying all along.
So how is it a proper discussion when vampire says it, but pointless oppositionism when I say it?
Says it all really.

This government, which is the one which is trying to dismantle it, break it up so it is no longer a National Health Service. is putting less money into it, whatever it says.
A soundbite seven day NHS cannot be run on even the same money as a five day, which is what Hunt appears to think it is at the moment.

gx99g.wordpress.com/2014/10/27/the-list-of-66-ae-and-maternity-units-being-hit-by-cuts-the-telegraph-26th-oct-2014/

More of them have closed since this was written.

thatbags, Maybe some GPs did stitches and dealt with minor fractures, but I've never had one who did. As a child in the 1950s and 1960s, I had all sorts of stitches and fractures, but I was always sent to A & E. It was the same in the 1990s when my own children went through that phase.

Perhaps it always varied, dd. A doctor definitely came to my parents' house in Leeds one day to stitch up a cut on my forehead, and I took a younger child up the road from my primary school in Lancashire (I was eleven) to a GP surgery for a stitch in her ear lobe.

The point really is that you don't need a hospital A&E for quite a lot of the things they cover nowadays so if a cheaper to run alternative could be designed, some of us think that might help relieve pressure on hospitals.

Vey Vamps a very good summary. BUT, and this is where the division starts, how do we fix it.

That's exactly what I just wrote! I really don't remember GPs doing any of those things, but there was a small hospital a couple of miles from where I lived as a child in the 1950s. I remember quite distinctly going there for X rays and the 'plaster room' and having a couple of very nasty cuts stitched up. I was born with a slightly deformed foot and had regular check ups with a consultant in the same hospital. Thinking back, I guess he did clinics there. These days, that hospital has gone. My parents and I would have to travel to an all-purpose hospital with A & E equipped with all sorts of hi tech equipment.

I don't know how people with no transport in my area manage to go to A & E or to planned hospital appointments.

Some of the biggest problems arise when people need care in the community since responsibility was transferred from the NHS to local authorities without ring-fencing the money. Some of these services have now been outsourced to the cheapest provider. I do know quite a bit about this, because this was why my sister was made redundant. It's quite obvious that vulnerable people in the community, formerly NHS clients, are often left with absolutely minimal support. Eventually it gets to the stage when there is no option but to admit them to hospital and keep them there until they can be safely returned to the community.

Rather than spreading staffing resources over 7 days, the government should try listening to what people really want. When CCGs were first introduced, my local one did a survey (last time it consulted ~lol~). Overwhelmingly, people wanted a stable team of local GPs, access to a local minor injuries/walk-in centre and reintroduction of district nurses, so that people could return home sooner. Since then, one GP surgery has gone completely, although the town's population has increased, an empty hospital building is being left to decay (probably earmarked for housing) and there are fewer district/community nurses than ever. There are NO mental health services for miles and the team is being dismantled.