Dispatches - NHS in Crisis
Discussion
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...
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...
so no one should make profit from providing services? Even if they can do so cheaper than the alternative?https://www.theguardian.com/society/article/2024/j...
Zaichik said:
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...
so no one should make profit from providing services? Even if they can do so cheaper than the alternative?https://www.theguardian.com/society/article/2024/j...
One of the big problems in the NHS is the ever increasing demands. This comes. It from immigration of any other east scapegoats but the much more obvious aging population, decreasing health at all levels with obesity, T2 diabetes, mental health (a lot of which is triggered by deprivation etc)
Treatments are much more complex (and thankfully effective) than even 20 years ago (just look at mortality for various operations) and are offered to patient who would not have been considered treatable not long ago whether due to age or severity of their condition.
That’s a good thing unless taken to extreme isn’t it? But it’s also hideously expensive.
Of course there is waste and inefficiency as there is in any organisation but it’s not as rampant as you might imagine and on the other hand staff constantly go above and beyond to compensate for lack of resources. That includes a lot of unpaid overtime managing without essential equipment rather than cancelling procedures etc. Unlike an airline who would ground a plane if everything was not right the attitude in the NHS is to muddle through because the alternatives are worse.
The private sector ethos in the NHS is a bit half baked and brings the worst of both worlds in many ways, endless layers of bureaucracy and internal markets without the real efficiency that competition would supposedly bring. Its reached ridiculous levels where departments within the same hospital ‘buy’ and ‘sell’ services to each other using accounting rules that appear to be plucked out of thin air. All this requires back office staff to generate huge amounts of data that have nothing to do with patient care while at the same time there are not enough ITU nurses of other frontline staff to actually deliver care.
Treatments are much more complex (and thankfully effective) than even 20 years ago (just look at mortality for various operations) and are offered to patient who would not have been considered treatable not long ago whether due to age or severity of their condition.
That’s a good thing unless taken to extreme isn’t it? But it’s also hideously expensive.
Of course there is waste and inefficiency as there is in any organisation but it’s not as rampant as you might imagine and on the other hand staff constantly go above and beyond to compensate for lack of resources. That includes a lot of unpaid overtime managing without essential equipment rather than cancelling procedures etc. Unlike an airline who would ground a plane if everything was not right the attitude in the NHS is to muddle through because the alternatives are worse.
The private sector ethos in the NHS is a bit half baked and brings the worst of both worlds in many ways, endless layers of bureaucracy and internal markets without the real efficiency that competition would supposedly bring. Its reached ridiculous levels where departments within the same hospital ‘buy’ and ‘sell’ services to each other using accounting rules that appear to be plucked out of thin air. All this requires back office staff to generate huge amounts of data that have nothing to do with patient care while at the same time there are not enough ITU nurses of other frontline staff to actually deliver care.
Hants PHer said:
Until the need for serious reform is accepted by the public, the politicians and the NHS itself things will get steadily worse.
Whatever the public thinks, Wes Streeting has often and openly championed "fundamental and deep" reforms of the NHS. However, NHS reform and funding aren't enough alone. We must also tackle our ageing population, obesity and its resultant Type 2 diabetes, and so on.740EVTORQUES said:
One of the big problems in the NHS is the ever increasing demands. This comes from the... aging population, decreasing health at all levels with obesity, T2 diabetes, mental health (a lot of which is triggered by deprivation etc)
Salted_Peanut said:
Hants PHer said:
Until the need for serious reform is accepted by the public, the politicians and the NHS itself things will get steadily worse.
Whatever the public thinks, Wes Streeting has often and openly championed "fundamental and deep" reforms of the NHS. However, NHS reform and funding aren't enough alone. We must also tackle our ageing population, obesity and its resultant Type 2 diabetes, and so on.740EVTORQUES said:
One of the big problems in the NHS is the ever increasing demands. This comes from the... aging population, decreasing health at all levels with obesity, T2 diabetes, mental health (a lot of which is triggered by deprivation etc)
- 30% health issues: obesiety, alcohol, drugs, mental health
- 30% people not needing an ambulance but calling one as they believe it will get them seem quicker (jumping A&E queue)
- 40% genuine need.
However it's not a vote winner for any Party to tell people the NHS will never recover due to people being too fat, alcoholics, druggies or just abusing the system.
tele_lover said:
This is the reason ALL public services are affected.
I’m afraid the answer is more nuanced and complex. On one hand, a larger population requires more NHS resources.On the other hand, immigration drives GDP. Plus, the NHS relies on people coming from overseas to do essential clinical and other roles.
The NHS’s issues are complex, including tackling a population that’s ageing, more obese and sedentary.
Salted_Peanut said:
I’m afraid the answer is more nuanced and complex. On one hand, a larger population requires more NHS resources.
On the other hand, immigration drives GDP. Plus, the NHS relies on people coming from overseas to do essential clinical and other roles.
The NHS’s issues are complex, including tackling a population that’s ageing, more obese and sedentary.
A lot of NHS issues could be resolved with a functioning adult social care system. It is not uncommon for beds to be occupied by people for social reasons instead of medical ones. If only the health and social care levy on NI wasn't scrapped there could have been a bit more in the potOn the other hand, immigration drives GDP. Plus, the NHS relies on people coming from overseas to do essential clinical and other roles.
The NHS’s issues are complex, including tackling a population that’s ageing, more obese and sedentary.
Lotusgone said:
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 have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.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.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5bn, or £3.3k per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
ETA: correcting millons to billions.
Edited by Megaflow on Friday 28th June 13:28
Edited by Megaflow on Friday 28th June 17:32
Megaflow said:
Lotusgone said:
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 have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.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.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
Megaflow said:
NHS budget in 1997 £48.9m, corrected to 2024 is £93.7m, or £1.6m per head.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
I think your figures may be slightly off...NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
budgets are in billions not millions and the per head spend in thousands.....
your point is still very valid though - we are spending proportionately more in real terms per head
Edited by Zaichik on Friday 28th June 12:22
Zaichik said:
Megaflow said:
NHS budget in 1997 £48.9m, corrected to 2024 is £93.7m, or £1.6m per head.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
I think your figures may be slightly off...NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
budgets are in billions not millions and the per head spend in thousands.....
your point is still very valid though - we are spending proportionately more in real terms per head
Edited by Zaichik on Friday 28th June 12:22
740EVTORQUES said:
Megaflow said:
Lotusgone said:
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 have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.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.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
Megaflow said:
740EVTORQUES said:
Megaflow said:
Lotusgone said:
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 have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.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.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
The real solutions?
Well, fund it properly so that rebuilding, maintenance etc can be done rather than shelved for short term savings.
Fund social care to unblock hospitals (ie pay carers enough to recruit them).
Pay staff properly to stop the recruitment and (more importantly retention) issues. This can't be over-emphasised, staff turnover and especially loss of trained staff to emigration, going part time (or private) or early retirement is catastrophically wasteful.
Stop devaluing GP's and other staff by using PA's as (not even that) cheap substitutes in order to meet short term promises on consultations delivered, while storing up expensive problems through excessive use of tests (which is what junior and less qualified staff tend to do) and missed diagnoses.
Where there are efficiencies to be gained, it's more from reducing the multiple layers of management, and faux internal markets that achieve very little other than increase costs, more than the oft raised meme that the woes of teh NHS are entirely down to feckless nurses standing around eating quality street on the wards.
I might be 100% wrong, but 30+ years on the frontline mean I probably have a fair idea of how it works.
740EVTORQUES said:
No you haven't proved anything other than funding has increased but care has deteriorated. There's literally no analysis to show any correlation there. That's what I mean by simplistic.
The real solutions?
Well, fund it properly so that rebuilding, maintenance etc can be done rather than shelved for short term savings.
Fund social care to unblock hospitals (ie pay carers enough to recruit them).
Pay staff properly to stop the recruitment and (more importantly retention) issues. This can't be over-emphasised, staff turnover and especially loss of trained staff to emigration, going part time (or private) or early retirement is catastrophically wasteful.
Stop devaluing GP's and other staff by using PA's as (not even that) cheap substitutes in order to meet short term promises on consultations delivered, while storing up expensive problems through excessive use of tests (which is what junior and less qualified staff tend to do) and missed diagnoses.
Where there are efficiencies to be gained, it's more from reducing the multiple layers of management, and faux internal markets that achieve very little other than increase costs, more than the oft raised meme that the woes of teh NHS are entirely down to feckless nurses standing around eating quality street on the wards.
I might be 100% wrong, but 30+ years on the frontline mean I probably have a fair idea of how it works.
But has your cousins, uncle twice removed not seen a nurse standing around once when they could have working?The real solutions?
Well, fund it properly so that rebuilding, maintenance etc can be done rather than shelved for short term savings.
Fund social care to unblock hospitals (ie pay carers enough to recruit them).
Pay staff properly to stop the recruitment and (more importantly retention) issues. This can't be over-emphasised, staff turnover and especially loss of trained staff to emigration, going part time (or private) or early retirement is catastrophically wasteful.
Stop devaluing GP's and other staff by using PA's as (not even that) cheap substitutes in order to meet short term promises on consultations delivered, while storing up expensive problems through excessive use of tests (which is what junior and less qualified staff tend to do) and missed diagnoses.
Where there are efficiencies to be gained, it's more from reducing the multiple layers of management, and faux internal markets that achieve very little other than increase costs, more than the oft raised meme that the woes of teh NHS are entirely down to feckless nurses standing around eating quality street on the wards.
I might be 100% wrong, but 30+ years on the frontline mean I probably have a fair idea of how it works.
Solving adult social care would a huge win for the NHS and then look at the rest. Expedite the scrapping of internal markets brought in by the Health and Social Act 2012 instead of the utter shower that is commissioning at present. God help us when they move a multitude of services from Specialised Commissioning to ICBs because the likelihood is that budget will not follow the devolved services and left in the same situation as now with static block contracts from ICBs which are still using 2019 (M1-6) as the baseline for funding.
Megaflow said:
So what is your answer then
The NHS’s issues are not just simple problems that can be easily solved. They are complex, multifaceted challenges that require a broad range of solutions. The solutions to the NHS issues, as suggested by 740EVTORQUES, are crucial. In addition, we must resolve social care. Implementing much-improved and better-resourced public health measures is vital, too. For instance, we could incentivise community pharmacies to provide smoking cessation services and combat the food industry’s lobbying power that obstructs obesity reduction. Obesity costs the UK over £65 billion annually, and around a third of this cost is borne by the NHS.
We must also take individual responsibility for our exercise and physical activity levels. One of the most significant costs for the NHS is complications associated with a sedentary lifestyle catching up with people in later life.
740EVTORQUES said:
That last bit is too simplistic, the growth in the population has been disproportionately in older people with more complex and more expensive health needs and in addition the amount of illness per head particularly mental health across all age groups has risen.
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
This is a key point. Diagnosis/technology has improved so much that old people no longer die of old age. They die of liver failure or a heart condition. Keeping old people alive has come such a long way but at a cost. In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
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