The NHS is gone ...

Britain has 2.3 hospital beds per 1,000 people, compared with 5.7 in France and 7.8 in Germany.

This is a quote from an article in this week's Economist (£). Later the article continues:

After more than 12 years in power, the Conservative government can be blamed for many of the NHS's current problems. Its refusal, until recently, to have a workforce plan helps explain why one in ten posts in the NHS are vacant.

If the Conservatives want us to believe this plan is for real perhaps we could have regular updates - or one question a week from Starmer asking how far they have got with this.

DaisyAnne

Whitewavemark2

Twitter post - bit sweary but I absolutely agree with the sentiment.

“The Tories plan for the NHS is "hospitals at home" it’s like an outtake from The Thick of It. Who will staff this? People can’t be sent home from hospitals due to no social care! People are literally freezing to death in their own homes. Gove is off his tits.

Fucking insanity.”

I think there is something in this idea. Just because it comes from people whose politics you oppose doesn't mean we shouldn't look at it.

The issue would be with the people whose politics you oppose running this. This particular party (12 years of government) has not given us any reason to believe they could do it with competence, nor would they even try. They seem not to believe in basic nursing - now generally lumped in with "social care".

We can't expect the NHS to run the same way it has in the past. We can't expect the NHS to survive under this group of so called Conservatives. We can - or I do - expect people to write as if they have a least a couple of brain cells to rub together. That cannot be said of that tweet Whitewave.

It sounds like their idea years ago to close down mental hospitals and replace them with care in the community. Except that all they did was close down the hospitals.

There's no reason at all why hospitals couldn't be run as they were in the past, DaisyAnne. That is to say, as they were run in the past when they worked. Their problems now are mainly caused by relentless and massive underfunding over the past 12 years. That and poor planning for training staff. And Brexit causing an exodus of EU personnel with none to replace them.
And some ridiculous reorganisations.

Hear hear.

MaizieD

There's no reason at all why hospitals couldn't be run as they were in the past, DaisyAnne. That is to say, as they were run in the past when they worked. Their problems now are mainly caused by relentless and massive underfunding over the past 12 years. That and poor planning for training staff. And Brexit causing an exodus of EU personnel with none to replace them.
And some ridiculous reorganisations.

There is, equally, no reason why running them as they were run in the past is a good thing. Surely, doing the best for the time we live in is what we need and we have to be open-minded to work out what that is.

The idea of Care in the Community was a good one. I don't know if you ever visited an old mental health establishment in the 1980s before the law changed. The practice in many was old-fashioned to a dangerous degree for some, and there was still a stigma around mental health issues. Many of those in asylums should never have been there but out of the community things could happen that we wouldn't allow now. And, of course, they had been left short of money, and the National Health estate had been run down.

Again, it is worth looking at the idea the tweet picked up. Communities are the best place for most people. There was a woman who had been treated in this way on The World at One. It's worth listening to.

We all know the problem cannot be solved by either extreme ideology. It is the staffing and the lack of money both for the staff and infrastructure in the public systems that is the problem. It is also the lack of monitoring and a feeling that there should be no constraints which affects some in the private system. We can run a private, and a public system, alongside each other with each learning from the other if our perspective is from the centre and not one or other extreme.

Hospital at home isn’t new, it’s been running with varying degrees of success for several decades in the UK now. It is definitely what the majority of patients want (not all, and definitely not the families of all). The biggest issue is that to do it well is more expensive, more risky for the patient, and more labour intensive than keeping older people in hospital. You need a night service as well as a daytime service, and on call staff for urgent issues. It uses more ambulance time because it’s not always successful and people can be in and out of hospital frequently. To run well needs a lot of well trained staff and joined up working. It can be great, but it’s not by any stretch of the imagination a quick fix,

It is the staffing and the lack of money both for the staff and infrastructure in the public systems that is the problem.

It is deliberately sustained cutting of funding that is the initial problem, DaisyAnne. That is a political choice, nothing to do with 'affordability'.

And there's no need to talk down to me as though I was calling for a return to hospital matrons and 'asylums'.

If you keep making up the other side of your argument and putting my name to it Maizie I will call you out when you do it.

So, where did I say anything about "affordability"? The lack of money both for the staff and infrastructure in the public systems that is the problem. This is down to this government starving the public services for the last 12 years. I cannot imagine how many times I have said that.

I did not mention matrons, so more of your imagined disagreement. The comment about asylums was in reply to Maybee's comment about care in the community, which I believe was a good idea, having seen what went before it. As I said, the problem was it was badly underfunded. It was nothing to do with anything you said. My replies are not all about you.

You are making up things simply to give yourself something to oppose but I did not write these things. Nor have I, at any time, suggested that was the case. Doing this can only be because either you have a problem with your eyesight (in which case you have my sympathies) or you have no substantive argument with my views but are determined to magic one up.

I didn’t say that care in the community was a bad idea. I just meant that the Conservatives used it as an excuse to throw people out onto the streets and had no intention of providing the care in the community that was promised. From memory I think it was based on what had been done in Sweden, the difference being that they did actually provide the support that was needed.

Care in the community is all very well but what if it's contracted out to the lowest bidder. There is a letter in today's Telegraph recording the lethal consequences for one elderly woman discharged from hospital in a previous pilot scheme. When asylums were closed there were reports of patients simply being given train tickets to Brighton.

Grantanow

Care in the community is all very well but what if it's contracted out to the lowest bidder. There is a letter in today's Telegraph recording the lethal consequences for one elderly woman discharged from hospital in a previous pilot scheme. When asylums were closed there were reports of patients simply being given train tickets to Brighton.

..and that's the problem. The principle may be good but we know it will be implemented in the most shoddy way possible with the main driver being saving money, not patient care.

Grantanow

Care in the community is all very well but what if it's contracted out to the lowest bidder. There is a letter in today's Telegraph recording the lethal consequences for one elderly woman discharged from hospital in a previous pilot scheme. When asylums were closed there were reports of patients simply being given train tickets to Brighton.

But it didn't have to be done that way. There was a big drive to sell of the buildings too - really do we expect anything else from the Conservatives? But do we expect the same from all other parties? I live in hope that they wouldn't behave like this.

The latest The Rest is Politics Leading is an interview with Alan Milburn in which he discusses the problems he faced as health secretary and what he thinks needs to be done now. It’s very interesting.

MayBee70

The latest The Rest is Politics Leading is an interview with Alan Milburn in which he discusses the problems he faced as health secretary and what he thinks needs to be done now. It’s very interesting.

There are some good political podcasts available, aren't there Maybee. So much better than watching/listening to a news broadcast that has one journalist commentating on what other journalists have said in newspapers.

I’m getting confused. Are you all talking about Care in the Community, the policy for deinstitutionalisation, treating and caring for physically and mentally disabled people in their homes rather than in an institution, or are you talking about Hospital at Home, which is the initiative to look after people who would otherwise be in acute or community hospitals, which is where the thread originally started?
It all seems muddled to me, with some thinking Care in the Community is the same thing as Hospital at Home? The government’s initiative isn’t about the former as far as I can see.

Casdon

I’m getting confused. Are you all talking about Care in the Community, the policy for deinstitutionalisation, treating and caring for physically and mentally disabled people in their homes rather than in an institution, or are you talking about Hospital at Home, which is the initiative to look after people who would otherwise be in acute or community hospitals, which is where the thread originally started?
It all seems muddled to me, with some thinking Care in the Community is the same thing as Hospital at Home? The government’s initiative isn’t about the former as far as I can see.

I was just that the governments announcement about caring for people at home reminded me of when they closed down mental hospitals but then didn’t follow it through by providing care in the community. Which means I don’t believe a word that they say.

DaisyAnne

MayBee70

The latest The Rest is Politics Leading is an interview with Alan Milburn in which he discusses the problems he faced as health secretary and what he thinks needs to be done now. It’s very interesting.

There are some good political podcasts available, aren't there Maybee. So much better than watching/listening to a news broadcast that has one journalist commentating on what other journalists have said in newspapers.

I love TRIP’s. And I suddenly realised that I have Alastairs book ‘The Blair Years’ which I bought from a car boot sake years ago but never got round to reading because I thought it would be heavy going. I was hoping it might be a signed copy but it just says ‘To Dave from Liz’. I don’t think Dave ever read it.

I may have been writing in my sleep, but I don't think I wrote about Hospitals at Home in the OP, although it was mentioned early on, Casdon.

Care in the community was someone making a comparison. Sadly, care in the community was grossly underfunded. Although this government may come up with good ideas - of which Hospitals at Home may be one - I think whatever they propose will still be grossly underfunded. It is the nature of these Conservatives.

Yep!

MayBee70

DaisyAnne

MayBee70

The latest The Rest is Politics Leading is an interview with Alan Milburn in which he discusses the problems he faced as health secretary and what he thinks needs to be done now. It’s very interesting.

There are some good political podcasts available, aren't there Maybee. So much better than watching/listening to a news broadcast that has one journalist commentating on what other journalists have said in newspapers.

I love TRIP’s. And I suddenly realised that I have Alastairs book ‘The Blair Years’ which I bought from a car boot sake years ago but never got round to reading because I thought it would be heavy going. I was hoping it might be a signed copy but it just says ‘To Dave from Liz’. I don’t think Dave ever read it.

So now we know what Truss got Cameron for Christmas

!

DaisyAnne

I may have been writing in my sleep, but I don't think I wrote about Hospitals at Home in the OP, although it was mentioned early on, Casdon.

Care in the community was someone making a comparison. Sadly, care in the community was grossly underfunded. Although this government may come up with good ideas - of which Hospitals at Home may be one - I think whatever they propose will still be grossly underfunded. It is the nature of these Conservatives.

I think I’ll leave you to it DaisyAnne, the figures quoted earlier on in the thread mainly refer to physical rather than mental health and learning disabilities, and I wasn’t specifically referring to you personally when I said there appeared to be confusion amongst posters between hospital at home style community care and Care in the Community - which isn’t surprising unless you have worked in the system. It’s not worth disagreeing over what is meant.

To go back to the article I quoted in the OP regarding our low number of beds, Denmark has only slightly more beds than us at 2.5 per 1,000 people. The difference, as they point out, is that it has fewer problems.

The writer describes the technology they use to monitor patient flow how many are on their way to A & E, how many are waiting there, and which wards have space available, meaning greater efficiency and better use of their decreased number of beds.

They quote Rory Deighton of the NHS Confederation, who says; The vision is right. The only way to deal with an ageing population is to help people to live independently, and in their own homes. The article concludes, But if you want more people out of hospital, you must also fund the alternatives. Noticeably, where Britain cut community nurses and practically abandoned the social care sector, the article tells us that the Danes have a long-term well-funded plan for elderly care.

It really isn't difficult to spot where we went wrong.

Hospitals at Home will be exactly like Care in the Community.

Both are good ideas - in principle - but they require a level of funding that the government is not prepared to commit to because the idea behind both is to save money.

My late mother, a retired SRN could've told you about Care-in-the-Community. She spent time every day responding to the distress (and the havoc it created) of a poor chap who was schizophrenic, who lived in the flat above hers. There just wasn't the staff nor the services in place to deal with him to any meaningful level.

Where are the services and staff for this project of Hospitals at Home - virtual wards - going to come from? There is a shortage of staff in just about every area of health care.

I always remember that poor man who was killed by a schizophrenic soon after care in the community began. His wife ran some sort of campaign I believe. It’s still happening because people aren’t being cared for properly.