UKC

/ NHS as told by Mr Pie

Please Register as a New User in order to reply to this topic.
The Lemming - on 07 Jan 2018

Not safe for work as it has a few sweary words.

https://www.youtube.com/watch?v=gqh0vfPy1ro

However is any of it incorrect?
Post edited at 17:00
bearman68 - on 07 Jan 2018
In reply to The Lemming:

It's not incorrect as it's just a shouty opinion. Nothing more.
BFG on 07 Jan 2018
In reply to The Lemming:
Well he's throwing around numbers in the video, so it's not just a 'shouty opinion'.

I actually don't agree that this is all the Tory's fault. Certainly, their policies have made the matter worse, but the UK is experiencing an increase in healthcare demand in step with Western nations. This has made the lack of investment by this current administration more painful for the NHS, but it would be myopic to blame an annual 4% rise in demand that stretches back decades entirely on the Tories.

Regarding Privatisation; remember that they've just continued with a pre-existing Labour policy. They are the ones who introduced both the purchaser / provider split and enabled private sector contracting to expand. But, bear in mind, there will always be some level of private sector involvement in the NHS. You're never gonna get public pharmaceutical companies, IT contractors or medical tech firms. It's just about funding the main body properly so that the NHS can manage the contracts properly.

Also, at the end of the day, I'm not sure why this is all kicking off now. Lists get cancelled in Winter, that's the way its been for decades. We've neither hit the peak of the crisis this year (we've got another cold snap coming and flu is usually at its worse in Feb, roughly), nor has it been as bad as, say, 2016... yet. The spate of articles all seems a bit premature to me.
Post edited at 20:22
The Lemming - on 08 Jan 2018
In reply to BFG:

> Well he's throwing around numbers in the video, so it's not just a 'shouty opinion'.

Are those numbers accurate, or deliberately misleading?
krikoman - on 08 Jan 2018
In reply to The Lemming:
Ralf Little disputed some of Hunts' figures but Hunt hasn't taken up the challenge to dispute them live on TV.


The whole "this was planned" bollocks doesn't wash though does it, because f it was planned, then there wouldn't have been any cancelled appointments in the first place.
Post edited at 13:00
jkarran - on 08 Jan 2018
In reply to BFG:

> I actually don't agree that this is all the Tory's fault. Certainly, their policies have made the matter worse, but the UK is experiencing an increase in healthcare demand in step with Western nations. This has made the lack of investment by this current administration more painful for the NHS, but it would be myopic to blame an annual 4% rise in demand that stretches back decades entirely on the Tories.

Sure but it's entirely reasonable to blame them for failing to match funding to increasing demand* and for cutting social services exacerbating the growth in demand for hospital beds and the cost of providing a health service. Running down the NHS is a policy decision and it's a policy that cannot now be far from bearing fruit.

*I'd have grudging respect were they honest about their health and social care policies pre-election but they're far from it.
jk
neilh - on 08 Jan 2018
In reply to jkarran:

In the last election it was only the liberals who promised to meet NHS's demands on funding from what I recall.
BFG on 08 Jan 2018
In reply to krikoman:

> The whole "this was planned" bollocks doesn't wash though does it, because f it was planned, then there wouldn't have been any cancelled appointments in the first place.

Well, it depends what you mean. We regularly plan elective surgeries that we suspect that we're gonna need to cancel, then tell the patient exactly that. It means you get optimal usage of your time as you rarely get advanced warning of when exactly the winter demand spike is going to hit.

Fundamentally, in principle these list cancellations have nothing to do with the Tories. Their healthcare policy may have made things worse but they haven't created this issue.

@Jkarran
> Sure but it's entirely reasonable to blame them for failing to match funding to increasing demand* and for cutting social services exacerbating the growth in demand for hospital beds and the cost of providing a health service. Running down the NHS is a policy decision and it's a policy that cannot now be far from bearing fruit.

I'm not here to defend the Tories. I agree with your point (that they're to blame), though I don't think there's any evidence that they're deliberately running down the NHS over the explanation that they're ideologically driven and incompetent. However, this in no way excuses the increase in pressure that has occurred on their watch.

I was arguing specifically against the black and white portrayal in the video.

Trangia on 08 Jan 2018
In reply to The Lemming:

I'm sure he could get his point across without so much swearing, which IMHO tends to negate what he is trying to say. Pity, because without it he still makes a valid point.
mountain.martin - on 08 Jan 2018
In reply to Trangia:

Sorry I don't agree, Yes I know he is playing a character, but I think the way he does it puts the message across more forcefully than a politician being political.

I'm not a shouty, sweary person myself but I do feel angry about the state of the health service, and other parts of OUR society. It's not all the fault of the Tories, but they are trying make out that none of it is their fault.

It is refreshing to me to see someone being angry and passionate but still coherent and put across a reasonable argument, wether you agree with it or not.

balmybaldwin - on 08 Jan 2018
In reply to The Lemming:

a lot of this is to do with that cretin Liz Truss screwing with the discount rate last year. In one foul swoop she increased costs for the NHS by approx £6Bn.

Of course this means Mr Hammond 's generous £4.4bn increase (or whatever it was last budget) doesn't even cover the increase.

This is what happens when you put people without a clue in charge of important decisions.
krikoman - on 08 Jan 2018
In reply to BFG:

> Well, it depends what you mean. We regularly plan elective surgeries that we suspect that we're gonna need to cancel, then tell the patient exactly that. It means you get optimal usage of your time as you rarely get advanced warning of when exactly the winter demand spike is going to hit.

> Fundamentally, in principle these list cancellations have nothing to do with the Tories. Their healthcare policy may have made things worse but they haven't created this issue.

There's a difference between contingencies and planning though, I fully understand the need to plan against adverse / emergency conditions, and while it might be argued that this year was different from last year. The crisis was still anticipated / predicted so planning to me would have involved not having scheduled operations in the first place, or if you're really good at planning, having the resources available to carry out the planned and additional burden, surely, that's planning?

I still think that having to cancel two months of elective surgery isn't planning, it's quite the opposite.
BFG on 08 Jan 2018
In reply to krikoman:

Okay, I'll rephrase: the NHS regularly schedules then block cancels weeks of operations over the Winter period. So far nothing that has happened is out of step with previous years (and not just previous years whilst underfunded under a Tory administration). We can anticipate that we're going to have a crisis, but not when, especially when you're dealing with a system as complex as the NHS.

This year will probably get worse than previous years; it's a little known fact that the NHS never came out of emergency reporting following last Christmas (daily situation reporting, etc). It's just not got worse yet.

Again, I'm not here to defend the Tories. I'm just pointing out the the current coverage of the Winter crisis in the NHS isn't giving you all the information. In fact, given that the main block of Winter performance data doesn't get released (even internally) until this Thursday, I have no idea why the stories have been running at all.
krikoman - on 08 Jan 2018
In reply to BFG:

> I have no idea why the stories have been running at all.

I'd imagine it's the number of people sitting in ambulances for great lengths of time waiting to get into the hospitals that might have given the game away.

Cancelling two months of elective surgery seems to me to be a very long time. I doubt my customers would be very happy with me saying, "Well we're really busy, we thought it would probably happen, but still, sorry. We'll see if we can fit you in after February".
I understand the NHS is a little bigger than us, but imagine if something really bad happened like Aussie Flu, this hasn't even taken a foot-hold over here, but what state would we be in if it did?

Not coming out of Emergency Reporting, might be an indicator that things aren't going swimmingly.

pec on 08 Jan 2018
In reply to krikoman:

> Cancelling two months of elective surgery seems to me to be a very long time. I doubt my customers would be very happy with me saying, "Well we're really busy, we thought it would probably happen, but still, sorry. We'll see if we can fit you in after February".

Its only one months operations isn't it? But regarding the comparison with your company, I think the essential difference is that your customers expect to pay for for whatever it is you provide them with, whereas NHS patients don't.
As I recall, none of the main party's spending plans were considered adequate by the Kings fund, Nuffield trust etc. Only the LibDems planned to increase general taxation to pay extra for the NHS and how well did that go down?
Everybody wants a better a NHS, nobody wants to pay for it.

kipper12 - on 08 Jan 2018
In reply to pec:

I’ve paid in, for nearly 40 years, by way of NI and income tax, and so far had very little out. I certainly don’t regard the NHS as a freebie, but one certainly should expect s functional NHS back in return. I’m in the camp of wiling to pay more aka the Lib Dem approach - provided it was ring fenced and the NHS was taken out of party politics, as far as possible. It’s too important to play politics with!
bearman68 - on 08 Jan 2018
In reply to kipper12:

Lucky you - I would prefer not to EVER have anything out of the service. And while you are willing to pay more, the majority of the electorate are not.
I did read though that 80% of your NHS consumption occurs within the last few years of your life (assuming you are 'average') I suspect that a large part of the A&E problems are associated with poor care among the very elderly and infirm section of the population
summo on 08 Jan 2018
In reply to kipper12:

> I’ve paid in, for nearly 40 years, by way of NI and income tax,

And over those years tax rates have gone down, thresholds up, but what the public expects has soared. There is your answer.

krikoman - on 08 Jan 2018
In reply to pec:

> Its only one months operations isn't it? But regarding the comparison with your company, I think the essential difference is that your customers expect to pay for for whatever it is you provide them with, whereas NHS patients don't.

I think most people realise there taxes or at least part of them pays for the NHS.
Operations were cancelled until the end of February.

> As I recall, none of the main party's spending plans were considered adequate by the Kings fund, Nuffield trust etc. Only the LibDems planned to increase general taxation to pay extra for the NHS and how well did that go down?

I'm not sure this was the reason why the Lib-Dems didn't do to well, I think there were other reasons, namely their failure to follow through with the promises made prior to joining the Tories.

> Everybody wants a better a NHS, nobody wants to pay for it.

I'm not sure that's correct, plenty of people are willing to pay, many people are against paying private companies, which is what we're currently being lead into by this current government. What are you basing these statements on?

Jon Stewart - on 08 Jan 2018
In reply to bearman68:
> And while you are willing to pay more, the majority of the electorate are not.

Well f*ck it then, vote Tory, and we'll all pay insurance premiums and watch people who can't afford it get no treatment.
Post edited at 22:32
FactorXXX - on 08 Jan 2018
In reply to krikoman:

I'm not sure that's correct, plenty of people are willing to pay, many people are against paying private companies, which is what we're currently being lead into by this current government. What are you basing these statements on?

Very few people want to pay more tax.
The Conservatives promise to keep individual taxes for everyone low and therefore spend less on Public Services. That's one of the reasons why people vote for them.
Labour under Corbyn have promised that the rich will pay for better Public Services and therefore ensuring that the vast majority of us don't pay anymore tax and that's why some people vote for them.
The only Party that seems to be advocating tax rises for everyone are the Lib Dems and guess what, no one votes for them.
If people are really concerned about Public Services, then maybe they should actually be voting Lib Dem and not believing the Corbyn dream that the rich will pay for those services whilst the rest of us pay the same or less than we do now.
DancingOnRock - on 08 Jan 2018
In reply to The Lemming:
> Are those numbers accurate, or deliberately misleading?

It’s political satire.

Non of it has to be accurate or true. That’s not the objective of satire. The objective is to poke fun at the establishment and excercise free speech.

Unfortunately when it comes to Pie, like Alf Garnett, there are people who think he’s real and speaks the truth.
Post edited at 23:11
pec on 08 Jan 2018
In reply to krikoman:

> I think most people realise there taxes or at least part of them pays for the NHS. >

Yes but it doesn't feel like it compared with the analagy you made about your company, free at the point of delivery etc.
Its also worth bearing in mind that many people who use the NHS most, children and some pensioners, don't actually pay any tax, at least not at the time they use it.

> Operations were cancelled until the end of February.

I heard one month on the radio several times. I googled it to check and everything comes up as one month. Perhaps I've missed something?

> I'm not sure this was the reason why the Lib-Dems didn't do to well, I think there were other reasons, namely their failure to follow through with the promises made prior to joining the Tories. >

Clearly there are multiple reasons why the Lib Dems did badly though the reasons you give are more relevant to the 2015 election than 2017. I haven't seen any evidence to suggest their promise to raise basic rate tax by 1% won them many votes though.

> I'm not sure that's correct, plenty of people are willing to pay, many people are against paying private companies, which is what we're currently being lead into by this current government. >

I'm sure there are many people willing to pay more for the NHS but most of them probably already vote for a party that promises to tax them more to do so, either that or they buy into the idea that the extra cash can be found by taxing people richer than themselves. Its swing voters you need to win over and history suggests they don't vote for increasing their tax bill. As an aside, Labour introduced privatisation into the NHS which is perhaps why some people are sceptical about their NHS credentials?

Speaking personally (the above are largely observations rather than my opinions) I wouldn't be opposed to paying a bit more tax to fund the NHS and I do wonder why, when faced with the choice of giving out a tax cut or using the spare cash to boost the NHS the Conservatives always go for the tax cut given that the NHS is their weakest card.
However I don't buy the idea that you can just tax a few rich people to pay for it all, we all need to pay a bit more (or at least go without a tax cut) but rarely do parties who promise to increase people's taxes win their votes.

> What are you basing these statements on? >

Years of following politics closely

mountain.martin - on 09 Jan 2018
In reply to pec:

> Everybody wants a better a NHS, nobody wants to pay for it.

I'm not sure that's true, part of the problem is that the Tories (and sometimes other parties) say they will maintain or improve the NHS without raising taxes by "efficiency savings" .

This probably isn't possible but it's what people want to hear.

I think if the parties were really honest and one said we will take a penny off your tax rate but run down the NHS and another said we will put a penny on the tax rate but make it a fully functional service a lot more people would vote to pay more.
summo on 09 Jan 2018
In reply to mountain.martin:

> and another said we will put a penny on the tax rate but make it a fully functional service a lot more people would vote to pay more.

That's exactly what the lib dems said last May.
mountain.martin - on 09 Jan 2018
In reply to summo:

Yes, but my argument was suggesting that all parties should be honest. Their ploy of being honest was completely undermined by other parties not being honest and pretending they could fix the NHS without increasing the tax burden.

Also their record in the coalition government and the compromises they had to make has completely destroyed their credibility and their trust with a large proportion of the public.
Postmanpat on 09 Jan 2018
In reply to Jon Stewart:

> Well f*ck it then, vote Tory, and we'll all pay insurance premiums and watch people who can't afford it get no treatment.

Straw man alert....
DancingOnRock - on 09 Jan 2018
In reply to mountain.martin:

Given that the NHS costs £116bn a year and income tax raises £177bn a year. Raising income tax hardly seems any kind of real solution.
Jon Stewart - on 09 Jan 2018
In reply to Postmanpat:

> Straw man alert....

To clarify : either pay for the health service or pay for the health service. The tory model does not involve paying any more through the tax system, so how else is one going to get treatment?

Labour aren't proposing the required tax increase. But when the chips are down, are they going to raise taxes, or change the funding model? Now, when the chips are down, what are the tories going to do : raise taxes or cut the service? The answer is staring you in the face. If the service is not there, how will you get treated? I'd suggest going private is probably a good idea.

Does anyone honestly believe that under tory leadership we will see the NHS return to health, rather than collapse? With their policies, how is it going to survive?
Jon Stewart - on 09 Jan 2018
In reply to pec:

> I do wonder why, when faced with the choice of giving out a tax cut or using the spare cash to boost the NHS the Conservatives always go for the tax cut given that the NHS is their weakest card.

This is fundamental to their ideology. The NHS is socialism. If you can lower taxes, that's the priority ahead of providing services. With the additional money in their pocket, people have the freedom to spend it on health care if that's what they want. This is better than the state spending their money.

> However I don't buy the idea that you can just tax a few rich people to pay for it all, we all need to pay a bit more

Exactly. If you want it, pay for it.
Post edited at 09:26
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

Some uncomfortable ethical questions need to be asked and answered over exactly what treatments the NHS should and shouldn’t be provided for free.

It’s esentially grown out of proportion and people are demanding too much from it.
summo on 09 Jan 2018
In reply to mountain.martin:

> Also their record in the coalition government and the compromises they had to make has completely destroyed their credibility and their trust with a large proportion of the public.

Only in the UK which is totally unaccustomed to coalition politics though would this be an issue.

You could argue the Uk voter is a helpless optimist as they'll vote for anyone who promised the world even though logic says it simply won't be possible or happen.
summo on 09 Jan 2018
In reply to Jon Stewart:
> Does anyone honestly believe that under tory leadership we will see the NHS return to health, rather than collapse? With their policies, how is it going to survive?

How does the current nhs route, differ from Labour's PFI and trust development?

The nhs will only survive when folk start paying more to save it, regardless of party. If not, it will decline further as the population grows, we age, treatments cost more, illnesses such as diabetes or obesity increase.
Post edited at 11:00
BFG on 09 Jan 2018
In reply to krikoman:
> I'd imagine it's the number of people sitting in ambulances for great lengths of time waiting to get into the hospitals that might have given the game away.

If you're going to quote me out of context I'll just stop responding. My point wasn't that there's nothing wrong with the situation atm; it was that the numbers for the height of the Winter period haven't been released yet and so it's all a bit premature.

> Cancelling two months of elective surgery seems to me to be a very long time. I doubt my customers would be very happy with me saying, "Well we're really busy, we thought it would probably happen, but still, sorry. We'll see if we can fit you in after February".

Well, as previously established the NHS is not a business; fortunately for the public, we don't get to change our prices to respond to supply and demand. Also, it's not two months.

> I understand the NHS is a little bigger than us, but imagine if something really bad happened like Aussie Flu, this hasn't even taken a foot-hold over here, but what state would we be in if it did?

I don't know, if we thought Flu might be an issue, we might cancel elective surgery as a precautionary measure to allow them to function as acute medical beds.

> Not coming out of Emergency Reporting, might be an indicator that things aren't going swimmingly.

You can always find anecdotes about the failing NHS. They're not necessarily wrong, but by their very nature they risk being distorting - newspapers aren't interested in 'everything is fine here' stories (not that it really is anywhere). We're talking about the fifth largest employer in the world so without concrete national numbers, you really have no idea what's going on in "The NHS" if you rely just on stories from the front line.
Post edited at 11:06
krikoman - on 09 Jan 2018
In reply to FactorXXX:
> If people are really concerned about Public Services, then maybe they should actually be voting Lib Dem and not believing the Corbyn dream that the rich will pay for those services whilst the rest of us pay the same or less than we do now.

The trouble is the LibDems are still toxic from the "No increase in tuition fees" pledge.

So in the minds of the electorate the LibDems were given the opportunity to do what they said they were going to, and failed.
Post edited at 11:09
krikoman - on 09 Jan 2018
In reply to BFG:

> If you're going to quote me out of context I'll just stop responding. My point wasn't that there's nothing wrong with the situation atm; it was that the numbers for the height of the Winter period haven't been released yet and so it's all a bit premature.

Do you really think we have to wait for figures to see what's going on, when there's plenty of evidence things aren't working as they should?

> I don't know, if we thought Flu might be an issue, we might cancel elective surgery as a precautionary measure to allow them to function as acute medical beds.

What I was saying was what if the recent flu bug had got hold and put an extra load on what we have now?

Any slack we used to have in the system has been used up or got rid of, there is no slack any more hence, operations are cancelled because there are no beds available, for after care. This is a massive drain on resources, many times operation staff are cancelled at the last minute, because the available beds don't become free.

> You can always find anecdotes about the failing NHS. They're not necessarily wrong, but by their very nature they risk being distorting - newspapers aren't interested in 'everything is fine here' stories (not that it really is anywhere). We're talking about the fifth largest employer in the world so without concrete national numbers, you really have no idea what's going on in "The NHS" if you rely just on stories from the front line.

The what do you base your information on?
Considering this isn't something new, and if things weren't failing the NHS would be coping and people wouldn't be waiting 10 or more hours on trolleys.

It's not like these are isolated cases either, my sister is a Sister, my BiL is a doctor and my cousin is another doctor, they are all saying the same thing, but they all work in different locations. So yes it may be anecdotal, but that doesn't mean it's not true.

BFG on 09 Jan 2018
In reply to The Lemming:

Regarding the general trend of the topic; I'm not convinced that the increase in cost is driven by people expecting more from the service (though this might be a factor), it seems like there's a more simple explanation: we have more sick people. If you look at the nationally produced numbers, we do not have more people going to A&E who do not need to be there, as a proportion of overall attendance.

At the end of the day, the regardless of your public sector beliefs, the NHS is probably the most cost effective health service in the Western world. Not always the best, but definitely cheap. There is no good evidence that getting people to pay for their own care reduces the lifetime cost to them; we all get sick eventually. Introducing a profit motive into the system necessarily increases cost and the fragmentation of the system it would cause also tends to increase waste and therefore cost. There's a reason why the American system is moving toward aping aspects of 'socialist' medicine; increased integration, paying for care pathways not treatments etc, because it's cheaper, more efficient and provides better care.

Now, there's a whole host of mixed systems on the continent. We can get into the German v French v Swedish v Spanish discussion but that would be missing the point.

NHS funding isn't really about NHS funding. 1 or 2 percent or system design is just fiddling at the margins or pushing the basic issue five years down the line. It's about having a better education system, building better houses, having better public transport, social groups for old people and yes, properly funding our social care system. The problem right now is not just that the NHS is being underfunded, but that it bears the external cost of every other public sector cut that has implications for the public's health.
DancingOnRock - on 09 Jan 2018
In reply to krikoman:

The Kings Fund. They’re an organisation specifically set up to analyse and make recommendations. They’re a-political.

There’s tons of analysis and recommendations and they understand how it works from the top to the bottom, they don’t just look at it from “the worker on the shop floor”.

Lots of their recommendations get put into place by the government and the NHS, but unfortunately that’s not very sexy and the papers tend to ignore the facts and rely on sensation.
DancingOnRock - on 09 Jan 2018
In reply to BFG:
Quite. One example is old people staying in hospital because they have nowhere to go. Too well to be in hospital, to frail to live at home alone.

While housing costs are high, people don’t have that extra room at home for granny or grandad.

When I was small and my gran had a heart attack, she lived with us for a while with my grandad. They didn’t need expensive ‘24 hour care’ they just needed support.
Post edited at 12:17
Jon Stewart - on 09 Jan 2018
In reply to summo:

> How does the current nhs route, differ from Labour's PFI and trust development?

It doesn't. The difference between Labour and Tories on the NHS is what will happen at the crunch point, as I said.

In general, when I criticise Conservative policy, I find it frustrating to be asked about Labour policy as a response, because I don't support the Labour Party!

> The nhs will only survive when folk start paying more to save it, regardless of party. If not, it will decline further as the population grows, we age, treatments cost more, illnesses such as diabetes or obesity increase.

Exactly as I say. Higher taxes. Actually higher, for everyone.
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

> Exactly as I say. Higher taxes. Actually higher, for everyone.

Or reduce the spend by educating people how to be more healthy.

Or as pointed out above spend the money in areas to prevent illness in the first place. I don’t believe just because people live longer they should require more care or automatically consider to have long illnesses.
mountain.martin - on 09 Jan 2018
In reply to DancingOnRock:

> Given that the NHS costs £116bn a year and income tax raises £177bn a year. Raising income tax hardly seems any kind of real solution.

I don't understand your point. Raising more money for the NHS by increasing taxation (could be income tax, NI or other taxes) can only improve the current situation assuming that all parties will do their best to spend the money wisely.

Have I misunderstood your post?
Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:
> Some uncomfortable ethical questions need to be asked and answered over exactly what treatments the NHS should and shouldn’t be provided for free.

At an ethical level, I agree with you, in part. I don't demand from an ethical standpoint that all services are provided to everyone from general taxation. There are some services which might be made available on the basis of whether the patient could have avoided the need (through lifestyle, having been warned by doctors; or by not doing risky sports; or whatever).

However, while I think this is ethically justifiable, I don't think it's remotely practical as a way of addressing the shortfall in funding. I don't believe for a second that introducing a "personal responsibility" assessment and charging scheme would make any difference. It would be a nightmare to implement, would lead to impossible situations whereby people didn't heed advice and ended up needing life-saving treatments that they couldn't afford (so let'em die? Not in a civilised country, sorry), and just wouldn't bring in anything like enough cash.

> It’s esentially grown out of proportion and people are demanding too much from it.

So you're saying cut services. How are you going to decide which services we don't really need? Who's going to go without treatment?

Why is that a better idea - obviously cutting services will lead to worse outcomes - than paying a higher price for better services? I can afford it, and so can everyone else in the upper half or more of the income distribution. Healthcare is more important than a slightly more expensive car or holiday.

Your view exemplifies the classic priority of the right: anything, no matter how awful, is better than paying more taxes to provide services for everyone.
Post edited at 13:52
Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:

> Or reduce the spend by educating people how to be more healthy.

> Or as pointed out above spend the money in areas to prevent illness in the first place. I don’t believe just because people live longer they should require more care or automatically consider to have long illnesses.

Do you really think it's that easy?
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

If it’s not controlled, the logical conclusion, is that we spend all taxes on the NHS. Policing, fire services, all the other essentials get no funding. That can not possibly happen, there is a finite pot.

Currently doctors and PCTs decide what and who the NHS treats. Ultimately, with tighter budgets, they will be the ones to decide which treatments are available and to who.

People think because they pay their taxes that they deserve to be treated. That’s not the case and that’s the kind of education that’s required.
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

> Do you really think it's that easy?

Yes.
BFG on 09 Jan 2018
In reply to DancingOnRock:

The only real issue is that, at the end of the day, these kinds of changes take decades to come into effect. Advocating for the ideal situation is all well and good, but in this case it we're wondering how we get through tomorrow.
Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:

> If it’s not controlled, the logical conclusion, is that we spend all taxes on the NHS. Policing, fire services, all the other essentials get no funding. That can not possibly happen, there is a finite pot.

I think I've been quite clear that I support raising taxes, not taking more for the NHS out of the current pot.

Obviously you can't provide anything and everything at the highest quality, for everyone. Which is why we have defined standards, NICE guidelines, etc. No one is saying that there should be no control. I'm arguing that we should maintain standards at an increasing cost - so we need to pay more.

> Currently doctors and PCTs decide what and who the NHS treats. Ultimately, with tighter budgets, they will be the ones to decide which treatments are available and to who.

> People think because they pay their taxes that they deserve to be treated. That’s not the case and that’s the kind of education that’s required.

There will always be a finite pool of resources which must be prioritised. I'm saying that that pool of resources must grow (yet will still be finite and prioritised) in order to provide the level of healthcare that I expect from living in a rich country.

I agree that every effort must be made to reduce demand on services through public health and everything that contributes to public health (better life opportunities, less poverty, etc). But it is not possible to just wish away the increasing demand on the NHS. You seem to be saying that we should cut services - so which services should be cut? And why is this better than paying more taxes to pay for the increasing demand, and while we're at it, some more public health education and broader improvements to public services to reduce the demand on the NHS in the long term?

Or are you just planning to magic the decrease in demand out of thin air without spending any money? Do explain!
BFG on 09 Jan 2018
In reply to DancingOnRock:

> Currently doctors and PCTs decide what and who the NHS treats. Ultimately, with tighter budgets, they will be the ones to decide which treatments are available and to who.

*cough*

https://www.kingsfund.org.uk/audio-video/how-does-nhs-in-england-work
mik82 - on 09 Jan 2018
In reply to The Lemming:

The concerning issue is that currently the level of winter illness is pretty much average.

In France there's currently a flu epidemic - the GP flu consultation rate was 527 per 100,000 of the population in the run up to New Year, compared to 21 per 100,000 in the UK. At this level, they're also having to cancel routine procedures. If our flu rate increases by 2500%, then who knows what'll happen here, as there's no spare capacity.
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

Maintaining standards isn’t the issue. As new modern expensive treatments become available, we will want to take advantage of them. Standards will have to increase. The amount of taxes will have to increase. Eventually you’ll get to a point where 100% of the money people earn is spent entirely on the NHS. Unless you put a cap on the spending and the treatments being offered.

Health treatments seem to be one of those areas where the demand increases to fill the availability. The more you tell people “We have a fantastic NHS, they can fix you when you’ve abused your body for years, and they’ll do it for free.”, the more people will leave it until tomorrow to take care of their own health.
DancingOnRock - on 09 Jan 2018
In reply to BFG:

At the point of delivery, there are meetings where the PCT and hospital consultants meet to ultimately decide who lives and who dies.
BFG on 09 Jan 2018
In reply to DancingOnRock:

Well there aren't; PCTs don't exist any more.
Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:
> Maintaining standards isn’t the issue. As new modern expensive treatments become available, we will want to take advantage of them. Standards will have to increase. The amount of taxes will have to increase. Eventually you’ll get to a point where 100% of the money people earn is spent entirely on the NHS. Unless you put a cap on the spending and the treatments being offered.

I don't understand why you think a tax increase would have to be to 100% of earnings? Why can't we increase taxes to pay for an excellent NHS, maintaing control of costs by prioritising a finite but increased budget? Why does it have to be an uncontrolled spending explosion or else no increase? This is called a black and white fallacy (or a false dichotomy if you prefer).

There always will be a cap. NICE will continue to advise on value for money, treatment by treatment. There is a system in place to control costs while maintaining quality, and I do not want to see the standards drop, I want to see the standards met. The NHS is currently failing to meet the standards e.g. A&E waiting times, and is running on good will rather than being adequately resourced. I've already said I don't expect every treatment available for every person at the highest quality, I expect an excellent service befitting one of the richest countries in the world. I expect our health service to compare favourably with similar countries'.

> Health treatments seem to be one of those areas where the demand increases to fill the availability. The more you tell people “We have a fantastic NHS, they can fix you when you’ve abused your body for years, and they’ll do it for free.”, the more people will leave it until tomorrow to take care of their own health.

You don't seem keen on paying more taxes to achieve an excellent health service. So what do you propose instead? Which services should be cut? Or how else should they be paid for?
Post edited at 15:26
knighty - on 09 Jan 2018
In reply to The Lemming:

We, as a nation, need to stop normalising obesity. It is the root cause of so many illnesses, yet it is for some reason unacceptable to say that someone is too fat.
Jon Stewart - on 09 Jan 2018
In reply to knighty:
I don't think it's obvious how you change attitudes towards obesity to get better outcomes.

I don't think people who are fat think it's fine, and if they were looked down on or criticised more then they would pull their finger out and lose weight. I would expect that most people who are fat also suffer lack of self esteem because of this. We don't exactly celebrate the beauty of fat bastards in our society, we think of them as sexually repugnant, and probably lazy and lacking in self discipline. We might be too polite to say this face to face, but I don't think in general we are particularly keen on fatties.

Making this even clearer wouldn't, I don't think, bring about better outcomes. The problem is that there is a lot of money to be made by exploiting people's short-term desire for foods containing large quantities of fat and sugar. If you can make a lot of money out of it, it will be done efficiently, the products will be cheap, consumption will be high and we have a vicious cycle leading to an obesity epidemic.

In general, I don't think that "changing attitudes" is a workable solution to anything. Attitudes change once something becomes normal in society. If you want people to stop filling their faces with KFC, then stand up to the fast food lobby and tax the living fuck out their poisonous products that rot the health of our society and drain the resources of the NHS.
Post edited at 16:05
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

I’m not advocating a ‘sudden explosion’ I’m just pointing out the mission creep that’s been happening over decades of the NHS’s exsistence. In 1975 the budget was £30bn in today’s prices.

That’s a 400% increase in spending on a population that has increased by 25%.

Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:

What I'm asking is, why try to reduce the service rather than pay more for a better service, within reasonable affordable limits for tax payers? I'm perfectly happy that the NHS now provides much more than it did in 1975. I can't see any reason to view this is as a problem.
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

Because the NHS isntrying to do things that are outside it’s remit.

As per the example I posted above. Old people using wards as hotels.
Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:

> Because the NHS isntrying to do things that are outside it’s remit.

> As per the example I posted above. Old people using wards as hotels.

So there's a problem with lack of social care provision, which is - completely ridiculously - being mitigated by using NHS resources. The problem here is not that the NHS remit is too broad, it's that there is insufficient social care provision, which, guess what, we need to pay for!

You can say "families *should* care for their elderly relatives" all you like, but it isn't a solution. How are you going to *make* families look after granny? Granny is in a hospital bed. There is no bed elsewhere. There is no family, or family will not support her. What do you propose is done with granny?
krikoman - on 09 Jan 2018
In reply to BFG:

> *cough*


I'm sorry bu that video sounds a little like Tory propaganda to me.

for instance the local CCG around here is closing our local maternity wing and closing down many of the services currently available.

We're now travelling more than 30 miles to a major hospital which is already struggling to cope, but need the extra funding closing the local services brings.

The CCG have not listened or ignored the issues highlighted under a review process and have obfuscated evidence against the moves. Nothing about the town we live in doubling in size was taken into account or services in this county shared with other counties on our border.

It's cost a fortune in meetings and appeals and saves nothing. The hospital everyone is supposed to travel to has no parking available, so how they expect relatives to visit isn't taken into account.
krikoman - on 09 Jan 2018
In reply to DancingOnRock:

> At the point of delivery, there are meetings where the PCT and hospital consultants meet to ultimately decide who lives and who dies.

Which if you look at the costs involved don't make any sense, 10 -12 people arguing their case for a bed, everyday. When the real problem is the lack of beds and nurses.

Having consultants and surgeons standing around waiting to see if they can start work is a false economy.
DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:

I don’t really care what you do with Granny, but one solution is to put her in a 5* Hotel in central London, which perversely is cheaper than having her stay in a hospital bed and she’d be better looked after with room service.

Pouring money into the NHS to try and create more bed space is a bit pointless. If there’s no space, money won’t suddenly produce more nurses, hospitals and beds. And it’s a waste of money and rescorces using nurses to care for people who are not ill.

But that’s just one area.
bearman68 - on 09 Jan 2018
In reply to Jon Stewart:

> Well f*ck it then, vote Tory, and we'll all pay insurance premiums and watch people who can't afford it get no treatment.

Well it wouldn't be for me to argue against democracy - it delivers crazy decisions every now and again, but the alternative is much worse.

So what to do:
1) Take on the food industry, and make sure all food is marked with the traffic light system.
2) Tax unhealthy food, especially take away. Tax it until its cost is reflected in the cost to society. Increase costs on cigarettes, minimum price for alcohol. Raised money is ring fenced for health and social care improvement, including the additional provision of stuff like cycleways. (Green benefit as well)
3) Resist planning applications etc for the fast food joints. Presumably a increased price will see a reduced demand as well.
4) Ban 'unhealthy' food advertising on TV. (And gambling ads when we are at it)
5) Improved education re the above, and an improvement in leisure facilities.
6) Make it law that everyone has to do at least 1 hour of 'hard' physical activity every week.
7) Improve social care. Involve the private sector in social care.
8) Think hard about what the NHS should do - restriction in delivery seems a must. I tend to think A&E and GP services are priority.
9) Small nominal charge for a GP appointment. (Say £10), to avoid piss taking.
10) Improve NHS staff efficiency. NHS sick rate is what? 3 times private industry,and 10 times worse than best practice.
summo on 09 Jan 2018
In reply to bearman68:
11, scrap religious assemblies in all schools and use the extra time for more gym lessons.
Post edited at 19:18
baron - on 09 Jan 2018
In reply to summo:

This would actually increase the cost to the NHS due to all the wrist injuries caused by parents constantly writing notes asking for their child to be excused PE.
Jon Stewart - on 09 Jan 2018
In reply to bearman68:

> So what to do:

> 1) Take on the food industry...

Like all these ideas.

> 6) Make it law that everyone has to do at least 1 hour of 'hard' physical activity every week.

This is weird (or more likely a joke). Are you sure the law is the right tool to encourage this behaviour change? And 1h per week to see a benefit on the NHS?

> 7) Improve social care. Involve the private sector in social care.

Isn't lots of social care delivered by private providers? Not sure this is a solution, we just need more provision, whoever delivers it.

> 8) Think hard about what the NHS should do - restriction in delivery seems a must. I tend to think A&E and GP services are priority.

I think it's difficult to come up with areas you can get rid of. But as new treatments are developed, they should continue to be rigorously assessed so that resources are effectively prioritised.

> 9) Small nominal charge for a GP appointment. (Say £10), to avoid piss taking.

I don't think this is too bad, since we already pay prescription charges it's very much the same thing. Could even move some of that charge, if it's the case that further charges would put off those who really need to see the GP.

> 10) Improve NHS staff efficiency. NHS sick rate is what? 3 times private industry,and 10 times worse than best practice.

Isn't it obvious that the high rate of sickness is because there aren't enough staff and they work under absurd pressure with the whole system running on good will, which has hit the limit? Jeremy Hunt has tried to squeeze more work out of the same doctors, and it wasn't a very popular idea...
summo on 09 Jan 2018
In reply to baron:

> This would actually increase the cost to the NHS due to all the wrist injuries caused by parents constantly writing notes asking for their child to be excused PE.

If you well enough to be at school, you can do sport. If you are injured then something from your doctors/nurse visit will suffice.
Jon Stewart - on 09 Jan 2018
In reply to DancingOnRock:

> I don’t really care what you do with Granny

I thought you did care, which was why you brought it up?

> Pouring money into the NHS to try and create more bed space is a bit pointless. If there’s no space, money won’t suddenly produce more nurses, hospitals and beds. And it’s a waste of money and rescorces using nurses to care for people who are not ill.

That's why the beds need to be in care homes, not in hospitals, as I said.

I really don't think that there are loads of things that the NHS can just not do, in order to resolve the crisis. It's been stretched as far as it can be, and it's now at breaking point. We must either pay more tax to keep the current funding model, or change the funding model and pay more a different way.

I don't care whether it's called tax or called something else, but I think it would be utterly tragic if we lost a system in which you pay in according to your ability and you take out according to your needs. Some people do decide to smoke and eat KFC until they need thousands of pounds worth of treatment, and they should be encouraged to live a healthier lifestyle. But people don't decide to have a child with a rare genetic condition that costs a huge amount in healthcare bills, which is why it's important to have a system that can cope with these cases whether the child is born into a rich or a poor family.

DancingOnRock - on 09 Jan 2018
In reply to Jon Stewart:
What I mean is it’s not the NHS job to be looking after old people.

I’m not sure private care homes are regulated tightly enough or audited properly. They seem to be a licence to print money while paying staff peanuts. But I don’t really have any experience of that so probably a discussion for another place.

If we are going down the route of food/health, we have to ask why we have a government with a conflict of interests. Their job is to get food productivity up while reducing the amount of food people consume. How does that even work?

We just have to be aware that having a health system that people dream about is going to cost a serious amount of money.

We will get to a point where there are more people who require care than there are carers, we are close to that and money can’t magic carers out of thin air.
Post edited at 21:38
BnB - on 10 Jan 2018
In reply to DancingOnRock:

> If we are going down the route of food/health, we have to ask why we have a government with a conflict of interests. Their job is to get food productivity up while reducing the amount of food people consume. How does that even work?

We grow more food here and import even less, thus rebalancing both production and consumption.

We could do this by changing our trading relationship with nearby growers like Italy and Spain. I wonder how that could be achieved? ;-)




This is not an invitation for a Brexit discussion, just a logical, if tongue in cheek, economic response to the question. Please don't let's start on the B-word.

Postmanpat on 10 Jan 2018
In reply to DancingOnRock:

> We just have to be aware that having a health system that people dream about is going to cost a serious amount of money.
>
We also have to aware that simply throwing money at it is not a solution. This is why the biggest threat to the NHS is one Jeremy Corbyn who wants to revert to a prehistoric command and control system of management that will guarantee inefficiency and poor outcomes. More money needs to be spent on healthcare but within a structure that works.
Rob Exile Ward on 10 Jan 2018
In reply to Postmanpat:

I agree.
The Lemming - on 10 Jan 2018
In reply to Postmanpat:

> More money needs to be spent on healthcare but within a structure that works.

And the Blue Team is doing such a Stirling job at this?

You can hypothetically blame Jeremy Corbyn al you like about how he may or may not manage the NHS. However you must first address the issue of a government that is actually in control right now managing and controlling the NHS.

Maybe you could tell us how the Tories have been so successful at managing the NHS on their Watch?

Maybe this coverage of a crisis in the NHS, people sleeping on floors and A&E departments working under borderline dangerous conditions is all Fake News created by Facebook and Twitter?

Postmanpat on 10 Jan 2018
In reply to The Lemming:

Straw man. I wasnt claiming the Tories have solved the priblem. They have at leat understood that a model designed 70 years ago and the brain dead solutioon of just throwing more money at is not a solution. Perhaps if it were broadly acknowledged that other models found in Europe, Asia and Australasia have much to offer we might have a chance if improving our health and care services.
krikoman - on 10 Jan 2018
In reply to Postmanpat:

> Straw man.

Who Jeremy Corbyn?
DancingOnRock - on 10 Jan 2018
In reply to The Lemming:
It’s not fake, but it’s pretty much sensationalist and probably a snapshot taken at peak periods. Are all hospital A&E departments full of people sleeping on floors 24hours a day? That’s certainly not what I have seen in my local A&E.

The NHS is failing to meet targets? Who set the targets? Are they achievable? Are we creating stress and disillusionment amongst hospital staff by having unrealistic expectations of what can be achieved?

Maybe we should manage the public’s expectations a bit better? Something like, if you have a non life threatening injury and you turn upat a peak period, you may be asked to return at 2am when it’s quiet.

From what I gather on the radio, triage nurses are massively overworked and can’t turn people away. Surely that’s got to be one of the first things to address.
Post edited at 10:28
krikoman - on 12 Jan 2018
In reply to DancingOnRock:

> From what I gather on the radio, triage nurses are massively overworked and can’t turn people away. Surely that’s got to be one of the first things to address.

 

How do you know if what you turn up with isn't life threatening without triage?

 

summo on 12 Jan 2018
In reply to krikoman:

> How do you know if what you turn up with isn't life threatening without triage?
>  

By following the advice they publically state. The first port of call shouldn't be a&e.

Can I self medicated; painkiller, day in bed, box set of usa trash....

Visit the pharmacy

Call helpline

Book with local nurse or doctor

Visit a&e

 

 

krikoman - on 12 Jan 2018
In reply to summo:

Easier said than done though in many cases, my daughter broke her foot the other week, I was all for leaving it (which would have been the case in my day to see what developed), obviously we didn't know it was broken before going to hospital. My wife insisted we go to A&E, and so we found out she needs a splint and crutches.

As for the other suggestions, it's very difficult to get to see a doctor. What do you do when it's out of hours?

While I agree there are many cases of people not using their heads, there are many people not bothering and ending up with more serious ailment because of it.

 

Girl in Scotland has just died, probably because she didn't get to hospital early enough.

Post edited at 10:03
DancingOnRock - on 12 Jan 2018
In reply to krikoman:

It’s more of a question of not having enough effective triage nurses during peak periods and not being able to give people A&E ‘appointments’.

”Yes, your foot is probably broken. We are very busy at the moment, here is an appointment for 6 hours time. You can go home and come back later.” 

That way the waiting rooms aren’t stuffed full of people with semi-serious ailments and no one ends up sitting on floors. 

mik82 - on 12 Jan 2018
In reply to DancingOnRock:

The real problem at the moment is people that are quite unwell arriving by ambulance, without the capacity in the department. These "majors" aren't going to be able to be triaged to come back, and it is a problem with bed space and staffing rather than triage.  This is likely to get much worse over the next few weeks as flu is likely to reach epidemic levels - something that hasn't happened since 2010/11.

In a busy emergency department, the waiting time for "minors" such as small broken bones in the foot often goes up to several hours anyway, and the sitting around waiting acts a filter for more trivial ailments - people give up and go home.  I'm not sure that giving appointments to come back would help, as you'd remove the filter and feed demand. 

DancingOnRock - on 12 Jan 2018
In reply to mik82:

That’s a fair point and kind of what I meant by sending minors home. Although thinking about it I’d surprised if the Triage nurses don’t have the power to tell people to go home as it’s not an emergency.

When I had a mallet finger they wanted me to see a doctor immediately, whilst not life threatening, it needed immediate remedial bandaging to make sure it repaired properly. I’m guessing it’s a tough call. 

krikoman - on 12 Jan 2018
In reply to DancingOnRock:

> It’s more of a question of not having enough effective triage nurses during peak periods and not being able to give people A&E ‘appointments’.  

But that was my point you have to go to hospital to find out it's broken, thereby adding to the chaos. It's pretty difficult to diagnose a broken bone without an X-ray, unless of course it's sticking out of somewhere. You still need the xray. As it happens we did get sent home and had to go to the fracture clinic the next day.

What do you do if a doctor tells you to go to A&E?
Not so long back I stuck a Stanley knife half way through my finger, I went to the doctor on site and he advised going to hospital, he'd cleaned it up and put steri-strips on it. The strips we holding and I didn't bother with the hospital. Had this been my daughter or son there'd have been no thoughts of not going to hospital.

Post edited at 16:45
The Lemming - on 12 Jan 2018
In reply to mik82:

> The real problem at the moment is people that are quite unwell arriving by ambulance, without the capacity in the department. These "majors" aren't going to be able to be triaged to come back,

 

Many people, who can arrange alternative transport, think that travelling by ambulance gets them to the front of the que on arrival.  Such people would rather wait for an ambulance than make their way to hospital under their own steam.  They would probably get to hospital quicker, in the current busy period, and be triaged quicker as a result.

 

We could also discuss the "111 Phone Service" and how effective it is, or not, on those added pressures and demands.

 

 

 

The Lemming - on 12 Jan 2018
In reply to krikoman:


> But that was my point you have to go to hospital to find out it's broken, thereby adding to the chaos. It's pretty difficult to diagnose a broken bone without an X-ray, unless of course it's sticking out of somewhere.

 

A few years ago I was assaulted and received an injured toe.  At the time I was told that it was a soft tissue injury.  It was just a toe and it would get better.  A week later and after doing four shifts at work the pain became intolerable.  An x-ray confirmed things were a bit more severe than a soft tissue injury.

 

DancingOnRock - on 07:29 Sat
In reply to krikoman:

I suspect A&E are trying to do two jobs. Accidents and emergencies. Possibly they need two systems. An accident system and an urgent  minor injuries clinic. 

DancingOnRock - on 07:34 Sat
In reply to The Lemming:

There is also the paramedic motorcycle service. I took my son to hospital for a gash in his head. Unknown to me someone had called 999. The paramedic arrived shortly after I had left. We were seen straightaway at the hospital, wound cleaned, glued and dressed. The doctor told me I should have waited for the paramedic who could have done all that and saved me a trip. 

So maybe that’s one solution. 

The Lemming - on 13:45 Sat
In reply to DancingOnRock:

You got to hospital under your own steam and you were seen promptly.

 

Every credit. 

 

I have yet to see a single paramedic who will glue a head wound and leave a patient at home.

krikoman - on 12:04 Mon
In reply to DancingOnRock:

> The doctor told me I should have waited for the paramedic who could have done all that and saved me a trip. 

> So maybe that’s one solution. 

Again how were you to know this?


Please Register as a New User in order to reply to this topic.