Re: Crisis in the NHS
 

Surely though hiring more GP's will relieve the overwork .Most of the overwork issue will be resolved by going 7 days a week because instead of treating x amount in 5 days you will be treating the same amount in 7 days .Those extra 2 days will make a massive difference to the NHS .

I agree we don't ,the message should have been " we will introduce a 7 day NHS and you will have to pay more for it"

Only for emergencies ,not for the vast majority of NHS work it hasn't .In 2017 it should be possible for me to get treatment in the Musculo skeletal dept of my local hospital on a saturday or a sunday .In this country it seems to be considered more vital to allow me to buy a tin of beans on a sunday or get so drunk i end up in A&E than to get a steroid injection for Arthritis which would allow me to continue working and paying taxes .

Re: Crisis in the NHS
 

Hire more GPs ? yes, but it'll cost ( and take years).

Non emergency appointments at weekends,? nice but it will cost.

This would be on top of the extra money required to maintain the status quo.

Question keeps coming back to are we prepared to pay? Although most say yes, they do say different when it comes to voting/affecting their take home pay. Buck stops with us all.

Re: Crisis in the NHS
 

As the old saying goes Mr K you can't fit a quart into a pint pot.

Re: Crisis in the NHS
 

tbh Den anyone who voted for the current Govt. can't really complain or be surprised about what's happening.

Re: Crisis in the NHS
 

Taking politics out of it this crisis has been coming for 20 year's plus but alas politicians from all parties have been in denial for that or even longer and are still in denial now and l cannot see now't changing sadly.

Re: Crisis in the NHS
 

Scrapping NI has been discussed for as many years as I have been working in the payroll industry (I teach it)
You need to take into account Employers NI and the other classes of NI where people are paying extra to cover gaps in their employment and self employed people.
All employees get an NI allowance.. An employee on NI Table letter A would be: (There are others for under 21s and Apprentices under 25 but these help the employer not the employee)
Primary Threshold: £155 per week £672 per month £8,060 per year (This is where the employees start paying NI at 12% on everything above this)
Secondary Threshold: £156 per week £676 per month £8,112 per year
(This is where the Employers start paying NI at 13.8% above this)

One people get to the UEL they pay 2 % on all earnings above that... this is because they have contributed enough for a full state pension. It used to be 0%, then 1%

If we compare the NI threshold to the personal allowance of 1100L employees can earn appox £916 a month before paying tax at 20% (rising to 1150L / £958.33 in 17/19) This means people pay NI before they start paying tax but at a lower rate.

There is one big discrepancy with NI which I think should be removed.. If you have more than one job you get the same allowance in both jobs (unlike tax where you can split the personal allowance or go onto a BR / 0T) unless you earn up to the UEL in one job.. you can get a certificate of deferment and just pay 2% in the 2nd job.

One more thing.. the LEL (lower earnings limit) is used to determine if an employee is entitled to statutory payments like SMP or SSP. NI is also used in the calculation of the Employment Allowance and the Apprenticeship Levy (Which starts in 2017/18).
National Insurance is more complicated than Tax (in my opinion) .. but has been simplified in recent years.

Re: Crisis in the NHS
 

If only we had started training more doctors in 2008...

http://www.bmj.com/content/337/bmj.a748 And this was only 9 years ago...

http://www.bmj.com/content/337/bmj.a...J_UK_TrendMD-0 (Waits for Mr K to find a reason why this was the current Government's fault...;))

Re: Crisis in the NHS
 

Our local GP's were paid to "extend their opening hours"

They did, but just had a longer patient-free period between the morning and evening sessions.

Morning sessions are at a set quota "first in, first seen, up to a maximum of 15". But if you are number 15 and a more "serious case" appeared you get told to come back the next day (no weekends of course). Triage by admin staff, not someone medical! And the 15 will one day be divided between a lone GP, the next it could be 2 or even 3.

Evening sessions have strictly limited numbers too, by appointment only.

Re: Crisis in the NHS
 

That BBC documentary that I linked to a couple of pages back showcased a GP surgery where they reduced the number of patients coming in and seeing a GP by 70%!
I'll say that again.....by working 'smarter', they reduced their workload by 70%
Imagine if all GP practices did the same......

Re: Crisis in the NHS
 

Is that because the 70% went to A&E instead?

Re: Crisis in the NHS
 

They slam the doors shut once their daily quota has entered the building? :confused:

Re: Crisis in the NHS
 

Although the last Labour government wasn't blameless, continuing to blame them after 7 years is wearing a bit thin Hugh.

A more open and honest way is to throw this back to the public and how much they are prepared to contribute to the increasing demands on the NHS. (sorry another referendum...)

Something along the lines of:-

- contribute no more. The NHS only to provide emergency care, you need private care for anything else (I suspect this is where the Govt. wants to go)

- 1p in the pound more tax. Try and maintain the status quo, with the NHS cutting some non-life threatening treatments.

- 2p more, status quo

- 3p more. More GP's and out of hours service

- 4p more. All singing and dancing 7 days a week NHS providing all care.

Not pretending these are the real figures or level of funding needed but an example of the choice we as the public, not politicians, need to make. Then we couldn't whinge because we'd made the choice.

It would certainly be a more honest approach than the current Govts. i.e. just let the NHS rot, blaming Junior Dr's, GPs, immigrants etc etc. When it collapses bring your private sector mates to the rescue...

Re: Crisis in the NHS
 

Nope. Listen to the program :)

---------- Post added at 19:20 ---------- Previous post was at 19:19 ----------

As above :)

---------- Post added at 19:21 ---------- Previous post was at 19:20 ----------

Listen to the program I linked to. the NHS doesn't need more money. It just needs to work properly and also not waste the money we give it.

Re: Crisis in the NHS
 

Please show me in the post where I blamed the Labour Government - I, in fact, pointed out that the BMA had voted against training more Junior doctors...

btw, it takes around 10 years from beginning medical training to being a GP, so there are no quick and easy answers, but if the BMA had supported more training, half of those qualifying would have been GPs next year, which would have been helpful...

Re: Crisis in the NHS
 

a big fat Zero.

????

What if we went for the 8p option? But then that proved not to be enough either, could we moan then?

more money isn't the answer, it's a little bit of the answer but I wouldn't give it more money unless the whole concept of the NHS was completely reimagined.

Re: Crisis in the NHS
 

You're beginning to sound like a management consultant mate....

Which one of these 'concepts' do you want to 'reimagine'?

http://www.nhs.uk/nhsengland/thenhs/...rinciples.aspx

Re: Crisis in the NHS
 

No.

Yes

Depends on the situation. The "Clinical need" is a good one. Certain elective procedures for example, may not have a pressing clinical need. Also those certain procedures without a pressing clinical need could be charged for.

Re: Crisis in the NHS
 

Source

So much for Labour "weaponising" the NHS. Looks like that backfired.

Re: Crisis in the NHS
 

Yep, they shot themselves in the foot with their own 'weapon'.

Re: Crisis in the NHS
 

We've all 'shot ourselves in the foot' by not funding the NHS properly. Even cancer operations are now being cancelled.

https://www.theguardian.com/society/...y_to_clipboard

Re: Crisis in the NHS
 

Some interesting statistics.

http://www.nhsconfed.org/resources/k...ics-on-the-nhs

Re: Crisis in the NHS
 

One of the problems, with A & E more specifically, is because it's free people take the piddle.

I bet you could cut down on people wasting time with minor issues if there was some kind of charge for attending A & E with a non-emergency issue.

Re: Crisis in the NHS
 

Yeah that's something that's being pressed upon up here. Recent one was, ''We're going to inform people what you shouldn't be coming to A&E for''

Surely that can't be the first time they've used that campaign :erm: It evidently doesn't make enough of a dent to really change anything.

Re: Crisis in the NHS
 

Any sort of charge is going to discriminate against the poor. You could exempt those entitled to free prescriptions. However here's bound to be cases of people not exempt but hard up, not going because of that pain in the chest, and it turns out to be serious.

I'm all in favour of fining/prosecuting drunks wasting A&E's time. I was in a A&E cubicle once with my son who had just been diagnosed with a potentially life threatening illness (fortunately he's fine). There were drunks either side of us carrying on, could have cheerfully killed them.

Re: Crisis in the NHS
 

That's the whole of Wales exempt then.

How do you know any change will impact the poor? Do you know something we don't or are you just coming out with your normal drivel?

Re: Crisis in the NHS
 

Try and think it through bud, there must be some brain cells there somewhere...

Re: Crisis in the NHS
 

Don't forget the NHS in Wales is controlled by Labour, and is in a heck of state too.

Leadership and admin within each Trust appears to be the constant that screws things up no matter what flavour government we have.

Re: Crisis in the NHS
 

Don't forget Mr K wants labour in control of NHS England too.

Re: Crisis in the NHS
 

No, it's going to discriminate against the stupid.

If you have pain in your chest you go to the GP. If you're having a heart attack you go to A&E, you should be able to tell the difference.

agreed, even if they're poor working class drunks, that are drunk through no fault of their own?

Re: Crisis in the NHS
 

Where did I say that? I just want it properly funded.

---------- Post added at 16:19 ---------- Previous post was at 16:17 ----------

I'm glad you've got wonderful powers of self diagnosis but not everyone has.

Re: Crisis in the NHS
 

Pain in your chest is a symptom of having a heart attack or just pain in your chest. You can also have pain in your chest which is symptomatic of a heart condition without being a heart attack and yet still serious such as Angina.

The advice is that any of these symptoms should be treated as a medical emergency because people aren't great and knowing the difference. Especially if you're older, unfit or have a history of heart problems.

Re: Crisis in the NHS
 

What about the heart attack that starts with a pain in the chest.

A&E should always be free for everyone .People should be able to get urgent medical treatment without fear of getting a big bill ever ,that is one of the founding principles of the NHS.The only real arguments are how do we fund it and how do we get such a huge organisation to use the money we give them effectively without getting used up in admin costs and managerial wages

Re: Crisis in the NHS
 

Seems to me that triage at A&E needs to be more aggressive and those turning up with grazes, split fingernails or paper cuts, yes they do, need to be sent on their way to the nearest pharmacy.

They call it triage but it's not the military kind. Three streams: Those who will get better without treatment, those who will die anyway even if treated and those who will get better with treatment. Only the last get attention on the battlefield.

Re: Crisis in the NHS
 

Indeed its hard to tell the difference between a heart attack and severe Heartburn as most of the ordinary Joe Public would not know the difference

http://www.mayoclinic.org/diseases-c...d/art-20046483

Re: Crisis in the NHS
 

At our local hospital non urgent cases arriving in A&E are directed to an on site GP service in the same place but I'm certain 99% of those people will say they've been treated in A&E.

I'm wondering if this is common and whether or not the waiting times for each dept. are recorded separately because the non-urgent stuff clearly has no bearing on waiting times for the actual A&E section dealing with the serious stuff.

Re: Crisis in the NHS
 

I suppose by the same token if you have a head ache you should run off screaming brain tumour as well?

People need to have a bit of self responsibility too.

Of course if you " have a history of heart problems". - no sh:t Sherlock phone 999.

But A&E is full of people every week, every day, who are there unnecessarily.

The clue is in the bloody title. Accident and Emergency

If we're going to sort it out we have to take responsibility for our own actions and if we go there and it isn't an Emergency we should, in my opinion be charged for it, for taking up time from people that really need it.

Re: Crisis in the NHS
 

No because the medical advice on when you feel a headache is not to go to your doctors right away.

The medical advice for chest pain is to deal with it ASAP because time is critical, you don't wait until you've collapsed with a confirmed heart attack to get it treated. You said previously that people should be able to tell the difference but by all accounts you sometimes cannot. Angina specifically very closely mirrors the symptoms of a heart attack but, whilst serious, it's not as time critical as a heart attack. Obviously you don't go if it's heartburn but 'chest pain', go.

Re: Crisis in the NHS
 

I had a psin in my chest last summer, it didn't involve shooting pains in my arms, or neck and I'm fairly healthy so I didn't think heart attack. Turned out to be muscular pain incurred whilst over exerting gardening the previous day.

Anyway, bottom line is the point is valid.

We need to take more responsibility, have some basic knowledge and common sense and only go to A&E if you are badly injured in an accident or whether it is a bonafide emergency.

Otherwise, you deserve to wait 6-7 hours.

Re: Crisis in the NHS
 

Interesting article with some useful figures on funding

Memo to Theresa May: it is vital that the NHS gets more money
"The NHS’s share of national income rose from 5 per cent in 2000 to nearly 8 per cent by 2009. Since then it has fallen to 7 per cent and, by the estimate of the King’s Fund, is heading towards 6 per cent. What this means is that Britain spends about 30 per cent less per person than Germany. So much for the NHS as the fabled “bottomless pit”.

Since 2010 the pressures have been multiplied by the government’s policy of imposing deep cuts in the social care budgets of local authorities. The effect has been to transfer the burden to the NHS — with elderly people needing care clogging hospital beds at twice or three times the price of nursing homes or help in the community.

Nor has government done much to make its own case. Last year Jeremy Hunt, the health secretary, picked a fight with junior doctors about working patterns. The doctors, Mr Hunt insisted, had to take a cut in weekend pay so he could meet the government’s promise of a “seven-day” NHS. After a series of acrimonious strikes Mr Hunt won the battle and lost the argument. A few months on, it is obvious that hospitals cannot afford the doctors and nurses to properly staff themselves even for five days a week."

The Financial Times states that Mr Stevens is a moderniser and is keen to move the focus onto primary and preventive care. His plan can deliver a cheaper and more effective health service but it needs the PM to face reality and provide more funding.

Google the above headline or subscribers can read the full article at https://www.ft.com/content/50d3a12e-...b-e7eb37a6aa8e

Re: Crisis in the NHS
 

However, German workers subscribe to workplace health insurance, which increases the money available for healthcare - just like France.

Why is this never mentioned when comparisons are given?

Re: Crisis in the NHS
 

Many UK companies offer staff access to workplace health insurance from the likes of Axa PPP and Bupa. Presumably, these are similar to the schemes in France and Germany.

Re: Crisis in the NHS
 

In wish people would stop trying to compare the NHS with the German model ,they are completely different and funded completely differently .We may well end up with a German type system as will the Americans but at the moment it's like comparing apples and oranges

Re: Crisis in the NHS
 

The problem is a shortage of staff, irrespective of whether there is a money shortage.

Re: Crisis in the NHS
 

Hire more GP's you say well there is a even bigger shortage at our surgery as 3 doctors have handed in their notice on top of the 10.000 more patients our surgery has had to take as they have had enough because the primary health trust in the city made even more health cuts.

Re: Crisis in the NHS
 

Per my previous post, the NHS is recruiting more doctors from Europe. http://www.cableforum.co.uk/board/sh...2&postcount=95

Re: Crisis in the NHS
 

I was listening to a phone in regarding GP services this morning and it apparent that there's a huge variance in appointment making procedures which is a big factor in how difficult it is to get to see a GP at a reasonable time. Our surgery has expanded greatly in the last 10 years but it's still possible to get a same day appointment and they also offer a ring back service where a GP will call to discuss your problems the same day. If you want to see a specific GP at a convenient time that may involve a delay of a week or two but if it's an urgent problem one of the other options would be available.

Having listened to all the callers it seems some surgeries have really efficient procedures which offer a range of alternatives for those wanting to consult a GP whilst others operate systems which are frankly inefficient and even amateurish. I can't understand why there isn't a nationally imposed model for handling appointments which reflects best practice because it's evident that some (maybe many) surgeries are falling way short of what they could offer their patients. It seems to me that might be a very good place to start the process of getting the best from the available resources.

Re: Crisis in the NHS
 

Selling NHS drugs - I wonder how much of this is going on too:

http://www.bbc.co.uk/news/uk-england...ngham-38598995

Re: Crisis in the NHS
 

Nothing new, it's been happening for years.

Re: Crisis in the NHS
 

Yes I'm well aware it has but on what scale is the big question. Having said that, it's unlikely to be a major factor on it's own but maybe the big issue with the NHS and what it costs (PFI aside) is in large part the cumulation of countless lesser abuses and inefficiencies which add up to a whole lot of time and money.

Re: Crisis in the NHS
 

Look after the pennies and the pounds will look after themselves as they say.

Re: Crisis in the NHS
 

No, they're not...

https://en.m.wikipedia.org/wiki/Healthcare_in_Germany

Re: Crisis in the NHS
 

A standardised booking system available to all GPs. Linking up the systems across the NHS so a GP can see the progress of a patient in real time as well as referrals etc and making patients' health records move seamlessly across the service would be a good start.

They start these projects, reward them to the cheapest provider, and then abandoning them when the cost and scale rises. However it's got to the done eventually.

Re: Crisis in the NHS
 

Why is there not a dedicated NHS lottery?.I have never done the lottery as i always believed it should be many winners at one million pounds each as that would transform more people's lives rather than one winner at 50 million.What is the price of a ticket now €2.50 i believe.if they made it a pound and it was guaranteed to go exclusivly to the NHS i would buy a couple every week for sure.Also i believe richard branson offered to run the lottery at no charge.i bet he would still do that for an NHS lottery.

Re: Crisis in the NHS
 

It's the government's job to raise money for services through taxes not the lottery .We can't have vital services like the NHS dependant on people's desire to play the lottery

Re: Crisis in the NHS
 

I thought there was an NHS based lottery although i could be wrong.

Re: Crisis in the NHS
 

There is the Health Lottery which is nothing to do with the NHS and raises money for local health charities

Re: Crisis in the NHS
 

There is this but it doesn't fund the NHS. https://www.healthlottery.co.uk/about-us

Re: Crisis in the NHS
 

That is the best question l have heard so far in this forum.

Yes, there should be a lottery for the NHS. And it could go towards a new baby unit, cancer unit or improving the services in A& E.

There is one very large question to ask and answer. Who would run it. The hospital, or the beaucrates that run the trust.

IF, l bought a NHS Lottery ticket - even a fiver, YES a fiver. Then where would that FIVER go.

I will tell you. 2 quid would go to the Management for running it. 2 quid would go on producing the ticket. and 50p would go towards some **** who think he should get commission, And the other 50p would go to the Hospital.

You only have to look at Camelot. They have luxury offices in Watford, l believe. And the Directors pay themselves thousands of pounds each year. And now they have put up the price to 2 quid.

I have bought Health Lottery tickets, but when l found out that it wasn't going toward Hospitals. I stopped paying it.

NHS Lottery is a brilliant idea, and yes l would pay a fiver. As they are NOT getting proper funding from this crap Government. And if l won it. I would give 50pc to the nearest hospital. And keep the rest.

Good idea

Re: Crisis in the NHS
 

If all of your £5 went to the NHS there would be no prize money and it would be a donation, not a lottery!

Re: Crisis in the NHS
 

Then he wouldn't be buying a lottery ticket.

Re: Crisis in the NHS
 

10/10

Re: Crisis in the NHS
 

Of course this would be on top of the current government funding.Not in place off.As i mentioned before, ask mr branson to run it for free, as he offered too before the government gave it back to the camelot "fat cats" again.I bet you people would desert camelot's lottery in droves if they thought their money was going to the NHS.Simples.Oh and peoples desire to play the lottery/gamble is insatiable these days and so would ensure a "healthy"supply of funding to the NHS.

Re: Crisis in the NHS
 

Thanks for the clarification guys i knew I'd seen lottery and health advertised somewhere but these days i have trouble remembering details.

Re: Crisis in the NHS
 

And earns the porn king that runs it quite a few bob too...

Re: Crisis in the NHS
 

tbf, he said it wouldn't make a profit, not that he would run it for free..

Camelot currently make just under two pence profit on every £2 ticket, and Camelot is owned by a Canadian Teachers Pension Fund, so any profit goes to paying Ontario Teachers pensions...

https://www.national-lottery.co.uk/l...the-money-goes So Camelot make around £75-80 million in profit each year on seven and a half billion pounds in sales - not exactly a massive profit margin...

Re: Crisis in the NHS
 

I'd like to have a look at their 'expenses'. ;)

Re: Crisis in the NHS
 

Running costs are 4%

Re: Crisis in the NHS
 

If you started funding it with lottery proceeds where would it end ? An education lottery? A transport lottery? Just ends up being another tax, which would be paid by those that can least afford it and like a gamble. The National Lottery is increasingly funding things which should be covered by general taxation. Make it simple and increase income tax/vat, and say what its for, then we don't need to worry about operator profits etc. There already is a national lottery of sorts anyway - called Premium Bonds, nobody in the private sector creaming off profits from that

Re: Crisis in the NHS
 

It really doesn't matter how much money you put into the NHS it would never be enough. There would always be someone, somewhere who fell through the net because of some reason or another.

The NHS does need to be run better but how? If the people who do the running are also the ones "profiting" from any mechanism put in place how is it ever going to work.

Sometimes though things are the wrong way round with suppliers controlling things. The NHS network is a case in mind. I worked on a hospital patient system for years. It was getting more complex and we were starting to integrate with some clinical data (scan images) and this was in the old MSDOS days. But there was a set of manuals on the shelf that detailed different data items and what values to use. So gender you have 1=male, 2=female, 3=neonate...8=not given, 9=unknown. We used the supplied manuals to write our system so when we needed to send data for central processing (anonymised for stats purposes) we were OK.
Problem - a US supplied lab system was bought and we had to integrate to it but it didn't understand the idea of "a patient". It knew about "an inpatient" and "an outpatient" but not simply the person who could be either (or in our hospital both at same time). We did the work and it was fine, we didn't need the data back at that time.

The issue is that different health suppliers have bought different platforms and these don't talk the same "language". Diagnostic and general coding can be different ICD, Read, proprietary. But that really shouldn't be a problem. The system can use what ever but the interface to the NHS network needs to speak NHS data. So query arrives in NHS speak, the system then needs to translate, do work, translate the answer to NHS speak back to the requester. The NHS dictates how data is formatted and transmitted. It just seems the vendors are trying to make the NHS a polyglot and do all the work.

I'm sure there are other projects with such control issues. All not helped by not having good managers because you've promoted your best clinical and technical staff who may not be good managers leaving less good staff (who could make excellent managers) left to do the actual work.

Re: Crisis in the NHS
 

To true tweetie...

Re: Crisis in the NHS
 

Everyone has known for a while the biggest problem in the NHS was mismanagement the trouble is every time we employ people to solve the problem they end up being just the same. An organisational reform is needed but also needs to be both better implemented and sold to the public so the "privatising the NHS" brigade doesn't get all hot and bothered. It's ridiculous an organisation with the size and buying power is getting such lousy deals on purchases and imo price gouged by certain sectors.

Personnel need to be better organised and managed then they are now as there are usually plenty of staff but badly dispersed. I agree that more money isn't the answer as there will never be a right amount as long as the organisation is so badly mismanaged.

Re: Crisis in the NHS
 

Re: Crisis in the NHS
 

https://www.theguardian.com/educatio...y_to_clipboard

Well there's a surprise. Applications for nursing down 23% after we take away bursaries from nurses, and force them take out massive loans to train to look after us. The reward being crap pay compared to other graduates and , a job in a dying health service where they are open to abuse and lawsuits from an ungrateful public. As if the NHS wasn't in enough trouble.

Do you think Jeremy will take action, or is operation meltdown going to plan?

Re: Crisis in the NHS
 

I've never understood why or when you needed a degree to become a nurse anyway.

Re: Crisis in the NHS
 

It's a farce. No doubt we'll have to recruit more nurses from overseas at more cost than the bursaries.

Re: Crisis in the NHS
 

NHS spending per person will be cut next year, ministers confirm
In a written statement to the House of Commons health minister Philip Dunne said NHS England’s per capita real terms budget would increase by 3.2 per cent in 2016-17 financial year.

However growth would fall sharply next year, down to just a 0.9 per cent increase in 2017. It would then go negative by 2018-19 with a 0.6 per cent fall in real spending per head in that financial year.

http://www.independent.co.uk/news/uk...-a7549686.html

Re: Crisis in the NHS
 

Well they have to fund the bargain basement upcoming tax policy somehow.

When people vote for low taxes what do you expect?

---------- Post added at 18:14 ---------- Previous post was at 18:04 ----------

You are correct to a point, the NHS has 2 problems, a combination of bad management and under funding. A good way to check how well funded it is, is to compare the funding per adult to france, germany and even america, we are behind all of them significantly.

On the management side I think a lot of issues are down to employees, particularly the skilled ones like GPs, consultants etc. been used to current very good employment terms and as such resisting more realistic terms.

e.g. my GP only see's patients 3 days a week, what is she doing on the other days? other GPs around here are commonly the same, not often available 5 days a week. At my old GP surgery where it was pretty much impossible to see a full time non locum GP, I was surprised to find one of the GPs who worked there at my DLA tribunal about 4 years back. So that explains what that GP was doing instead of seeing patients. I think a lot of doctors, do private work alongside their NHS work to maximise their earnings, the issue I have is this compromises their availability for NHS work which is why I think any doctor employed by the NHS should agree to doing no private work.

There is also a lot of hidden information which to some people may be a wake up call, e.g. in some areas a GP refferal has to be vetted by a middle man department to get the referrals approved, a cost management exercise. Many GPs have limitations on referrals they can carry out per financial year, again a cost management exercise. Many people do not get the support they need to lead better quality of lives as a result of the NHS not been able to cope.

This varies heavily from area to area which is why some people find it hard to understand how bad it is, e.g. my sister can ring her GP surgery at 1pm and get an appointment the same afternoon, my surgery opens its phone lines at 7.45am and by 7.55am the appointments are gone for the entire day. They allow advanced appointments to be made up to 2 weeks ahead, but 90% of the time there is none available. If you ring and say its urgent they tell you to goto A&E which is actually against NHS guidelines to try and reduce load on A&E departments. Once an ambulance took me to my GP surgery after I was refused an appointment due to lack of slot, and they had claimed there was no such thing as emergency appointments, the surgery manager was embarrassed when the paramedic explained the obligations they have to fullfill with everyone in the waiting room listening. They of course never changed their policy tho.

Re: Crisis in the NHS
 

As l say its important that money is not wasted in the NHS as there is only a finite amount of money Andrew but l have always said no matter what party are in power if the public want a better funded health system like they have in some other European countries they will have to realise that you will have to pay a bit more for it.

Re: Crisis in the NHS
 

I'm sure our up coming trade deal with our US friends will only help the NHS to survive

Re: Crisis in the NHS
 

I agree. Of the two main parties, Labour are unelectable thanks to their leader and the Conservative party is unlikely to raise taxes. So I can't see the situation changing anytime soon.

Re: Crisis in the NHS
 

But France fund their Health Service with a combination of Tax and Private insurance...

https://www.theguardian.com/society/...his-is-the-nhs

Re: Crisis in the NHS
 

One could argue the UK needs to do the same if it is not prepared to increase public spending to fix the shortfall then we could adopt the french policy of making it income dependent, a good friend of mine told me of some of the better things about the french health system, e.g. in the UK if you need an X ray, you get sent to the hospital to have one, in France they have X ray machines at the GP surgery, thats just plain common sense, it makes things faster and more efficient.

To me I would adopt the following to improve workload on the system.

Grant extra powers to pharmacists to issue prescriptions.
Make some drugs not require a prescription when used in low dosage. So e.g. antibiotics, you can get issued one set without prescription per year, more require prescription which can be issued by either GP or pharmacist.
Implement more stuff to be carried out at GP surgery, such as X rays.
GPs open 7 days a week and 12 hours a day.
Ban doctors from doing private work if they wish to pull in a NHS salary.
Let HC1 cert owners reclaim travel costs to see GP (currently they dont). This can reduce home visits required.
Add video conference facilities. To reduce people needing to attend surgery for physical examinations.
Add email contact mechanism between patients and their GP, a GP can take 1 minute to respond to single query over email vs allocating a 5-10 min booking slot for someone to come in to ask the same question.

There is more but these I thought of off the top of my head quite easily.

Re: Crisis in the NHS
 

Doing half of that would create more opportunities for fraud and misuse and we would have a lot of doctors and medical staff leaving so not really practical. The NHS should have one central purchasing organisation that then distributes to the NHS facilities that way the massive buying power of the NHS could best be used and would provide valuable data to finetune patient care. The only thing you said i agree with is that whilst receiving a salary from the NHS they should be the only organisation they work for. I'd increase state support for nurse training with a clause that they serve a minimum of ten years in the NHS.

The amount of money is not so much the issue as the way so much of it is misused and until we sort that out absolutely no more money should be thrown at the NHS as it will just disappear like a lot of the current budget does.

Re: Crisis in the NHS
 

Having looked at the various health care models in use around the world I would agree that as a nation we probably should consider moving to more of a insurance top up based system or hypothecated tax system, which is what much of the rest of the world uses. My fear is we are heading more towards an American based health insurance based model with all the problems that this can entail to the individual.

With regard to the other points pharmacists already have more power than most people realise with regard to issuing medication, it is a myth that you need a prescription to get a prescription medicine. As long as you have already been prescribed that medicine by a doctor previously and it is reasonable that you would require that medicine on a long term basis a pharmacist can provide you with an emergency supply if you are unable to obtain a prescription from a doctor.

Making it possible to get some drugs without a prescription is looked at regularly and is generally based on the perceived benefit of making some medicines easier to get for example it is now possible to get PPI medication as an OTC medication without a prescription. Antibiotics are perhaps a bad example of a medicine that could be provided in this way as they are already possibly the most over subscribed class of medication. If you look at countries that do have a more relaxed attitude towards provision of antibiotics (Greece springs to mind) the associated incidence and prevalence of resistant infections is massively higher.

X-Rays in a GP surgery is something I like; however until we move to an alternative funding system I don't think it would be practical for every surgery to absorb the capital cost of the equipment plus the provision of qualified radiographers of which there is already a big shortage of.

In principle 7 day GP working is a great idea; however the big issue at the moment with this is there simply are not enough GPs in this country to make it work. There is also a growing body of evidence that suggests that when weekend appointments are available they are not always used. Personally I would prefer increased numbers of GPs working during the week when we do know that demand is massively out stripping the supply, hence why surgeries appointments are all fully booked within 5-10 minutes of opening!

How do you propose stopping GPs from doing private work? As far as I am aware the vast majority are not Technically employed by the NHS they are employed by their surgery which is an independent provider and is paid a sum per patient that is registered at that surgery.

As far as I am aware a lot of GPs already offer telephone consultations and some even use video conferencing for this as well. It is also already possible to email the surgery I am registered at with non urgent queries.

Re: Crisis in the NHS
 

http://www.bbc.co.uk/news/health-38853709

Interesting figures - seems to have been a steady increase since 2010, wonder what happened then?

Re: Crisis in the NHS
 

More people used the NHS?

In November 2010, there were 1.55 million attendances at English A&E; in November 2016 there were 1.9 million.

Also, comparing usage from a decade ago is quite illuminating...

http://www.nhsconfed.org/resources/k...ics-on-the-nhs

Re: Crisis in the NHS
 

To add to this thread, my sister had to travel to loughborough yesterday (saturday) to see an out of hours GP, as after waiting 4 hours in the royal infirmary only for the receptionist to tell everyone there is no doctors available.

What a mess.

---------- Post added at 01:39 ---------- Previous post was at 01:26 ----------

Thats why I said just one pack of antibiotics per year enough for a 5 day run.

Whilst it may be easy to say they over subscribed its worth bearing in mind some people really over estimate the ability of the immune system to fight infections, before antibiotics were invented people died at a much younger age from minor ailments that could get out of control. So something that starts of as trivial without treatment can become serious. This risk that you talk about can be mitigated by only supplying one type of antibiotics this way, e.g. so most of the antibiotics remain prescription only.

I have never been refused antibiotics whenever I have suggested it either to a dentist or GP, so the system as far as I am concerned has never blocked the use of antibiotics but only delayed it.

This is of course without taking into consideration like people been absent from work etc. whilst waiting to see a doctor.

Re: Crisis in the NHS
 

It is slightly dangerous to think of antibiotics as this panacea that can be taken with no risk to the individual or long term consequences to the population as a whole.

Whilst I would be one of the first to acknowledge their benefit to overall life expectancy as well as their ability to cure diseases that at one time were a death sentence. It is also important to acknowledge that they have to an extent been abused and dished out like smarties by doctors for a variety of reasons and we are now left with a situation where resistant bugs are becoming more and more common! MRSA, VRSA, carbapenemase producing enterococci to name a few of the top of my head.

Sad fact is that most antibiotics that have been prescribed were not needed and have simply been used to treat viral infections or mild bacterial infections that the bodies own immune system would have dealt with if it had been given a chance. These infections are largely self limiting and whilst they can be unpleasant they are not in themselves any threat to the individual. In fact there is increasing evidence that show a correlation between increasing antibiotic use and increased incidence and prevalence of autoimmune disease.

Your idea of only making one antibiotic available to prevent resistance is unrealistic as it assumes that any antibiotic can be used to treat any type of bacterial infection and this quite simply is not true. Most antibiotic regimens are tailored to the likely bug that is causing the infection for example trimethoprim and nitrofurantoin tend to work well on bacteria that cause UTIs whereas amoxicillin and clarithromycin tend to work well on bugs that cause chest infections, and for dental infections metronidazole tends to be the antibiotic of choice. That's not to say there aren't antibiotics that have a very broad spectrum and can be used against multiple types of infections, the problem with these though is they tend to need to be given intravenously such as tazocin or ertapenem and often have very nasty side effects such as in some cases liver failure.

All that said there are advantages to making antibiotics available to certain groups of high risk patients where the benefit of ensuring they receive prompt antibiotic therapy outweighs the risk, for example patients with COPD will often get a "rescue pack" from their GP which contains steroids and an antibiotic usely doxycycline. When these patients get the start of an infection they can start their rescue pack medication and then book to see a GP.

It's difficult for me to comment as to why you have always been given antibiotics when you have suggested it to the GP or dentist without knowing the circumstances around it. My slight worry though is that as you had to suggest it, they may not actually have been needed but this may have simply been a way to get you out of the door quicker! It's a sad fact that GPs are heavily constrained by time with 10 minutes for a consultation at a good practice and some have just 5 at poorer practices. Faced with a patient who questions whether they should have antibiotics the GP may have to weigh up the time taken to explain the rationale of not giving antibiotics which can take 1-2 minutes if the patient is understanding or much longer if the patient wants to argue! Compared to the 10 seconds it takes to print of a prescription. In this circumstance especially if the GP is already over running they may simply be taking the path of least resistance.

Re: Crisis in the NHS
 

Source

Maybe the impure placebos, such as improper antibiotic use should be changed to just pure placebos which can often be as effective as an active product and doubtless is much cheaper for the NHS as well as addressing some of the resistance issues.

Re: Crisis in the NHS
 

It would definitely be a lot safer for the patient! Couldn't find any figures for the UK but in the U.S. Iatrogenic causes of death which includes death caused by medication is the 3rd largest cause of death.

Can just see it now "Here you go Mrs Smith just take one of these pills (Tic Tacs) three times a day and not only will your sore throat be better within 7-10 days but your breath will be minty fresh as well"

Re: Crisis in the NHS
 

I think that's a unproven fact but rather speculation.

What is a fact tho that the strict auditing of drugs this country has is burdening the system.

You even went on to prove my point in that I said the immune system is over estimated in its abilities by many people, and then you went onto say that the immune system would cope anyway. I got news for you it does not always cope. A moderate bacterial infection without antibiotics can grow out of control rapidly. When antibiotics is pointless is when it is a viral infection, of which antibiotics will have no affect, however if a doctor cannot be sure it is a viral infection then they should play it safe.

I have an ongoing eye infection for the past 5 years, the immune system clearly cannot cope, likewise whenever I have had infections via my teeth antibiotics have always been needed.

Before antibiotics were invented people would routinely die of teeth abscesses at a young age.

Resistance will grow, its inevitable, I find it a weak reason to hold treatment back, if you holding treatment back, its the same affect as the treatment not working is it not? Requiring GPs to approve minor drugs simply takes up resources.

Also I spoke to my GP this morning about some problems, she is clearly under a ton of pressure to save money as she has started to take the NHS line where my illness is my fault and more specifically all under my control, by this if you look at the NHS website, various articles disagree with the common global opinion and blame the patient for specific health issues. After a heated conversation I have to go in for an examination to see if I warrant the support I have asked for. It looks like I am going to need to put some cash aside for private treatment as the NHS is becoming more and more unfit for purpose with the state it is in.

When my eye infection blown up I had to get private treatment then to get it in a manageable state.

Back on to the subject of drugs it is clearly more dangerous to withold drugs than to issue them "just in case" something happens like the person developing a resistance. It is also clearly a expensive policy to audit the use of such drugs as they are currently.

Instead of telling me whats wrong with the ideas I listed why not come up with some of your own? or do you think the NHS is fine as it is and doesnt need changing?

http://www.dhdeurope.com/blog/antibi...fe-expectancy/

Mind you I suppose if we withdrawn antibiotics it would help the NHS given people would die earlier and there would be less pensioners tieing up the beds.

An interesting read as an example. Am I fat because of a slow metabolism? Check "Am I fat because of a slow metabolism?" and "Can certain medical conditions cause a slow metabolism?", assumptions been made abou tthe patients to justify a cheap type of treatment.

http://www.nhs.uk/Livewell/loseweigh...etabolism.aspx

Also interesting is comparing how american doctors talk about conditions and comparing it to the UK NHS guidelines. Differences can be quite stark. e.g. American doctors consider withdrawing antibiotics too early as dangerous because the affect is that they withdrawn before the infection is beaten, then if they are represcribed later it can then be too late as the infection has time to develop a resistance during the gap of treatment.
There is also certian conditions in america that are treated as an emergency whilst for the same conditions in the UK the NHS advises people to wait it out "just in case you recover on your own".

One big problem with the NHS which is used to save money is to make assumptions based on probability e.g. if a hospital doctor has a choice of sending someone for a scan or discharging them with the merit that people in their age group only have a 2% chance of having a condition they can use the probability as a justification which is dangerous. A lady died in her 20s 3 years ago of a condition that typically only people 50+ get, the doctors continued to refuse to diagnose it simply based on her age.

Re: Crisis in the NHS
 

https://www.theguardian.com/politics...y-unacceptable

https://www.sochealth.co.uk/wp-conte.../04/Hunt-1.jpg

Hunt really is a bit of a smug turd. What he wants to do is find out who has been in charge of this predictable shambles for the last few years.... If it wasn't costing lives it would be funny.

Nhs appalling crisis
 

http://www.msn.com/en-gb/news/uknews...-bed-shortages

Reading this article made me want to be sick. How can the NHS get into such a state.
A woman could have been saved. Except due to the appalling NHS crisis and the way its being run by this horrible Tory Government

I hope that the Muldowney sue the NHS England and Mr Hunt for damages

Re: Nhs appalling crisis
 

There are many many reasons the NHS is in a state Arthur as stated very succinctly by many others on this forum as it goes far beyond the two main political parties as well as up to now they have both made a bloody great mess of it with their own dogmatic doctrine of policies rather then running it how it should be run in the best interests of the country.

Re: Nhs appalling crisis
 

A fantastic organisation that is being slowly dismantled by the government and having to do more with less money.

And your answer is to sue them

You really are a weapons grade helmet.

Re: Nhs appalling crisis
 

Re: Nhs appalling crisis
 

I thought we already had a current NHS in crisis thread?

Oh yes here it is.

http://www.cableforum.co.uk/board/sh...php?t=33704264

Re: Crisis in the NHS
 

Re: Crisis in the NHS
 

What stereotyping generalising.....:rolleyes:

Re: Crisis in the NHS
 

Citation/link, please, regarding your first assertion... :)