NHS - in crisis ?

[SabreSheep]

I agree their are inherent flaws in the system.

 

Originally when imposed we didn't have quite a growing domestic population and also an aging population at that.

 

As the number of older people increases so does the burden on the NHS. Same issue with Pensions etc. When these schemes were implemented there was little foresight into the decades ahead.

[tobyjugg2]

I agree their are inherent flaws in the system.

 

Originally when imposed we didn't have quite a growing domestic population and also an aging population at that.

 

As the number of older people increases so does the burden on the NHS. Same issue with Pensions etc. When these schemes were implemented there was little foresight into the decades ahead.

 

Why do you consider a growing and aging population as an 'inherent flaw' in the NHS rather than a political/funding issue (for example) Sabresheep?

(and as an aside a major success of the NHS philosophy)

 

I don't deny what you mention among many other things far less 'worthy' in my opinion are issues and that they impact the NHS significantly, but surely capacity is a funding and resource issue, not an inherent or fundamental flaw in the NHS itself.

 

Or do you believe that the NHS itself is a fundamentally flawed concept and that it should not exist and all care should be payed for by the person in need at the time of need or by insurance policies - which would of course add another profit overhead into the equation?

I already think there is too much profit made by external people and companies from the NHS - now I think that is a fundamental flaw in the political choices affecting current NHS implementation and practice.

 

Some clarity on your reasoning would be appreciated.

[SabreSheep]

Oh trust me, I fully support the NHS and am fully against Privatisation. But my support for the NHS is neither here nor there when all I am doing is stating an observation.

 

Funding and resources are an integral part of the NHS, and thus where they have failed to anticipate the rise in the resources required, demonstrate a fundamental flaw in the whole dam thing. The NHS as a whole is a Political Issue.

 

Note Principle 6

The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources. (http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx)

 

The failure here is that the "Finite resources" do not match the requirements to complete the rest of the objectives of the NHS

 

 

 

Now does this mean a fundemental flaw is automatically fatal? Nope, or at least I hope not.

 

 

Just look at Pensions and that debacle. The ideology just like the NHS is SOUND. Just an aging population caused by longer life expectancies created big problems.

 

And if we wish to split hairs, I didnt say that a growing anti aging population were an inherent flaw. The flaw was failing to predict that the service would have to increase its resources to cope.

[tobyjugg2]

And if we wish to split hairs, I didnt say that a growing anti aging population were an inherent flaw. The flaw was failing to predict that the service would have to increase its resources to cope.

 

I don't agree that the increase in needed resources was not predicted repeatedly from many sources, including the NHS, but funding and to a large extent what is treated is defined by politics, not the NHS.

 

The decision about how much money parliament will give to the Department of Health to spend on the NHS in England is made as part of the Spending Round process.

http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/how-nhs-funded

 

(I take your other points as being differences in our interpretations rather than a fundamental difference in opinion)

[unclebulgaria67]

NHS costs about 9.5% of GDP. Average level of similar healthcare systems is about 12.5%. Other countries also have some system of charges and more private insurance. In France for example they have more Doctors in relation to population. They also have facilities where they will carry out more tests close to Doctors surgeries, Doctors get more time with patients.

 

I have family abroad and they say that their experience is better than NHS. One living in Australia had cancer issues later in life. They received treatment very quickly after diagnosis which did the trick and then they were able to have very regular check ups to ensure they stayed cancer free. Some say they had an additional 20 years of life, they may not have enjoyed living in England. NHS still has a big problem with early cancer diagnosis and treatment.

 

If there was a referendum, people would willingly pay more tax for ring fenced additional spending on NHS services.

[fletch70]

I think that you are missing the 'point of entry' qualifier, which although undesirable is necessary.

 

Quality healthcare does not necessarily mean the highest paid consultants, and in many ways is contrary (one 'top' consultant employed as apposed to 3 very capable ones?)

Also the sheer cost and size of the required equipment and support mechanisms.

 

Even an unlimited budget would not give care for every situation in every town.

 

That there should be more centres like those you describe I agree with fully fletch, as I am sure do those in the NHS, but the realities of funding and political will define otherwise

 

Why is the entry point necessary

By the very structure of the medical profession senior Doctors train the junior ones so when those senior Dr's are allowed not to participate fully in the NHS the whole service suffers. In addition , in poorer areas there was a lack of GP's and we had to import GP's to fill these places. Some will think this is a racist comment but it is far from it , these Dr's ended up working in poorer areas with poorer health so their workload was higher . The greater the strains on the resources the more chance of mistakes , longer waiting times, less access to healthcare

 

Although the NHS was a massive boon the the welfare state it was allowed to keep an element of market forces i.e money and background . That in itself is inherently unfair and leaves many people disadvantaged

[tobyjugg2]

Why is the entry point necessary

 

Because there isn't enough money to deliver all services to your door. They need to be centralised to be affordable within the allocated budget - great if one is near you if you need them, not so great but better than no service if its far away.

 

Just like GP's are centralised at surgeries

More specialised services are centralised at local community hospitals

Even more specialised (and expensive to supply) services are at major hospitals

etc ...

[citizenB]

The worst thing that happened within the health service was to shut down all the hospices. This would take the weight off some hospitals where elderly people are waiting to be assessed by Social care before they can return to their own homes. There would also be far superior "end of life" care for those who need it.

[tobyjugg2]

The worst thing that happened within the health service was to shut down all the hospices. This would take the weight off some hospitals where elderly people are waiting to be assessed by Social care before they can return to their own homes. There would also be far superior "end of life" care for those who need it.

 

I don't know anything really about the decisions, let alone the validity of the decisions, to close Hospices.

 

If Hospices could be funded from the pension entitlements of those in the Hospices, then the only potential political downside is that the people would live longer - but this would perhaps be balanced by the increased employment in the care industry funded by the pensions entitlements.

But there is then still the issue of what about property they own? Income from other than state pensions?

 

The only option would seem to me to be that state pension entitlement must fund it - else choose to take the private option.

 

I really don't know enough about the costs and issues.

[fletch70]

Toby

It seems that you do not understand what a hospice is

They are wonderful places but also very sad, generally people of all ages go there not necessarily to die but to get a bit of respite, maybe get their pain under control. The Drs who work there are marvellous and think 'outside the box' with pain relief . When my stepson was nearing the end it was the Doctors from Loros (Leicestershire) who sorted out his pain relief , prescribed ketamine as well as diamorphine . Yes we all knew that these drugs may shorten his life but they relieved the pain . His last two weeks of life in the hospice were relatively pain free, he was happy. they even had a smoking room-lets face it , a cigarette wasn't going to kill him. he was 30 when he died and will have had virtually no pension entitlement -he had been fighting the disease for 10 years

 

 

As for talking about point of entry, I think you are saying that the poor or those that live in different locations are not entitled to the same level of health care under the NHS as people who live in cities or the south. The same is happening with our legal system where people on legal aid get less qualified or more work laden lawyers . In the U.S which is where we seem to be going, the public defenders are the new inexperienced lawyers or the plain bad-how is that equitable and fair .

[fletch70]

 

If there was a referendum, people would willingly pay more tax for ring fenced additional spending on NHS services.

 

I am not sure that I would agree to more tax just for ring fenced money, I would want strings to that, equality of care wherever you are and who ever you are .

[tobyjugg2]

Toby

It seems that you do not understand what a hospice is

 

It would seem that is exactly the situation.

Even more so than I thought.

[unclebulgaria67]

I also thought a hospice was only for terminally ill.

 

The other issue is end of life management in care homes. People go into care homes towards the end of life, when they cannot care for themselves. The NHS or local council does not pay, if you have more than about £23k in assets. You are expected to pay out of savings or to sell houses to pay care home costs. Even if you have aged related conditions like dementia, the NHS does not assist with costs. The care home monitors health with a nurse and local GP's. They get any pain relief they need and they try to feed/water. But towards the end they cannot eat or drink, so just fade away. Not very nice, but it happens across the country every day. They are not admitted to hospitals and put on drips, when they are at the end of their lifes.

[fletch70]

One of the great problems with pain control is that many GPs will not provide adequate drugs. Some do this because they are scared of being accused of doing a Harold Shipman, others do it out of some sort of moral or religious conviction where they see the giving of heavy duty pain relief as akin to assisted suicide or even murder. What can be more caring than ensuring that people are not in unnecessary pain- on top of that they provide expensive drugs where morphine and paracetamol is a highly efficient and incredibly cheap course of pain relief

[fletch70]

http://www.hospiceaid.org.uk/guide-to-hospice-care

 

Just some info on hospice care

I am an absolute fan of this system having had a family member use the services of LOROS

[BazzaS]

Because there isn't enough money to deliver all services to your door. They need to be centralised to be affordable within the allocated budget - great if one is near you if you need them, not so great but better than no service if its far away.

 

Just like GP's are centralised at surgeries

More specialised services are centralised at local community hospitals

Even more specialised (and expensive to supply) services are at major hospitals

etc ...

 

It isn't only money.

 

You have a 11 month old child. They need an anaesthetic to have a facial cut stitched. The stitching is simple enough : doesn't need a consultant.

 

However : how often does an "ordinary" consultant anaesthetist give an anaesthetic to an 11 month old?.

Do you want the one on duty that day to "have a go"?

 

Do you want one anaesthetist at the hospital to take all the cases aged under 1 (so they might see enough to "keep current") : what if they are on leave or on a day off after a hectic weekend on call / up all Sunday night?

 

For more rare situations there arent "enough cases occurring" for "everyone to keep up their skills" - some degree of centralisation of services to allow enough specialists at that site to keep their skills up to date (through experience) becomes necessary.

 

This is independent of financial issues (& doesn't mean that sometimes decisions are made on a financial rather than clinical basis, where "more funding" might deliver a better service)

[tobyjugg2]

However : how often does an "ordinary" consultant anaesthetist give an anaesthetic to an 11 month old?.

Do you want the one on duty that day to "have a go"?

 

Do you want one anaesthetist at the hospital to take all the cases aged under 1 (so they might see enough to "keep current") : what if they are on leave or on a day off after a hectic weekend on call / up all Sunday night?

 

For more rare situations there arent "enough cases occurring" for "everyone to keep up their skills" - some degree of centralisation of services to allow enough specialists at that site to keep their skills up to date (through experience) becomes necessary.

 

That is an excellent point BazzaS.

We sometimes forget that many areas of these sciences are sometimes as much skillful art as science, and need continuous practice and experience as well as knowledge and care.

[Conniff]

Crisis is the wrong word, there is 'no' crisis in the NHS, that is the opposition MP speak to try and get one up on the government.

 

Remember it was Labour that landed the hospitals with very heavy monthly bills where the PFI bills have risen from £11.3bn, to £65.1bn now that is privatisation of the NHS by Labour.

[tobyjugg2]

In 1992 PFI was implemented for the first time in the UK by the Conservative government of John Major.

 

Both Conservative and Labour governments have sought to justify PFI on the practicalgrounds that the private sector is better at delivering services than the public sector.

 

Proponents of the PFI include the World Bank, IMF and (in the UK) the CBI.

 

https://en.wikipedia.org/wiki/Private_finance_initiative

 

After lots of finger pointing by everyone, it goes on to say:

 

"The truth is the coalition government have made a decision that they want to expand PFI at a time when the value for money credentials of the system have never been weaker."

 

 

So Summarised:

* Implemented by Tories

* Stupidly expanded by Labour against the wishes of most.

* Then Expanding again in the last parliament (err Tories) despite all evidence that its a steaming heap of poop

[Conniff]

Rubbish, it was Labour, everything that has gone wrong with this country as been because of Labour, remember the biggest crash this country has ever had, that was Labour.

[Guest]

an eg re the issue of 'weekend' care, or lack of, in the news. have experiencied it. relative admitted around 5 on friday. all busy. come 5.30, ghost hospital. no consultant until mon morn. the junior doc having no clue in the mean.

[tobyjugg2]

Rubbish, it was Labour, everything that has gone wrong with this country as been because of Labour, remember the biggest crash this country has ever had, that was Labour.

 

Strange, The rest of the world understands differently:

 

http://www.economist.com/news/schoolsbrief/21584534-effects-financial-crisis-are-still-being-felt-five-years-article

 

and UK deregulation was powered by ... Thatcher,

like PFI was implemented by her prodigy ...Major,

and continues to be promoted and expanded to this day by ... Conservatives.

 

... Although Labour is by no means innocent in any of this.

[fletch70]

Conniff

Are you saying that Labour was responsible for the world crash?

 

You are sadly mistaken , economically New Labour share very similar views to the Tories, there is little to divide them. Socially they are slightly better.

 

I have to say as well that no sensible person can fail to see the NHS is in crisis, a lack of GP's , in fact they are leaving general practise alarmingly quickly . Being a G.P. is no longer about treating a person, it is about getting them in and out and seeing as many unique cases as possible. This come from my self admitted conservative G.P. but I don't hold that against him, hell I even talk to Tories on here

[SabreSheep]

I agree with toby

 

What we have seen is a rewrite of history so that Labour carries the can. And part of the reason Labour lost is it allowed history to be re written

[tobyjugg2]

I agree with toby

 

What we have seen is a rewrite of history so that Labour carries the can. And part of the reason Labour lost is it allowed history to be re written

 

I'd go even further than that.

As fletch70 says, Labour not only didn't undo the Tory changes, they jumped on board in far too many cases.

Labour was in power more than long enough to apply some proper regulation to the banking systems and reverse PFI - if they weren't afraid it would burst the happy bubble on their watch - well it did anyway.

|It wouldn't have been easy by any means, but thats not the point.