NHS again -

[observer]

The annual Winter crisis in the NHS gives the politicians the opportunity to kick this political football around for Party benefit, but offers nothing to resolve problems.  But the fact that the NHS is used as a political football, with political interference and cosmetic changes, tell us that the whole problem needs to be taken out of the hands of politicians and placed in the hands of professional medicos, and funded by NI and a National lottery ?  Does it also tell us, that superficial administrators, Trust Boards and inflated salaries need to be curtailed ?  Is it time we had a national conversation about what exactly we expect from the NHS; is it a primary life saving organisation or something that caters for want, such as gender re-assignment, IVF etc ?    Should we be ensuring that adequate indigenous staff are provided through free training schemes ?  And finally,  is it time to bite the bullet on the issue of social care and make adequate provision for the elderly to avoid bed blocking ?          

[Davy51]

National lottery takings would certainly be better spent on NHS & not meaningless good causes & furthering the careers of shamateur sports people & their governing bodies.

Another must for me though is to get the GP to be the first point of contact & treatment to relieve A&E pressure & allow staff to be used on treating patients who really need their expertise. It is no wonder patients head for A&E when the first available GP appointment could be 2 weeks away.

[observer]

Think we have to thank political interference by a Labour Gov (Andy Burnham ) for the GPs mess; basically a pay rise for less hours and a reliance on suspect locums for out of hours services. The situation is now to get worse as many GPs are due to retire, so it raises the issue of recruitment and training.  I agree, unless in cases of real emergency, the GP'S surgery should be the point of entry into the system, and GPs are the only medics to actually know their patients over years; which should place them in a position of overseeing their care throughout their treatment.   The other example of political interference (from Labour) was PFI, which has left the NHS with massive debts and no hospital at the end of the contract period; so more myopia, intended to save political skins rather than develop a better service in the long term.    

[asperity]

If the NHS is such a wonderful organisation, why is it permanantly in crisis? More and more money is thrown at it, but it's never enough seemingly.

[observer]

It will never be enough Asp, unless limits of operation are established by a public conversation, providing a mission statement of precisely what is expected of it.   For a start, it supposed to be a "national" health service, yet it is abused by health tourism.   It depends on political funding whims, rather than a guaranteed ring fenced funding stream such as a separate NI tax and lottery.  It has an expensive  excess of non-clinical administration and management, and Trust boards formed by faceless and unelected leaches.  It's own success in terms of new and expensive procedures, using ever more expensive technology just adds to demand, as well as catering for none essential cosmetic want, rather than need.  Drug reliance and drug procurement is yet another expensive cost.  It's necessary labour intensive nature adds to overall costs. But perhaps the biggest problem is the failure to integrate and fund a massive increase in social care need, which to-date has been the responsibility of under funded local authorities. So a huge challenge and a poisoned chalice for Jeremy Hunt;  but the ball rests with the public, if you want a state of art NHS, everyone will have to pay more; and providing such payment goes directly into funding the NHS through hypothecated taxation or separate NI contributions for every adult (incl the elderly); perhaps boosted by a National lottery; we're going to suffer this regular political hand wringing and political point scoring, without solutions.        

[Confused52]

I suspect that the problem is that the public doesn't understand where the problems really are. I know I don't. I have been told that there is too much management; well the figures are in the public domain. In Warrington (WHHT)  there are 144 FTE Management types out of a total workforce of 3515 ( Figures at Autumn 2017), most of the management types seem to be on low grades. You need someone to do payroll, IT, Hr and so on. This may be political posturing to avoid finding the real problem.

If you look at the bed blocking figures there are an average number of people waiting for discharge which from memory was of the order of 30, not very large really. There are figure about how the LA's and the hospital trust perform. This is really not the problem for Warrington NHS or WBC. WBCs problem is how much they spend on adults under 65 which is well above average. They don't seem to have a big problem above 65. It is what LAs do to recount stories of hardship nationally to make us all believe that the problem is with old folk but that doesn't mean the local figures show that it is true.

The problem is when you look into the detail there isn't much in any of the usual lines of attack. If anyone can find one where the detail is backing the problem up with facts it would be useful to know but honestly I suspect that the managers know what is going on already.

When the currently in training Doctors and Nurses come on line the Agency i.e the NHS Bank usage will go down but the WHHT only has 99 FTE from the bank (costing £237k a year, not all of which can be saved) so that is not a Magic bullet either. Bed usage was only 86% instead of the target 85%, which is intended to give 15% capacity for emergencies so that isn't a problem. So what the problem really is I don't know but I would like to.

[observer]

Anecdotal maybe, but on a recent visit to a Hospital ward, I counted at least 30% who were elderly, and perhaps termed geriatric cases, thus taking up beds.  Warrington has shown some initiative in the provision of half way provision like Padgate House, with medically supervised care for many elderly, prior to release to home care or care home.  I would treat stats and figures with care, as there are damn lies and statistics !        

[observer]

On the plus side, the skill and dedication of the NHS workforce appears to be generally exemplary;  as shown in the BBC documentary about surgical procedures.        

[Latchford Locks]

If anyone on this forum can remember pre1947 and the sickness and social deprivation that was taken as part of life then they will know that todays generations just don't know how lucky they/we are.

No more Polio/Rickets/TB/Scarlet Fever and the common occurrence of Mother or Child losing their life during routine childbirth.Just to mention a few examples.

My Parents lived through those days and use to tell me how heartbreaking the general conditions were.

Yes The NHS can improve but just thank God we have it.

 

[observer]

... and we're going to need it Latch;   if we drift into a post-antibiotic era.      

[Davy51]

9 hours ago, observer said:

... and we're going to need it Latch;   if we drift into a post-antibiotic era.      

I don't know if you watched Countryfile this week but some of the problems with antibiotics were placed at the door of farmers.It was stated that farmers are only too willing to use antibiotics on their livestock with gay abandon with little regard for the consequences. It was suggested that animal waste & urine from the fields was entering the food chain & rivers & exposing us to antibiotic overload  via foodstuffs & drinking water.

[asperity]

On 12/01/2018 at 8:12 AM, asperity said:

If the NHS is such a wonderful organisation, why is it permanantly in crisis? More and more money is thrown at it, but it's never enough seemingly.

Someone gave me a downvote for saying the obvious. There's some strange people around!

[observer]

1 hour ago, Davy51 said:

I don't know if you watched Countryfile this week but some of the problems with antibiotics were placed at the door of farmers.It was stated that farmers are only too willing to use antibiotics on their livestock with gay abandon with little regard for the consequences. It was suggested that animal waste & urine from the fields was entering the food chain & rivers & exposing us to antibiotic overload  via foodstuffs & drinking water.

Not just farmers Dave,  but the UK probably has tighter rules on antibiotics than most; they've been abused and mis-used to the point where the super-bugs are winning; which would make most infections terminal.     

[Milky]

The problem with the Warrington NHS is that it is inefficient.

Last time I was in A and E in Warrington was stuck in the cubical for hours waiting for a blood test.  while the nursing staff run around like headless chickens the Doctors seem to spend most of their time around the computer screens around the admin area, I am not for one second suggesting they are being idle, but obviously their tim is being taken up with other things then looking after their patients.

While the ambulances seem to bring in mostly elderly patients go into the walking area and you will find it full of much younger people, which suggest the problem is not only because of aging population. I suggest drugs and alcohol must take a large proportion of the blame, . Some guy who was obviously under the influence of something was being pulled out by the police and given a lift home. Whatever happened to the drunk tank idea floated around a few years ago?

Now discharge, Doctors don't seem to come round in the mornings any more, often late afternoon which means the bed was taken up for much longer then needed, then comes admin and the wait for pharmacy can take hours.

In addition there seems to be a lot of admin staff, I wonder what the ratio of clinical to admin staff is now?

PS: I brought someone in to hospital and was not the patient

[observer]

Don't think its a Warrington only problem Milky.

[Milky]

On 2/3/2018 at 2:17 PM, observer said:

Don't think its a Warrington only problem Milky.

Yes I know, but my experience outside Warrington is very limited. The only other experience I have is of the Manchester Royal, where I stood in A and E behind a lady in full niqad who had arrived from Saudi Arabia a few days previously and a translator was being arranged for her. The cardiology ward was staffed better then the Warrington cardiology  ward is, many of the nurses were from Italy and Spain who were telling use how wonderful the NHS is compared to their countries health service.

Has anyone ever noticed the TV units in hospitals no one ever uses as they are so expensive are always on, who pays for the electricity?

[Davy51]

My wife was referred to A&E a few years back by her doctor with a hip problem ,poked by numerous doctors, nurses & students ,plied with various drugs & kept in overnight. She saw the doctor in the morning who said he would discharge her "soon" with suitable painkillers . She was finally discharged ,after repeated requests ,at 6 30 pm after threatening to just walk out of the hospital. Another bed tied up & that was about 8 years ago.

[observer]

Well it seems the politicians are starting to think about the situation: the LibDums (of all people!), have commissioned a report which advocates a separate, ring fenced NI tax; literally an hypothecated tax; they could add that the National Lottery also be used to fund the NHS. But it really needs to be made into an arms length entity, in order to stop the politicians from using it as a political football, and a clear mandate established based on the majority expectation of the public.      

[asperity]

You could throw every penny of the entire government budget at the NHS and it still wouldn't be enough.

[Togger1]

2 hours ago, asperity said:

You could throw every penny of the entire government budget at the NHS and it still wouldn't be enough.

see below a pie chart showing where the money goes.  As you can see the above claim is nonsense but there you go.  

[observer]

Don't think we're dealing with a static equation here, as supply and demand plays a part:   On the supply side, there have been leaps and bounds in what can be treated and the high tech equipment to support it, which costs money; so in effect, the NHS could be deemed a victim of it's own success.  The fact that treatments now extend from need (life saving) to want (IVF), again adds to costs; that's why we need a public debate to establish the boundaries of provision.  We now have the suggestion that e-cigs should be supplied on prescription;  a notice in my GPs surgery now gives a list of items no longer included on prescription, which includes anti-perspirant ; so do we need to introduce some red lines on supply ?    On the demand side, we have an aging demographic; but the ambition for longevity comes at the price of age related diseases, and consequent increase in demand.  Lifestyles and environmental factors, such as obesity and air pollution can impact on demand too; and of course, the elephant in the room, over-population. So clearly a complex and moving target; which can only be controlled by establishing parameters to what we expect from a health and social care service.      

[Togger1]

the elephant in the room is a rapidly growing ageing population, removing younger people from the equation can only exacerbate it.

[observer]

Think I covered the age demographic.   Don't "young people" use the NHS ?     

[Togger1]

of course they do, but not as often or as profusely as the elderly, plus the elderly tend not to work in the NHS, after a certain age.  Have you not heard of the problems with social care of the old?

[observer]

Of course, I've mentioned it in many a post;  but to suggest that all elderly folk are infirm, is as nonesensicle as suggesting all youngsters are fit.  Every day we hear of kids with genetic deseases  and cancers; pre-mature kids on life support with parents demanding they stay on it; nutters knifing each other or crashing cars - so it would be fair to say all age groups get treated by the NHS, and some would argue the elderly have paid more into it !