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Everything posted by ckn

  1. I've closed the strike thread as it's now a bit redundant given talks have started again. Hopefully we can start a nice new NHS thread to discuss all the upcoming changes. If the strike stuff starts up again then I may start a new thread. Jeremy Hunt and SImon Stevens (head of NHS England) today defined to the Commons Health Committee what it means by 7 day NHS. It doesn't mean a 7 day NHS, it means a 7 day acute hospital service with these definitions: 1: All emergency admissions must be seen and have a thorough clinical assessment by a suitable consultant as soon as possible but at the latest within 14 hours from the time of arrival at hospital 2: Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography (CT),magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology. 3: Hospital inpatients must have timely 24 hour access, seven days a week,to consultant-directed interventions that meet the relevant special. 4: All patients on the Acute Medical Unit, Acute Surgical Assessment Unit, and Intensive Therapy Unit and otherhighdependency areas are seen and reviewed by a consultant twice daily; Once transferred from the acute area of the hospital to a general ward patients should be reviewed during a consultant-delivered ward round at least once every 24 hours, seven days a week. I'm not sure too many people could disagree with that, even in the hardest lines of the militant wing of health unions. The biggest impact will be on consultants rather than junior doctors, junior doctors do all of that anyway and are usually well covered in rotas. What that does mean though is that the junior doctors contract really was all about cutting costs rather than improving the NHS, well, who would ever have guessed that one. Not sure where they're going to get the money to pay for point 2 as the expensive bits of that is outsourced to the private sector in the majority of England. Also, not sure where they're going to get the money to pay all those extra consultant hours. If they think junior doctors are an irritable lot the wait until the harrumphing that'll come from touching consultant contracts! Also, many of the points are for Emergency Medicine Consultants which is one of the hardest roles to fill in medicine already, never mind when it changes to fully 7 day working.
  2. A few years ago I arranged for something to couriered to our office on next-day delivery from the US. Cost us a fortune to do so as it was a fairly bulky thing. "Unable to deliver, no answer at recipient's door". This was a multinational law firm with a dedicated delivery bay, two visible security guards at the delivery bay entrance and at least five postal/internal courier workers of which at least two were expected to be in the delivery bay at any one time. I can't remember the courier but their view was "you're not getting your money back as it's your responsibility to be there when we deliver".
  3. If those religious folk are right and what you suffer in this life is a test then $deity will be getting a right earful from me for how much he/she/it has tested my wife over the last seven years. I'll spend eternity punting $deity in the private parts to see if he/she/it likes being "tested".
  4. That's the problem in a nutshell. If we went into ANY sort of free trade agreement, we'd be giving up our EU vetoes over virtually everything of substance to go into an agreement driven by the needs of the EU27 and at a net financial loss. The VAT issue is a bigger issue than more people realise and will result in many involved in export/import having quite big cash-flow changes almost overnight.
  5. I'd simply add "state-owned" before your last few words but... I agree with you.
  6. The entirety of Nottinghamshire has declared a "Major Incident". Paywalled HSJ article. The polite way of describing a NHS "Major Incident" at this scale is that nowhere in Nottinghamshire can provide patients with care where the hospital can guarantee life saving treatment is available. This falls into the "black" alert system that usually is listed hospital-by-hospital but this time across an entire NHS system. I watched last week hospital after hospital fall into this with nowhere for patients to go unless they were a blue-light life-or-death emergency. This isn't what I want from my NHS. I challenge ANYONE to say that they're satisfied with this level of care.
  7. What really makes me angry is that this is largely ignored in politics just in case people ask "well, what would you do?" Labour under both Miliband and Corbyn have robustly failed to answer that question. It's beyond unacceptable that Corbyn hasn't got a public policy for at least stopping the rot given that minority governments have a high risk of failure, Corbyn could be PM in around two months' time if the government failed today. In 2015, Labour offered LESS money for the NHS in their manifesto than the Tories did. No-one expected the Tories to meet their manifesto commitments, and they didn't, but Labour offered so little that it wouldn't even have met the next year's expected inflationary cost increase. In 2017, Corbyn's manifesto was, again, woeful in regard to the NHS, it barely covered the stand-still costs of the NHS, never mind looking to reverse even the worst of the Tory damage. Here's the big problem. We know what the NHS is like now, the stories over the thread above cover all of that, there's £22bn of more cuts due by 2020/21 and that's being exacerbated by the government fiddling the books with the money they say they're paying. The Tories promised this last year in their manifesto (p68): The budget following the election funded SOME money, but below inflation and a concrete real-terms funding per head cut year on year. That's an indisputable fact, the figures are a few pages back now but they're solid and use the Chancellor's official budget announcements as proof. Even the "new" money pledged for winter pressures is a one-off fund rather than some new recurring money that's needed. So, that £22bn of cuts is actually higher as they have to make both that £22bn and also do without the funding promised in the Five Year Forward View. Have Corbyn and co promised to halt those £22bn of cuts? No. They actively avoid the subject and respond with a lengthy politicised language version of ""Oooo, look! Look over there! Nasty Tories making cuts!" Remember, that £22bn of cuts is extra cuts from the state we're in now, entire hospitals are scheduled for closure, overwhelmed A&E departments will be "rationalised" and "regionalised" into ones capable of taking about half of the "regionalised" patients in need, community care will be cut even further(!), mental health will get even further ignored and waiting lists will keep getting bigger. Actually, on that last one, they may not get bigger because there's plans in place in more areas each week to stop patients getting onto the list in the first place. If you've smoked, you're getting blocked from anything other than urgent care, if you're overweight then that's another blocker, if your GP spells one irrelevant word wrong then they'll reject the referral, if your consultant isn't a financial wizard capable of decyphering the CCG's interpretation of the national tariff then they'll reject the funding for treatment. Finance folk cutting people off from clinical care because there's no money to treat them, and no care if people suffer because of it. For Corbyn and co to completely ignore this and pledge to stop them is essentially appeasing the Tory cuts. Unless he pledges to halt those cuts pending a complete review then he's got to be taken as planning to keep them going. I have no hope that we'll see anything of the kind from Labour though. There is no political party out there with any plan for even putting a bandage over the NHS's arterial bleeding wounds. Now, that's angry.
  8. Scottish Labour haven't changed despite getting a Corbyn-approved new leader. Yesterday in the Scottish Parliament was budget discussions, Labour spent their chance to talk railing at Tory austerity then voted with the Tories against the SNP anti-austerity plans. They'd rather sabotage the SNP than approve the funding of something that aims to mitigate Tory austerity. They voted against £400m more to the Scottish NHS, £120m more to direct funding of education and lifting the 1% public sector pay cap. The measures still got through due to other party support for the minority SNP government but you'd think Labour would jump at the chance to mark Tory austerity as an "outlier" and unacceptable position rather than a position that Labour actually support.
  9. Don't forget that the amount we pay INTO the EU is recovered by a factor of 10 by companies getting free market access to the EU with no import/export tariffs and an EU-wide VAT system meaning intra-community trade is far more cash efficient. The tax take alone from that extra profitability of a single market pays us more into the Exchequer than the amount we pay into the EU. We could go on for a VERY long time about the items where the country will be worse off while the Leave lot just look at a simple surface view of "we don't have to pay into the blood-sucking EU!"
  10. People dying before they find out they could have had paid-for care from the NHS, report from the Public Accounts Committee. This is one area where the CCGs (Clinical Commissioning Groups, the lot that hold the localised purse strings for much of the NHS) are acting like US-style insurance companies. Many start with a position of "sorry, no" on many routine items that others in the neighbouring area get without hassle. One example of that in practice. There was a programme on telly a couple of years ago about "elective" treatment in the NHS. One young woman had massive breasts on her tiny body and it was causing her significant back pain, her NHS specialist consultant said that if she didn't reduce the weight and imbalance that she'd be disabled within a decade due to the spinal deterioration that had already started. Rather than just get breast reduction scheduled in as you'd expect in a nationalised NHS following a NHS specialist saying it was essential, she had to go through the CCGs' funding approval process (IFR, Individual Funding Request). The programme said where she lived, it was in an area that could have been caught by one of two CCGs, West Essex CCG and Mid Essex CCG, I said to my wife that if it were the former she'd get it paid, if the latter she'd be rejected due to Mid Essex being substantially skint in comparison to the former. I saw on the programme her pull up to Chelmsford, I said "rejected". The non-clinical panel reviewed her case with her and said "no justification to fund the surgery", a team of non-medical or clinical people overriding a specialist consultant simply because of money. On the story in the link though, CCGs delaying funding suits them perfectly because most can't afford to fully fund even the non-elective things in their area. If they can delay something that is a definite no-discretion funding scenario until later then they may never have to pay if the person dies, and they simply don't care about that patient's dignity or lack of care in their last days. It's beyond shameful and I know of one scenario where an old man died on his own but for a twice daily carer who came in funded by a leading charity, he should have been in a care home or hospice but the funding approval was delayed and delayed, he died of his underlying health problem, on his own. But the CCG didn't have to pay out so there's a win for the Tory reforms and the accounts. A very cynical clinician I know said that the lengthening waiting lists in hospitals are being allowed to lengthen by CCGs without intervention simply because a delay means no payment to the hospital is needed. If they worked to reduce the waiting list then they'd have to pay out both the expected funding and also the backlog funding that'd come due by the reducing waiting list.
  11. Or learn how to effectively use the Ignore function. I'm happy to instruct people in its use if they can't work it out. The short version: - on the desktop site: hover over a user's name, at the bottom of the pop-up there's an option "Ignore user", click on that and add what you want to ignore. - on the mobile site: I genuinely don't know... if someone can show me on this version of the forum then I'll be grateful.
  12. Can you HONESTLY imagine Trump telling anyone he's smaller in ANYTHING than he is in real life?
  13. The "smug, sanctimonious, condescending, obsessively politically-correct, champagne-socialist public schoolboy Remoaner" ((c) The Sun, 17 Jan 2018) James O'Brien had an hour and a half of his LBC show this morning on this subject and kept a line open the entire time for someone to come on and give any credible reason for the government's actions on this. Not one caller came on to defend them. I disagree with the view though that this is a drive towards making it privatised by reason that it becomes no longer saveable otherwise. No private company in the world would touch A&E and urgent care as it stands as the government would need to up their tariff per patient by around 500% to make it break even commercially, never mind profitable.
  14. On that specific point, if a government produced ID document, such as a driving license (shown in many news sources over the last day) says he is 6'2" then that's a published fact and can be relied on in court.
  15. 2 inches for Trump could mean the difference between having and not having children. Small hands... small reproductive organs, as the saying goes.
  16. The number of GP practices in England from July 2017 to January 2018 fell by 133. 534,452 patients registered with a GP practice no longer have their original practice due to closures and mergers in that time.
  17. It's behind a paywall but the headline and first paragraph summary makes the point well enough that you don't need more. NHS England required GPs to order less-expensive and less-effective flu vaccines this year, causing many more patients than normal to be admitted to hospital with the flu following vaccination. Surely some mistake, I thought the government had done everything it could to minimise the winter crisis...
  18. People don’t understand auditing. They’re not there to do anything other than say that the public financial records reflect what they’ve found. A semi-competent bookkeeper, never mind accountant, can make a disastrous trading year seem like fair trading and do it well with the accepted accounting rules. As long as they weren’t hiding anything then the auditors have done nothing wrong.
  19. When it applies to the royals having more than two state funded offspring then I’ll accept people suggesting the jobless do the same.
  20. Turn that around. Why should they go out of their way to do a good deal with us when, as it stands, they will benefit from any delay as we’re far more desperate than them?
  21. Food and drink thread

    Slow cookers are very good for things like lamb shanks or other cuts that are either a bit fatty or have connective tissue. It does things like that perfectly and makes lovely dishes easily. Useless for things like premium meats with low fat contents as it doesn't half dry them out unless you're especially careful.
  22. The Culture Wars

    I think what this flags is that you're reacting the same way that the generation before you reacted to the likes of Bernard Manning and so on being criticised 20 years later with a "oh come on, you're not serious". I don't see the problem with Friends, it's harmless entertainment aimed at a definite audience who lapped it up. But then I'm not in the generation of folk who are pointing out all the bits that'd never make it into a TV show today. Just as years ago I looked at my dad for being a bit of an imbecile for thinking Manning was harmless, I'm sure younger folk would look at me the same way for thinking things like Friends was harmless as well.
  23. Conspiracy Theories

    No... my mate mentioned it on Friday... no original ideas in my head unfortunately.
  24. Conspiracy Theories

    Alternatively, we are in a huge alien version of the Truman Show, unfortunately ratings are a bit down so they have to ramp up the entertainment. Cue 2016 with the mass pile of celeb deaths being the undercover aliens ditching the failing "Earth Show" to go back home, then you get the panicking producers with Brexit and Trump. Again, explain much about the things that go on?