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The end of the NHS. (Read 193087 times)

jfw

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#50 Re: The end of the NHS.
May 09, 2013, 11:45:26 am
Does anyone have "their own" doctor anymore? - I never have in Sheffield - just whoever is available in the practice on the time I could (eventually) get an appointment.

A lot of the time it wouldn't matter  - but I had a period of chronic night time cough a few years back where I kept going back and seeing a.n.other doctor , explaining from scratch what the symptoms were/ history was/ what was tried with the previous doctor(s).

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#51 The end of the NHS.
May 09, 2013, 01:05:10 pm
The new contract effectively made OOH non viable for GPs. The OOHs system for visits now has a navigator that goes with the GP. I'm not sure how many young female GPs would be happy doing a home visit alone at 3am?  And for an individual practice to employ a navigator is impossible.

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#52 Re: The end of the NHS.
May 21, 2013, 09:14:18 am
Informed consent or opt out, neither seem to apply.

And yet non-commercial entities are as mentioned denied access to the data.  :greed: :greed: :greed:

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#54 Re: The end of the NHS.
July 01, 2014, 09:44:46 am

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#55 Re: The end of the NHS.
July 01, 2014, 10:21:15 am
Rule 1:  Penalise GPs for missing cancer diagnoses, they should be investigating more.
Rule 2:  Penalise GPs for referring too many patients.

Go figure why the whole thing is about to implode.   :coffee:

Ru

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#56 Re: The end of the NHS.
July 01, 2014, 11:31:55 am
From where I'm sitting, this part of it all got fucked because GP's didn't want to get up in the middle of the night.
Educate me?  I could be totally off here.  I don't think I am though.

Sort of. There was a massive GP recruitment crisis, in part because no-one wanted to do a job that involved getting up in the middle of the night, amongst other things. To solve the crisis they gave GPs the option of opting out of OOH and taking a pay cut. They accepted. Recruitment crisis solved in the short term, OOH problem created (note, it wasn't a case that there were no problems before - having GPs do OOH is only viable if there are enough GPs).

Since then a few other things have changed - GPs are responsible for the management of many more chronic diseases, patient numbers have increased, pay is being cut, targets are being increased, patient demands have increased, working hours have increased along with work density, management support has been removed and cash flow problems have been created by sacking everyone that knew what they were doing in the PCT finance departments that payed the practices.

So no-one wants to be a GP anymore. Many are leaving to go abroad, some are retiring early, training posts are unfilled. And now they want them to do OOH again, without paying them for it. And blame them for failing to make enough cancer referrals. Whilst cutting the number of referrals for cancer they are allowed to make. And so on.

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#57 Re: The end of the NHS.
July 01, 2014, 12:33:05 pm
Basically as long as we wil continue to treat people who get fat for the inevitable consequences of their fecknlessness the system will never be able to cope; we need politicians to say that the NHS can't do everything for all, all the time and free at the point of need; ohh yes and old community hospitals & etc  which are no longer fit for purpose will ahve to close.

Let's start by having the presumption of a charge @A&E which is written off if the attendance required A&E attendance.  We already have the proceses in place to recover costs from insurers and while the revenue it would raise would be minimal it would stop the inundation of people at A&E who simply don't need to be there.

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#58 Re: The end of the NHS.
July 01, 2014, 12:44:14 pm

Let's start by having the presumption of a charge @A&E which is written off if the attendance required A&E attendance.  We already have the proceses in place to recover costs from insurers and while the revenue it would raise would be minimal it would stop the inundation of people at A&E who simply don't need to be there.

Good luck training the population to understand the biology and first aid/medicine required to be able to self-assess whether its worthy of attending accident and emergency (yes there are some cases which are very obvious, but many that are not quite so clear cut and require qualified medical assessment).  I feel sorry for those without sufficient funds to afford such a charge who delay attending when they should have because they wouldn't be able to afford to pay such a charge and subsequently suffer far worse than had they attended at an earlier point.

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#59 Re: The end of the NHS.
July 01, 2014, 01:21:17 pm
The suggestions that are bandied about by A&E doctors is that something like 30-40% of attendances at A&E are clearly not merited, I wonder if the docs on here could comment as to whether this proposition is reasonabe?

A classic example are those who attend A&E after a minor road traffic collision and are sent home with a photocopied sheet and some over the counter pain pills; they 'evidence' their injuries by the A&E attendance, the NHS charges the insurer of the liable party £690 and A&E is unnecessarily congested.

I think most people genuinely know when there's cause to attend A&E and when there isn't.

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#60 Re: The end of the NHS.
July 01, 2014, 01:29:39 pm
Do away with the ability to claim for non-injuries and you won't see those people pointlessly filling up A&E.  Address the cause not the symptom.


I'm no clinician, but I can think of one condition which could easily be construed as not worthy of attendance yet is actually quite life-threatening if not treated quickly.....appendicitis.


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#61 Re: The end of the NHS.
July 01, 2014, 02:19:12 pm
What about getting a saucepan stuck on your head?

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#62 Re: The end of the NHS.
July 01, 2014, 02:54:58 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

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#63 Re: The end of the NHS.
July 01, 2014, 03:00:41 pm
What about getting a saucepan stuck on your head?

That would depend on how urgently its need for cooking dinner.

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#64 Re: The end of the NHS.
July 01, 2014, 04:20:54 pm
Do away with the ability to claim for non-injuries and you won't see those people pointlessly filling up A&E.  Address the cause not the symptom.


I'm no clinician, but I can think of one condition which could easily be construed as not worthy of attendance yet is actually quite life-threatening if not treated quickly.....appendicitis.

There's plenty that would like to see an end to soft tissue injuires, but just because you have no bony injury doesn't mean that you haven't been injured. 


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#65 Re: The end of the NHS.
July 01, 2014, 04:26:37 pm
Your previous post implied to me that many were simply getting a doctors note to claim insurance, not that that they weren't genuinely injured, which is why I was suggesting preventing the litigation culture that seems to have grown over the last decade or two.

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#66 Re: The end of the NHS.
July 01, 2014, 04:35:43 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective. And we can afford it. Admittedly we could do with a few more billion, perhaps by building less trident subs or perhaps making the odd TNC actually pay tax on UK income. But clearly this government isn't worried about saving or making money. Indeed, their changes to higher education, healthcare and possibly even benefits, all seem to be costing us more. And they've basically let the city and TNCs go feral on their watch.  They've also now basically given up even pretending they've improved the NHS.

The NHS is struggling in some places, purely because of unnecessary and ideological budget cuts (as you say), but it's perfectly viable and very cost effective.

---
 The National Health Service has been praised as the world's best health-care system by an international panel of experts who said it was superior to those found in countries which spend far more on health.

The study, entitled “Mirror, Mirror on the Wall,” also described US healthcare provision as the worst globally. Despite investing the most money in health, the US refuses care to many patients without health insurance and is also the worst at saving the lives of people who fall ill, it found.

The Commonwealth Fund, a Washington-based foundation produced the report. The fund is respected around the world for its analysis of the performance of different countries' health systems. It examined 11 countries, including detailed data from patients, doctors and the World Health Organisation, the Guardian reported.

"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency," the fund's researchers conclude in their 30-page report. Their findings amount to a huge endorsement of the health service, especially as it spends the second-lowest amount on healthcare among the 11 – just £2,008 per head, less than half the £5,017 in the US. Only New Zealand, with £1,876, spent less.
http://www.telegraph.co.uk/health/nhs/10907823/Britains-NHS-is-the-worlds-best-health-care-system-says-report.html
---
You can call that selective usage of data, subjective interpretation or whatever the fuck you want, and I don't believe our system is the best in the world, but it's a bloody brilliant system and it is highly cost effective. Unviable? As long as you ignore all the evidence.

Sloper

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#67 Re: The end of the NHS.
July 01, 2014, 04:49:24 pm
Your previous post implied to me that many were simply getting a doctors note to claim insurance, not that that they weren't genuinely injured, which is why I was suggesting preventing the litigation culture that seems to have grown over the last decade or two.

Yep; that's about the size of it, they've been in a minor bump and want their compo and they know it assists their claim if they go to A&E.

As for the litigation culutre, unfortunately its largely come about due to Labour's removal of civil legal aid and legislation allowing 'no win, no fee'.

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#68 Re: The end of the NHS.
July 01, 2014, 04:57:58 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective.

Let me clarify.

Primary Care can not continue to be free at the point of access for unlimited access.  Funding is going up for secondary care.  It is being cut for primary care and the workload is going up.

Secondary Care does not have open access to unlimited numbers (except for A+E).  You can't just turn up at outpatients and demand for a same day appointment.

Our recent LMC survey showed that a proportion of GPs are having to lay off staff due to practice finance changes, and it's only going to get worse.

You want an 8 til 8 service?  On the same money?  With the same number of GPs?  I'm interested to know how you think that'll work.

Bottom line is that patient demand is going up, staffing and money is going down and the opposite is true in the hospitals.

So how is it viable and Daily Mail bullshit?

Sloper

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#69 Re: The end of the NHS.
July 01, 2014, 05:06:13 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective. And we can afford it. Admittedly we could do with a few more billion, perhaps by building less trident subs or perhaps making the odd TNC actually pay tax on UK income. But clearly this government isn't worried about saving or making money. Indeed, their changes to higher education, healthcare and possibly even benefits, all seem to be costing us more. And they've basically let the city and TNCs go feral on their watch.  They've also now basically given up even pretending they've improved the NHS.

The NHS is struggling in some places, purely because of unnecessary and ideological budget cuts (as you say), but it's perfectly viable and very cost effective.

---
 The National Health Service has been praised as the world's best health-care system by an international panel of experts who said it was superior to those found in countries which spend far more on health.

The study, entitled “Mirror, Mirror on the Wall,” also described US healthcare provision as the worst globally. Despite investing the most money in health, the US refuses care to many patients without health insurance and is also the worst at saving the lives of people who fall ill, it found.

The Commonwealth Fund, a Washington-based foundation produced the report. The fund is respected around the world for its analysis of the performance of different countries' health systems. It examined 11 countries, including detailed data from patients, doctors and the World Health Organisation, the Guardian reported.

"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency," the fund's researchers conclude in their 30-page report. Their findings amount to a huge endorsement of the health service, especially as it spends the second-lowest amount on healthcare among the 11 – just £2,008 per head, less than half the £5,017 in the US. Only New Zealand, with £1,876, spent less.
http://www.telegraph.co.uk/health/nhs/10907823/Britains-NHS-is-the-worlds-best-health-care-system-says-report.html
---
You can call that selective usage of data, subjective interpretation or whatever the fuck you want, and I don't believe our system is the best in the world, but it's a bloody brilliant system and it is highly cost effective. Unviable? As long as you ignore all the evidence.

Utter one eyed lefty fuckwittery of the highest order.

1. Tuition fees and the removal of the cap / review was a Labour policy, legislated for by Labour, implemented by Labour and the TOR for the review set by Labour who agreed to be bound by the outcome.

2. The majority of the changes to the NHS in respect of private providers etc were legislated for by Labour.  No party has a good record of reform of the NHS and I can't see that the current mob are any worse than the previous few goverment's.

3. There have been more loopholes closed by Boy George than probably any other chancellor.  Your grasp on history is simply tenuous at best re regulation.

4. In case you haven't noticed the government have introduced a cap on non disabled benefits claimants and sought to restrict criteria for claiming.  Whether universal benefits 'saves' money in the long term is something we'll only be able to assess in 10 years or so.

5. ideological, blah blah, blah. The NHS is a wonderful institution and probably the least worst model for delivering healthcare on almsot any measure, but that doesn't make it perfect.  There's a culture of covering up failures, excusing dysfunctional practice and overlooking what are self evident risks, IT & infrastructure have probably never been well managed and procurement has always been bedeviled by fraud & etc.

The problem is that increased inputs in terms of £bn do not result in improved outputs in terms of patient care and so on.  the NHS needs radical reform in respect of the delviery of services to the increasingly aged population, the estate in many areas is simply not fit for purpose and there needs to be a culture change in respect of errors and failures (look a the trend of MDU & MDF payments for negligence etc).

None of this will happen without aggressive political action and the flaccid drivel that you and others like you come out with make the necessary reforms more difficult to scope and deliver.

if the type II diabetes bombshell hits us then we're going to need a f--king mircale to cope with the increased numbers, expenditure does not go up in a linear progression with the average age of the population.

in shorth the NHS was designed for a different time and metaphorically a different place, the UK and its population has changed radically in so many ways and yet the NHS has as a whole remained preserved in aspic.

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#70 Re: The end of the NHS.
July 01, 2014, 05:09:59 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective.

Let me clarify.

Primary Care can not continue to be free at the point of access for unlimited access.  Funding is going up for secondary care.  It is being cut for primary care and the workload is going up.

Secondary Care does not have open access to unlimited numbers (except for A+E).  You can't just turn up at outpatients and demand for a same day appointment.

Our recent LMC survey showed that a proportion of GPs are having to lay off staff due to practice finance changes, and it's only going to get worse.

You want an 8 til 8 service?  On the same money?  With the same number of GPs?  I'm interested to know how you think that'll work.

Bottom line is that patient demand is going up, staffing and money is going down and the opposite is true in the hospitals.

So how is it viable and Daily Mail bullshit?

Indeed.  The perfect system is unobtainable.  If I 'need' to see my GP why can't I just turn up and see him (and I mean him, not one of his colleagues) regardless of the time of day or day of the week?  What you mean I can't, you Tory bastards.  :-\


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#71 Re: The end of the NHS.
July 01, 2014, 06:14:25 pm
Bottom line is that patient demand is going up


I think this is an interesting point and ties into the A&E (mis-)use.

What is driving the increase in patient demand? 

There has been a slight increase in the population size over the last 50 years, and the standard of medical care in terms of what can be treated is has vastly improved, but this isn't necessarily for the common things, rather its for rare conditions.

Life expectancy has increased as a consequence of improved treatments for communicable diseases and as a consequence the population is ageing well, and the incidence of heart disease, cancer, type II diabetes, dementia (catch all term for the broad spectrum) have all increased as a consequence.

This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

I don't have any real answers, but will say that recommendations for how money is spent within the NHS on different treatments is for the large part governed by The National Institute for Health and Care Excellence (NICE) which takes an evidence base approach.



As an aside the continual Tory v's (Nu-)Labour to-ing and fro-ing bashing is pretty pointless, its clear that current Labour party do not represent the values the party held 70+ years ago when the established the NHS.

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#72 Re: The end of the NHS.
July 01, 2014, 06:42:00 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective.

Let me clarify.

Primary Care can not continue to be free at the point of access for unlimited access.  Funding is going up for secondary care.  It is being cut for primary care and the workload is going up.

Secondary Care does not have open access to unlimited numbers (except for A+E).  You can't just turn up at outpatients and demand for a same day appointment.

Our recent LMC survey showed that a proportion of GPs are having to lay off staff due to practice finance changes, and it's only going to get worse.

You want an 8 til 8 service?  On the same money?  With the same number of GPs?  I'm interested to know how you think that'll work.

Bottom line is that patient demand is going up, staffing and money is going down and the opposite is true in the hospitals.

So how is it viable and Daily Mail bullshit?

It's viable because it's extremely cost-effective and the current problems at the front end are just being caused by a lack of funding. Yes, that funding could become a means-tested cost at point of service, but it could equally continue to be funded via taxation. We're going to pay for it one way or another, and there's no solid reason to suggest we need to change the way we fund it. The current government's attempts at synthesising a crisis are reversible.

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#73 Re: The end of the NHS.
July 01, 2014, 09:16:03 pm
I'm not sure you are au fait with the background to all this, you sound a little uninformed.
Effectively, the reversibility is very doubtful as this path has been followed for a lot longer than you realise.

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#74 Re: The end of the NHS.
July 01, 2014, 11:04:23 pm
I'm reasonably well informed.
I was only actually talking about reversing real-term funding cuts to front line services.
I'm aware of the creep that's been occurring regarding outsourcing and restructuring and wasn't actually talking about that, although I'd say some of it is probably still worth assessing with regards reversal. But I'm under the impression that these are contributing less to the difficulty in keeping up with demand.
Obviously you can play with some things. It might well be worth changing the targets and allowing triage of A&E arrivals so that the 'abusers' don't have to be dealt with within 4 hours. And there's plenty of questionable paperwork all round, especially I think for GPs. I think the whole notion of targets being tied to payments and penalties is a mixed bag. I'm not saying it's bad overall, but there perhaps needs to be recognition that it can lead to problems in some cases, and can push struggling services into debt. Last time I checked, schools in special measures got a funding boost to help them improve. Currently it seems you get the opposite in the health service, or is there something I don't know?

 

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