Pondering the state of the NHS - much as I love it

Unexpected visit to hospital which followed a call to 111, visit to A&E and 14 hours later admitted to a ward (down Sarf rather than the general). Some amazing staff from all manner of backgrounds, but what they have to work with is shocking:

Trying several pieces of kit before they find one that works
No drip stand things, so using blue nitrile gloves to tie the drip to an old curtain rail
Asked about whether it would be possible to have a wash or shower over the next couple of days, to be told that none of them work on the ward I'm on...

 

All part of the plan
Underfunding to prove the concept is flawed; so when they roll out the insurance scheme to guarantee us healthcare it looks like a solution.

It’s heartbreaking, thinking what this country will be when my kids get to my age.

 

Trying to reconcile this when added to the general state of education, social services, transport and public infrastructure crippling cost of living etc with the following reported today on the BBC papers 'round up' .........

"....... senior minister Simon Clarke told the Times newspaper the government needed to explain more about how it would control spending, as well as boosting economic growth.

"We have acquired spending habits that outstrip our ability to pay for it. That needs to change," he said.

He suggested the government was looking to make significant cuts and "trim the fat" when it comes to public spending.

What "fat" is he referring to? Unless it means the excessive layers of management in many public sectors I cannot see 'excess fat' anywhere. Surely after 10 years or more of austerity most public service should have reached the stage of being 'emaciated skin and bone'. Reducing the above might be the way to go but I suspect, given the 'trickle down' ideology that 'bleep and booster' are fixated on, and it is frightening to contemplate, but the cuts will be made via reducing front line staff, cancelling new infrastructure projects (hospitals) etc. and privatising yet more public services that should remain in the public sector.

"Trim the fat" = yet more cuts!!

I seriously hope I am wrong.

 

I've never been a worrier and have always been reasonably fortunate in absorbing budget/inflation/market changes. But in the same way there is no fat to trim in the system, there is no fat to trim for me either and I can seen us not being able to afford to live when our fixed rate ends next year

 

I understand and agree with the arguments about underfunding - but it's still the 10th largest employer in the world. I can't really understand how it's got quite so bad.

There has got to be something that can be done with systems and processes - it can't just be me that's noticed that every time you go on a ward you can't find nursing staff to get something done but there's always 973838 people inputting stuff into computer terminals? The ratio of patient facing hours to paid hours in that organisation must be miniscule.

 

I think it is like the police force (the same problems exist in Italy).... Pen pushers outnumber people actually doing the work by about 3 to 1. The bloated layers of bureaucracy/management in the NHS is insane. Bear in mind many at the highest levels are paid (I won't say 'earn' ) more than Senior Doctors and nurses who, let's face it, are the ones really needed. Much like the army, hospital logistics are as important as the people on the front line, but in both scenarios, too many layers of command/management complicates, and slows the processes of delivery and increases costs. I cannot state for certain but I believe the PFIs are still quite a drain on NHS funding (another 'failed' Govt initiative stretching back years and something we are still paying for!)

 

We all need healthcare, whether organised on the basis of the NHS, through insurance, or fully privatised. But the latter two methods require not just the cost of treatment but the scope to provide a profit for someone, which as day follows night, must be more expensive to the population as a whole. It seems to me that the division between public and private provision must also turn on whether you believe that there should be equal access to healthcare for all, or whether you think those with greater personal wealth should have access to better services. It seems inescapable that with an insurance-based or fully private scheme, those able to pay more will demand better for themselves. Even for those of a capitalist bent, this is short-sighted, as it cannot possibly benefit anyone for chunks of the population (and importantly, workforce) to not be adequately provided for in terms of healthcare. The NHS needs improvement, but first and foremost it needs adequate funding and staffing. That has not been the case since Cameron and Osborne commenced their austerity programme. And it is likely to worsen if Truss and Kwarteng remain in office for long. They are already eyeing further cuts to departmental budgets and are beginning to roll the pitch for the abolition of the triple lock on pensions.

 

I’m praying that Liz Truss will do so much damage to the Tories that we will have a Labour/Labour coalition for a while to come. Labour aren’t perfect by any stretch but they will fund our public services properly.

 

This is very true - the focus appears to be the records that make them accountable rather than the patient time itself.
They're also hindered by systems designed to help - terminals that record lunch orders that are hit and miss and result in paper records being needed anyway - all of which will be different to the ones they use in the neighbouring trusts.

also wastage on uniforms - they're all covered in scrubs and could save a fortune if they reverted to the uniforms that Barbara Windsor wore in that hospital docuseries she made in the mid 60's

 

My fear all along since Brexit has been that, from Boris onwards, it would be necessary to create a new, poor underclass, who would be compelled to work for peanuts in order to create the profits for business and to make us competitive against the likes of China and India in terms of production. Your experience shows that society is becoming more and more divided along these lines. Security gates on big houses is only the start. More and more are being 'locked out' in terms of what they can afford. I can't see how public services can be cut any more than they have been since the late 1970s. It is the greed for money and the lack of any sort of compassion which is destroying the well-being of UK society. The revolution against this is most likely to come from the left and I have fears about that as well. Hey-ho! "Peek-a-boo; I can't see you! Everything must be grand! Boo-ka-bee, you can't see me, as long as I've got me head in the sand." Politicians can't just keep burying their heads and not see what is happening. Where are the saviours of society when we need them?

 

The cuts will be dressed up as efficiency savings which begs the question as to why Ministers who've been Conservative MPs since 2010, when the Conservatives took over the reins of power, have been happy to go along with inefficient departments.

 

The number of management positions in the NHS as a proportion of the workforce is less than half that of the UK economy as a whole - 4% NHS, 10% UK.

A huge part of the problem with the NHS currently is a lack of clinical staff, mainly because there has been no credible workforce plan for years - put simply, we don’t train enough doctors and nurses, and recent political events have made it much more difficult to attract trained clinicians from abroad. Add a chronically underfunded social care sector into the mix and you end up where we are now - demand for appointments and beds vastly outstripping supply. And while COVID had and is having an impact, the number on waiting lists for elective care was north of 4 million even before COVID.

No easy solutions to any of the above unfortunately. It takes 7 years to train a Dr, 3 years to train a nurse. Much longer than that for senior and specialist roles. We could find more money for social care but t’old Liz and Kwazi have just nixed that idea because it’s obviously more important for people on 500 grand a year to be able to put more money into little Tarquin’s trust fund.

 

Yep. Record keeping a big part of it, certainly in dentistry and I can't imagine it's different in medicine. Your records are what give you a chance in court so, although only a small percentage of patients will ever sue you, every record has to be written with that in mind. My typical notes for a check up for which no follow up treatment is required have gone from a single sentence 20 years ago to about 400 words today. It is no longer feasible to record them whilst the nurse cleans the surgery between patients so they are dictated at the time and I stay at the end of the session until they're all typed up.

I would never suggest that a patient who has been injured by medical negligence should not get a fair hearing and reasonable recompense but it is definitely hindering efficient healthcare delivery in the UK.

To give some perspective about the UK (this is dentistry but I imagine we are not alone), the UK used to have the best dental health in the world, though in recent years we have fallen to third behind Italy and Canada. Dentists' average pay, conversely is 18th in the world or, in the case of dentists who do 75% or more of their work on the NHS, then it's 32nd.

However, if you look at likelihood of being sued, likelihood of litigation being successful for the claimant and the typical size of the compensation payout awarded, the UK tops the whole world on all 3 metrics (yes, even the USA - we're truly world beating). Unless that balance can be redressed, the admin and audit mountain can't be addressed and the number of patient facing hours can't increase.

 

Nail on head' yet some working class folk will carry on fighting their corner and popping their cross in the box..

 

Too many chiefs and not enough Indians . Money is squandered throughout the NHS . Like most industries nowadays, management failure and made up jobs add to it .
However, I cannot fault any treatment I've had over the years.

 

The removal of the nursing bursary and subsequent reinstatement at a much reduced level will surely have had a large affect on this.

 

But Truss says we're going to be a high wage economy; that's what all the reforms are about.

 

Due to long and unsocial hours, high pressure, low pay following lengthy and expensive training - nursing and to some extent, medicine - have become unattractive professions. Whatever the funding model, we simply do not have sufficient numbers of trained professionals to meet care needs and we can't fix that overnight.

We need more training places urgently but we need to fund a health service to retain staff.

Again, using dentistry as my example as it's what I know best, 4% of graduates never take a job in dentistry. By 15 months after graduation, 9% are doing postgraduate study and 8% are unemployed (which, given the shortage of dentists suggests they have no interest in becoming one, the jobs are out there). Of the ones that are in emloyment, roughly a quarter (28%) have either left the profession or left the UK. Then you've got leakage to the private sector, where pay, conditions and job satisfaction are considerably higher. By ten years after graduation, 42% of dental graduates are providing some NHS dentistry. Less than half.

Politicians are obsessed with value for taxpayers' money and believe that squeezing more work for less pay out of its workforce is the way to keep costs down. Unfortunately, value for money healthcare systems require the system to function, which requires adequate numbers and motivation amongst the workforce.

They seem to think they don't need health professionals on side to provide good healthcare and, particularly as they've made it harder to come in from overseas and work here, they couldn't be more wrong.

 

100%. As has stagnating pay rates. The Tories can bang on about the ‘overpaid public sector’ as much as they like, but if you don’t pay the going rate, people leave and go and do something else (it’s those market forces Conservatives seem to be such big fans of). You can earn nearly as much working in Aldi as you can in loads of healthcare roles and you don’t have to work nights, you can clock off when you’re supposed to, and your customers are unlikely to die on you while you’re serving another one.