[Politics] NHS today

[drew]

Myth or not, as of 2021 there were 219 trusts, including 10 ambulance trusts. Do you really need that many "independent " trusts with it's own board of directors CEOs etc?

It is a myth, didn't you follow the link?

The NHS employs over a million people. Even if you had one 'CEO' at the very top, they would be on an astronomical salary for that responsibility and you would still have regional senior managers just as you would with any national organisation. You can't get away from that.

If you don't have the managers, then you have to give those roles to medical staff which takes them away from their frontline roles!! You can't have it both ways.

The trusts aren't small operations either. I'm not saying they couldn't be more efficient but they aren't as bad as some of the press like to make out. Our local trusts cover 7 hospitals, 3 in Brighton and one each in Haywards Heath, Worthing, Chichester and Shoreham.

I'd be interested to see what you think is a fair salary for running a trust like our and how you arrived at that figure?

 

[drew]

If you need to attend as an emergency, don't call an ambulance, get a taxi. Ambulances are in queues hours long because patients in A&E can't be moved into beds, because beds are full. Very ill patients have to stay in the ambulances with paramedics attending them. The average wait for an ambulance is 7-14 hours.

How can you have an average of 7-10 hours? Surely, if that's correct, the average would be 8.5 hours or thereabouts!

That said, I agree with your sentiments about getting to hospital. You should only call an ambulance if it is or is possibly, a life threatening situation. When people can't be arsed to get a cab or get a lift of family or friends, that immediately uses up an ambulance that might be needed for a more serious case.

 

[BLOCK F]

I know your story and I feel the same about the NHS in general. And don't get me wrong, most of the people I dealt with yesterday were excellent. But there was a lack of organization and, I fear, knowhow. And yes, the NHS is conceptually brilliant - which I suppose is my point - it seems to have been allowed to become deeply suboptimal, and the extent may be patchy around the UK. I apprecaite that many tories love the NHS and it is no loger seen as 'that socialist monster'. However I am not sure that there are not a few ghosts in the political machine who don't mind the neglect and have a ready solution - go private.

During Covid I had a hernia op. They were short staffed. Doing the bloods was a bit of a sweat, with an ambulance driver and a 19 year old medical student eventually getting a vein at the fourth attempt. That's fine.

Yesterday the hospital was visibly quiet. When I was taken to have my bloods done it was by someone who was doing nothing but taking bloods. When he first collected me he said 'where are the IV lines?'. I said 'nobody has put any in yet!'. I was sent away for half an hour.

I was called back. He tried to spike me when I still had my coat on. He didn't ask me to pump my fist and when I offered he said it wasn't needed. He couldn't get into one vein. He then thought he had the one in my hand, shoved the needle in further and I though 'he gone through it, do I say something?'. He then proceeded to pump a mix of my blood and air into the subcutaneous space. After giving up he said he'd get 'the machine'. That's when I went into maybe 3 hours of sitting around till I asked and found that he had no access to 'the machine' as it was being used elsewhere, and had initiated no action (like asking someone competant to spike me) so I was in limbo. I complained to some other staff and a nurse offered to do it and 2 minutes later she had put the lines in. It was the most absurd spiking experience I have had and I have been spiked dozens of times. That's not pressure due to emergencies. At the time there were none. And I was in among the acute medical need lot - one step down from car crash, heart attack or stroke victims (albeit there was a woman in there with acute heart failure who should have gone direct to the cardiology unit). Organizational chaos.

The bottom like is it matters not whether he NHS is generally brilliant (which it is on many levels), or whatabout how well you were treated, what happened yesterday was completely unacceptable. Every patient I spoke to told me this was their worst ever NHS experience. The glaring and simple issue that could be fixed is transparency. They don't tell us anything. Expectations are not managed. And they lie about how long you've been waiting (in a particularly nasty way - accusing patients of being wrong when they question the nonsense) - and yet not on purpose - the system predicates this. There is no need for that. Indeed at no time yesterday did anyone ask me how I was, and whether I needed any pain relief, even though I was doubled up in agony repeatedly. And it isn't if nobody was around - there were on average 10 staff buzzing around at all times. When people went to the front desk with a question they got daggers. I did. That simply isn't acceptable.

Sounds like sheer incompetence re the ‘spiking’ and there should be no excuse for that.
Anyway Harry, I hope you get the treatment you need and feel better very soon.

 

[drew]

this is true and a large hurdle. however we've seen Conservatives rise taxes for social care so it is possible if there is a will. the larger hurdle is the doctrine to keep out private health care, despite all evidence across europe of alternative approaches. there is an obsession that this is binary, either 100% public owned or US style 100% insurance based. nothing in between exists in many minds, despite the fact our system has never been 100% public owned. much to admire about the German system starting with the simple business of seeing a specialist instead of a GP.

Just a point of order, none of that money has yet been allocated to social care yet. That was the big headline but I won't hold my breath.

 

[Harry Wilson's tackle]

Firstly, get well soon Harry. I hope it’s sorted asap.


In the past 2 years we had to turn to the private health sector - over a knee injury, and for a formerly diagnosed “actively suicidal” adolescent. My wife & child had waited an entire day at the Royal Alex to see their resident shrink, they told us to go there, only for the professional to cowardly skulk away home at 5pm. We only found out by chance at 6:30pm!


Let’s just copy the German system.

Everyone but the poor are compelled to pay significant private insurance premiums.

It works.

I’d love Starmer to simply propose this and really mean it. But no party will. 90% of Brits have a lifelong loathing of taxes, it’s in our DNA.

Instead the Dec 2024 GE will only see parties suggesting a few % increase here or there.


The NHS is badly run. Gerry Robinson came up against a brick wall when called in for a televised series to help a hospital trust. Senior management couldn’t manage incredibly stubborn alt confident senior consultants/surgeons who were not prepared to change, or interrupt their afternoons at private hospitals. Mrs.W is an NHS frontline practicioner - she describes illogical inefficiencies and systems, stubborn individuals unprepared to change to help patients.

In summary, follow the German financial model, but also look at widespread rejigging of the chaos.

Cheers, Westy.

Your analysis and proposals are sound.

I'd say one thing about consultants. The system has created a situation for them not entirely different from that of royal princes. Even the nicest of them slip easily into airily expecting one of their three PAs to sort things out for them. The system is far better than it was when I started at STH in 86 where we'd get junior registrars doing a research rotation and expecting the lab tech to clean up their mess every day; rude and selfish. But the system certainly needs a shake up. Widespread rejigging indeed.

 

[beorhthelm]

Just a point of order, none of that money has yet been allocated to social care yet. That was the big headline but I won't hold my breath.

it was observation of the change in sentiment. we keep saying we wont pay more, seems we're more open to it.

 

[Harry Wilson's tackle]

It is a myth, didn't you follow the link?

The NHS employs over a million people. Even if you had one 'CEO' at the very top, they would be on an astronomical salary for that responsibility and you would still have regional senior managers just as you would with any national organisation. You can't get away from that.

If you don't have the managers, then you have to give those roles to medical staff which takes them away from their frontline roles!! You can't have it both ways.

The trusts aren't small operations either. I'm not saying they couldn't be more efficient but they aren't as bad as some of the press like to make out. Our local trusts cover 7 hospitals, 3 in Brighton and one each in Haywards Heath, Worthing, Chichester and Shoreham.

I'd be interested to see what you think is a fair salary for running a trust like our and how you arrived at that figure?

I think the point is that yes a lot of the organization of the NHS could be co-ordinated centrally, avoiding needless replication of effort. And the trusts do compete and look to power grabs. We do, at least, now have a decent medical records system, and the lad I saw at Ashford was quickly able to view the record of an internal examination I had in Herne Bay* 5 years ago.

I think my concern is that in life, in general, things get better. Despite medical advances, access to healthcare is not what it was, and the trajectory is not obviously upward. That's a cause for concern.

But, anyway, it is a fallacy to extrapolate from the specific to the general so perhaps my experience is not an exemplar.

Meanwhile, back in my reality, my GP was supposed to call me back today to discuss what I should do. I set that up this morning. Still haven't received the call. That would be a first.....

*not a euphemism

 

[Harry Wilson's tackle]

it was observation of the change in sentiment. we keep saying we wont pay more, seems we're more open to it.

Perhaps. And Johnson looks like he may loosen up cash. The announcement today about private rentals was interesting, and commendable if it comes to pass. Some of his policies at a national level are bordering on socialist.

 

[Thunder Bolt]

How can you have an average of 7-10 hours? Surely, if that's correct, the average would be 8.5 hours or thereabouts!

That said, I agree with your sentiments about getting to hospital. You should only call an ambulance if it is or is possibly, a life threatening situation. When people can't be arsed to get a cab or get a lift of family or friends, that immediately uses up an ambulance that might be needed for a more serious case.

I have seen several anecdotes recently from ambulance crew, and relatives of old people who have fallen, waiting for ambulances for those lengths of time. The 14 hours was an old person with a broken hip.
As I said the problem isn’t getting to patients but offloading them at the hospital
I also watch the Ch4 programme every Monday night about Barnsley A&E called Casualty Every Second counts.

 

[Harry Wilson's tackle]

Above all it works, and works very well. as an adendum to my earlier post the missus had to book a post-surgery consultation. She rang yesterday at 4:05....office was closed so she left a message. They called her at 6pm last night, and twice this morning. She has an appointment for 9am on Monday. This was just for very minor and elective op. A friend had a hernia done and dusted within 5 weeks from onset.

What I like most about the system is that my care, in old age, will be paid for b the state. No selling of house, no dipping into my savings...all paid for by the state. The 14% I often refer to is, in part, a savings plan for my old age.

Wow.

What about if you have to go into a care home? My great aunt had £20K saved and that was vaccuumed into the pocket of the care home in the last year of her life.

 

[Thunder Bolt]

Wow.

What about if you have to go into a care home? My great aunt had £20K saved and that was vaccuumed into the pocket of the care home in the last year of her life.

Old people are allowed to keep £23K of their savings.

 

[Harry Wilson's tackle]

I think you make some good points and there may indeed be an element of postcode lottery. The NHS on Merseyside is exceptional, partly I think because of the teaching hospitals here (eg my hospital) and centers of excellence in neurology at Liverpool Walton and the cancer hospital at Clatterbridge. I get a taxi to work and several drivers have told me about the southerners they have picked up who have come up here for several days for the cancer care. If I still lived down south I might have died because of a misdiagnosis after my stroke. That was at the height of Covid when resources really were stretched. That was put right by consultants from Liverpool Walton and my hospital, working collaboratively.
Your story about the bloods makes me shiver. I always book in with the same nurse at my GP surgery as she is very efficient and never misses !
I think the point about ‘he who shouts loudest’ has always happened for non acute cases. I remember when my MIL died and older family members were afraid to question anything. She only got increased painkillers when we stepped in and asked.
The debate that needs to be had is what do we want from our NHS ? It was set up for one thing and it’s reach has extended so much because of medical advances. Someone earlier in the thread talked about modern expectations and that is also a factor. Higher taxation is the only way to go if we want everything and that is nothing to do with socialism.
I hope you are all sorted and feeling better now.

Thank you for your kind comments, and your assessments, which are thoughtful and balanced as always.

Yes, it is interesting that we can cure diseases now and manage others well that were lethal or debilitating only 20 years ago. Yet meanwhile it has become hard to get a GP appointment in a meaningful timeframe in parts of the country.

I have mainly spoken about process and structure rather than money, but I heard a conversation yesterday about ward closures, and bed shortages. I remember Thatcher closing wards at St Thomas' when I worked there in the late 80s. Ward closures and bed shortages....if there was ever anything that went hand in hand, one hand tugging one way in the direction of 'save money' and the other tugged away from 'sufficient money', that would be it. It seems that the NHS money managers would rather have a shortage of beds than one empty one. That can't be right, or even economically defensible given the knock on effects such as people being taxid (in ambulances) around the country to find a bed. Does that still happen? It certainly did.

Mrs T has just erupted about the fact I did not get the GP callback today despite being in A and E for 10 hours. I haven't had a spasm for 5 hours now so my perspective has changed a bit. Cut them some slack. It's amazing how quickly one can become out of touch with anger.

 

[Harry Wilson's tackle]

Old people are allowed to keep £23K of their savings.

Are they? Unless this changed in the last couple of years, my little brother has bogarted all her cash, then.

 

[Thunder Bolt]

Are they? Unless this changed in the last couple of years, my little brother has bogarted all her cash, then.

My StepMum certainly did.

This is the official document £23,250.00
https://www.gov.uk/government/publi...t-social-care-charging-reform-further-details

 

[Harry Wilson's tackle]

My StepMum certainly did.

This is the official document £23,250.00
https://www.gov.uk/government/publi...t-social-care-charging-reform-further-details

Thanks.

I'll be having a word with my brother.....

 

[dejavuatbtn]

The underlying problem is that each government thinks it can squeeze more out of the crumbling NHS by reorganisation, rather than reinvestment. We have had an ever ageing population, more (costly) solutions to keeping people alive and fewer health professionals. We have fewer overseas care workers coming in from abroad and no takers for ancillary jobs because benefits pay better. High tech solutions are contracted out to private companies that take a disproportionate amount of the NHS budget. We have government ministers doing deals with their mates to provide equipment at non economic rates.
The whole thing is a shambles and is now probably unfixable. If they put up national insurance to a level that provided a decent budget the money would get spent elsewhere.
Rant over.

 

[drew]

I have seen several anecdotes recently from ambulance crew, and relatives of old people who have fallen, waiting for ambulances for those lengths of time. The 14 hours was an old person with a broken hip.
As I said the problem isn’t getting to patients but offloading them at the hospital
I also watch the Ch4 programme every Monday night about Barnsley A&E called Casualty Every Second counts.

That's fair enough but you did say the average was 7-10 hours but is that based on statistics across the country or anecdotal evidence. Also, there is a big difference between waiting for an ambulance and waiting for admission at A&E. If you're waiting for the ambulance you're pretty much on your own but once the ambulance get's to you at least you are having medical attention even if you then have to wait in the car park at the A&E. Big problem is getting people out of hospital back into the community to free up beds so that those in A&E can be admitted to wards when necessary.

Sort out social care and that will have a positive effect on the through flow of patients in the hospitals. Unfortunately, despite promises of a ready made plan, this government has done **** all, again.

 

[Cheshire Cat]

The clinical side of the Health Service might be good, but it's management and administration are utter garbage. It also manages to squander vast amounts of money that could and should be better targeted.

Internal f***ing market bollocks.

 

[PILTDOWN MAN]

Hope you get the treatment you deserve HWT.

I had yet another op on my shoulder last week which I always knew as Spire(Hastings), I'm fortunate to have private health care through work. It has been bought and now operates as Sussex Premier Health, wholly owned by the NHS, treating private patients but all profits go back to the NHS trust. I "think" I'm ok with that but while I am happy profits don't reach shareholders and profits are going back into care I did note the drugs I received come from the Conquest next door and I wasn't ask to pay for them.

 

[BLOCK F]

My StepMum certainly did.

This is the official document £23,250.00
https://www.gov.uk/government/publi...t-social-care-charging-reform-further-details

We have been going through the process for my mother in law with adult social care at WSCC.
Good grief, they are difficult to deal with, it really is like wading through treacle.