[Closed] Hospitals - a rant

He might've been fired by now, you don't know.

Utter rubbish. Competition causes the easiest cases to be cherry picked, allowing remaining hard stuff to dropped back into then-underfunded NHS, including where the private gods of medicine screw up

Right back at you AdamW -- utter rubbish.
The hard stuff will end up being priced properly. At the right price, the market will be happy to provide the service, and there will be competition to provide it.

The system in the states would work well with just a couple tweaks -- tort reform being the major one.

So, woman has blocked nose and hospital suggests over the counter remedy, woman goes to GP who suggests expensive drugs that she'd had before but clearly didn't work, no wonder the NHS has no money, I can't wait for GPs to be in charge of the budgets

rocketdog - she has more than a blocked nose*. This was recognised by her GP and he has prescribed a course of drugs that worked the last time she had the same condition.

*She is in so much pain she is sometimes almost in tears, just being a passenger in a car is painful, she can't wear her glasses because the pressure on the bridge of her nose is too severe. On Saturday morning she couldn't even move her head from side to side when she first woke up (which was why I insisted she went to the hospital).

Well yes but it also doesn't mean everyone is bad, like any organisation there's good and bad. Budgets won't make any difference to that.

I've always worked in the private sector and one thing I've noticed is that when a company is growing and/or has a huge budget it's easy to throw money at headcount. Because of the speed required quite often not enough diligence is applied to the selection criteria, so you end up with some less than ideal candidates getting jobs. I'm sure the NHS is no different.

I think the 'expensive' drugs did work RD but this is a recurrence of the same problem, which is the point of the OP's post.

Edit: too slow - that's what comes of working at NHS pace 😳

What I am suggesting is that if management were held a little more accountable then they might start to look for better value for the budget they have

I think you seem to have a misconception, management are accountable. If I'd ignored the issues I raised and had been found out chances are I wouldn't be working in the NHS any more and even lost my registration.

"He might've been fired by now, you don't know."

Unfortunately I doubt it. I quite often hear about poor performance in frontline NHS and it appears that very little often happens to get rid of poor performers even when colleagues complete the official incident forms or complain to seniors.

In fact I even know of one senior consultant who has been know to perform babdly for many years, yet no one has ever tried to get rid of him because of his status within the NHS. Colleagues and juniors try and avoid working with him where ever possible as they do not want to be involved in his negligence.

Anyhow.. on the whole frontline NHS staff work very hard and will always try and do 100% for the patient. The majority of the time its the system that goes wrong, not the individuals providing the care.

simple terms, people get ill, this is not the fault of hospitals or their staff, its a human condition. The people that work in hospitals are people, sometimes they make mistakes. Ever cut a gear cable too short or rounded a bolt?

People remember when things go wrong, and assume everything is right all the time. their are a lot of patients who don't have bad experiences, and a lot that do.

The people that work in hospitals are people, sometimes they make mistakes. Ever cut a gear cable too short or rounded a bolt?

Not read all of this but it has a certain familiar ring to it...

Patient attends out of hours at the weekend and is dissatisfied with the outcome. The patient then sees their own GP in normal working hours and is given what they wanted in the first place.

It happens all the time and also happens the other way round.

It's not got much to do with health or medicine or science, it's got a lot to do with people getting what they want/think they need/were given last time this happened.

If you want science:
Most respiratory tract infections are self limiting i.e. they get better no matter what you do. If you get better after taking antibiotics you tend to assume it was the antibiotics that made the difference.

Just looked up the local guidelines:

With sinusitis, about 30-40% are bacterial, and 70% resolve in 10 days.

In a STUDY comparing antibiotics with placebo (and both groups used decongestants and steam) antibiotics showed no benefit over placebo, and caused harm.
So best practice is to consider antibiotics only after 10 days of symptoms.

That is all fair enough but given the GP in OoH didn't know how to write a prescription and didn't spot that she didn't have tonsils didn't fill us with confidence in his abilities nor his diagnosis.

And on top of that he appeared to have chosen not to consider the history and that this is a recurrence of a condition. Perhaps it would have got better in it's own time but it didn't last time it appeared and her regular GP seems to agree with that assumption.

I think you seem to have a misconception, management are accountable. If I'd ignored the issues I raised and had been found out chances are I wouldn't be working in the NHS any more and even lost my registration.

Again, I'm not questioning the dedication, hard work, and ability of the majority, just trying to point out that not everyone shares those qualities. Bad apples need to be removed for the good of the system as a whole, wether that's in a private sector corporation or an area of the public sector as emotive as the NHS.

theyEye - Member

@adamw

Real competition coupled with complete information leads to better, more efficent, more customer centred services.

What utter rubbish - in health care privatised services are more expensive every time if full costs are included. The NHS is actually very efficient especially compared to private care.

Its simple - we get our healthcare cheap - the US you so like spends almost twice as (as % of gdp) much for worse outcomes. ~Competition
does not work in the NHS, cannot work, has been tried and failed badly

Slide side note so apologies, but is it just me or does anyone else think that Penny Valentine bird off of Holby City is a minx?

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"in health care privatised services are more expensive every time if full costs are included. The NHS is actually very efficient especially compared to private care."

Completly agree, as do quite a lot of private health care providers who are apparently deciding not to bid to provide NHS services come the NHS reorganisation as they can not see any profit in it.

TandemJeremy - Member

Its simple - we get our healthcare cheap

No argument there. Refer to OP.

TandemJeremy - Member

in health care privatised services are more expensive every time if full costs are included. The NHS is actually very efficient especially compared to private care.

Sigh...

'Private' is usually a precursor of competition, but doesn't always lead there. Equating 'private' and 'competitive' is naive at best, and disingenous at worst. Furthermore, competition doesn't always lead to efficiency, quality, etc. because it needs complete information to work -- i.e. educated consumer choice.

And another thing -- efficiency isn't always the same thing as cheapness.

So we're not talking about the same things at all.

TandemJeremy - Member

Competition does not work in the NHS, cannot work, has been tried and failed badly

Sniff Sniff. What is that smell? A vested interest in the status quo, perhaps?
does not work -- It doesn't work because it doesn't exist.
cannot work -- 🙄
has been tried and failed badly -- really? In the NHS? I don't think NHS has even a vague idea of what real competition is.

TandemJeremy - Member

the US you so like spends almost twice as (as % of gdp) much for worse outcomes

I'm not saying that the american system is perfect, or even good. It's not. But the fundamental idea of choice and competition is right, and would work like a charm if implemented properly. It's a matter of philosophy, and unfortunately will be for the forseeable future. Judging the market on the basis of what happens in the States is like judging socialism on the basis of what happened in the USSR.

FunkyDunc - Member

...quite a lot of private health care providers who are apparently deciding not to bid to provide NHS services come the NHS reorganisation as they can not see any profit in it.

Don't know the details, but this is likely a problem created by the government/health service through price interference. If the private sector cannot provide the same service as the NHS at the same price, this to me sounds like an indicator of the NHS 'undercharging'. That leads to cutting corners or not paying people what they're worth, i.e. reduced quality, brain drain, etc. Again, refer to the OP.

"If the private sector cannot provide the same service as the NHS at the same price, this to me sounds like an indicator of the NHS 'undercharging'"

Maybe your thinking about it from the wrong angle. A private company wants to make profit/pay share holders therefore needs to make its margin. The NHS doesnt have to do this in every transaction it makes. The NHS each year is over spending more and more compared to budget, I'm not sure this is the same as undercharging.

Judging the market on the basis of what happens in the States is like judging socialism on the basis of what happened in the USSR

Has true socialism worked in any country? As far as I'm aware, the socialist philosophy culminates in dictatorships. Therefore, if we're comparing private healthcare in the USA as a bad example, can you provide a good example of where it works well (or is it the same problem as socialism, where the system is exploited to benefit those at the top of the pile)?

And genuinely interested, by the way, as beyond the American model, no one has mentioned any other private healthcare model.

Mastiles, what do you do for a living? Just want to know so that I can dredge up any incidents from my life when I've had to interact with someone else from that line of work and been less than satisfied, and then tar all of you with the same brush.

The problem really relates to the "modern" provision of out-of-hours services. In the olden days you would have spoken to / been seen by a GP from your own practice. Now-a-days it's a mish-mash of GPs covering huge swathes of the population. Locums are often involved and I think quality is sometimes "variable". That's not to say that everything was spot on in the olden days, and to be fair back then expectations from patients were a good bit lower I think.

We ended up in this pickle because when the GP contract was renegotiated about 8 years ago the governement valued this antisocial work at only £8,000 per annum per GP. Most practices decided to take the hit and ditch this unpleasant side of work. Can't blame them since most would have endured years of antisocial hours and ruined family life, not to mention the years spent as juniors working 80+ hours a week and being paid 50% of the hourly rate for all hours over and above the first 40 per week. Yes folks that's overtime at HALF the standard rate. When I was a junior the cleaners made more than me on nights and weekends!

Hospital medicine is also sliding into the same cess pool of mediocrity thanks largely to the European Working Time Directive. Traditional firm (team) structures have been broken up by shift working, patients get passed from one team to the next with huge potential for cock-ups. The need to save money results in reductions in bed numbers so the patients are shuffled from ward to ward, the bed barely cool from the departure of the last occupant. And people wonder why hospital infection rates are on the rise.

The medical profession is doing it's best to hold the whole show together. I am amazed by the enthusiasm of many of my colleagues and their efforts to engage with management and politicians in order to try and safeguard patient services. I gave up engaging with them long ago. It seems to me that as quickly as you fight off one stupid re-organisation on initiative they think up another one. I just focus on looking after the patient in front of me and sod the bigger picture. It's the only coping strategy I have.

Just to complicate matters, demands on the service are increasing due to an ageing population and the exponential rise in the cost and complexity of medical technology, while funds are in short supply.

How did we end up here? We voted for successive bunches of idiots who think health care can be run like any other factory. It can't.

As for the private sector, those who have said it will cherry-pick the easy stuff are quite right (I should know I sometimes work there too). The private sector has no interest in those with serious chronic health conditions, they want healthy patients having discrete interventions such as arthroscopies or hip replacements. The last labour government negotiated contracts with private firms which paid them 15-30% over tariff and guaranteed them quantities of work. When the patient numbers going to the private hospitals didn't materialise the private firms were still paid for the full contract. Meanwhile those too complex or sick for the private sector still had to be done by the traditional DGH. Hardly a level playing field, but a great way to make the private sector look much more efficient than the NHS proper.

Be careful what you wish for - you might just get it.

Consultant Anaesthetist
17 years NHS service

Gasman Jim - Nice post

Mastiles, what do you do for a living? Just want to know so that I can dredge up any incidents from my life when I've had to interact with someone else from that line of work and been less than satisfied, and then tar all of you with the same brush.

Answer the question. What do you do?

But what does it matter? Your 'argument' is based on my tarring everyone in the NHS with the same brush when I commented hours ago to the contrary so anything you could say is irrelevant anyway.

But heyho, to give you your chance in the spotlight I work in the creative industry, mainly involved in designing and building websites.

Ohh, and we have done several for both the NHS and surgical organisations as well as lobbying groups and specialist disorder sites 😉

.....on 2nd thoughts

As far as I'm aware, the socialist philosophy culminates in dictatorships.

Not quite.

I suspect tyou're thinking more of revolutionary sociaism (what we called communism). On the revolution - the overthrow of the ruling system - the proletariat necessarily have to become a command organisation in order to ensure that socialism is planted. This is the dictatorship of the proletariat.

What you have then is a dictatorship lead by the rulers of the revolution and the continuing existence of a nation state.

The next phase - and the one no socialist state has ever got beyond - is the dismantling of the state and the removal of a ruling structure. At best, all that should remain is a self regulating bureacracy. Each person is to contribute what s/he can and receive what s/he needs.

Unfortunately, while a wonderful philosphy, the experiments have demonstrated that in practice it is not possible to move beyond the dictatorship of the proletariat.

Oh, and as for the concept of competition in public services, all this tells me is that politicians are incapable of taking responsibility for the fair, equitable and efficient distribution of the nation's wealth to those who need it.

docrobster

Just looked up the local guidelines:

With sinusitis, about 30-40% are bacterial, and 70% resolve in 10 days.

In a STUDY comparing antibiotics with placebo (and both groups used decongestants and steam) antibiotics showed no benefit over placebo, and caused harm.
So best practice is to consider antibiotics only after 10 days of symptom

So actually best practice was followed

So out of office hours medical attention was sought. A Doctor was seen and best practice guidelines applied. A prescription was given for medication. No money changed hands.

It is not certain or even likely that the antibiotics prescribed at the second free visit to a doctor actually will do anything to alter the course of the illness.

So - what was the problem again? Overprescription of antibiotics?

Right back at you AdamW -- utter rubbish.
The hard stuff will end up being priced properly. At the right price, the market will be happy to provide the service, and there will be competition to provide it.

The system in the states would work well with just a couple tweaks -- tort reform being the major

Yeah, right. [b]Your proof being?[/b] My proof is adequately shown by looking over the Atlantic. If you have money or can afford insurance all is cosy. If you can't, well, tough.

Any market tries to form itself into monopolies. Health provider A comes into the market, undercuts the NHS with nice cherry-picked stuff as a loss-leader. Hospital loses services and hence money and is denounced as crap. Oh look, a private hospital opens. Oh look again. All the prices have gone up. Compettition? Well yes, if you want to travel 50 miles to their hospital to get it done. Oo, can't afford that out of taxes, everyone must have personal insurance. Haven't got it? Well, we'll have a 'safety net' NHS. Lets call it, ummm, 'Medicare?'.

The US spends far more than us on medicine (and it's as corrupt as hell) and overall gives a poorer service.

I went to A&E last night

Wached Jaws 3 in the waiting room (total cost so far £1.5 parking, total saved £15 cinema tickets with the missus)

Saw locum doc (Russian, no beside manner, minimal chit chat*), poke wrist, ask questions, x-ray, check x-ray, nothing wrong with bones, points out which tendons connect where and most likely to be a bit sore for a few weeks, just keep it still for 48 hours, 2iburprophen 2paracetamol, 3x a day, and I'm off.

*I'm an engineer, I like this doctor

Should I have demanded antibiotics? I feel cheeted now.

Damn, Mastilles, I was really hoping you were a mechanic (particularly a VW mechanic) or a builder or a banker or an estate agent then I could have got my tarring brush out good and proper. But the "creative industry"! How am I supposed to use that to my advantage? That's just not fair. 😉

So - what was the problem again? Overprescription of antibiotics?

The problem is applying consumerist principles to a state run tax funded health care system. M-F didn't get the service he thought he should, so he has come on here to moan. The fact that that the service was in the best interests of the patient (no antibiotics) and the state (very cheap) has been overlooked.

Again, I'm not questioning the dedication, hard work, and ability of the majority, just trying to point out that not everyone shares those qualities.

I said that way back there somewhere but like I say no budget change will make that any different.

Gasman Jim a nice post up there.

Gasman Jim,

An excellent post.

I recently attended the Bristol Royal Infirmary and received what I considered to be a very efficient and satisfactory service. I'm aware that we ought to retain a sense of perspective on matters in the public sector.

Nice username - a derogatory name for your trade!

All the best.

The US spends far more than us on medicine (and it's as corrupt as hell)

It is a bloody racket. The hospitals bill the insurance companies for procedures, so the more they do the more money they make. So they do loads of stuff to you that you don't need and bill your insurance company for it. So then your premiums are huge.

To make the premiums affordable for employers they offer a sliding scale of cover. Most people are only covered up to a certain amount. If you have a big problem you have to stump up yourself, many tens or hundreds of thousands.

You might find that childbirth is not covered on your insurance, so you have to pay all the bills yourself to have a kid. And everyone gets the full medical works - operating theatre, doctors, nurses etc. You don't get a room and a midwife like you do here (if there are no problems).

The NHS tries to economise wherever possible, which can actually result in better treatment since the impetus is to only do what's needed and to get it right first time.

Answer the question.

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What do you do?

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PAXQUEEN!!!!!! 😀

[url=

brush vs @rsehole[/url]

A True pain in the arse patient for the NHS to deal with. Subsequently went to theatre to have it removed and bled like a stuck pig apparently.

Isn't just GP's though as the surgeon at first tells the casualty officer to just pull it out.

The only time I've ever really needed proper medical care was coincidentally due to my sinuses; Went to GP, he gave me a steroid spray (biggest polyp he'd ever seen!), 10 days later, it hadn't worked so I was referred and seen by ENT the next day.

Was seen by someone clearly incompetent, she couldn't speak good english, and took an unnecessary (and very painful!) biopsy and then left me sitting there bleeding for about half an hour! Wasn't very happy about all that, but after her faffing for a while she decided to get help.

I was then seen by a consultant, who would have booked me in for the following week for an op (I waited a week longer so I didn't have to miss any uni!), turned up on the day about 15 minutes late (at 9.15) because they'd told us to park in a car park which was closed and due to be demolished. Was told I wouldn't be seen til later so was given some squash (as I hadn't eaten/drank anything since 8pm previous night). Was then left sitting watching TV until 4.30pm when I was finally called in.

Op was over quickly, and I'd been told I could go home that day, problem was my consultant had gone home (I was the last one on his list), but all the nurses were very nice and eventually they got hold of the consultant who said I could home (and to come back in straight away if there were any problems).

Sinuses flaired up again a couple of months ago, I went straight to the GP as I was worried the polyp was back, he reassured me that it was jus tan infection, and no polyps but gave me some antibiotics to clear it up quickly (as previous polyp had apparently been caused by a long lasting infection in the sinus)

Not sure that was really relevant but it makes the point that there are a few dodgy people in the NHS, but generally people will go out of their way to help you.

Hope your wife is feeling better soon too, sinusitis is not pleasant 🙁

Junior Dr's you say.

Check out the awesome Paramedic with the bald head, he works long shifts, gets home late and he's not fat. Good looking lad too.

Show me a person that has never made a mistake and I'll show you someone that has never tried to do anything.

The NHS is consistently brilliant with moments of shit.

Excellent post, Gasman.

But the fundamental idea of choice and competition is right, and would work like a charm if implemented properly

Go on then, explain how competition would work in the context of acute services currently provided by a major teaching hospital - I'm talking A&E, emergency theatres, ITU etc. You spout this ideological dribble, and yet you are unable to offer anything except platitudes about the "market". The irony being that high quality care is often best characterised by [i]co-operation[/i] - between individuals, between teams, between - gasp! - hospitals.

thisisnotaspoon - Member

*I'm an engineer, I like this doctor

All my favourite doctors have had no people skills at all. Inspires confidence, you know straight away this guy didn't get where he is by playing the game and buttering up the right people, therefore, must be a good doctor.

To the OP; so the out of hours gp you saw followed NICE guidelines (no ABx for 5 days, but steroid spray if significant sinusitis), and you're not happy because you think antibiotics are the answer to everything?
This isn't an attack at you, but more in general the idea that a lot of people demand everything from the nhs (evidence lacking treatment, instant access to a consultant etc) then moan when a gp/a&e don't supply it!
If you want that sort of choice, go private. If you want treatment that is evidence based, and isn't going to drain the national health resources, sick with the nhs...

DrP

Check out the awesome Paramedic with the bald head, he works long shifts, gets home late and he's not fat. Good looking lad too.

and you're not happy because you think antibiotics are the answer to everything?

Why don't you read the OP and consider what I said, or, if you wish I will recap...

[i]It is an ongoing condition and only ABs helped last time. My wife told the GP this fact.

The GP didn't know how to write a prescription.

The GP needed a second opinion on what drugs he should give *for his (seemingly incorrect) diagnosis*

The GP thought my wife's tonsils were not inflamed.

My wife had her tonsils removed as a child.[/i]

Maybe I've just been lucky but my experiences of our local hospitals have been superb.

My mum had a heart attack last week. The standard of care in the local hospital was excellent and all the staff lovely. I'm eternally grateful.

Similarly good experiences with birth of both kids (with a difficult birth with one and my wife poorly after the 2nd), myself hospitalised with glandular fever, ligament damage, A&E after injuries etc.

It's easy to knock big organisations like the NHS but they generally do an excellent job. Just be grateful you have a mostly free medical system where you can actually see a doctor so easily.