The NHS Debate (Merged threads)

[gazza77]

Wife had to take her mom to A &E last night as she'd cut her leg.

The good bit, as she's old and a bit frail she was triaged, saw a doctor and given treatment in casualty with 45 minutes.

The bad bits, Mrs D bumped into a friend of ours who is a sister in casualty, she told the wife she had 18 patients in casualty who needed a bed for at least the night but there were no beds free in the entire hospital, plenty of empty wards but no beds. She had to turn casualty into effectively a ward whilst new arrivals were being treat in ambulances.

It's not good enough, it's not nearly good enough.

Glad she had good care.

Be interesting to know how many of the patients in the hospital have no medical reason not to be discharged but have nowhere appropriate to be discharged to. That's often the block in the system, which causes a&E to back up.

[ckn]

Glad she had good care.

Be interesting to know how many of the patients in the hospital have no medical reason not to be discharged but have nowhere appropriate to be discharged to. That's often the block in the system, which causes a&E to back up.

The drive to get care home costs as low as possible mean that care homes won't take back elderly people until they're at as low a care level as possible.  If they come back to the care home with issues requiring proper clinician care then that's a costly premium over the normally minimum to near-minimum wage care assistants.  Many hospitals just can't get elderly people out meaning they block beds.

 

A common care home tactic is to wait for the ward doctor or consultant shift changeover time then to query any discharge order meaning a usual wait of at least another couple of hours while they refuse to take a senior nurse's word over the discharge note.  They then swamp patient transport with transport orders all at once grossly over-taxing the transport system meaning the poor patient has to stay on the ward for yet more time.  Then when they get brought back to the care home they'll get their own duty clinician to reject the patient as unfit for the care home meaning the poor patient has to go back into hospital and the whole cycle yet again.  The tricks are just outrageous to keep the number of people they actually have to care for to an absolute minimum while still getting the income for them in the majority of cases.

 

A disclaimer: Some care homes truly do care, I've seen some that have paid high five figure sums to get a primary care clinical system that allows them to do all the medical record transfers immediately and link it with the local GP practice.  They do this so that they can manage their charges in the best way possible for all parties.  Unfortunately, in my experience of a not too huge proportion of care homes, is that they'll do the opposite if it threatens their profitability and viability figures.

[gazza77]

The drive to get care home costs as low as possible mean that care homes won't take back elderly people until they're at as low a care level as possible. If they come back to the care home with issues requiring proper clinician care then that's a costly premium over the normally minimum to near-minimum wage care assistants. Many hospitals just can't get elderly people out meaning they block beds.

A common care home tactic is to wait for the ward doctor or consultant shift changeover time then to query any discharge order meaning a usual wait of at least another couple of hours while they refuse to take a senior nurse's word over the discharge note. They then swamp patient transport with transport orders all at once grossly over-taxing the transport system meaning the poor patient has to stay on the ward for yet more time. Then when they get brought back to the care home they'll get their own duty clinician to reject the patient as unfit for the care home meaning the poor patient has to go back into hospital and the whole cycle yet again. The tricks are just outrageous to keep the number of people they actually have to care for to an absolute minimum while still getting the income for them in the majority of cases.

A disclaimer: Some care homes truly do care, I've seen some that have paid high five figure sums to get a primary care clinical system that allows them to do all the medical record transfers immediately and link it with the local GP practice. They do this so that they can manage their charges in the best way possible for all parties. Unfortunately, in my experience of a not too huge proportion of care homes, is that they'll do the opposite if it threatens their profitability and viability figures.

That was kind of what I was getting at. The NHS gets it in the neck, when the real issue is inadequately funded or basly run social care.

[JohnM]

My 94 year old  mother in law has been  in a care home (not a nursing home) for several years after a difficult years spent with us and a similarly difficult year in an extra-care apartment

 

She was placed there by "social services" who assessed her and placed her.

 

As she had assets worth more than £23,500 (approx) she did not qualify for state support for the fees after the first three months (I think it was 3).

 

As her assets by this time was her flat, she ( we) had to sell it to pay the care home fees.

 

Because she is self-funded, she has to pay the full rate of care home fees, not the lower fees as set by the local authority. Mind you, she has been fortunate (fortunate is not the right word - hard working is a better description), having worked all her life up to retirement in the business she and her late husband built up from nothing in the 1950s.

 

However, there are people in the same home who have the same level of care and the same accommodation, but who are paid entirely by the local authority  (at a lower rate as dictated by the local authority). 

 

Each time she is ill, the care home makes an assessment, and as these things almost always happen at night, usually call the NHS who send a first responder and then an ambulance. Once that step has been taken, it is out of their hands and the NHS machine takes over. The ambulance takes her to the nearest hospital (usually Boston - 30 miles away - or Grimsby 37 miles away), she gets admitted and over a period of time (this has been anything between 12 hours and six days). She then goes back to the home from which she came, so there have been no issues of bed blocking, etc. This happens roughly once every year.

 

I can't say how things are in other parts of the country, but over here, the system seems to work quite well, though the medical  records do not seem to be 100% accurate.

 

This is just a snapshot of what the whole country will have to face: how to handle and finance the support of an increasing number of older people with health problems.

 

In my view it is naive to think that a few £ billion or even a few tens of £ billions of taxpayers money is going to sort this problem. No matter what party is in government, no matter what party is in power, the will be faced with the same almost impossible problem.

 

There are approximately 4.5 million higher rate( 40% rate)  income tax payers in the UK.  Ask each one to pay £4.5 K a year more tax and you'd raise £20 billion a year - still hardly enough to touch the sides when you know very well most of it will go in pay increases etc.

[ckn]

John, you're right but then a government with any spine, regardless of rosette colour, would assess the likely cost and impact that's going to happen over the next few decades and account for it.  Present us, the electorate, with the costs to do it properly and then set out the tax implications.  Tell us bluntly that we have either the choice of getting thrown in the skip of life and hope we get a lucky break or we fund it properly and this is the cost.  No point sticking our heads in the sand over it, just bite the bullet, fund it properly and stop complaining as a nation over something we have the power to fix.

 

How I would help fund it would be to offer a variable tax rate to higher rate taxpayers.  Pay an extra 5% (or so) in income tax for a minimum of 15 years (or 50% of the number of years you are earning higher rate income, whichever is lower) and your assets are exempt from means testing if you have to get geriatric nursing home care or assisted living care.

[Trojan]

_{Why is this guy being allowed to run our NHS is the ultimate aim isn't privatisation?}

 

 

_"

_{"One worry comes from Mr  Hunt’s role overseeing Danny Boyle’s Opening Ceremony for the Olympic Games, in which hundreds of dancing Great Ormond Street nurses and luminous hospital beds celebrated the post-war creation of the world’s first single payer healthcare system. Reportedly, on being presented the plans for the show by Boyle’s creative team, Mr Hunt tried to persuade the director to remove the sections featuring the NHS.}

_{Another lead lies in a book co-authored by Mr Hunt in 2005, just after he was elected as an MP. The short book entitled Direct Democracy: An Agenda for a New Model Party, contains a plan for the NHS to be denationalised and replaced with a system where individuals purchase healthcare off a variety of competing private providers."}

_{https://www.thebureauinvestigates.com/2012/09/11/opinion-the-new-health-secretary-and-the-650m-private-healthcare-takeover/}

 

[JohnM]

 Proof that the BAM Trade Union strike is political.

 

"A victory for the Junior Doctors would signify the first real crack in the entire edifice of austerity in the UK."

 

This is from a a call to action  from the BMA Trade union web site and being widely promoted by the SWP and other hard left organisations.

 

A call from the BMA – to our fellow workers, trade unionists and activists: we need you!’ by Dr Yannis Gourtsoyannis, a member of the BMA Junior Doctors Committee National Executive.

 

eg: http://shopstewards.net/2016/01/nssn-274-support-the-junior-doctors-strike-nhs-bursaries-march/

 

It is illegal for the  BMA to urge  political activists, concerned citizens and hard-left unions to join them in picketing hospitals across the country.  Of course, I realise that no one on here condones illegal activities.

[Wolford6]

I've been ill over Christmas ... pneumonia. Spent my first ever and hopefuly only ever night in hospital. The staff and facilities at Bradford Royal Infirmary were fantastic on the day and on subsequent visits.

 

Some of the friends and families accompanying Eastern European patients in A&E reception were a disgrace. I'd hate to have to work there.

[Trojan]

 Proof that the BAM Trade Union strike is political.

 

"A victory for the Junior Doctors would signify the first real crack in the entire edifice of austerity in the UK."

 

This is from a a call to action  from the BMA Trade union web site and being widely promoted by the SWP and other hard left organisations.

 

A call from the BMA – to our fellow workers, trade unionists and activists: we need you!’ by Dr Yannis Gourtsoyannis, a member of the BMA Junior Doctors Committee National Executive.

 

eg: http://shopstewards.net/2016/01/nssn-274-support-the-junior-doctors-strike-nhs-bursaries-march/

 

It is illegal for the  BMA to urge  political activists, concerned citizens and hard-left unions to join them in picketing hospitals across the country.  Of course, I realise that no one on here condones illegal activities.

98% of them voted for a strike.  98%!  I reckon they're pretty upset, political or not.

[ckn]

98% of them voted for a strike. 98%! I reckon they're pretty upset, political or not.

These bloody doctors. Rabid lefty anti-establishment anarchists the lot of them.

[Griff9of13]

I've been ill over Christmas ... pneumonia. Spent my first ever and hopefuly only ever night in hospital. The staff and facilities at Bradford Royal Infirmary were fantastic on the day and on subsequent visits.

Some of the friends and families accompanying Eastern European patients in A&E reception were a disgrace. I'd hate to have to work there.

Only the eastern Europeans? On most of the occasions I've been in A&E it's the indigenous population you need to watch out for.

[WearyRhino]

I've been ill over Christmas ... pneumonia. Spent my first ever and hopefuly only ever night in hospital. The staff and facilities at Bradford Royal Infirmary were fantastic on the day and on subsequent visits.

Some of the friends and families accompanying Eastern European patients in A&E reception were a disgrace. I'd hate to have to work there.

Clearly, they didn't manage to cure your narrow mind whilst you were in there.

[Alfie Taylor]

Good for them. It also finally puts to bed the myth that it's a vocation, it's about money.

I find it concerning that they think that care will worsen if they have to work weekends, do we really want people in the NHS who become incompetent oafs if they have to work on a Saturday?

Hunt should just impose the contract, there's no obligation on anyone to sign up for it, if they don't like it they can get lost, this appears to be the way some would like us to deal with businesses who threaten to leave the country if they don't get their own way.

[ckn]

Good for them. It also finally puts to bed the myth that it's a vocation, it's about money.

I find it concerning that they think that care will worsen if they have to work weekends, do we really want people in the NHS who become incompetent oafs if they have to work on a Saturday?

Hunt should just impose the contract, there's no obligation on anyone to sign up for it, if they don't like it they can get lost, this appears to be the way some would like us to deal with businesses who threaten to leave the country if they don't get their own way.

You just haven't been following the debate then. The new contract actively penalises multidisciplinary training rather than encouraging it. It's a long acknowledged truth that the best diagnosticians typically have more than one core training subject. The new route means you pick one track and stay on it or are actively penalised financially.

Also, you seem to not have realised that these typically are in the brightest group of students at university while their peers doing law and going into banking will start their careers years earlier and at typically twice to three times the starting salary. Doctors then will not even touch the starting salary of their peers until 10+ years after they leave medical school. It takes about 12 years later than their peers to reach an equivalent starting salary. Even then, the typical fully established doctor consultant will earn 1/10th of their legal and banking academic peers at partner level.

Yep, it's all about the money.

[Trojan]

Good for them. It also finally puts to bed the myth that it's a vocation, it's about money.

I find it concerning that they think that care will worsen if they have to work weekends, do we really want people in the NHS who become incompetent oafs if they have to work on a Saturday?

Hunt should just impose the contract, there's no obligation on anyone to sign up for it, if they don't like it they can get lost, this appears to be the way some would like us to deal with businesses who threaten to leave the country if they don't get their own way.

The doctors are already working weekends. The problem is that all the back up staff needed for 7 day working, pathologists, statisticians (blood counts etc) radiographers, porters, receptionist, cleaners aren't.  A  7days a week NHS was just a Tory election slogan, another way of justifying more privatisationi.

[Bedford Roughyed]

Proof doctors are political (that JohnM will ignore) -

 

http://www.independent.co.uk/life-style/health-and-families/health-news/junior-doctors-whitehall-officials-edited-letter-from-independent-medic-to-build-hard-edged-case-a6801501.html

[Alfie Taylor]

You just haven't been following the debate then. The new contract actively penalises multidisciplinary training rather than encouraging it. It's a long acknowledged truth that the best diagnosticians typically have more than one core training subject. The new route means you pick one track and stay on it or are actively penalised financially.

Also, you seem to not have realised that these typically are in the brightest group of students at university while their peers doing law and going into banking will start their careers years earlier and at typically twice to three times the starting salary. Doctors then will not even touch the starting salary of their peers until 10+ years after they leave medical school. It takes about 12 years later than their peers to reach an equivalent starting salary. Even then, the typical fully established doctor consultant will earn 1/10th of their legal and banking academic peers at partner level.

Yep, it's all about the money.

And they know all that before they start university. It was also the case before this "new deal". They're not happy with the recompense for the new "anti social" hours. Which is absolutely fine, they'll have a figure that will suddenly make all their problems go away and make them be able to function fully at work, but please, please, please don't pretend patients will suffer, it's about money. It's always about money.

[Alfie Taylor]

The doctors are already working weekends. The problem is that all the back up staff needed for 7 day working, pathologists, statisticians (blood counts etc) radiographers, porters, receptionist, cleaners aren't. A 7days a week NHS was just a Tory election slogan, another way of justifying more privatisationi.

So the doctors are working weekends but everyone else isn't? The doctors, when not treating patients, are doubling up as receptionists? Porters? Cleaners? They probably have to open up in a morning and lock up at night. No wonder they're knackered.

[ckn]

And they know all that before they start university. It was also the case before this "new deal". They're not happy with the recompense for the new "anti social" hours. Which is absolutely fine, they'll have a figure that will suddenly make all their problems go away and make them be able to function fully at work, but please, please, please don't pretend patients will suffer, it's about money. It's always about money.

Yes, they knew that before university.  They also knew the terms of their job and the career paths that they'd like to go down, the government is changing it in a negative way that is detrimental to the doctors, the NHS and the patients all to suit a hastily put together political commitment.  It's not all about money, a doctor could make more money in the new scheme by refusing to multi-skill, narrowly follow a single path of least resistance and increase their income, it certainly won't make them a better doctor though.  Let's not pretend it's about anything other than ego for Hunt.

[ckn]

So the doctors are working weekends but everyone else isn't? The doctors, when not treating patients, are doubling up as receptionists? Porters? Cleaners? They probably have to open up in a morning and lock up at night. No wonder they're knackered.

One part of our service provides a support service 7am-10pm, with reduced hours at weekends; we were asked to provide a proposal for making it full-service 24x7 and got indignant replies when we said the staffing cost alone would go up by 1/3.  The belief was that we should increase the service provision by 40% at no extra cost.  The dictat from on high was "do it 24x7 whether anyone needs it or not" and we're giving you no extra money.  The clinical services then try to pass that down to us.  Fairy land these lot live in.

[Alfie Taylor]

Yes, they knew that before university. They also knew the terms of their job and the career paths that they'd like to go down, the government is changing it in a negative way that is detrimental to the doctors, the NHS and the patients all to suit a hastily put together political commitment. It's not all about money, a doctor could make more money in the new scheme by refusing to multi-skill, narrowly follow a single path of least resistance and increase their income, it certainly won't make them a better doctor though. Let's not pretend it's about anything other than ego for Hunt.

Of course it's ego for Hunt. He's a politician.

[Alfie Taylor]

The doctors are already working weekends. The problem is that all the back up staff needed for 7 day working, pathologists, statisticians (blood counts etc) radiographers, porters, receptionist, cleaners aren't. A 7days a week NHS was just a Tory election slogan, another way of justifying more privatisationi.

I just thought I'd ask an NHS radiographer if they work weekends.

"Diagnostic radiographer a work 247 therapy work mon to fri and are on call at weekends. They will work bank holidays or weekends to make up for missed treatments. Why?

Yes still going to Mcr tomorrow x"

I then asked to clarify they work 24/7 as it was a bit garbled.

"Certain aspects of diagnostics have a service that requires 247 cover so the staff will work shifts but it is common practice for them to be on site on call for 24 hours in one go. CT and MRI radiographers cover depends on the hospital and demand but weekends are common. A&E rad cover is 247"

[Trojan]

http://www.mirror.co.uk/news/uk-news/tory-policy-chief-oliver-letwin-7141244

http://www.mirror.co.uk/news/uk-news/david-cameron-under-pressure-order-7142531

Shows the Tories' attitude to the NHS.

[Alfie Taylor]

http://www.mirror.co.uk/news/uk-news/tory-policy-chief-oliver-letwin-7141244

http://www.mirror.co.uk/news/uk-news/david-cameron-under-pressure-order-7142531

Shows the Tories' attitude to the NHS.

Aye. The same as Labour and it's hypocritical voters.

[Saintslass]

I just thought I'd ask an NHS radiographer if they work weekends.

"Diagnostic radiographer a work 247 therapy work mon to fri and are on call at weekends. They will work bank holidays or weekends to make up for missed treatments. Why?

Yes still going to Mcr tomorrow x"

I then asked to clarify they work 24/7 as it was a bit garbled.

"Certain aspects of diagnostics have a service that requires 247 cover so the staff will work shifts but it is common practice for them to be on site on call for 24 hours in one go. CT and MRI radiographers cover depends on the hospital and demand but weekends are common. A&E rad cover is 247"

Everyone knows that hospital cover at weekends is not the same level as it is during the week.  We have all heard or read recent reports about the increased likelihood of death in hospitals at weekends yet this has now been 'forgotten' by some people, most notably those on the left who are yet again (to the boredom of the rest of us) shouting their 'privatisation' dogma all over the place, and with the junior doctors who appear to have forgotten that their job is to help heal the people who pay their wages. 

 

I don't support the doctors in their strike action.  They need to remind themselves why they became NHS doctors in the first place.  It was not to earn loads of money in overtime but to care for people in need.