Discussion on today's 1:00 news

[graduate_owner]

Just listening to a discussion on the BBC news at 1:00. regarding NHS funding between a doctor and a retired doctor. This retired doctor stated - this issue of a shortage of hospital beds is nonsense. People don't want to be in hospital, they want to be back in their own homes. ( Not verbatim)
I thought that was just unbelievable. We don't need more beds? Closing wards is not a problem? What about people having to stay in ambulances because there are no beds for them? What about people having to wait far too long for emergency ambulances because the ambulances are still waiting outside hospitals because of those patients still in them? And this, as I said, was from a retired doctor.

OK, rant over.

K

 

[Phil Pascoe]

I was in a bay of six people, I was lucky, I got sent home eight days after a leg amputation but two others were waiting for a bed in a community hospital. The last time I was in that community hospital I was in a bay of four - three of the four were bed blockers because the council couldn't sort their property or old people's home places out. So, yes - he is 100% correct.
We could throw the GDP of the Country at it and it would still have problems. As my consultant, a brilliant surgeon, said when I pointed out something that potentially cost the hospital £100,000s p.a. - the management don't listen to us, we're only consultants. It's badly run.

 

[woodenstx]

We could throw the GDP of the Country at it and it would still have problems. As my consultant, a brilliant surgeon, said when I pointed out something that potentially cost the hospital £100,000s p.a. - the management don't listen to us, we're only consultants. It's badly run.

Agreed.
Likely it needs more money to keep it moving, but the major issue is you could give it all the money in the world and it would still function exactly the same as it does right now (allbeit with more managers taking the pish)

 

[DoctorWibble]

Bed blocking is a growing problem but that doesn't mean it cant be fixed. Care outside the NHS falls to family and to local authorities and for a variety of reasons neither are able to step up in the way they used to. The second could be fixed at least. If the electorate are bothered enough to vote to fund it.

 

[Phil Pascoe]

All necessary care should be funded by the NHS - it would stop the wrangling on who should pay for what - one Trust and another, one trust and the local council. I left hospital without a cushion on my wheelchair because the wars manager decided the other hospital should pay for it - that's how petty it gets. Imagine the wrangling about a month or months long stays.

Wars manager...probably a good title, but I meant ward manager.

 

[deema]

I believe there are a number of issues, some of which are highly controversial.

The population is aging, operations are now being carried out in people over 80 that a few years would never have been done as it was too risky. Most admissions to hospitals I understand are for the elderly. With the population predicted to have an ever older profile and will have more people retired than working it's likely to be a situation that no party can resolve.

There is a lack of doctors and nurses due to a reduction in places at teaching hospitals a number of years ago. This will take time to fix as it takes a number of years to train people. There are lots of beds, the wards didn't disappear just closed / moth balled!

The care needed for when a person can leave hospital is in short supply causing bed blocking. Relatives / family in general no longer feel any obligation to look after their family as they once did, preferring to live their lives and have the state provide. Care homes and care at home is expensive and with the prospect of people being charged higher levels is likely to push people into 'staying 'in hospital longer.

The culture of blame and litigate has created a lot necessary paperwork that didn't previously exist. It also depletes funds fighting spurious claims.

The cap on pay for civil servants has created an artificial market that isn't attractive for highly talented managers. It's very popular to blame 'fat cat' managers however, few people understand the complexities or could manage a £1+ billion budget and 20K staff. The size of a large trust. That's larger than most FTSE 100 companies, the directors of which earn a factor of at least 10 more than a typical NHS CEO. Most people don't seem concerned about what a foot ball player or pop star earns, but god help anyone earning more than £140K in the NHS. The result of this artificial market is that the best most talented people will naturally go for the appropriate reward....,the private sector. It's a global market for those who have talent. Foot ball players move to clubs around the world that pay the most, so do highly creative, value creating managers.

There is a lot of money about that could fix most of it. Overseas aid is massive, and it's a decision to increase it that was made a few years ago that was missed by most in the manifesto that included it. The proliferation of government to meet the aspiration of local accountability carries a high cost. The UK has four parliaments (London, Ireland, Wales, Scotland), and the introduction of local Mayer's is also being rolled out.

 

[Jacob]

All necessary care should be funded by the NHS - ...

We aren't even high spenders compared to the rest of Europe. The yanks pay even more per capita for their very ineffective medicare set-up, being demolished by Trump.
To keep up we need to spend more and tax more. The money goes around the economy, businesses benefit, we employ more and we have better health - it's a no brainer.

 

[DoctorWibble]

The culture of blame and litigate has created a lot necessary paperwork that didn't previously exist. It also depletes funds fighting spurious claims.

Dead right. I've never understood why someone doesn't simply propose legislation to grant all public services -NHS, Schools etc blanket immunity from the ambulance chasers and opportunists.

Its not just the claim costs it's that hospitals and schools are now obliged to document every action to a standard that withstands potential scrutiny in court. An insane waste of time and money and a great way to erode staff motivation. If I had to diarise my every move I think I'd simply stay in bed.

 

[pip1954]

Hi my wife spent time in hospital, and on her ward there was her and three other elderly lady patients who could not go home and had no other place to go ,where is all the after care now .
I to was in hospital recently and there where a lot of people stuck in hospital waiting for local authorities to sort out places for them to go , you are to well to be in hospital and to I'll to go home, I wonder if it is after care bit that is the that is missing.?
Every body knows how to fix we must all be experts in how to run our NHS. :lol:

 

[Jacob]

..
I to was in hospital recently and there where a lot of people stuck in hospital waiting for local authorities to sort out places for them to go , you are to well to be in hospital and to I'll to go home, I wonder if it is after care bit that is the that is missing.?
E...

Yes definitely - it's been talked about at length. They are called 'bed blockers' - people ready for discharge - still in need of care but having nowhere suitable to go. The system isn't joined up. The NHS should cover ALL care so that these bottle necks are taken out.

 

[RogerS]

All necessary care should be funded by the NHS - ...

We aren't even high spenders compared to the rest of Europe. ....

Anyone reading that statement would think that there was a huge disparity between our expenditure and the rest of Europe. In fact the truth is that there is only a marginal difference which the OECD figures show.

 

[DoctorWibble]

....where is all the after care now ?

Local Authorities always get the brunt of central gov't budget cuts. Westminster figures it can easily enough duck the blame for any consequences. They've been playing that game since at least the early 1980's. And of course the cost of anything that needs physical space (eg residential elderly care, high speed railways) has gone through the roof along with house prices. Voters it seems rarely join the dots.

 

[AJB Temple]

Very erudite post from Deema I thought. With an ageing population, UK headcount growing, and all the other factors mentioned, it is a very difficult problem. There is a left wing media / political tendency to say put more money in. Tax the rich etc. It is beyond naive. The top 1% of earners pay 40% of all income tax. The top 1% of earners are the most mobile and the most desirable in other countries.

Slice the top 5% of earners and you have covered the vast bulk of all income tax based funding for the entire population.

 

[Phil Pascoe]

The culture of blame and litigate has created a lot necessary paperwork that didn't previously exist. It also depletes funds fighting spurious claims.

Dead right. I've never understood why someone doesn't simply propose legislation to grant all public services -NHS, Schools etc blanket immunity from the ambulance chasers and opportunists.

Its not just the claim costs it's that hospitals and schools are now obliged to document every action to a standard that withstands potential scrutiny in court. An insane waste of time and money and a great way to erode staff motivation. If I had to diarise my every move I think I'd simply stay in bed.

I had a charming young lady doctor come to tell me that I had been put on a supplement as my kidneys weren't functioning properly. My heart sunk, my wife said J. wept, as if you haven't enough problems. Two days later the doctor came back and said cheerfully your kidneys are fine, actually ... we were looking at someone else's notes.
I hung her out to dry by mentioning it when she was with my consultant, whom I know quite well - I knew she'd suffer for it, but the girl made a mistake. It wasn't the end of the civilised world, but she must have thought oh, god, here we go, then been glad of a bolllocking. I know many who would have sued.

 

[Phil Pascoe]

All necessary care should be funded by the NHS - ...

We aren't even high spenders compared to the rest of Europe. The yanks pay even more per capita for their very ineffective medicare set-up, being demolished by Trump.
To keep up we need to spend more and tax more. The money goes around the economy, businesses benefit, we employ more and we have better health - it's a no brainer.

I wasn't making any political point about funding, merely pointing out that everything would run better if paid for from a central fund, rather than different hospitals, trusts and local authorities.

 

[Phil Pascoe]

Thinking about Deema's post - I was in hospital with a seventy nine year old man who'd had what they call a "hind quarter amputation" (the whole leg taken at the hip). I wondered whether he should have been allowed a comfortable death. Maybe he would have liked one ... but that's a no no.

 

[finneyb]

Thinking about Deema's post - I was in hospital with a seventy nine year old man who'd had what they call a "hind quarter amputation" (the whole leg taken at the hip). I wondered whether he should have been allowed a comfortable death. Maybe he would have liked one ... but that's a no no.

Dangerous ground, but I agree with you. I'm fit and well for the moment but have been looking at euthanasia for the future. Basically , I want control and I also want the doctors to have one thing on their mind - keeping me alive - I want to decide when to go.

Looking on the Exit and similar websites it seems the drug of choice is Nembutal - a barbiturate cocktail. One Australian has suggested that everyone over 70 years should be given a bottle to keep in their drug cupboard. While I accept the simplicity of the concept I can well imagine some less than nice relatives suggesting that I take the drug so that they can benefit.

Seems that Nembutal elixir has a shelf life of 20 years - the basic problem is getting hold of it and also knowing that it is what's on the label and not coloured water. Of course, I wouldn't tell anyone I had it.

Brian

 

[RogerS]

There is also the unfortunate side-effect of some of the ageing population having expectations beyond current medical capabilities. Years ago, they would have been dead due to all the various illnesses and infirmaties that, at that time medical science couldn't easily fix. Now, those have been fixed but the body is still ageing. The reality is that medical science cannot do anything to help. Or if they do, prescribe drug A (usually to shut up the patient) which then reacts with drug B and so on.

And I know that some of the elderly treat the visit to the GP or hospital as a social occasion. Yes, they are lonely. Possible that offspring are at the other end of the country or even abroad. But still, some of the elderly carve out a network of friends and so have their own support network. And others keep calling 999 crying wolf. Very, very complex.

 

[RobinBHM]

I think its time to take the NHS out of party politics.

Parliament has 5 year max time spans, the NHS needs a long term plan that is independant of it being a party political football.

Medical advances has meant increasing cost of cspital investment, new skilled staff needed to use the technology and an ever increasingly aged population combined with an increasing population.

Private Finance Initiatives have financed new hospitals but has lead to big loan repayments soaking up NHS money.

The bed blocking issue is also a huge problem. Ive seen this myself with a parent in hospital long term. Social services do anything they can to avoid agreeing to continuing care as its funded by a hospital trust, as its money thats paid out to a third party, even though the cost of keeping somebody in hospital is far more expensive, but the cost doesnt show as its already in the cost and cant be avoided.

At some point free at the point of entry cant continue. Also nursing and home care help has to be funded properly. Its a contoversial subject, but it needs to be discussed.

 

[Phil Pascoe]

Another problem - it is said of our local large hospital that if you don't have an infection when you go in, you'll have one when you come out. This is why my consultant says the last he wants his patients is in hospital. That's why I was home eight days after a leg amputation.