Take care of your health

[Garry Edwards]

We all know that it can be very difficult to even speak to a GP on the phone, let alone actually see one face to face. A neighbour was experiencing severe abdominal pain, and had suddenly lost a lot of weight. After waiting 10 days he was able to speak to a GP on the phone, and she prescribed a laxative, which helped for about a week. He kept trying to speak to a doctor again, over a period of about another 3 weeks, but with no result.

He told me about this on Tuesday morning and we immediately went to the local A&E and after the usual long wait he was seen by a doctor and admitted immediately. There were no beds for over 30 hours but they found a trolley for him.

Long story short, he has a perforated bowel and will be having major surgery today. Statistically, his survival chances are about 70%, but his illness is life-changing. A&E departments frequently complain that people go to them instead of seeing their own doctor, but I'm just glad that he agreed to go there.

 

[Sky]

What's a doctor? There's more chance of seeing a unicorn.

 

[AndrewFlannigan]

but I'm just glad that he agreed to go there.

It's good that you got him there.

He kept trying to speak to a doctor again, over a period of about another 3 weeks, but with no result.

The primary healthcare system is in a mess.

However: what can we expect, when we have a private system alongside the NHS, which people with money can use to sidestep the queues in the public system?

 

[cambsno]

It's good that you got him there.


The primary healthcare system is in a mess.

However: what can we expect, when we have a private system alongside the NHS, which people with money can use to sidestep the queues in the public system?

Its not the private system - many other countries with better healthcare have private care as well and it works fine.

 

[john.margetts]

It's good that you got him there.


The primary healthcare system is in a mess.

However: what can we expect, when we have a private system alongside the NHS, which people with money can use to sidestep the queues in the public system?

The NHS is a mess because it is seriously underfunded. It needs proper funding on a par with other first world countries and that means proper taxes.

 

[AndrewFlannigan]

The NHS is a mess because it is seriously underfunded. It needs proper funding on a par with other first world countries and that means proper taxes.

I agree.

However, so long as there is a private alternative, those who excercise the most influence over decision making can ignore the problems, which don't directly affect them. If they had to join the queue, it seems to be a reasonable assumption that changes would happen.

 

[Garry Edwards]

It's good that you got him there.

I can be a bit of a bully at times, and I felt guilty about it during the hours of waiting, but I'm now glad that I'm not a nice person.

The NHS is a mess because it is seriously underfunded. It needs proper funding on a par with other first world countries and that means proper taxes.

I'm sure you're right, but I can't help wondering whether the acute shortage of GP doctors is at least partly due to their very high earnings, they can earn a good living on just a couple of days of work a week, so don't need to work full-time. By contrast, junior hospital doctors are badly paid and have to work very long hours.

 

[cambsno]

I can be a bit of a bully at times, and I felt guilty about it during the hours of waiting, but I'm now glad that I'm not a nice person.


I'm sure you're right, but I can't help wondering whether the acute shortage of GP doctors is at least partly due to their very high earnings, they can earn a good living on just a couple of days of work a week, so don't need to work full-time. By contrast, junior hospital doctors are badly paid and have to work very long hours.

The whole thing needs a rocket up it - NHS needs to be non political and be run by a cross section of MPs with people who know what they are doing advising (i.e. ex doctors). We need to understand what we need to do to have the best service and how it is built and run, stealing the best ideas from other countries and not being stuck behind political ideals like privatisation is good or is bad.

IMO many GPs are not actually that good on a number of issues either.

 

[Pound Coin]

The whole thing needs a rocket up it - NHS needs to be non political and be run by a cross section of MPs with people who know what they are doing advising (i.e. ex doctors). We need to understand what we need to do to have the best service and how it is built and run, stealing the best ideas from other countries and not being stuck behind political ideals like privatisation is good or is bad.

IMO many GPs are not actually that good on a number of issues either.

Agree it needs separating from politics. However, ex-doctors aren't administrators or managers. (Nor are Health Secretaries!)

So it should be run by a selection of people. And overseen by a non-political committee.

Two fundamental problems with the NHS:
1) seriously underfunded by the "Austerity" lot - possibly to make privatisation to mates more palatable
2) constant changes from people that are trying to make a political name for themselves. Here Today, Gone Tomorrow Health Secretaries, I'm looking at you.

 

[AndrewFlannigan]

I'm sure you're right, but I can't help wondering whether the acute shortage of GP doctors is at least partly due to their very high earnings,

As sound an argument for a proper income and taxation policy as I've read.

Not likely to go down well with the average greedy b*****d tory politician, though.

 

[Pound Coin]

The shortage of Drs is down to various causes.

Those brought in from Africa and Asia retiring
Better paid Drs at the end of their careers retiring earlier than expected, because of the effect on their pensions of the higher pay from the settlement
Not enough modelling (and response to it) to make sure we are training the Drs we need

 

[AndrewFlannigan]

One thing we could do, which I'm aware will meet a great deal of resistance, is to create a path for appropriate nurses and paramedics to move towards being doctors.

This would, I think, encourage more people to move into the health sector and eventually make us less dependent on poaching doctors needed in their own countries.

 

[lindsay]

We should look at the whole system in comparison with the best in other countries and learn from that instead of being wedded to one that is not fit for purpose. What I've seen in France is a system that is essentially private with funding both direct from government and from patients via insurance. Fundamentally though, social insurance is higher but the liability threshold is also higher. You pay to see a GP but most of the cost is recouped from your insurance or is covered by the govt if you are very low income.
Private healthcare in this country is pretty ropey in my opinion - I have used it several times and been underwhelmed, eg getting a post-op infection, paying for a private room but the tv didn't work, waiting 3 hours post op for a porter to move me, and in the latest experience we walked out due to miserable receptionists and dirty floors. Also NHS usually has better equipment than private hospitals.
The NHS is inefficiently run with under-utilisation of resources due to inadequate staffing which is mainly due to poor pay and conditions at all levels, compared to the value of staff. General Practice started going downhill when it was subjected to grouping up and clinical commissionag hubs etc. Now we have mainly part time doctors who are overloaded with work so they burn out, nurses expected to undertake a lot of work previously done by doctors, and don't get me started on the dreadful provisdion of mental health services.

 

[Craig1912]

Don’t agree it’s underfunded but it is very badly run and those funds aren’t allocated properly. Too many overpaid administrators and managers. Saying that the GP service isn’t really the NHS as they are private companies and the system in many areas is shambolic. I know two people who have died in the last year because they could not get a GP appointment in a reasonable period of time.
I’ve had two procedures privately in the last six months because the NHS would have taken too long, or longer than I thought was reasonable.

 

[Pound Coin]

If it is badly run, that is because the idiotic Tory politicians cannot leave it alone to recover after each of their reorganisations. They are after votes, not a well run NHS.

Whether you agree that is underfunded is immaterial; it is.

 

[sphexx]

Don’t agree it’s underfunded

You’ll have to cite some evidence for that. We spend less on healthcare than other comparable countries so unless we are massively more efficient, which you seem to doubt, then it’s underfunded.

 

[woof woof]

I'm not so sure the NHS is actually underfunded. Perhaps it's more that money is spent on the wrong things.

Overpaid diversity managers and removing the word "woman" from everything may only be a teeny tiny fraction of the waste but I do think these things indicate a culture, a culture I recognise from years working out of a government establishment, a culture that sees spending taxpayers money as an end in itself.

I'm not so sure I'd blame the Cons or any party, not as such, as I think one issue is that politicians are too frightened of a backlash if they interfere and try to implement any meaningful reform of this beloved institution but I do think the NHS needs reform.

 

[Craig1912]

You’ll have to cite some evidence for that. We spend less on healthcare than other comparable countries so unless we are massively more efficient, which you seem to doubt, then it’s underfunded.

We also spend more than some comparable countries (some of whom have better outcomes for various illnesses). Before we commit to spending more on the NHS we need to ensure the current funds are efficiently utilised, and currently they are not.

 

[sphexx]

NHS we need to ensure the current funds are efficiently utilised

Nobody is in favour of inefficiency. However, I’ve been listening to hearing politicians, mostly Tory, saying they will cut waste and increase efficiency since about 1952 so I’m surprised there is any left to cut ;(. Of course these promises ain‘t true but people like to hear them. Reorganisation is another. Look at how well organised the politicians are in their working environment in the HoC and Downing Street if you want to get an idea of how good they are at organising.

Did you see the clips of the 1922 Committee sitting at their 1850’s type school desks — how long does it take them to get themselves in and seated at those?

Edit: typo

 

[Pound Coin]

We also spend more than some comparable countries (some of whom have better outcomes for various illnesses). Before we commit to spending more on the NHS we need to ensure the current funds are efficiently utilised, and currently they are not.

I think you will need to evidence that, rather than just state it.

One of the problems with the political interference is that reorganisations take time and have hidden costs. Simple ones like rebranding, moving offices, and complex ones like a new team settling in and finding out what it is now supposed to do.

There are then significant issues that occur when you reorganise. Like the offers of voluntary redundancy. Good people go. (and set up as private consultants - because their expertise will still be needed.) Bad people stay, and their poor performance gets lost in the melee of the reorganisation. Well managed, stable staff are productive. Constant change is not productive.

The whole thing is just settling down, and along comes another Government (they happen every 5 years) or another Health Secretary with 5 minutes experience, with another reorganisation. Of course, these are dressed up for the loyal masses "No top down reorganisation!" (so they do a bottom up one - the venal, evil, vote-harvesters) The new reorganisation sets the whole process off again.

You also get lovely things like policy on the hoof. A Health Secretary visits a hospital. Like The Queen, he/she smells fresh paint, sees fully staffed activity, and is quite often shown some pet process or 'innovation' that is, of course, going wonderfully in the hospital. Three weeks later - it is policy.

When you hear people say the NHS is not efficient, you do wonder what it is that they know about the NHS, and where they gleaned it from.

 

[woof woof]

When you hear people say the NHS is not efficient, you do wonder what it is that they know about the NHS, and where they gleaned it from.

Some form an opinion from working in or with the NHS, some will get it from being a "customer" or being close to customers and some will come to an opinion by being impartial whilst following the news.

Conversely some will deny that the NHS could ever be less than perfect and the envy or the world and will repeatedly call for more evidence and of course however much evidence is presented they'll never accept it.

 

[Pound Coin]

Some form an opinion from working in or with the NHS, some will get it from being a "customer" or being close to customers and some will come to an opinion by being impartial whilst following the news.

Conversely some will deny that the NHS could ever be less than perfect and the envy or the world and will repeatedly call for more evidence and of course however much evidence is presented they'll never accept it.

Do you know if the news you follow is impartial?

 

[Garry Edwards]

Some form an opinion from working in or with the NHS, some will get it from being a "customer" or being close to customers and some will come to an opinion by being impartial whilst following the news.

Conversely some will deny that the NHS could ever be less than perfect and the envy or the world and will repeatedly call for more evidence and of course however much evidence is presented they'll never accept it.

Based entirely on my own experience (which sadly I've had quite a lot of) and leaving aside the political element, all of the problems seem to result from poor administration and even worse communication. And, because these failures are both routine and expected, nobody seems to care about them.

But, the front-line staff are superb in terms of effort, competence and dedication, and despite being grossly overworked they never seem to hesitate to do everything they can to help their patients. There may be odd shortcomings sometimes, such as perceived abruptness, but I think that that's usually down to nothing more than language difficulties.

 

[Pound Coin]

Based entirely on my own experience (which sadly I've had quite a lot of) and leaving aside the political element, all of the problems seem to result from poor administration and even worse communication. And, because these failures are both routine and expected, nobody seems to care about them.

But, the front-line staff are superb in terms of effort, competence and dedication, and despite being grossly overworked they never seem to hesitate to do everything they can to help their patients. There may be odd shortcomings sometimes, such as perceived abruptness, but I think that that's usually down to nothing more than language difficulties.

and I'd follow that up with a statement:

Constant reorganisations are not the way to improve administration and communication. Stability that leads to people knowing what they are supposed to do is good. Constant change and the glorification of change management is the problem.

 

[JohnC6]

I recall a TV series in which Sir Gerry Robinson, a well known businessman, would work alongside business people who were failing and get them back on track. One episode..or maybe series..included the NHS. I had to Google it to recall what he'd recommended.First off, I was saddened to learn that ,at only 72 he died in October last year. I do recall him being very frustrated that some operating theatres remained unused at weekends and evenings because consultants wouldn't work the hours. He found them to be obstructive. I think in one instance there was a matron. or nursing team leader, who did manage to get co-operation from consultants and had a good working relationship and an efficient system re operations but that was the exception.

I've found an article about the series re the NHS. It was in 2007. http://news.bbc.co.uk/1/hi/health/6250441.stm

Several years ago I listened to a Radio4 programme that was about pulling one's belt in re cost of living rises and one studio contributer said that the last thing she'd forgo ( I checked..it is forgo rather than forego ) was her private health insurance. Fortunately, when I retired I was able to continue with my private health scheme membership and I pay £79 a month for full cover and amongst other ops I've had 4 shoulder ops over the years, two each shoulder....rotator cuff damage caused by a growing spur of bone not the usual sports injury eg tennis..cricket (fast bowlers)..squash, rugby etc and from diagnosis to op a matter of weeks. The way I look at it is that,yes, I'm fortunate that I can afford it and greatly benefit re time but I'm also saving the NHS a lot of money and before retiring paid National Insurance. As cambsno says in his 11.07 post this morning,the problem with the NHS is not the private sector. He also rightly says,as did Sir Gerry Robinson, that the politics needs to be taken out of the equation.

 

[JohnC6]

One thing we could do, which I'm aware will meet a great deal of resistance, is to create a path for appropriate nurses and paramedics to move towards being doctors.

This would, I think, encourage more people to move into the health sector and eventually make us less dependent on poaching doctors needed in their own countries.

My wife tells me that these pathways are already in situ re a level of knowledge but,as you say, not to become a doctor which would require a Uni course. One of her friends, a paramedic, is about to gain a level of qualification equivalent to a registrar.

 

[ancient_mariner]

Based entirely on my own experience (which sadly I've had quite a lot of) and leaving aside the political element, all of the problems seem to result from poor administration and even worse communication. And, because these failures are both routine and expected, nobody seems to care about them.

But, the front-line staff are superb in terms of effort, competence and dedication, and despite being grossly overworked they never seem to hesitate to do everything they can to help their patients. There may be odd shortcomings sometimes, such as perceived abruptness, but I think that that's usually down to nothing more than language difficulties.

I have interacted with the NHS as someone supplying knowledge and technology, as a customer, and as a friend of multiple nurses and a few medics within the system. Basically it seems to be grotesquely badly managed: funds are silo'd, communication is sometimes minimal, doctors are unaware of key information about patients despite a computer system that allows access to patient records, there is wastage with un-necessary things being done due to poor systems.

I love the NHS, but a private company run like that would fold rapidly. Morale has a bit to do with it, but only a bit.

 

[JohnC6]

We should look at the whole system in comparison with the best in other countries and learn from that instead of being wedded to one that is not fit for purpose. What I've seen in France is a system that is essentially private with funding both direct from government and from patients via insurance. Fundamentally though, social insurance is higher but the liability threshold is also higher. You pay to see a GP but most of the cost is recouped from your insurance or is covered by the govt if you are very low income.
Private healthcare in this country is pretty ropey in my opinion - I have used it several times and been underwhelmed, eg getting a post-op infection, paying for a private room but the tv didn't work, waiting 3 hours post op for a porter to move me, and in the latest experience we walked out due to miserable receptionists and dirty floors. Also NHS usually has better equipment than private hospitals.
The NHS is inefficiently run with under-utilisation of resources due to inadequate staffing which is mainly due to poor pay and conditions at all levels, compared to the value of staff. General Practice started going downhill when it was subjected to grouping up and clinical commissionag hubs etc. Now we have mainly part time doctors who are overloaded with work so they burn out, nurses expected to undertake a lot of work previously done by doctors, and don't get me started on the dreadful provisdion of mental health services.

Re your private health care experience my nephew,who is a consultant in the NHS, told me that for serious procedures..eg, re heart ops..it's safer in the NHS because there are consultants and doctors on hand day and night. That isn't always the case in the private sector. Also, staffing levels are higher in the NHS. I've only had a couple of negative experiences, one was getting a cuppa... the other a meal. In both instances I'd been forgotten. Re the meal..it was lunch...I had to have soup and a sandwich as chef had gone home. Also, On that occasion I had a nasty sore throat..I think re a tube being inserted for whatever reason and my wife visited and told the nurse what medication I needed. It's not the care that I've kept paying my premiums for but to avoid long waits. I had an op not long ago and the NHS waiting list to see a consultant let alone have the op, was 10 months. I've kind of put my principles to one side on this issue.

 

[sphexx]

Re your private health care experience my nephew,who is a consultant in the NHS, told me that for serious procedures..eg, re heart ops..it's safer in the NHS because there are consultants and doctors on hand day and night. That isn't always the case in the private sector. Also, staffing levels are higher in the NHS. I've only had a couple of negative experiences, one was getting a cuppa... the other a meal. In both instances I'd been forgotten. Re the meal..it was lunch...I had to have soup and a sandwich as chef had gone home. Also, On that occasion I had a nasty sore throat..I think re a tube being inserted for whatever reason and my wife visited and told the nurse what medication I needed. It's not the care that I've kept paying my premiums for but to avoid long waits. I had an op not long ago and the NHS waiting list to see a consultant let alone have the op, was 10 months. I've kind of put my principles to one side on this issue.

There are a number of downsides to private health but they are usually different from those in the NHS. Really, if you can afford some private health care then you (not you particularly John) have the best of both worlds.

 

[sphexx]

One thing we could do, which I'm aware will meet a great deal of resistance, is to create a path for appropriate nurses and paramedics to move towards being doctors.

I don’t know the details but my local hospital has an out of hours GP service and, from experience, some of those “GPs” are nurse consultants of some kind (not sure of the naming).

 

[Jelster]

My sister-in-law was a nurse for over 30 years, worked her way up to manage the whole cancer ward(s) in a large hospital in Kent. But the constant demands for reports, upper managers not giving a stuff, and hardly any time off, forced to leave the NHS and work for BUPA. Better hours, better pay and less stress.

Her & her husband retired early, sold their house, and now live on a narrowboat. The boat is called "Dunworkin'".

 

[Brentor]

My sister-in-law was a nurse for over 30 years, worked her way up to manage the whole cancer ward(s) in a large hospital in Kent. But the constant demands for reports, upper managers not giving a stuff, and hardly any time off, forced to leave the NHS and work for BUPA. Better hours, better pay and less stress.

Her & her husband retired early, sold their house, and now live on a narrowboat. The boat is called "Dunworkin'".

Sounds like a good plan.

 

[ancient_mariner]

Some of the nurses I know think a significant issue with caring more generally is that nurses are now graduates who do less of the hands-on care for patients, and are thus much less able to understand their patients problems because they don't bath them or take them to the toilet etc.

 

[Pound Coin]

I recall a TV series in which Sir Gerry Robinson, a well known businessman, would work alongside business people who were failing and get them back on track. One episode..or maybe series..included the NHS. I had to Google it to recall what he'd recommended.First off, I was saddened to learn that ,at only 72 he died in October last year. I do recall him being very frustrated that some operating theatres remained unused at weekends and evenings because consultants wouldn't work the hours. He found them to be obstructive. I think in one instance there was a matron. or nursing team leader, who did manage to get co-operation from consultants and had a good working relationship and an efficient system re operations but that was the exception.

I've found an article about the series re the NHS. It was in 2007. http://news.bbc.co.uk/1/hi/health/6250441.stm

Several years ago I listened to a Radio4 programme that was about pulling one's belt in re cost of living rises and one studio contributer said that the last thing she'd forgo ( I checked..it is forgo rather than forego ) was her private health insurance. Fortunately, when I retired I was able to continue with my private health scheme membership and I pay £79 a month for full cover and amongst other ops I've had 4 shoulder ops over the years, two each shoulder....rotator cuff damage caused by a growing spur of bone not the usual sports injury eg tennis..cricket (fast bowlers)..squash, rugby etc and from diagnosis to op a matter of weeks. The way I look at it is that,yes, I'm fortunate that I can afford it and greatly benefit re time but I'm also saving the NHS a lot of money and before retiring paid National Insurance. As cambsno says in his 11.07 post this morning,the problem with the NHS is not the private sector. He also rightly says,as did Sir Gerry Robinson, that the politics needs to be taken out of the equation.

Ah, yes, that program.

I remember it too. It was made at the time that a hip replacement cost £x,000. (I have no idea if it still does - I've not seen anything to say that procedures aren't costed at a set price)

So if you do 4 a day, for 5 days, it costs 20 x £x,000.

The theatres are free over the weekends! Lets use them like Tesco Checkouts!

Except, it isn't like asking a Tesco check-out operator to put a few more customers through in an hour. It would be, if you gave the Tesco check-out operator £5 for every customer - but you don't - you pay them by the hour.

Back to opening Operating theatres at the weekends, as per Sir Gerry Robinson.

Now, you do 8 more operations in the same room. But it costs you 28 x £x,000. 40% more. Where is the budget for that?

 

[ancient_mariner]

Now, you do 8 more operations in the same room. But it costs you 28 x £x,000. 40% more. Where is the budget for that?

If you're going to do them all anyway then the cost is the same but the waiting time is less.

 

[Pound Coin]

If you're going to do them all anyway then the cost is the same but the waiting time is less.

Yes, but, there is only a budget to do a set number of operations. So if you do more, you go over budget. One way of saving money (if, for example, a government has championed "austerity", is to do fewer operations. And let the waiting lists grow.

When Labour cut waiting times from 2 years to one, there was a cost to the NHS of a year extra.

 

[ancient_mariner]

Yes, but, there is only a budget to do a set number of operations. So if you do more, you go over budget. One way of saving money (if, for example, a government has championed "austerity", is to do fewer operations. And let the waiting lists grow.

When Labour cut waiting times from 2 years to one, there was a cost to the NHS of a year extra.

A perfect illustration of why the NHS is run badly & it's not really about the money - you pay less in the future.

 

[Pound Coin]

A perfect illustration of why the NHS is run badly & it's not really about the money - you pay less in the future.

No. It is far more complicated than that.

The sad and bad thing about the NHS is armchair experts peering round from behind their Daily Telegraphs and Daily Mails explaining how much better it could be if only things were done better.

 

[ancient_mariner]

No. It is far more complicated than that.

The sad and bad thing about the NHS is armchair experts peering round from behind their Daily Telegraphs and Daily Mails explaining how much better it could be if only things were done better.

And from behind their Guardians too, it seems.

 

[Pound Coin]

All media is biased. I try and read as many as possible. Unfortunately the Telegraph is behind a paywall and I don’t want to give them any money. The Mail is a disgrace. The Express, more so. It is good to read different sides of arguments, seeing the slants, and biases.