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The underfunding of the NHS is very complex and multi faceted.
Waste and poor resource allocation and poor planning are all factors.
I worked in a cancer research department in St Thomas's hospital 30 years ago, thankfully not funded by the NHS, but even then your comment about poor resource allocation and poor planning was commonly used. Successive governments of all kinds haven't managed to fix it, just make it worse.
Godwin’s Law isn’t really applicable here
This thread is possibly one of the worst examples of my point but it seems that the only threads that make it so far as page 3 without mentioning them are ones introducing a new four legged designer lifestyle accessory.
The solution is not simply pumping more money into the NHS its diverting that money to places that
Carte blanche? No of course not.
Targeted structural reform is what's needed in particular management rather than service delivery.
It's a monumental project to rescue/restructure such a huge service provider, possibly unprecedented.
Hence the government wants to outsource bits of it and potentially all of it to avoid recompense.
Oh did company x fail after we paid them zillions of pounds? Not our problem, mate.
Slow privatisation is an easy way out.. Pass the responsibility on to a 3rd party supplier for this and that.
It's more about avoiding having to tackle the issue than actually tackling the issues.
Waste and poor resource allocation and poor planning are all factors.
Bit of a red herring, no organisation can be 100% efficient and every time anyone compares Health service efficiency they find the NHS is one of best performing Health services in terms of efficiency eg compared with Europe and the US. Overall ranking of 4th at the moment IIRC.
Our funding per head population is lower than a lot of comparable countries eg EU15 and US.
The UK spent £197 billion on healthcare in 2017, equating to £2,989 per person. This was slightly above the median expenditure for member states of the Organisation for Economic Co-operation and Development (OECD), which was £2,913 per person, but below the median for the EU15¹, which was £3,663 per person (Figure 1).
I learned a valuable lesson whilst lying at a (relatively) remote roadside with an unrideable bike beside me, a broken collarbone and some considerable road-rash. I was so far down the list of priorities that they eventually just said there was no ambulance coming, find your own way to a hospital.
I think because most people aren't having to use the NHS services they are unaware the reality of the current state of them and think you will magically get an ambulance.
the chap down the road died about 3 weeks ago while waiting 7 hrs for an ambulance, welcome to shit hole britain.
it was funny that he was unresponsive when the first one arrived, they managed to get another 2 there in about 15 minutes.
calling 111/999, or turning up at their local ED, they know how to play the system and what to say to the call takers to get an ambo call out.
This!
I’ve a friend who is an A&E consultant, this is their take.
They’ve analysed their attendance (large provincial hospital) and their 10 most frequent visitors (so not hospitalised) come in between 40 and 130 times per year; costing alone over £150k. They had over 1100 patients who came more than 5 times in a year (again no hospitalisations) costing £2M. These people should have been seen in the community by GPs and social care. So a combination of huge underfunding and unavoidable resource wastage. If an ambulance can’t unload it can’t leave, if the A&E team are seeing people who should be seen by a GP (some are equally aware of how to summon an ambulance unnecessarily) then they can’t see the less urgent patient on the ambulance etc etc.
It is a multi factorial problem with no easy fix, so no hope with the morons we have in charge with their short term goals. My friend says it should be driven from the bottom up (ie by those who actually do it), but that medics when they become political usually become useless (political disease!).
If you want to complain about it meaningfully - do it at the ballot box
Waste and poor resource allocation and poor planning are all factors.
NHS ( even in england where admin costs are twice as high as Scotland) is actually a very efficient operation providing exceptional value for money
The problem is anyone can call 999 and if there's any vauge chance of an emergency they have to respond and probably have to attend.
So if some Karen calls 999 hyperventilating because she's spilled her tea and has a mild burn... Etc
So it goes back to government and underfunded education.. No one in thier right mind would call 999 if they stubbed thier toe on a chair and thier toenail has fallen off.
That's not a medical emergency! That's clean it up with some TCP and put a bandage on it.
It's a huge issue, lack of education, people clogging up the health services with minor ailments that are easily treatable at home.
The health services have to assume the worst though, and have to respond. Even if they send most home with a plaster and a lollypop and a sticker to say what a brave little soldier they have been.
Carte blanche? No of course not.
Targeted structural reform is what’s needed in particular management rather than service delivery.It’s a monumental project to rescue/restructure such a huge service provider, possibly unprecedented.
Hence the government wants to outsource bits of it and potentially all of it to avoid recompense.
No, even that's misdirecting the solution. Yes of course such a megascale organisation must have efficiency savings and multiple layers of bureaucratic management appears to be part of the problem - but some of that might actually be how you measure and therefore direct the savings.
The issue is thinking of the "NHS" in isolation. e.g. we have obesity issue - rather than chucking yet more cash at NHS divert some of that investment to prevention or early intervention; we have an ageing population with complex needs which makes discharge complex / slow, divert investment into getting people out of (and staying out of) hospital; we have people going to hospitals because they can't access GP (or believe they can't); we have people going to hospitals who should probably go to pharmacy, but don't pay pharmacists to be accessible outside M-S 9-5; we have people going to hospital because they are in police custody and need examined, but don't encourage funding for police in house medical staff etc.
Even within the NHS - the ambulance service is not necessarily understaffed IF they can drop off their patients and go to the next job (I'm sure Drac will probably disagree - perhaps I should say not as critically underfunded!); but the cost to the ambulance service of having staff stuck outside A&E (and probably extra staff handling the queue on the phones, and the management dealing with the complaints etc) isn't a cost for the (e.g.) hospital pharmacy budget that meant today's discharges couldn't leave quickly and blocked the beds so a&e couldn't clear their cubicles and ambulances had nowhere to leave their patients. It would be a very bold ambulance service manager that said - we'll give you a tiny bit of our budget if you can stop this happening...
Three years ago my mother fell down the stairs and cracked her head open, blood everywhere and she was out cold. Took the ambulance 90 minutes to get to her and she lives less than a 5 minute drive from the hospital and ambulance station.
Although the NHS is currently underfunded we have nothing to worry about as the Brexit dividend of 350 million a week for the NHS will sort out any funding problems.
@Drac or others in the know:
Do you ever send community first responders to your low priority cases to (a) potentially resolve a trivial issue and avoid taking to hospital (b) assess if actually its a stoic elderly person who should really be higher priority? I appreciate that their main purpose is to reduce first on scene time for the highest priority calls. Or can you directly request (out of hours) GP to attend your low priority cases that are stacked up - and assess?
I’m no tory – but it does seem to be going that way. It somehow ignores that the public that voted for the tories (or enough of them did, and not enough voted for opposition perhaps due to a lack of credible opposition) are the same idiots that clutter up A&E.
because no-one want to pay what we’d have to to get the NHS we think we have. Until they phone for an ambulance or try to get a referral.
anyway, a bit more clapping should speed up call out times right?
because no-one want to pay what we’d have to to get the NHS we think we have.
Not true. Multiple polls have shown people willing to pay more and the previous scots government was elected on a tax raising manifesto
Good point, but not enough do so here we are..
You have to remember that the UK voting system means the tories get in on a minority vote
Blame for this lies at one place only - tory central office. Its deliberate policy to run down the NHS
FFS we even had Gove bragging about sending his kids to A&E rather than the GP
Same question that is asked all the time, unfortunately we all now live longer, but not healthier, they have managed to increase life expectancy, but not in any healthy state, so the numbers of octogenarians and above has increased hugely, and with the cost of support, a lot are having to do things that they shouldn't at that age.
Same with obesity and several other illnesses/conditions, on the increase and at the end a high chance of a 999 call required at some point.
On any visit to A&E you always notice the triage service, hence why people mutter when some mum brings in their kid with a tummy ache or sprained ankle, last time i was in (for a broken collarbone and so on) there was a mum who had the sprained ankle kid, but on entry it was suspected broken ankle, even though the kid was walking on it and chasing his sister with that weird herr flick walk.
I did notice a lot of NHS adverts trying to educate people, especially with the misuse of 999 and A&E to try and assist in reducing the burden they have, not sure how you fix this without trying to reduce the burden as well as increase funding to the areas that require it most?
I’m no tory – but it does seem to be going that way. It somehow ignores that the public that voted for the tories
It also ignores the fact that in the last 24 years we have only had 4 years of Tory majority government, but apparently everything that is wrong is the fault of the Tories and no one else.
And it ignores the fact that Labour governments pissed billions of NHS money down the drain on PFI, and billions more on killing brown people with a funny religion in faraway distance lands.
But they weren't Tories so that's alright.
Back about 20 years ago worked for the NHS,quite a few of the ambo staff said they where sent out to meaningless jobs as a taxi service, passengers, sorry patients would tell the call centre they had chest pains to get a call out, so one crew plus van off the road, then got another job working with on call GP s at night, and guaranteed every night youd have people who could have rung a gp and gone to a surgery would ring up for a GP visit, think i actually called an ambo on 2 or 3 ocassions for emergency treatment.
Whats needed is more funding for out of hours services, and a mental health team on call that actually go out or visit patients in need, no need for an ambulance to be sent, add in more capacity and staffing at A and E departments for major injuries and trauma with beds available not one in one out as is current practice,
Only last week a freind was taken ill at night and had to wait 5.5 hr for an anbulance on the advice of her GP on call service over the phone, i didnt find out next day or would have taken her there.Finally there used to to be a term called Scoop and Run, where the patient was scooped up, stabilised in ambulance and taken to nearest hospital, but they cant happen now due to under capacity and bed blocking etc.REleasing ambo and c rew for next scoop and run.
BBC1, now. Or iPlayer later on. The new series of Ambulance is just starting.
Gives a good idea of how much pressure they're under (we filmed it Jan-March this year).
I really can't understand this thing where ambulances can't just drop the patient off and get on to the next job where the on-board paramedics could save, or prevent a downgrade in, a life.
A few years ago I remember a crew positively coaxing a mate into an ambulance after a tumble at Penmachno. Somebody had seen the fall and called 999. He was kidnapped and taken up to Bodelwyddan near Rhyl. It was a chilly day and all the ambulance crews were happy having a warm cuppa and chat for a few hours until their cargo was triaged and handed over.
"The health services have to assume the worst though, and have to respond. Even if they send most home with a plaster and a lollypop and a sticker to say what a brave little soldier they have been"
I don't know what it's done in the last couple of years but until quite recently the percentage of A&E attendances that led to a full on hospital admission was the highest it had ever been. So while there are inappropriate attendances, the 'plaster and lollipop' types are a small and shrinking group.
There's huge pressure for beds at the hospital I work at right now (London). Which is weird, because the number of Covid patients is high but holding steady- and nowhere near the level it was in the second wave (it's about two wards full including ITU, as opposed to every ward in the entire hospital). It's basically looking like so many people stopped themselves coming into hospital over the last 18 months that a lot of them are
a) all coming in at once now and are
b) twice as sick and therefore staying twice as long
I really can’t understand this thing where ambulances can’t just drop the patient off and get on to the next job
because there is no room in A&E and / or no staff to care for that person in A&E so they paramedics have to continue caring for them
Don’t be angry with the service. Instead, be angry with the political system that made this happen.
I’m more angry with voters who can’t see beyond their own immediate needs.
My Dad lives in Shropshire too, and needed a 999 ambulance transfer to A&E recently
He was on the verge of cardiac arrest, the ambulance came immediately, which took 30 mins given the rural location
At the moment it’s a perfect storm in Shropshire. Old people have stayed hidden inside through out COVID and not had their health issues dealt with and now they are all getting very sick, GP’s are still not inviting people in for appointments, the local hospital has been poorly managed for the last 10 yrs or so, so the infrastructure isn’t fit for purpose or the population it serves. Ambulance crews are left with no option but to take people to A&E as there are not the correct support services in place.
Shropshire is rural, low population density so ‘shouldn’t’ need a large ambulance service, but then the population is dispersed, rural and elderly
All means that A&E attendance is at record levels and it’s only the middle of the summer
Oh and then of course we can blame Labour for its poor management of the NHS, and the population for not wanting to pay more in taxes, and caring more about our own neighbours.
Its not labour to blame - the NHS improved hugely under the last labourr government even tho money was wasted on PFI.
Haing worked in healthcare since the 70s its totally obvious - tories run it down. labour try to repair the damage and last time around actually improved it
. I took great delight in telling her she was in no position to complain about NHS issues as she voted for a man who wants to end the NHS and turn it to insurance
They voted for Frank Field?
I've sat in a ward watching the Matron bollock nurses for the wrong socks whilst ignoring the undischarged patient waiting for his prescription so he can go home. Still there 8 hours later, resorted to sitting in the aisle so they couldn't ignore me the bed blocker
The problem isn't just funding it's the organisational culture
TJ - I don’t think it’s the conservatives to blame either, it’s the populations appetite to pay equitably to fund the service to the standard people want it to be.
as it stands currently I think all political parties see increasing taxes as political suicide, regardless of left or right politics
Apparently this was labours fault
funkydunc - it is 100%
they have deliberately run down both the NHS and support services so that the A&E depts are under huge pressure along with bed reductions
Its deliberate policy so they can claim the NHS is failing so it can be given to their pals
The problem isn’t just funding it’s the organisational culture
Nonsense shows how ;little you know about the health service. Most staff work well above and beyond the call and their job description
Oh - and that was not a "matron"
Just got off the phone with my mother. My father had a fall at home yesterday evening after a few months problems with his legs. My mother called the emergency services and they advised as it wasn’t life threatening they would be there in around 60 minutes. Eight hours later they eventually turned up to take him to hospital after spending the night on the floor not being able to sleep because he was in such pain and not able to get up. Is this normal service in the UK these days? Shropshire Ambulance Service for reference. I’m personally livid about the situation.
To get to the top of the list, tell 999:
1. Your dad has just overdosed on heroin and is down to 1 breath a minute and totally unresponsive.
2. Your dad is a pisshead and has fallen, cracked his head, is unconscious and unresponsive.
My dad was in exactly the same position last week. We pay for a response care package so he can be lifted but unfortunately that didn't work so they called an ambulance. 6 hours wait in a collapsed state THEN head to be taken to hospital in case he had caused kidney damage...Catch 22!
As someone else has posted, our NHS and Ambulance Service have been run down to below skeleton service levels. Read into this what you will but I can hear BJ reciting all the failures as he announces major new funding for the NHS from a major American backer.
And we all know how that ends.
Paging Kier Starmer. Anyone seen him?
This was in the news yesterday.
https://www.bbc.co.uk/news/health-58186708
The soundbite was to the effect that radical decisions have to be made to "help out the NHS". It seems pretty obvious to me what will happen next - this is just the government softening us up.
I work with a guy who has had some major health issues over the past couple of years - he still continues to pay himself a rate below the minimum for NI contributions while having seemingly regular ct scans and visits to his consultant. So I'm afraid we get what we pay for, and what we vote for.
Something that we can all do to help reduce pressure on the system is to make sure that we have enough training to self fix ourselves, our buddies and any incidental problems that we encounter. Knowing that the injured may be waiting some time for help means that carrying some simple environmentals should be a no-brainer; a spare layer, a sit mat and at least two foil blankets should be in your pack at all times. It might be you sat on the ground for hours with a collar bone fracture; you might be first on scene when a pensioner falls in the street.
We can mitigate some of the impact we have in engaging in our (slightly) risky activities through first aid training and self treating where suitable. Our lifestyle choices can make an impact on the actual day when we get hurt but overall, these same choices lead to us having healthier lives with much less need for medical support over a lifetime.
An extension of that same mitigation- For a lot of years, this has been one of our key objectives in setting up and providing medical cover at Scottish ultra marathons. Building up the event structure and resourcing in such a way as to minimise potential impact on the health service, treating the vast majority of our casualties and illnesses at the event instead of having to ship them out. Normally, we'll be able to for example clean and suture wounds there and then, so that's one less person waiting for hours in a Q at A&E on a Saturday night. On scene blood analysis allows for differential diagnosis, exclusion of serious illness and recovery in our remote care setting. Still learning though..
a sit mat and at least two foil blankets should be in your pack at all times. It might be you sat on the ground for hours with a collar bone fracture;
With a collar bone fracture you walk out not wait for assistance FFS
Foil blankets are pretty useless
TJ, you know me; I've walked folk out in that (and worse) situations on several occasions. But many people will not cope with that pain level and will sit down. Foil blankets are far from useless; a bothy shelter, lots of clothes, a heat blanket and a rescue team are all better but we're trying to educate here, not criticise.
Fair enough.
Nonsense shows how ;little you know about the health service. Most staff work well above and beyond the call and their job description
Many do I agree
The conversation I had with the nurse when I asked him the umpteenth time when am I am going as I was bed blocking is that it made no difference to him as someone else would then be in it.....
My experience of maternity services doesn't make me surprised at the scandals emerging
The treatment of ambulance staff managing a late night transfer akin to entering an American prison
If we continue to pedal the myth of a NHS full of saints we will never fix the organisational culture issues
The NHS can be great, world leading, but it also has problems, some are funding, some are organisational culture
And again - you show your ignorance and lack of understanding of how things work.
He has a point tbh, some of the practices and cultures my mrs tells me about really gets your goat, not everyone is trying their best, right through the pay grades.
of course not. But to say its organisational culture them blame the shop floor staff is wrong and blaming individuals for burnout that leads them to be cynical is also wrong - as is as B&D did continually asking the same questions for something that is not in the nurses power to do anything about but to continue to waste their time then is surprised when he gets a snippy answer
With a collar bone fracture you walk out not wait for assistance FFS
Foil blankets are pretty useless
I've told this story before, but I was up on a Peak ridge when a rider coming the other way went OTB quite fast. She'd clearly knackered her shoulder and was bashed about and in no mood for walking off a hill with a painful dislocated shoulder. What was a lovely breezy sunny day (we were only wearing T-shirt and shorts) quickly became quite cold after we stopped riding. I guess we waited for about an hour, she was cold shivery and blue after about 10 minutes. Fortunately, some passing walkers had some sleeping bags and a bothy bag to keep her warm.
Nowadays, a foil blanket is the only concession to first aid that I carry (Because race bike).
Superficial
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With a collar bone fracture you walk out not wait for assistance FFSFoil blankets are pretty useless
I’ve told this story before, but I was up on a Peak ridge when a rider coming the other way went OTB quite fast. She’d clearly knackered her shoulder and was bashed about and in no mood for walking off a hill with a painful dislocated shoulder. What was a lovely breezy sunny day (we were only wearing T-shirt and shorts) quickly became quite cold after we stopped riding. I guess we waited for about an hour, she was cold shivery and blue after about 10 minutes. Fortunately, some passing walkers had some sleeping bags and a bothy bag to keep her warm.
Nowadays, a foil blanket is the only concession to first aid that I carry (Because race bike).
As stated earlier, if practical, get them down the hill, depending on how many are there it's a simple case of immobilising the shoulder, getting others to carry the kit and slowly descending, or getting to a pick up point where someone can then drive too.
Staying static isn't helping anyone with this type of injury, just letting them get cold, possibly going into shock and so on.