Dispatches - NHS in Crisis
Discussion
Vasco said:
InformationSuperHighway said:
But I thought Brexit was going to help with all this? No?
Good one.
Where is the extra $350m a week?
https://www.bbc.co.uk/news/articles/cqqqq4vwy0ro
'There is a dental crisis and voters deserve better'
'There is a dental crisis and voters deserve better'
BunkMoreland said:
Tom8 said:
When has the NHS not actually been in a "crisis"?
The whole thing is an utter shambles. Recent experience of it over a 12 month period has confirmed every thought I had about it and more. Amazingly poor coordination, communication, zero leadership, a hell of a lot of the "angels" don't actually care at all.
We had to use a brand new casualty department, new built last year. Spent about 7 hours observing it all. Even that, the design and layout and organisation was appalling. Simple example, the electric door frame created a lip, so when a wheelchair was pushed through the entrance the patient would be tipped out as the wheels caught on it. Everyone had to turn round and carefully reverse in.
The NHS was built in the post war period for a population of 50 million providing essential care.
The same model is now used to provide for 70 million and growing using the same principals albeit now with vastly more expensive care, equipment and drugs.
I will be raising a formal complaint against the trust as it was all so bad.
THIS!The whole thing is an utter shambles. Recent experience of it over a 12 month period has confirmed every thought I had about it and more. Amazingly poor coordination, communication, zero leadership, a hell of a lot of the "angels" don't actually care at all.
We had to use a brand new casualty department, new built last year. Spent about 7 hours observing it all. Even that, the design and layout and organisation was appalling. Simple example, the electric door frame created a lip, so when a wheelchair was pushed through the entrance the patient would be tipped out as the wheels caught on it. Everyone had to turn round and carefully reverse in.
The NHS was built in the post war period for a population of 50 million providing essential care.
The same model is now used to provide for 70 million and growing using the same principals albeit now with vastly more expensive care, equipment and drugs.
I will be raising a formal complaint against the trust as it was all so bad.
Its the closest thing to a religion in the UK
It can NEVER be seen as anything other than "world best" or "run by amazing staff"
When anyone whose had more than a few GP appointments will know its useless most of the time. Staffed by a million "computer says no" types who seem to outnumber the people who give a s
t by 10K to 1! And that's before we even get anywhere near the malpractice! But mention changing the system or introducing any form of health insurance and people assume you mean the USA model.
When what they actually mean is the French or German systems (Small stuff is Private funded either patient or insurance. Big stuff like Cancer is funded by taxation
Too many treatments available but the NHS makes everything a "condition". As you say, a graded contribution would be far more effective. I don't know anyone who thinks the US system is the way to go.
"Free" at point of entry meaning people take the piss. Many people don't need to be there. During covid they were telling people "only use A&E in emergency" Really? Why the hell are they using it if it isn't? Hereford hospital recently had a nurse prowling A&E. She spoke to everyone to find out why they were there. She dispatched many of them to ring 111, go to a pharmacist, book a GP appt or just take a paracetamol. She probably saved half the NHS budget in one shift.
Too many people. People demand an ambulance when they don't really need one usually thinking it will get them through casualty sooner.
Too many staff not doing a lot. In our local hospital the outsourced (Privatised!!) cleaning team were far more helpful and friendly than any of the NHS staff.
Unnecessary waste, why are they prescribing "free" paracetamol for example? So many faults in a system. The only Labour front bencher who sounds like he might be OK is Wes Streeting so when they get in let's hope he means it and begins to reform the vast behemoth of waste and failure that is the NHS.
Don’t forget the 35% pay rise for junior doctors to train them in opening a private consultancy.
My kids both have mental health issues and mostly the support and consultants we’ve been referred to are useless / time wasting / generic.
My wife found out more than we’ve ever been advised.
My kids both have mental health issues and mostly the support and consultants we’ve been referred to are useless / time wasting / generic.
My wife found out more than we’ve ever been advised.
Oakey said:
epom said:
It comes down to accountability, the days of there being any are long gone. Our crew are currently building a hospital that is expected to cost €2.4billion once finished. Yes Billion.
That sounds like it'll be fantastic with all the high tech equipment you'll be fitting. How many MRI's and such does £2.4billion get you?740EVTORQUES said:
I started as a junior doc in 1995, consultant in 2002, still working full time.
When I was training people waited more than a year for surgery and not infrequently died on the waiting list. It then improved and the waiting lists almost disappeared under New Labour
Over the past 15 years it has gradually deteriorated. We routinely send people home who previously would be kept in hospital for urgent surgery, instead to wait on a waiting list. I can perform less than 1/2 the operations I did per year compared to 20 years ago simply due to a lack of staff and resources. Management overreach is rampant.
It’s dire, hard to see how the NHS can flourish under a Conservative Government. They’ve had more than enough time to try to prove they are competent and we can see the results..
The Tories haven't cut NHS funds. The NHS budget has increased every year since 2015. Perhaps the NHS should stop spending money on pointless sWhen I was training people waited more than a year for surgery and not infrequently died on the waiting list. It then improved and the waiting lists almost disappeared under New Labour
Over the past 15 years it has gradually deteriorated. We routinely send people home who previously would be kept in hospital for urgent surgery, instead to wait on a waiting list. I can perform less than 1/2 the operations I did per year compared to 20 years ago simply due to a lack of staff and resources. Management overreach is rampant.
It’s dire, hard to see how the NHS can flourish under a Conservative Government. They’ve had more than enough time to try to prove they are competent and we can see the results..
t like diversity managers?Labour (and Tories) flooded the UK with millions who pay barely any tax yet suddenly have public services beyond their wildest dreams. Guess what? They use them a lot. Oh and many of them have 4 children families.
That's what has caused this. It's not the supply side, it's demand side.
Downward said:
leef44 said:
Vasco said:
Isn't the problem just the sheer size of the NHS operation.
By coincidence, yesterday I had to go to a major local hospital A+E for various tests. About 100+ patients were waiting for apx 3 hours (better than usual apparently), despite the fact that the staff were clearly working their socks off.
I then had to go to another section where 6-8 staff were generally milling around their Reception area. They were certainly readily available to meet any urgent demand but an average of, say, 6 staff doing very little got a bit tiresome after another 3 hours.
The whole organisation needs a massive overhaul and reorganisation - which simply won't happen.
It's just so ridiculously vast. Where would you start?
And it is growing. Every time someone comes across another gap in society where an illness/sickness/condition has not been catered for then it hits tabloid headlines. Politicians want to score points by being the one who allocated billions implementing another division/department.By coincidence, yesterday I had to go to a major local hospital A+E for various tests. About 100+ patients were waiting for apx 3 hours (better than usual apparently), despite the fact that the staff were clearly working their socks off.
I then had to go to another section where 6-8 staff were generally milling around their Reception area. They were certainly readily available to meet any urgent demand but an average of, say, 6 staff doing very little got a bit tiresome after another 3 hours.
The whole organisation needs a massive overhaul and reorganisation - which simply won't happen.
It's just so ridiculously vast. Where would you start?
At the same time, there are no additional staff and this is to be absorbed into the current overstretched workload.
Hang on a minute, didn't I say billions are allocated? Yes, where does that money go because it is not in additional staffing.
It's so oversized and creaking so inefficiently while being economically unsustainable.
The budgets for each department are say 50 WTE’s on various bands.
To run that service at demand you need x number of staff. When the staff are unavailable (sickness, maternity, job vacancies) then there’s a requirement to employ agency staff.
For example the cost of 1 consultant from Agency is the same as 3 WTE consultants.
You can see how quickly the money goes.
Someone said about the paracetamol problem too. Why can you buy them for 3p each from the supermarket but the NHS pay X ?
There are also lots of discussions about reducing staff costs by changing job bandings. However I’ve never heard folk saying that the Senior management banding should be reduced. It’s always Band 4 and below.
To just pay silly money like there's a magic money tree is a disgrace.
Fastchas said:
I would ban the use of agency staff from hospitals. From her experience, lots of nurses are leaving the NHS, then signing up to agencies, only to be given shifts back on the wards or in critical care at inflated rates. They're all at it.
If the use is banned, where else can the agency staff go? Back to the NHS at their old rates is where, which means increased numbers of nurses.
Agreed, but I suspect it's like the police, ex colleagues helping each other etc.If the use is banned, where else can the agency staff go? Back to the NHS at their old rates is where, which means increased numbers of nurses.
Megaflow said:
Also, can someone tell me why the system has gone to st in the last ~10 years. The population of the country has not changed significantly in that time, so in theory at least the physical capacity of the system should be ok, so why is it struggling so much with actual capacity?
We received 800,000 people last year alone.... t in the last ~10 years. The population of the country has not changed significantly in that time, so in theory at least the physical capacity of the system should be ok, so why is it struggling so much with actual capacity?tele_lover said:
The Tories haven't cut NHS funds. The NHS budget has increased every year since 2015. Perhaps the NHS should stop spending money on pointless st like diversity managers?
Labour (and Tories) flooded the UK with millions who pay barely any tax yet suddenly have public services beyond their wildest dreams. Guess what? They use them a lot. Oh and many of them have 4 children families.
That's what has caused this. It's not the supply side, it's demand side.
It depends how you want to define it.t like diversity managers?Labour (and Tories) flooded the UK with millions who pay barely any tax yet suddenly have public services beyond their wildest dreams. Guess what? They use them a lot. Oh and many of them have 4 children families.
That's what has caused this. It's not the supply side, it's demand side.
Maybe a better phrase would be strangling NHS funding. It increases year on year due to an inflationary uplift but for example this year the uplift is 1/4 of inflation at the time they calculate it. So now NHS Trusts are in a bit of chaos as the anticipated inflationary uplift to their budgets from DHSC are not what they expected them to be. No reason or explanation for the recent change in numbers from HMG
So yes the funding does increase however it does not keep pace with the cost increases of running the NHS i.e. staff, drugs, equipment etc. In addition they used smoke and mirrors to champion extra investment when in reality they were just stripping money from one NHS pot and giving it to another. good example would be when they raided Health Education England to fund an increase in acute NHS funding. Now we are in a bit of a mess with NHS training as HEE has less budget.
Do you have a figure on the cost to the NHS (and other public services) of these millions who have flooded the UK? Not just anecdotal Daily Mail tripe but how much does this cohort access the NHS compared to a similar cohort of UK citizens who also may not support the country through employment related taxation but receive benefits?
I haven't watched the documentary yet, I had it recording but just haven't had the desire to sit down yet as I know I'll be furious with it.
In my eyes the NHS is like an institution, dislikes change, thinks the way it does things is right and is unwilling to embrace new ways of working, technologies etc.
When you look back at Covid and how the NHS staff struggled but worked all the hours possible to treat people that alone should have been enough public exposure for the current government to jump in and have a drains up review of working practices and trim the fat, all they did was capitalise on the pandemic and millions/billions of pounds of public money spent on ineffective PPE.
Then when you watch programmes like the Ambulance you can see it in every episode how the NHS is the catch-all for any issue, loneliness, mental health issues, old age, these should be addressed by other teams/services not first line paramedics. You also see they dispatch multiple ambulance units to an incident while other people are left for hours suffering, to me this looks to be an inefficient use of resources from the start, then those ambulance crews are effectively strewn across hospital A&E areas as there are no beds/corridor space to get these patients in, there's a huge bottleneck and it keeps ambulance units tied up. And that's not even covering once patients are admitted or have been on a waiting list for god knows how long.
You then have patients on waiting lists for operations - some life changing/life saving who at the last minute their operation is cancelled due to the lack of available ICU beds/staff and they usually go to the back of the queue as everyone else is scheduled.
I could go on about my own experiences and I'll be honest the staff have always been great, but it's broken and needs a reboot. I have a view that the current public hospitals would easily be filled with A&E patients, but people who are there for scheduled operations need new facilities. Controversial I know, and I have no idea how this would be funded, any scheduled operations/consultations etc should go the private sector and any A&E emergencies/outpatients should stay within the NHS.
In my eyes the NHS is like an institution, dislikes change, thinks the way it does things is right and is unwilling to embrace new ways of working, technologies etc.
When you look back at Covid and how the NHS staff struggled but worked all the hours possible to treat people that alone should have been enough public exposure for the current government to jump in and have a drains up review of working practices and trim the fat, all they did was capitalise on the pandemic and millions/billions of pounds of public money spent on ineffective PPE.
Then when you watch programmes like the Ambulance you can see it in every episode how the NHS is the catch-all for any issue, loneliness, mental health issues, old age, these should be addressed by other teams/services not first line paramedics. You also see they dispatch multiple ambulance units to an incident while other people are left for hours suffering, to me this looks to be an inefficient use of resources from the start, then those ambulance crews are effectively strewn across hospital A&E areas as there are no beds/corridor space to get these patients in, there's a huge bottleneck and it keeps ambulance units tied up. And that's not even covering once patients are admitted or have been on a waiting list for god knows how long.
You then have patients on waiting lists for operations - some life changing/life saving who at the last minute their operation is cancelled due to the lack of available ICU beds/staff and they usually go to the back of the queue as everyone else is scheduled.
I could go on about my own experiences and I'll be honest the staff have always been great, but it's broken and needs a reboot. I have a view that the current public hospitals would easily be filled with A&E patients, but people who are there for scheduled operations need new facilities. Controversial I know, and I have no idea how this would be funded, any scheduled operations/consultations etc should go the private sector and any A&E emergencies/outpatients should stay within the NHS.
740EVTORQUES said:
It's a combination of a lack of funding (yes even with the increase we are behind similar countries and they are struggling as well) and poor management.
For example short-termism in not keeping up with repair and replacement of estate and equipment leading to things breaking leading to service interruption and higher costs. Happens all the time in the NHS.
Another example, our trust has a special panel scrutinising job appointments, fair enough you woudl think, but it means that when someone leaves (and staff turnover is high) the necessary replacement is delayed and the whole service suffers in the meantime. Other staff get pressured to do more and more people leave etc etc.
Equipment is getting sweated way past its recommended lifespan.For example short-termism in not keeping up with repair and replacement of estate and equipment leading to things breaking leading to service interruption and higher costs. Happens all the time in the NHS.
Another example, our trust has a special panel scrutinising job appointments, fair enough you woudl think, but it means that when someone leaves (and staff turnover is high) the necessary replacement is delayed and the whole service suffers in the meantime. Other staff get pressured to do more and more people leave etc etc.
For example a new hospital opened 2012. Endoscopy had all new scopes and stacks.
We get x years down the line and capitals been cut to replace this equipment. So 10 years later we have this equipment which is out of date.
A Hospital I worked at in 2013 had a window replacement program on the capital plan. I went past there a month ago and the windows were just getting replaced.
Most Trusts do have bank staff but I guess if an agency is going to pay you more for the same job what would you do ?
Edited by Downward on Thursday 27th June 10:37
Edited by Downward on Thursday 27th June 10:40
Freakuk said:
I haven't watched the documentary yet, I had it recording but just haven't had the desire to sit down yet as I know I'll be furious with it.
In my eyes the NHS is like an institution, dislikes change, thinks the way it does things is right and is unwilling to embrace new ways of working, technologies etc.
When you look back at Covid and how the NHS staff struggled but worked all the hours possible to treat people that alone should have been enough public exposure for the current government to jump in and have a drains up review of working practices and trim the fat, all they did was capitalise on the pandemic and millions/billions of pounds of public money spent on ineffective PPE.
Then when you watch programmes like the Ambulance you can see it in every episode how the NHS is the catch-all for any issue, loneliness, mental health issues, old age, these should be addressed by other teams/services not first line paramedics. You also see they dispatch multiple ambulance units to an incident while other people are left for hours suffering, to me this looks to be an inefficient use of resources from the start, then those ambulance crews are effectively strewn across hospital A&E areas as there are no beds/corridor space to get these patients in, there's a huge bottleneck and it keeps ambulance units tied up. And that's not even covering once patients are admitted or have been on a waiting list for god knows how long.
You then have patients on waiting lists for operations - some life changing/life saving who at the last minute their operation is cancelled due to the lack of available ICU beds/staff and they usually go to the back of the queue as everyone else is scheduled.
I could go on about my own experiences and I'll be honest the staff have always been great, but it's broken and needs a reboot. I have a view that the current public hospitals would easily be filled with A&E patients, but people who are there for scheduled operations need new facilities. Controversial I know, and I have no idea how this would be funded, any scheduled operations/consultations etc should go the private sector and any A&E emergencies/outpatients should stay within the NHS.
Very true. Outsourcing of responsibility is systemic in this country. When people are old or ill they just hand them over to the NHS or the tax payer to fund a care home. What happened to family responsibility? The police are similar, social working rather than poicing then we all wonder why they don't do crime solving any more.In my eyes the NHS is like an institution, dislikes change, thinks the way it does things is right and is unwilling to embrace new ways of working, technologies etc.
When you look back at Covid and how the NHS staff struggled but worked all the hours possible to treat people that alone should have been enough public exposure for the current government to jump in and have a drains up review of working practices and trim the fat, all they did was capitalise on the pandemic and millions/billions of pounds of public money spent on ineffective PPE.
Then when you watch programmes like the Ambulance you can see it in every episode how the NHS is the catch-all for any issue, loneliness, mental health issues, old age, these should be addressed by other teams/services not first line paramedics. You also see they dispatch multiple ambulance units to an incident while other people are left for hours suffering, to me this looks to be an inefficient use of resources from the start, then those ambulance crews are effectively strewn across hospital A&E areas as there are no beds/corridor space to get these patients in, there's a huge bottleneck and it keeps ambulance units tied up. And that's not even covering once patients are admitted or have been on a waiting list for god knows how long.
You then have patients on waiting lists for operations - some life changing/life saving who at the last minute their operation is cancelled due to the lack of available ICU beds/staff and they usually go to the back of the queue as everyone else is scheduled.
I could go on about my own experiences and I'll be honest the staff have always been great, but it's broken and needs a reboot. I have a view that the current public hospitals would easily be filled with A&E patients, but people who are there for scheduled operations need new facilities. Controversial I know, and I have no idea how this would be funded, any scheduled operations/consultations etc should go the private sector and any A&E emergencies/outpatients should stay within the NHS.
The NHS will never change though. If you look at NHS job advertising it always emphasises previous experience in the NHS so self perpetuating the innate failure and cementing it into the fabric. The NHS needs people who are not tainted by it and can look at it differently. They endlessly train this type of thinking in diversity training...
Like I said with the private sector hoovering up profits the NHS will just get worse.
https://www.theguardian.com/society/article/2024/j...
https://www.theguardian.com/society/article/2024/j...
The NHS is not an isolated entity. It is heavily burdened by the escalating costs and resources required to manage a population that is becoming increasingly sedentary and obese. This, coupled with the social care system's reliance on NHS resources, underscores the pressing need for improved population health – from more individual responsibility to government action on ultra-processed foods.
IFS said:
In summary, the most recent estimates of the cost of obesity are around 3% of GDP, £58 billion per year (2020).
GDP has risen by around 12% between 2020 and 2022 (ONS, 2023), so expressed relative to GDP in 2022, this would be £65 billion. This estimate would be considerably higher if it included estimates of the costs of child and adolescent obesity since these are likely very large and long-lasting.
GDP has risen by around 12% between 2020 and 2022 (ONS, 2023), so expressed relative to GDP in 2022, this would be £65 billion. This estimate would be considerably higher if it included estimates of the costs of child and adolescent obesity since these are likely very large and long-lasting.
pavarotti1980 said:
tele_lover said:
The Tories haven't cut NHS funds. The NHS budget has increased every year since 2015. Perhaps the NHS should stop spending money on pointless st like diversity managers?
Labour (and Tories) flooded the UK with millions who pay barely any tax yet suddenly have public services beyond their wildest dreams. Guess what? They use them a lot. Oh and many of them have 4 children families.
That's what has caused this. It's not the supply side, it's demand side.
It depends how you want to define it.t like diversity managers?Labour (and Tories) flooded the UK with millions who pay barely any tax yet suddenly have public services beyond their wildest dreams. Guess what? They use them a lot. Oh and many of them have 4 children families.
That's what has caused this. It's not the supply side, it's demand side.
Maybe a better phrase would be strangling NHS funding. It increases year on year due to an inflationary uplift but for example this year the uplift is 1/4 of inflation at the time they calculate it. So now NHS Trusts are in a bit of chaos as the anticipated inflationary uplift to their budgets from DHSC are not what they expected them to be. No reason or explanation for the recent change in numbers from HMG
So yes the funding does increase however it does not keep pace with the cost increases of running the NHS i.e. staff, drugs, equipment etc. In addition they used smoke and mirrors to champion extra investment when in reality they were just stripping money from one NHS pot and giving it to another. good example would be when they raided Health Education England to fund an increase in acute NHS funding. Now we are in a bit of a mess with NHS training as HEE has less budget.
Do you have a figure on the cost to the NHS (and other public services) of these millions who have flooded the UK? Not just anecdotal Daily Mail tripe but how much does this cohort access the NHS compared to a similar cohort of UK citizens who also may not support the country through employment related taxation but receive benefits?
Downward said:
Like I said with the private sector hoovering up profits the NHS will just get worse.
https://www.theguardian.com/society/article/2024/j...
But they are only ever paid NHS tariff (is it annex A) costs though. Still worth their while as it is economies of scale and they can set up larger units and have a conveyor belt of patients waiting. https://www.theguardian.com/society/article/2024/j...
Megaflow said:
That comparison works both ways though, what about all the years under Labour when they got a 7% increase, way above inflation.
The timing is the issue. The budget "re-alignment" was 1 week before Sunak called the GE whereas it was always done prior to the contracting meetings in February/MarchIt was addressing a massive issues to try and drag it back towards a some kind of 1st/2nd world healthcare provider. Now it is just back to the peaks of troughs. The whole thing needs removing from government and be a cross party thing because you cannot plan healthcare on the whim of a PM like Johnson or Truss.
Edited by pavarotti1980 on Thursday 27th June 13:30
There's the usual smattering of posts in this thread blaming the Evil Tories for everything. And yet things are as bad, or worse, in Wales, Scotland and NI. Scotland has tax raising powers, has used them, and still things aren't good enough. Wales gets more spending on healthcare per head then England.
The common denominator isn't the politicians, it's the NHS itself. The NHS has become like a religion where any criticism is regarded as blasphemy, and like many institutions has become self serving and highly resistant to change. Suggestions for reform are met - especially by those on the left - with cries of "Hands off our NHS!" or hysterical references to the USA model, which nobody is proposing. Until the need for serious reform is accepted by the public, the politicians and the NHS itself things will get steadily worse.
The common denominator isn't the politicians, it's the NHS itself. The NHS has become like a religion where any criticism is regarded as blasphemy, and like many institutions has become self serving and highly resistant to change. Suggestions for reform are met - especially by those on the left - with cries of "Hands off our NHS!" or hysterical references to the USA model, which nobody is proposing. Until the need for serious reform is accepted by the public, the politicians and the NHS itself things will get steadily worse.
There are several factors contributing to the current state of the NHS. What is clear though, is that the only method tried so far - more money - is not the answer. If your car keeps using more fuel (or electric), do you refuel more often or take it to the garage?
I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
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