Forum menu
Crikey - very simple really...(and to repeat)...one that is managed better for the benefit of patients. This is not weasingly, it is merely a different perspective with different terms of reference.
Like most aspects of economics/politics/businesses[b] the "system" [/b]is massively over-stated as the reason or cause of both good/bad performance. Worse than that it obscures the real issues - but when has that ever stopped the headline makers? Its comes down to the people involved. Too much debate comes down to polarised views, so yes I will counter the argument that central planning is the only solution, not because the opposite extreme is necessarily better (although always happy to smile when other put those words into my mouth) but because that is not supported by the facts. Simple. Hence perhaps the most interesting part of the health care analysis for me is:
There is no health care system that performs systematically better in delivering cost-effective
health care. [b]In fact, the efficiency estimates vary more within country groups sharing similar
institutional characteristics than between groups.[/b]
Comes down to having good people in the right jobs. Basic business/common sense.
And FWIW, as I have said before the current reforms are unlikely to achieve this.
Missed TJ's barb in posting - you can breath out now 😉
So what system do you want? Its a simple question.
so yes I will counter the argument that central planning is the only solution,
Please do. I would be interested to hear it. So far all you keep doing is repeating platitudes that you don't understand.
for instance the entire philosophical basis for dementia care is "patient centred"
So what do you want?
Most of these debates end up the same way; care is at the centre, people tend to argue about how to fund it, either through taxation or by insurance.
What do you actually want that is different?
See if you can be succinct, brief, perhaps get to the point?
Myself and my partner were in hospital for 5 days last week giving birth, and post natal care to our daughter. The care was extraordinary - the mid wife never left my partners side except to use the loo, she refused to even go eat in case something happened. In the end my partner had a c-section which went extremely smoothly with great communication and care by all the staff.
I for one am extremely proud of our NHS, sure it has it's problems - but our we should support our doctors, nurses and midwives, and be proud of what we have access to!
told you not to hold your breath crikey. 🙂
Give the geezer a break TJ, he's obviously putting a lot of effort into his reply. Stuff like that takes time. I know crikey said [i]"See if you can be succinct, brief, perhaps get to the point?"[/i] but teamhurtmore likes to be thorough.
I'm getting quite excited - I hope he's not too long.
One is tempted to assume that, like apocryphal warriors of old, they don't like it up 'em.
Which is a shame, because the debate is not black and white, not NHS or not, not private vs public, its about finding out what the best way is, hopefully in an apolitical way.
Healthcare for a population is more important than politics.
So what system do you want?
I can honestly say that the vast majority of the public want the NHS left alone
it fairly obvious with the coverage that the bill is getting- very few folk want it so just **** off and leave it alone
Healthcare for a population is more important than politics.
And yet healthcare is always a highly political issue - always has been.
Here, in the US, ....... all over the world - everywhere.
It is, and of course we know it is. But...
We can argue forever about it, most far better than I can, thm is a case in point, as is ernie, but the outcome is more important than the argument, much, much more important.
The only bit of tory policy I liked seems to have been forgotten. to take control out of the hands of politicians and to set up an independent board to run the NHS.
[b]TJ[/b] my view hasn't really changed. I think there could be some very good changes made to the NHS, and the private sector has a role to play. Not everything which involves it is bad. And there are GPs who have been involved in this stuff for 20 years now. I think your previously expressed views are a bit too polarised.
But the way it is currently being configured is doomed to fail. From a pragmatic point of view it sucks.
jota180 - MemberSo what system do you want?
I can honestly say that the vast majority of the public want the NHS left alone
it fairly obvious with the coverage that the bill is getting- very few folk want it so just **** off and leave it alone
People are generally resistant to change anway but that doesn't mean they don't want better healthcare.
Not a supporter of the bill or the Tories for that matter but having been on the wrong end of "our envy of the world/fantastic NHS" I want,in fact, demand better healthcare.Anecdotal stories are only part of the evidence but I can assure you that if you had experienced some of the appalling "care" first hand that the NHS dished out your views would be influenced by that.IME the poor care was nothing to do with lack of funding but systemic failures and the whole complaint process was farcical.We eventually got an apology but by then my father was dead.....
and that is a very fair comment.
One becomes rather unpopular by complaining about poor service patients get. About to do the same with a department which is letting my patients down. There is some real complacency. 🙁
TandemJeremy - MemberThe only bit of tory policy I liked seems to have been forgotten. to take control out of the hands of politicians and to set up an independent board to run the NHS.
To an extent I agree but would a board set up to run the NHS ever advocate it's dismantling even if it was in the best interest of the patients?
There are many areas of public policy which should stop becoming political footballs-pensions ,care,education even defence where more or less everyone agrees on what the outcomes should be for the benefit of the nation. It's the delivery and cost question that keeps it political.
As front line staff, I am intimately aware of these kind of problems, more than I would ever wish on anyone... Nut... these kind of problems are not a function of the NHS, they are a function of any healthcare organisation, anywhere.
This kind of points out the issue I was alluding to; healthcare at the point of delivery, at the bedside, at the operating table, at the GPs desk is the same, however it is organised...
We can argue forever about it.......... but the outcome is more important than the argument, much, much more important.
I agree, I would say the same thing also concerning the economy, and most other things for that matter. We don't however live in that sort of society - every issue is treated as a political football. It's all down to vested interests - on all sides. If you want everyone to sing from the same hymn sheet you're going to need a very different sort of society. That's not going to happen any time soon.....so just carry on.
nick - while its obviously wrong to get poor care I really doubt it would have been any better dealing with shortcomings from the private sector - more likely worse. People with a financial interest in protecting their reputation are not good at disclosing fault
I am a strong believer in no fault incident investigations so full disclosure is made allowing lessons to be learnt.
there was an avoidable death in Lothian which has resulted in a complete overhaul of ways of working across the entire area. something that could not have been done had we had a foundation hospitals and the fragmented system the tories want to impose in England
...and just to try to even up the balance, I and many of my colleagues have sat with the relatives of our patients and helped them, even insisted that they complain about treatment that patients have received. Poor treatment is poor treatment, and we will call it so whenever we see it.
the nhs is being wrecked. not by dave and his mates but by the tens of thousands of incompetants, shirkers and pocket liners it employs. many are genuine caring professional talented people but alas an increasing number fall easily into my first description.
i ve had strokes heart attacks heart surgery so have reason to be grateful for the second group but no tinkering from dave and herr clegg will threaten them nor regrettably the former group.
the physio who insists i have a twisted muscle in my shoulder that i should self treat with heat and ibuprofen ( which could simply kill me) without even touching me and in the first two sesssions of physiotherapy has yet to touch me other than to hand me pre printed sheets of excercises ( unlike the private consultant and two physios who are actively and physically treating the trapped nerve revealed by x rays and touching my back..
the trust management team who may lose thier 'roles' in any new proposal who are now spending 1 day a week networking to agree / position thier new roles in a future reorganisation and a second day each week preparing another trust for the same reorganisation..
the nurse who would nt remove the drain from my chest when asked by three doctors to do so and left at the end of her shift asking a student to do it ( i was her only patient in an hdu)..
the consultant who diagnosed my stomach condition without speaking to me or doing any investigations as he was too busy to see me..
the a and e doctor who when handed a letter from a prof. of genetics with clear instruction on how to react when presented with my daughter who decided to ignore our pleading and the instructions so that contary to the instructions he could run some tests which would lead to her death.. until my wife removed the daughter from him and contacted the prof. who had to scream down the phone at the dr to get him to do as it said in the letter..
the 12 nursing staff who ignored the plight of a blind deaf man in considerableain for 12 hours as other patients asked them to care for him and finally the priest had to feed and change the chap.
the nurses who paraded and made fun of a now senile famous former MP in his soiled underwear..
the nurses who made fun of a former tv star of the seventies who could no longer care for himself
angels there are some and i owe my life and eternal gratitute to several.. shamefully there are many who are not.
Sorry to hear that totallshell -there is no excuse really .
London / south east?
This is not an NHS problem, this is a people problem, and you should complain and make it stick. I see a number of 'it should have been different' cases, and I ask and push for each and every one to be looked at.
It's not professionalism, its not any kind of high minded stuff, its because I'll be there one day, and I don't want to be treated like that.
nick1962 - MemberI can assure you that if you had experienced some of the appalling "care" first hand that the NHS dished out your views would be influenced by that.
So sure of that? Without going into too much detail, the NHS totally fumbled treatment of a condition of mine and the result will leave me in pain every day for the rest of my life (managable pain, most of the time). But it was a situation that could have occurred just the same under private care, right, mistakes happen? Except, except, I'm diabetic on insulin and I couldn't afford health insurance under the US model. So in all likelihood I'd actually be much worse.
Only an idiot says the NHS is perfect, or couldn't be improved, or couldn't be more efficient- nothing is perfect. But on balance it provides mostly decent care, for a hell of a lot of people.
That's a rather long post totalshell, which according to you, isn't relevant to the issue : "[i]no tinkering from dave and herr clegg will threaten them nor regrettably the former group[/i]"
Since you don't think that the Health and Social Care Bill will deal with the issues you've highlighted, why mentioned them - just fancied have a dig at the NHS/medical professions and thought this would be a good opportunity ?
And, I'm going to risk the big ban hammer now, if you know of a way to make things better, for ****s sake, say so. It's OUR healthcare system, let's make it as good as we can?
totalshell
Sadly there are too many similar tales. 🙁
TJ
I am a strong believer in no fault incident investigations so full disclosure is made allowing lessons to be learnt.
+1
People with a financial interest in protecting their reputation are not good at disclosing fault
Isn't that still the case in the NHS though,professional reputations,jobs/pensions all at risk if fault is found?
Do NHS trusts not try and defend their reputation as much as BUPA or whoever would?
An independent complaints system outside of the NHS or relevant private healthcare provider could mange this surely?
Northwind
Only an idiot says the NHS is perfect,
And only an idiot would advocate us adopting the American system of healthcare 🙂
Want the TJ prescription?
1) remove all vestiges of foundation hospitals, internal market, fundholding and so on. Been done up here and immediate and obvious improvement as it meant rational planning could be done and information shared.
2) a moratorium any further restructuring for 5 years at least bar getting democratic accountability at regional level returned and an independent board to run the NHS
3) strengthen NICE, have a rational debate about rationing.
4) Be prepared to use more and better quality management
5) share best practice and use meaningful quality indicators to pinpoint poor practice
6)Make care of the elderly nursing a speciality in its own right and work to increase kudos and give a higher priority to the sector. Remove dementia care from mental health services
7) no fault incident investigations
Longer term integrate health and social care - the interface is rubbish and leads to a lot of issues.
Look to other countries and compare and see where we perform less well and look to why
Overhaul training of healthcare staff - a common foundation year for all perhpas.
TJ
Do we get the English to pay for your prescription? 😉
An independent complaints system outside of the NHS or relevant private healthcare provider could mange this surely?
No - It has to be "no fault" otherwise you do not get full disclosure People being scared of being blamed leads to over up. worse in the private sector but happens all over.
This is the recent case in Edinburgh where a woman died. One thing that is apparent is there was no one fatal mistake - indeed a lot of mistakes occurred over a long period of time from the nurse who asked for training and did not receive it to the doctors rota that meant no one with specific knowledge was on duty to a series of errors and omissions during her care. However several people gave incomplete evidence or attempted to shield themselves from blame which makes it harder to see what went wrong
This case has meant major changes to the way things are done and every member of care staff medical and nursing has been retrained and tested on assessing unwell patients and a system for reacting to incidents of this nature is displayed everywhere. SEWS and SEBAR. Displayed by every phone
I have no doubt at all that the changes in care could not have been made as eaily under a system of competing hospitals and fragmented care - this involved 3 major hospitals in two different towns and a significant number of subsidiary units. All ahd to co opertate to make the changes
http://www.scotcourts.gov.uk/opinions/wightman.html
nick1962 - MemberAnd only an idiot would advocate us adopting the American system of healthcare
Watch out- you can get modded to bits for telling idiots that they're idiots on this forum.
Sadly there are too many similar tales.
There are so many tales to be told, and some of them are dramatically different. Two days ago a former g/f was giving me the heartbreaking details of the final hours and minutes leading up to the death last month of her 23 year old daughter from terminal cancer. She spoke of the dedication of the staff, including the doctor who refused to go off duty just in case he was needed to be there and administer medication to stop her daughter from panicking (I don't know why it needed a doctor). He stayed until she died. For over a year since first being diagnosed the NHS had looked after and treated her daughter. During that time she has hardly worked due to her commitment to her daughter, leaving her penniless. But also during that time, her daughter received the best treatment available from NHS, and without delay. I cannot begin to imagine how she would managed without the services of the NHS and the dedication of its medical staff.
my experiences are all oop north.. and the reasons people dont complian and force the issue at the time..
let me think you/ your loved one is seriuosly ill in bed and your life is in the hands of the person your complaining about... not a hard decsion is it..
if your on a coronary care ward on a night ( about this time) your life is 100% dependent upon the willingness of the one nurse and two assistants.. you keep your mouth shut and smile and make yourself as attractive as possible you dont complain fuss be unco operative because when you need that rash cart which patient will they CHOOSE to resuss..?
ernie a sad tale but i ask this.. if we had the same survival rates as France 7000 more people would be alive each year... thats not down to money thats down to poor care and its the staff who provide that care..
France spends a third more on healthcare than we do. But it's definately nothing to do with money?
ernie
Sad story indeed and there are many examples of fantastic work ABCD by NHS staff.That's why anecdotal evidence has to be treated carefully.
Would my father or your friend have got better or worse treatment if they had been treated under a different system? Would private hospital nurses/doctors have been as good/bad? I can't answer,not sure any of us can.
But perhaps more importantly would they have been treated at all which I think is the more pertinent question and from where a lot of fears about change in the NHS arise .
if we had the same survival rates as France 7000 more people would be alive each year
What that's for - all cancers ?
Unless French doctors can work miracles then I doubt that my ex g/f daughter could have been saved. She had two lots of completely unrelated cancers. I don't think her daughter's death had anything to do with "poor care and its the staff who provide that care". She was particularly impressed by the speed of the treatment and the dedication of the staff. On Saturday she told me, in fact she made a point of telling me, how grateful she was that they had given her daughter an extra year of life - her daughter was very very ill when she was first diagnosed. And a year which her daughter very much enjoyed btw, she went out with her mates, went back to uni, etc. In that whole period only once did a medical member of staff give her reason to complain - an inexperienced staff member told her daughter prematurely that her cancer was terminal. When senior staff found out they were furious and bollocked the woman, saying that wasn't how they "were treating it". Yes sometimes mistakes occur.
"One of the wonderful things about living in this country is that the moment you're injured or fall ill — no matter who you are, where you are from or how much money you've got — you know that the NHS will look after you."
We should all get business cards printed with this on and always keep them on our person just in case.
Call Me Dave's words BTW!
[b][i]"Doctors and nurses need to be able to use their professional judgement about what is right for patients, instead of being forced to follow bureaucratic processes that often put lives at risk."[/i][/b]
Conservative Party Election Manifesto 2010.
In 2012, doctors and nurses are telling the government that after using [i]"their professional judgement"[/i] they believe that the Health and Social Care Bill should be ditched. The Conservative Party isn't listening.
Some kwality arguments in this thread. Interestingly our experience in my trust of the reforms and cost savings so far have been good in some senses: I haven't noticed the effect of a whole chunk of managers leaving/being laid off, but the immense pressure we are getting in [s]sometimes[/s] usually rather inconsequential 'measurables' does seem to reflect the worry about money and ultimately their jobs that the remaining senior managers must have. They have even started abbreviating 'Key Performance Indicators' to KPI's and dropping it in all over the place, like they actually make a difference to the care our patients recieve! 🙄
because when you need that rash cart which patient will they CHOOSE to resuss..?
A long while since I worked with cardiac/coronary patients. And I usually just walk away from contentious comments, but this bit is utterly utterly wrong.
DNR status is hugely important in all areas of NHS (we even formally record it for teenagers in mental health, as if you would wonder whether not to attempt resuscitation ffs). Compassion and 'why you do this job in the first place' aside, to ignore an arresting patient is sackable/stike-offable at the very least. In fact, the 'reportable/untoward incidents', complaints and disciplinaries about resuscitation arise because people ignore DNR's and resusciate folk who for various reasons shouldn't have been!
Shockingly bad care is available all over the health and social care sector, public or private. NHS arguably has better support for 'whistleblowers' and it is far far easier to flit from job to job or agency to agency in the private sector being rubbish, negligent or just 'orrible, because these places don't talk to each other/'network' in the way that nhs facilities in the same geographical area do.
[edit] Good post Ernie; the professionals on here are again being accused of opposing this because we have our own interersts or limited scopes at heart. I am well used to my own professional judgement being 'factored into' bigger decisions led by my consultants and senior managers, and the outcome not always being what I thought best, perhaps because I lacked the bigger picture, or the years and years of experience.
But what to do when pretty much [b]everyone's[/b] professional judgement, including defunct SHA's, commsioners, trust directors, senior managers, consusltants and all say this bill is not in the interest of the patients? 🙁
Petition mentioned on first page now [b]signed[/b]. I will pass the address of it on to some friends as well.
Thanks for posting this.
"Doctors and nurses need to be [s]able[/s] made to [s]use their professional judgement[/s] follow bureaucratic processesabout what is right for [s]patients[/s] shareholders of healthcare providers, instead of [s]forced to follow bureaucratic processes[/s] thinking they should use their professional judgement [s]that often put lives at risk[/s] to provide a level of dignity and effective healthcare to patients."What the [b]Conservative Party Election Manifesto 2010[/b] actually meant to say
Strange that if a tradesman does sopmething wrong in your house or to your car/bike, ,you have bad food at a restraunt, a bad haircut,
YOU COMPLAIN,
yet you go into hospital, for an operation or some diagnosic tests and the system fails, or the staff fail, then you never complain, or if you do,only on bike forums or annonymously, for fear of repercussions, as if things go wrong you have to met the same staff who failed you at the same hospital.
Lets all remember Staffordshire hospital, and a few more who seriously fialed its patients, and even managed to kill a few, due to neglect, and poor management.
I can't decide if Lansley is mendacious or completely mad, or both.
100,000 signatures! Awesome.[url= http://epetitions.direct.gov.uk/petitions/22670 ]Please forward this link[/url] to friends & family.
Anyone interested should follow @cpeedell @bengoldacre and (for comedy value) @Lala_Lansley on Twitter.
I'll stop going on about this for a bit and get back to building my retro steel Kona commuter.
Cheers