Non aviation content. Play nice – No religion, no politics and no axe grinding please.
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#1511042
If I understand it correctly, the problem is that demand is rising by 4% p.a. which the government is not quite keeping pace with in real terms rises and the UK is already at the low end of EU spending on health. HMG is trying to get more efficiency while still increasing the overall spend above inflation but not spend per head. We will get headlines while HMG doesn't give in. At the margins a few more people may die earlier than they otherwise would.

The NHS as a whole perhaps should be trying harder, but there are two lots of demographic changes causing the problem as well as one social one.

First, no-one is prepared to wait for trivial problems that clear themselves up - something that social media should be helping but isn't. (As a former hypochondriac - seeing the doctor because I don't know - I wince a little since I know I was causing the problem 20 years ago).

The two demographic problems as I see them:

The aging population one is the one that is referred to publicly - we no longer send granny back to an empty house - and there's extreme pressure on local government social care especially in the shires that get a less generous settlement - also containing the population of children of aging parents who will complain more vociferously to the Guardian/BBC. Council taxes and overall spend will have to rise. Council tax is essentially taxing the rich rather than the poor and doesn't get the headlines. Not being so far off an age where I might need help, I find it hard to complain too much about that.

The second problem is referred to less: a large number of migrants not used to the GP structure and who may not be registered. Many of those also use A&E as a second opinion when the antibiotics are not handed out like smarties. (Health tourism is a drop in the bucket - the age range is such that we now have a large number of new young families with sick children who will get better - but like any first time parents they worry).

On my time looking at NHS management I saw a lot of variance. There are some pretty rubbish overpaid people - and a fair population of get rich quick merchants bordering on fraudsters - but also some highly creative and hard working lower paid ones. The NHS is itself a powerful lobby since it has so many employees and contractors, so I don't trust every word I hear from them.

That said, the big numbers on spend per head are hard to argue against. If we want a better NHS without waiting a long time, we will be paying more tax or buying less of something else, such as nuclear weapons platforms.
#1511059
I have had far more experience of A&E than I'd like as a result of my late wife's cancer.

First she saw the consultant at our local hospital who phoned up and arranged for her to be referred to the main hospital immediately. We were taken to the the main hospital by ambulance, complete with blues and twos. And ended up in A&E for about 10 hours with no treatment at all before they could find a bed. What our GP described as an own goal, part of the reason that A&E is so busy is that it's the only way into hospital.

Then we ran out of Oxycodone on a Sunday afternoon. The district nurse phoned the local walk in centre and arranged for me to get a prescription from them. I went there and had to queue for two hours before I saw a doctor. Then had to find a chemist that was open at that time. Meanwhile the District Nurse was waiting by my wife's bedside. This didn't seems the best use of her time but I was past caring.

You can't run a hospital like a budget airline and aspire to 100% seat/bed occupancy. You need slack in the system so you can cope with the inevitable peaks and troughs. Most people don't need hugely expensive drugs or procedures, what they need is a bit of care from people who know what they are doing and, crucially, have the time to do it. The hospice that my wife ended up in after a few days was like that. They didn't do anything complex but they had the time to do the nursing properly.
#1511060
Does this make sense? The author was previously a medical director and consultant at a large hospital with on of the busiest ED's in the country.

The root cause of the problem is lack of hospital beds. The mathematics is very simple. If you multiply the number of patients admitted to hospital by the length of time they stay there and it adds up to more than the number of bed that are available each day there is a problem. You can only fix it by admitting fewer people, increasing the number of beds or reducing the time each stays in hospital.


The major effort seems to be currently directed at reducing length of stay, but there's only so far you can go with that. Indeed, the article above goes on....

For many years the number of emergency admissions has been increasing as UK population increases and gets older (on average). Bed numbers have been falling as a result of government policy. We have managed to keep things going by reducing the average amount of time patients stay in hospital but I believe we have now reached the limit of what is possible with early discharge.
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#1511061
From DEC 2012, the BMA website:
BMA accepts cut in student numbers to reduce unemployment
Recommendations to reduce the number of medical students could help alleviate the risk of unemployment among newly qualified doctors, the BMA has agreed.

Those students would be qualifying August 2018 or so, so would have helped the Doctor shortage.
The Junior Doctor dispute finally boiled down to money, there were a group who made a lot of overtime working weekends, and would have lost out, although the base salary was increased by 13%. All the safety issues had been agreed.
As someone working in the airline industry with a Junior Doctor daughter, I have been shocked at the rostering, 12 days/nights on the trot anyone? Work/Life balance is an issue, burnout is a very real risk for many of them. She is supposed to be trained, but there is simply no time or people to do it. A colleague was told off by the consultant for trying to show my daughter how to do a procedure...
It goes on.
P.S. She had a patient come into A&E with a verouca......
#1511065
Dept of Health wrote:Recommendation 5
There should be a 2% reduction in medical school intakes, to be introduced with the 2013 intake – and this level should be adhered to until further decisions to change.

Recommendation 6
There should be a further review of medical school intakes in 2014 (for 2015 intakes) – followed by a 3 year rolling programme of further reviews.


http://dera.ioe.ac.uk/16155/1/medical-a ... ntakes.pdf
#1511093
That's a shame Pete, you have insights denied to others, and social media is the way to influence these days.

I can't help feel that the agenda is to promote the failures of the NHS in order to support the agenda of hiving off the state-run services to others. Those who trained as a vocation (managers included) are trapped in the middle.

The NHS highly efficient compared to others internationally, but underfunded as a % of GDP compared to those same others.

If the question was asked of the electorate honestly, " are you willing to have 10% added to your tax bill in return for health and social care (which are in actuality indistinguisable), to be available to all with based on clinical need, with no means test, or do you want to go to the insurance market for those who will pay premiums?"
(Part of this will include showing them how much it costs to insure a pet) .
The answer may surprise those with political dogmas of all shades.
#1511097
Will pick this weeks [edit - the hospital show] up later on iplayer....

What I am interested in is what is causing a crisis with GPs? Is it purely a shortage - and if so, why would unemployment be a risk for med students? Granted not all med students want to be a GP...

Or is it that qualified GPs decide it's too hard and do something else, go private, or do what my sis in law did and move overseas (though that was motivated by something other than occupational/earnings incentives)?

I can't help but think if there was decent capacity with GPs (and they were willing/allowed to do a bit more at their surgery - I was shocked that mt then GP couldn't take out a deep splinter that was starting to get infected and sent me to A&E - then the A&E issues surely would subside - would they not?
Last edited by jerry_atrick on Wed Jan 11, 2017 9:30 pm, edited 1 time in total.
#1511101
Jim Jones wrote:GP has 10 mins per consultation and targets to meet. Taking time to extract a splinter is costly. Push that cost to another budget, job done.
Next patient please!


That is so cynical - but probably true!

Still doesn't explain why there aren't enough of them and the BMA are advocating reduced student numbers...

Something to do with NHS budgets?
#1511118
jerry_atrick wrote:
Jim Jones wrote:GP has 10 mins per consultation and targets to meet. Taking time to extract a splinter is costly. Push that cost to another budget, job done.
Next patient please!


That is so cynical - but probably true!

Still doesn't explain why there aren't enough of them and the BMA are advocating reduced student numbers...

Something to do with NHS budgets?


No.

Most GPs will refer someone to another service if the required procedure is beyond their clinical skills or competence, or they lack the required equipment.

There is zero cost to a GP to take a splinter out, the greatest cost is the time consumed as that is the scarcest commodity and that time has already been 'used' for seeing the patient in the first place so there are no savings to be made by referring someone to the A&E department for having the splinter taken out.
#1511124
If you use your time on another target, then there is a saving, of time. The time used on the splinter at A&E is someone else's time.
Time = £ ultimately.

The lack of "joined upness" is a huge waste of resources, from health promotion/education budget cuts to prevent ill health at one end, to the lack of care home beds to allow discharge from high cost hospital to lower cost nursing home at the other.
#1511127
Jim Jones wrote:If you use your time on another target, then there is a saving, of time. The time used on the splinter at A&E is someone else's time.
Time = £ ultimately.

The lack of "joined upness" is a huge waste of resources, from health promotion/education budget cuts to prevent ill health at one end, to the lack of care home beds to allow discharge from high cost hospital to lower cost nursing home at the other.


To extricate a splinter costs less time than printing off the summary and writing a note to the A&E department asking them to take it out.
User avatar
By PaulB
#1511129
jerry_atrick wrote:Still doesn't explain why there aren't enough of them and the BMA are advocating reduced student numbers.


It was the Dept of Health that proposed the cut.
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