[Sloper]

Well, given the financial situation we're in should there be cuts and are the current government's proposals the best way to go about things?

http://www.guardian.co.uk/society/2010/jan/28/nhs-cuts-leak-unison-foundation-jobs

[slackline]

Simply working more efficiently would be a major help, there's waaaay too much wastage, unnecessary bureaucracy etc. etc.

[Sloper]

Indeed and things like this don't help

http://news.bbc.co.uk/1/hi/england/staffordshire/8483169.stm

What happens happens, identify and learn from clinical incidents, covering them up costs more and does more damage.

[fatkid2000]

Efficiency savings are needed no doubt.

There are many who need to justify their jobs - there's plenty of people who are a waste of space.

The general public need to respect the NHS and treat it well. In my mind people need to be charged for some of their care. For example: Drunks, inappropriate use of ambulances and just pure abuse of the system.

I know that's a controversial view and that of somebody who has spent 6 months in A&E but the strains on the system are enormous. If we want to fund things like the latest chemeo for cancer - the country has to make a choice - spend £3 billion a year treating piss heads on treat people with cancer. I know where I want my tax to go.

[slackline]

If we want to fund things like the latest chemeo for cancer - the country has to make a choice - spend £3 billion a year treating piss heads on treat people with cancer. I know where I want my tax to go.

  ?

I'll play devil's advocate and suggest that people need to realise that they're going to die one day.  The main reason that cancer and heart disease are major killers is simply because people aren't dying from communicable diseases as they used to in the past.  Medicine is becoming a victim of its own success and as life-expectancies increase western societies are facing a massive problem of a burgeoning, aging population that they currently can't cope with and the situation is only going to get worse.

I've not read anything on the details of the newer cancer drugs, but if for example a £20000 treatment extends life by on average one year I personally don't think that thats money well spent (but then I'm fortunately not in the position to have to make that call, and even more fortunate not to be, or know anyone else, who is in need of such treatment).

I'm of the firm belief that quality rather than quantity of life is important.

[fatkid2000]

What you state is true Slack-line: some of the drugs that are available in the rest of Europe, are not good value for money - and health economics is what it boils down to.

However - when the campaigning starts for the election we'll get the usual shit that the NHS will become as good as French, Spanish, Swiss health care etc - where these treatments get funded. So the country needs to make a choice.

During my last Saturday in A&E - we recorded the number of alcohol / drug / fight related attendances. It was somewhere in the region of 60% - 70 % after midnight. Thats around 40 attendances. 30 were delivered by ambulance.

£200 / ambulance ride = £6k plus hospital treatment. That's say £8 - 10 K spent. That's in a small DGH department.
So in the Sheffield region alone that's about £60K on an average Saturday night.

[slackline]

The campaigning will unfortunately just be empty promises to get the votes (in my cynical point of view).

Those numbers for A&E are pretty bad*

* Although I've been one of those statistics in the past after drinking 9-10 pints and trying to ride home, only to hit a phone box 10 metres from where I'd unlocked my bike and fly over the handlebars, crack my head open and knock myself out.  Ambulance staff were very kind and let me bring my bike on board and lock it up outside A&E before going in, even managed to get the bus driver to let me bring my bike on-board on the journey home, and our local publican opened the doors on a lock-in when he saw the state of me (figured I had that much alcohol in me one more point wasn't going to hurt, although probably not the wisest thing I've ever done).

[tomtom]

The campaigning will unfortunately just be empty promises to get the votes (in my cynical point of view).

Those numbers for A&E are pretty bad*

* Although I've been one of those statistics in the past after drinking 9-10 pints and trying to ride home, only to hit a phone box 10 metres from where I'd unlocked my bike and fly over the handlebars, crack my head open and knock myself out.  Ambulance staff were very kind and let me bring my bike on board and lock it up outside A&E before going in, even managed to get the bus driver to let me bring my bike on-board on the journey home, and our local publican opened the doors on a lock-in when he saw the state of me (figured I had that much alcohol in me one more point wasn't going to hurt, although probably not the wisest thing I've ever done).

Theres certainly an element of    for that story - though probably a bit of  too  :-)

[slackline]

though probably a bit of  too  :-)

Only one bit, but that was what necessitated the visit to A&E.

Worst of it was feeling like a twat whilst being stitched up and reeking of booze.

[bigd942]

In my previous life (medical supplies) I came accross a nurse binning an o2 sensor at £90 a time every patient, alarm bells rang as we couldn't keep up supply so someone rang and asked how they were being used, only the probe that pushed into the breathing tube needed replaced every patient, customer service were told during the phone call by the nurse etc in charge "I think I should know what I'm doing", probably still binning £90 sensors.
They were also selling £1 plastic buckets bought from somewhere like B&Q for £30 a time, think calling them "surgical buckets" was the trick. Medical supplies in general are a rip off, margins are in the hundreds of percent, things costing 90p to make being sold to the NHS for £15 or soo, PEEP Valves etc.
Flipside is I've also saw the treatment given to people like my dad who has a defibulator fitted due to heart failure, staff all along the line going out of their way to make things happen.

[fatkid2000]

Worst of it was feeling like a twat whilst being stitched up and reeking of booze.

Did you ask the guy stitching you up - if the nurse treated you was single. That has to be the most common question I got from the pissed up. Either that or some other random conversation whilst refusing to stay still.

[duncan]

Well, given the financial situation we're in should there be cuts and are the current government's proposals the best way to go about things?

http://www.guardian.co.uk/society/2010/jan/28/nhs-cuts-leak-unison-foundation-jobs

None of the suggested policies in that link should be at all surprising to anyone working in healthcare planning.  The main thrust seems to be spending less on expensive secondary healthcare (big hospitals, consultants, specialist centres), more on primary healthcare, and greater emphasis on care in the community.  All of which sound like excellent ideas.  Stand-by for the screams from the specialists. 

Over the last 50 years, healthcare cost inflation has been typically two or three times as much as general inflation and is showing no signs of slowing down.  This is mostly due to new health technologies and an ageing population: more can be done and more want things doing.  This is applies throughout the western world, irrespective of health system or hue of government.  To give the NHS it's due, it is a relatively efficient healthcare provider for a western country. 

Healthcare has to be rationed, either by market forces (see the mess that is the US system), or some other way.  Unfortunately not many politicians seem prepared to discuss this.  NICE (one of this government's best ideas) are making an attempt at sharing a limited pot equitably rather than the money going to those who shout loudest as has been the case.

[mrjonathanr]

What's wrong with borrowing the Polish idea of a sobering-up house (with a few doctors assessing in case of need for a referral to A+E) plus charge for service?
Won't clear out A+E or the cells, but might be ease some pressure on the services?

As for the NHS, we're just going to have to pay more, one way or another.

[slackline]

Worst of it was feeling like a twat whilst being stitched up and reeking of booze.

Did you ask the guy stitching you up - if the nurse treated you was single. That has to be the most common question I got from the pissed up. Either that or some other random conversation whilst refusing to stay still.

My embarrassment at injuring myself in such a retarded manner was compounded by the fact that the person stitching me up had two X-chromosomes and a rather pretty face.  No recollection of what the nurse looked like 

[stone]

I have used the NHS more than my fair share. It does have its problems. My guess is that it might be a good system to deal with a very very inadequate buget but is hit and miss at making use of a more appropriate generous budget. Perhaps the German or Spanish systems might be better at that? What the NHS seems exceptional at is making full use of specialist nurses. What it seems bad at is having too much unfounded faith in the idea that GPs can make a diagnosis based on an interview with a patient. If GPs could just immediately refer patients on to the appropriate specialist team (perhaps mostly nurse led with occasional short input and oversight by a specialist doctor) and the specialists quickly delt with them then I think outcomes would improve with the same budget. In cancer care, my impression is that problems arise because 1/3 of cancers present as the category "there is a 2% chance this might be cancer". The NHS system leaves those cases to get worse and untreatable/expensive to treat. Although expensive cancer drugs get the headlines, cheap radiotherapy has waiting lists because the innane career structure in the NHS makes radiotherapists feel undervalued and so throw in the towel after a few years in the job. Whilst I got the impression that cancer care was floundering, I have got the impression that NHS psychiatric care is an awesomely efficient system with instant referal to specialist nurse led accurate diagnosis and treatment. Perhaps other people have got the opposit impression and it is very hard to extrapolate from one experience.

[fatdoc]

 

good post.