Junior Doctors strike

Been at hospital again today with Son for a procedure and happy to report things are running almost normally again after the Drs strike. Just a fire alarm going off and staff telling people to evacuate the building and nobody taking any notice.

Aveline

I know it shouldn't happen but it does. It's just a suggestion.
The NHS needs a comprehensive reorganise and for it to be funded and managed out with the usual three to five years of a government. The BMA has a role to play too though.

I'm not sure whether you know, but it's just had yet another comprehensive reorganisation, as the boundaries of the Integrated Care Boards have been changed - again.

What do you suggest needs reorganisation and how do you think that would impact on and improve patient care?

The 'integrated care boards' are clearly not working! Rearranging the deckchairs on the Titanic springs to mind.

Aveline

The 'integrated care boards' are clearly not working! Rearranging the deckchairs on the Titanic springs to mind.

How do you suggest the whole NHS is organised? It's too big to be managed as one unit from the centre. It has to be divided into some kind of regional board system.

My own feeling is that the problem is the internal market, which means that GPs have to use many different providers, who don't communicate well. The main stake holder (the patient) gets lost in the process.

I agree. There needs to be much more localised organisation and with the appropriate funding for that population following it. Some overarching body but only with the lightest touch. No more endless meetings and quangos each with their own governance and standards.

Here there is a delay between GP and Hospital information, it does get through but is out of date, which can make follow up difficult.
Big variation in time to see consultant Cancer is very quick, other investigations can take a very long time, often 6 months between diagnosis and treatment.

Big variation in time to see consultant Cancer is very quick, other investigations can take a very long time, often 6 months between diagnosis and treatment.

Currently 15 months between diagnosis and treatment.

That's very poor. I'm just thinking about it. The number of patients referred and the availability of appointments for treatment don't match. Therefore what is required is actually more hospitals/treatment centres which would in their turn required more staff this offering more job and training opportunities for doctors. Currently it seems they're trying to pour a gallon of patients into a pint pot of hospital appointments.
Only thing missing is the money and/ or the will!

I don think it’s quite that straightforward Aveline. There is a problem with lack of operating theatre capacity and staffing, and not all procedures by any means are suitable for treatment centres, which don’t offer post operative intensive or high dependency care, which some patients need, or need to be in a hospital where it is available as they have risk factors.

Actually it is as straightforward as that. There needs to be more actual hospitals. Treatment centres for orthopaedics and ophthalmics and maybe Obs and Gynae. There needs to be therefore, an exponential increase in relevant staffing and requisite training. I'm thinking big here and trying to see what might actually help. I'm not constraining my thinking to current provision.

Aveline, it isn’t and can’t be as straightforward as that. Routine operations can be done in treatment centres provided staff and facilities are available. By no means all operations are in that category, particularly in general and specialist surgery specialties as opposed to some orthopaedics, and cataracts. Treatment centres are not set up with the very specialist equipment that some surgeries require either, they are there to do high volume, routine operations. They also don’t cater for emergency operations resulting in the cancellation of other complex cases which were booked to take place, and that happens all too often. More capacity is needed in general hospitals, including ITU and High dependency, to solve the waiting list problem.

No. We need more actual hospitals as well as treatment centres for more clear cut conditions. It's called blue sky thinking. Try thinking much bigger.

It’s more fantasy land than reality though isn’t it, that’s the problem with blue sky thinking. Chronic underfunding has left a huge backlog, and there are few options left in the short to medium term I fear.

I was in A&E after a fall and a head injury - after 5 hours, I saw the maxilo facial folks who pinned my teeth, and even though not their job steristripped my lip and eyebrow and cleaned me up. I then spent another 4 hours sat in a draughty dark corridor while waiting for a doctor, alongside a frail elderly lady in a wheelchair who had been there for 8 hours with nothing to eat or drink (my DH got her a cuppa, and had a go at an auxiliary nurse to chase up her wait, a very grumpy doc arrived about 3/4 hour later complaining about having been called out) By this time DH was getting poorly as he had nothing to eat (diabetic) so we went home, where he ate and sat up all night to make sure I was OK, then called the GP out in the morning. And that was a fast track. Chap sitting next to us had been waiting 10 hours for just a stitch in a deep hand cut, so he could drive 100 miles home. You can imagine what he thought of our A&E

Just a wee irrelevant moan coming up,
'Why, as a country, did we let things get so bad?'

Casdon I * know* it's a fantasy!! The whole NHS started as someone's blue sky thinking. If we can imagine what we actually need we can start planning how to get it. Otherwise we're left in the current situation.
In an obvious suggestion, why not open all the old convalescent and cottage hospitals to discharge the current bed blocking patients? That should clear things up. Again, all that's missing is the money and the will.

The blue sky thinking that created the NHS thought free universal health care would result in a healthier population that needed less treatment. It didn't predict the increase in people living longer lives with comorbidities, the increase in treatments and expensive medical interventions, the need to provide increased social care when women entered and stayed in the workforce etc etc. I think if it had we would not have had a free at point of access service.

Aveline

Casdon I * know* it's a fantasy!! The whole NHS started as someone's blue sky thinking. If we can imagine what we actually need we can start planning how to get it. Otherwise we're left in the current situation.
In an obvious suggestion, why not open all the old convalescent and cottage hospitals to discharge the current bed blocking patients? That should clear things up. Again, all that's missing is the money and the will.

What my blue sky thinking would tell me is that what is required are more surgical, orthopaedic, and surgical specialty beds with all the back up, in general hospitals, because that is the safest place for surgical procedures. Community hospitals with outpatient and minor treatment facilities and rehabilitation beds for older people already exist, in Wales at least. What we are short of are beds for people with both dementia and medical issues who awaiting assessment prior to placement. People awaiting long term care packages should not be in hospital at all, so key to my plans would be Local Authority managed interim facilities.

It was also created on the premise that the vast majority of those able to work would be doing so Vintagewhine, and there would be sufficient tax contributions to fund it.

Is it back to the deficiencies in 'Social Care', which was the first promise broken by the Tories, when they swept to power last time?

Maremia

Just a wee irrelevant moan coming up,
'Why, as a country, did we let things get so bad?'

Its a fair moan. the long period of conservative government has a heck of a lot to answer for.

Amongst other things, letting the situation arise where Resident Doctors pay so much for training then can't move up the food chain with a job. What a mess. What a waste. How crazy. They have to pay back the training money, without proper career prospects, and we are deprived of those doctors.

this was actually the reason I supported the strike. I am unsure about the pay issue, but the waste, the pointlessness of this, is truly significant going forward.

I'm finding some of the newer measures taken excellent. Take cataract treatment now - people used to have to wait a year of more, now it's going to a specialist clinic.
I've just been refereed via a new scheme, to an advanced optician for a series of eye problems. It's called The Community Eye Service and the place is within an 8/10 min drive or taxi. What a relief.

I was blue lighted in mid January to A and E and had only 4 hours to wait before I was taken to a bed on a ward because my oxygen levels were dangerously low.
I think provision is patchy. And departments vary. ENT in one area is good, in others, not good.

Good things are being done, despite all.

The new local arrangements in my city are working out as in grouping practices, but we do have a very good practice manager and lead GP who takes advantage of any opportunities. MH is probably the one they cannot deliver on consistently, but it was always the Cinderella service. We don't have enough beds locally in my big city and they are farmed out at great expense, which makes it difficult for visitors. 16 beds for over 65's (excluding dementia which is separate) for the whole city.

Of course the current situation of an ageing population and an explosion of new treatments could not be predicted back in the late 40s. Seventy years on from now where will we be? We'll still have older people, joints will still wear out and cataracts form. Or probably will. However, AI will have caused huge improvements in aspects of care in other illnesses, diseases and conditions. What planning needs to be done right now to try to predict and intelligently plan for the future of NHS? We can't continue to be constrained by the 'its aye been' thinking.

£60million is being earmarked for translators in the NHS. That is truly shocking.

Why?

I get what you're saying Aveline. Make new plans, discuss new 'routes'. Then develop the ones that will work.
I have a possibly 'horrid' answer to your question about in 70 years.
Assisted dying might be well established by then.