[Closed] The NHS isnt working

TandemJeremy - Member
McBoo - your ideological hatred of the NHS shines thru.

Nope, I try not to be ideological about anything. Just try and form my own opinions by weighing up the evidence and my and my family's experience. But thanks for the personal attack.

Oh and please, enough with all the Tory-hate. The Coalition is increasing health spending in real terms at a time when other departments are taking cuts of up to 25%. Labour policy at the election was to cut spending.

Yes of course, the NHS always does much better under Tory governments than under Labour ones. Because the Tories have a passionate commitment to the socialist principle of free healthcare for all, whilst Labour on the other hand has always been opposed such wastefulness - everyone knows that.

Along with your defence of international global investment bankers who refuse to pay interest on money they owe the inland revenue, you show all the skills of a Tory front bench politician mcboo.

I take it you're a stinking rich multimillionaire and not just a mug ?

mcboo - well its clear you know the price of it but not the value. Its clear you are not coming to this with an open mind

I spent a few nights in hospital bed-bound a couple of years ago.

The standard of healthcare was very good, the other care not so - this wasn't a big deal for me as I don't have a problem with been 'forward' plus had plenty of cash for the little 'chap' (not sure what he did, porter maybe?) to pop to the shop/cafe for me. He made some money, and I was comfortable.

Hate to imagine been in there longer term under other circumstances.

TJ - money might have been an excuse 5-6 years ago - but as a proportion of GDP, the NHS is [i]now[/i] not much cheaper than many successful European systems.

For me the challenge is how you introduce financial and clinical accountability to the system, with some sensible competition to spur people and services on, and penalise failing teams rather than reward them, without dismantling the ethos and structure of the current service.

What do you think of the issues about how nursing has changed which are raised above and in radio/newspaper commentary?

Still a significant difference stoatsbrother. around 20% per head less funding

from a slightly cynical perspective. I was overhearing the sister on my Ward discussing that apparently the nursing union are considering strike action over pensions ( which I massively disagree with) on 30th Nov. Who runs the care quality commission? timing of the release of this report seems a bit convinient to remove public support from the nurses?

TandemJeremy - Member
mcboo - well its clear you know the price of it but not the value. Its clear you are not coming to this with an open mind

Riiiiiiiiiiiiiiiiiiight

Yes mcboo - 'cos this is such an objective assessment

mcboo - Member

The unnacceptable part of this is that it is happening after a period where the NHS was sprayed with cash. Labour what doubled the real terms spend on healthcare? Everybody got a payrise.....

The public support the nurses when they do the job properley, not neglect patients who are old and infirm , who cnat look after them selves.

Most workers can strike, some peeps will support them and some dont,a report on poor quality care, which is based on truth, and had trained nurses involved just shows up failures in the system that need to be sorted, if staff dont like the job or the pension, then leave.

some sensible competition to spur people and services on

The idea of competition is just rhetoric, it isn't the best solution in many systems, such as the NHS. What is needed is getting the whole organisation and its partners pulling together for the same goals, not competing against each other. Create a system with winners you also get losers, the competition is damaging to the system.

Yes mcboo - 'cos this is such an objective assessment

mcboo - Member

The unnacceptable part of this is that it is happening after a period where the NHS was sprayed with cash. Labour what doubled the real terms spend on healthcare? Everybody got a payrise.....

Which part of that isn't objective?

Hugely increased health spending is Labour 1997-2010 crowning achievment, I don't remember Brown being shy about talking about it at every opportunity. Didn't NHS staff get a pretty substantial payrise?

Some of that spending was sorely needed and who would begrudge doctors and nurses a lift from the relatively low salaries they were on in the 80s and early 90s. But the money wasn't all well spent and there isnt a whole lot more.

Which part of that isn't objective?

The [b]unnacceptable[/b] part of this is that it is happening after a period where the [b]NHS was sprayed with cash[/b]. Labour what doubled the real terms spend on healthcare? Everybody got a payrise.....

Pejorative terms. prejudging the outcome, use of "sprayed"

Really - its laughable who much you want to twist the facts to fit your preconceptions

But the money wasn't all well spent and there isnt a whole lot more.

Any evidence that the money was not well spent?

How about we start with this?

http://www.guardian.co.uk/society/2011/oct/13/nhs-hospitals-care-of-elderly <

Nice circular argument. so that story shows to you that the money spent is wasted? No evidence or reasoning to back this up.

Now I'll ask again. Any evidence to back up your idea?

I know the NHS improved dramatically for the injection of cash. A&E waits down, waiting lists down, outcomes improved, new treatments developed and offered. All backed by hard data. Try the kings fund for data

Of course since the tories got in and started cutting the NHS and preparing it for privatisation waiting times have shot up. What a surprise

Any evidence that the money was not well spent?

Hows about 4 million quid a year on Homeopathy?

http://news.bbc.co.uk/1/hi/8524926.stm

was that money well spent TJ?

TJ - From the Kings Fund:

In 2003/04, the NHS cost £63.7 billion pounds. In 2004/05, hospital and community services
(the largest component of NHS spending) have received an additional £5.1 billion pounds.
However, much of this will go on pay and other ‘cost pressures’, such as clinical negligence
claims and the additional cost of new drugs. As a result, the extra money available for
additional patient services is only 2.4%.

In addition, NHS productivity (the amount of activity provided in the NHS for every pound spent)
has been falling, according to the official measure. On the face of it, this suggests that the NHS
is getting worse value for money than it used to.

Money well spent? 😐

I don't have much time, but I'd just want to add my 2pworth.

1. The fact that we are crating up the WWII generation on understaffed, under-resourced elderly care units indicates that something is seriously wrong in this country. IMO, that transcends any issues with the NHS (highly significant as they are) - & the projected demography requires a shift in attitude by all of us.

2. I do not doubt that there are slack nurses - indeed, I've met 'em. Nor would I seek to excuse poor practice. But stuff not getting done because of deliberate neglect is very different from stuff not getting done because there ain't enough boots on the ground. In that respect, little has changed since the day of [url= http://www.patientprotect.org/pink.htm ]Graham Pink[/url]. Elderly care has always been a cinderella service - starved of investment, even as we prolong life and improve treatments. On, say, a 26 bedded ward in my old hospital, it would not be unusual for night shifts to be staffed with 2 x RNs and 2 x care assistants. Given the workload - a large number of dependent (and frequently confused & frightened) patients - how in Flo's name are the staff expected to do it all (think: keeping the patients clean & comfortable, adequately hydrated & nourished, IVs, drug rounds, liasing with medics, handover to other wards, answering the phone, escorting patients off the ward for scans etc), not least given that [i]everything[/i] has to be documented, or it's your registration on the line? Now, my own view is that once you have a tickbox for stuff you should be doing anyway (e.g. 2 hour intentional rounding), then the profession has already failed - the answer to the problems created by lack of staff isn't to create yet [i]more[/i] paperwork. Besides, try and document everything, update the bed status and check blood results on the computer - and somebody will [i]still[/i] accuse you of reading [i]Heat[/i] magazine at the nurses' station.

3. Acuity on general wards has shot up since the mythical golden age of Hattie Jacques. Patients who once would have occupied HDU beds are now nursed on general wards, with considerably worse nurse:patient ratios than high care settings. As part of their role, staff nurses have taken on far more 'medical' tasks, partly as a consequence of the reduction in medical cover (medical/surgical 'firms' are ever smaller, with resulting on-call overstretch). The senior nursing hierarchy seem to have treated this as a glorious opportunity for professional empowerment, but they generally ain't the ones having to deal with it on a friday night. Specialist and extended role nurses (e.g. tissue viability, drug support, ITU outreach etc) do a superb job - but they should be working in partnership with medics, not replacing them.

4. IMO, the debate about the 'academicisation' of nurse training is something of sideshow (and one frequently given to [i]Daily Wail[/i] hysteria). Are people saying that academic ability and simple compassion are a contradiction in terms? FFS, it's perfectly possible to know your biochem backwards [i]and[/i] be capable of comforting a patient. What has gone (IMO) [i]very[/i] wrong is the import of faux-sociology nonsense into nurse training. No course can prepare you for the wards, but your time can be used well - & frankly I'd have preferred to have been drilled in stuff other than 'reflective practice'. That [i]doesn't[/i] mean that uni-trained nurses are too posh to wash - some of the best I've ever worked with are fresh out since P2000, and some of the worst have been decidedly old guard. Besides, the care assistants who now have the majority of patient contact time are frequently themselves nurses, medics, physios etc in training. And if you are a senior HCA or AP, you are more-or-less the equivalent of the old SEN (but without the recognition). There is a route to band 5 (staff) status for such inviduals, many of whom have absolutely gleaming skills and clinical acumen. But the long-running argument over nurse education still doesn't alter one basic fact: [b]there ain't enough of them[/b], and the single biggest improvement to patient care in this country would be to sort out the bludy awful nurse:patient ratios. As for whether the ConDem reforms will achieve that... 😕

other half has done home care. Problems as follows unrealistic work loads, you have to get round a number of people and you are given an expected time, a time that takes no account of what the client actually needs. Add in that the money you earn is based on what the council thinks it takes not what it takes. ie unpaid overtime to get the job done.

The other issue is a large proportion of the people who end up as care workers, to be fair most people would turn them nose up at the job and the regular "wipe arses for a living" jibes you get.

Would you really want to be earning minimum wage and deal with the crap you get subjected to?

Yes there are good carers as well as bad, but the way staff are treated in many homes it is hardly surprising that the start to get jaded and stop caring.

To noteeth's comments, I'd just like add - how many people think that a pay freeze, increased pension contribiutions, increased parking charges where I am (cheers, private sector parking company), increasing workload and decreasing resources to met that workload expectation is in anyway a motivational or incentivising factor to anyone considering starting a career in healthcare?
clue - someone pointed out earlier that we have massives of stupidly expensive equipment lying about not being used at night. use it at night? great idea, but where do we got the staff from? We already struggle to recruit enough people to operate a daytime service, and believe me there are not floods of people training to replace those who are leaving.
We've heard the daily mail'ist "if you don't like it leave". people have said that on here often enough. Well, congratulations - they're leaving, and look at the result

Of course since the tories got in and started cutting the NHS

Cuts? What NHS cuts are those?

I'd go look through the web and produce something that illustrated perfectly the abovementioned fall in NHS productivity, but seeing as it's you asking, whats the point? You're the guy that won't accept data from the IFS because they have a well known right wing bias.

I dont normally bother to comment on this sort of thing as it often gets you nowhere and to be honest I ride bikes and use cycling forums to take my mind off this sort of stuff but unfortunately I couldnt help but read this. As a registered nurse of ten years experience and three years before my training as a healthcare support worker i would like to offer noteeth a pat on the back for hitting the nail on the head. It was refreshing to read a really sensible well informed post from a fellow professional.

OECD Health Stat numbers 2008

Total Healthcare spending(i.e private and public as % of GDP)

US 16.4,France 11.1, Germany 10.7,Sweden 9.2, italy, spain, both 9, UK, Ireland, both 8.8, Norway 8.6, Japan 8.5, Finland 8.4

2009 where available

US 17.4,France 11.8,Germany 11.6, Sweden 10, UK 9.8, Norway, 9.6, Italy, Spain and Ireland all 9.5, Finland 9.2 - no figures for Japan.

A 20% increase in spending would take us to equal second in the world for health spending on these figures.

Cuts? What NHS cuts are those?

Total health expenditure as a share of GDP, 2009

[img] [/img]

Z11, mcboo etc.

What you don't account for in your criticism is anything to do with demographics.

You talk about an absolute rise in the overall budget, but conveniently forget that the UK population is growing - 5% over the last 10 years - hmmmmm..... so what would the implications of that be for the NHS budget even for services to remain the same I wonder?

Doen't take a genius does it?

And, proportionately the elderly population (the ones who tend to need lots of health care) is growing even more.

Perhaps we could concentrate on how to make things better rather than using the topic as a political football, y'know, like politicians do?

Perhaps we could look at how we are going to manage the healthcare needs of an aging population, that's you that is, in the future?

Perhaps you could argue for a few posts about the public and private sectors, then we could all get grumpy with one another and see if that helped?

Then as the issue drops off the front page and we all go back to arguing about helmets or hora, everything will be ok won't it?

😐

Thanks hilldodger- couldn't find the graphs, the Netherlands number appears to be slightly odd due to a change in methodology as it was only 9.9 in 2008.

OECD Health Stats 2009 (Government spending on healthcare as % of gdp)

France 9.2, Germany 8.9, US 8.3, UK 8.2, Sweden 8.2, Norway 8.1, Italy 7.4, Ireland 7.2, Spain 7, Finland 6.8.

My wife is a nurse working in a very busy Oncology unit. She has her own job to do and now also the job of another department due to staff leaving. The staff are leaving regularly but not being replaced due to cuts!
She works longer hours than contratced and is not paid any extra. She is constantly abused by the public who are forced to wait long beyond their appointment time due to the lack of staff.

Many times after she has come home in tears I suggest she leaves, but as a caring person she says ‘yes but then that gives the problems to someone else’.

She qualified over twenty years ago, and agrees the ‘new’ degree nurses don’t want to get the hands dirty and many of them don’t understand the principles of basic care.

Oh and the best bit…….. she’s just had her pay cut!

mefty - you need to look at total spend not just governemnt spend to get a real comparison. some of these countries have large private sectors doing what the NHS does

TJ, the OECD figures [i]are[/i] total spend, public in dark blue, private in light blue.
Can't find any figures for health spend per capita, and not really sure what the various sets of figures represent 'on the ground' anyway 😕

What Hilldodger said. See my first post and his, second post is purely gov spending where we are near the top.

[img] [/img]

Why do you think that spending more is a good thing?
Why do you think that hospitals are a good thing?

A significant redirection of money from acute care (eg. hospitals) to prevention and early intervention, (eg. GP's and Physio's) could save hundreds of billions - try doing it, and the unions would be calling for blood and out on strike overnight!

Its about what you spend it on, not what you spend.

[i]Why do you think that spending more is a good thing?
Why do you think that hospitals are a good thing?

A significant redirection of money from acute care (eg. hospitals) to prevention and early intervention, (eg. GP's and Physio's) could save hundreds of billions - try doing it, and the unions would be calling for blood and out on strike overnight!

Its about what you spend it on, not what you spend. [/i]

Despite your history of right wing nuttery, this is actually right.

Unfortunately it would take about 20 years to really see any benefit from it, and would be unpopular for most of that time. Spending £2000 a day on Intensive Care for alcoholics is a waste, when that money should have been spent 20 years ago on pre school care and education for the mother of that child.

Z-11 Prevention and early intervention like Andrew Lansleys latest wheeze

[url= http://www.mirror.co.uk/news/health-news/2011/10/14/jamie-oliver-hits-out-at-andrew-lansley-s-obesity-strategy-115875-23487368/ ]worthless, regurgitated, patronising rubbish[/url]

Yip. That'll revolutionise healthcare eh?

France gdp per capita USD 29,000, therefore spending on health per capita 3,470 and government spending 2,700.

UK gdp per capita USD 32,000 therefore spending on health per capita 3,140 (a 10% difference) and government spending 2,625 (a 3% difference).

Germany has a similar gdp per capita so relative spends will be similar to those shown earlier.

No Binners - how about Increasing the Number of GP's by 19%, and decreasing their average list size from 2,247 to 1,918.

Oh, no, we choose to forget that thats [b]exactly[/b] what happened between 1980 and 1991 under the evil she witch Thatcher. But, like Crikey said, you'd make yourself really unpopular taking bold decisions like that wouldn't you...

You are right Z-11, investing in Primary care is the most sensible use of any healthcare spending, full stop.

But... and this is perhaps a bit trickier; it works best with some attempt at social engineering built in. Give poor parents help, with benefits, with subsidised jobs, with extra cash and input, and you begin to break the cycle of being born into poverty and the subsequent ill health associated with that.

Essentially it's about investment in people, but it takes a generation or maybe two to have any effect, which is 4-5-6-7-8 different governments who all have to appeal to the populace.

Nobody has so far actually explained how these failing nursing staff and more importantly the management are still employed, or even employable.

Basic needs of patients, like water and food doesnt require much education, its a human need,yet so many fail to understand the concept.

Crikey - maybe, just maybe, part of the social engineering problem lies with people knowing that they don't [b]have[/b] to take responsibility for their own actions and long term health, means that people take less care of themselves than if there wasn't a "free" NHS which will

There's a significant difference between the state (ie. us) paying for healthcare from a disease or chronic condition that the patient cannot control, and paying to repair a pissed up idiot who puts their fist through a window, should he have to foot the bill for his own actions? its not an unreasonable suggestion!

but where does that stop - obesity, gout, diabetes, all have an element of personal responsibility and lifestyle choice, and where does an injury in the process of mountainbiking down a rocky hillside come in that equation/balance? its a bloody good question... and I don't have the answer.

I agree with a lot of that Z-11, we have created or fostered a situation where people don't have to take responsibility, but I think the solutions take longer than the natural life of a government, so we never get to see what works or what doesn't.

Gotta sleep now, 12 hours of public service tonight...

mcboo - Member

The unnacceptable part of this is that it is happening after a period where the NHS was sprayed with cash.

Oh dear... Modern medicine is expensive. New drugs and procedures are expensive. My treatment for my hip cost several times more than an oldfashioned hip replacement. It also helped to increase waiting times, most probably, since I got several times more physio than a hip replacement patient would get. Just for an example.

And the absolute most expensive thing a health system can do is keep people alive, which we've got much better at- people live longer, terminal conditions take longer to kill people, and people survive things which would previously have killed them. All at great expense at the moment of treatment, and ongoing expense to look after the person who previously would have been a cash-efficient corpse.

As per above - treatment costs going up and up. Putting a 700 quid plate on a wrist not two forty pound wires uses up money. Not that hard to put 10-20k of metalwork in a spine now.

Add that up across all specialities and all treatments and costs are going crazy.

Equally 18 week target means yes everyone is treated quickly but far more are being treated too - even more costs, especially when lots of surgery being done in private sector/outside hours to meet targets.

Could go on....!

crikey - Member

I agree with a lot of that Z-11

That's probably because Zulu-Eleven hasn't, as is absolutely typical of right-wing neo-conservatives, said what he truly believes.

Zulu-Eleven takes his political direction from his mentor Dan Hannan and his beloved bible "The Plan", which he often promotes on here.

Dan Hannan has very clear views concerning the NHS, he considers it to a "failed experiment" which makes people "iller" and would much prefer the American healthcare model. Which despite the ongoing huge political debates and furore in the US concerning its failure to deliver effective cover to all its citizens is, he claims, better.

Of course unsurprising Dan Hannan is somewhat "shy" of telling the British electorate how strongly he opposes the NHS's existence, knowing full well how much it is cherished by the British people.

He is however more candid and forthright in expressing his true feelings concerning the NHS when speaking to an American audience, specially when being interviewed by his political soul mates Fox News.

I have in many occasions posted this video of Dan Hannan rubbishing the NHS and singing the praises of American healthcare provision, but it's always worth remembering what Zulu-Eleven's political mentor and guru has to say on the NHS, specially when Zulu-Eleven joins in the healthcare debate.

I have yet to hear Zulu-Eleven ever criticise or distance himself from any opinion expressed by Dan Hannan, so we can safely assume this also represents Zulu-Eleven's views on the matter, despite his understandable reluctance to honestly express them.

It should be added that David Cameron publicly criticised his friend, and former Tory Party leader speechwriter, Dan Hannan, for giving that interview - well Hannan wasn't suppose to say those things publicly was he ? just like the BNP who don't like to publicly admit they're racist, in fact they will strenuously deny it.

For over 60 years the NHS has provided high quality open-ended healthcare to millions based on clinical need, not how healthy your bank balance is. It was one of those fundamental reforms which changed people's lives in a real, tangible, and profound way.

There are however those who see healthcare and the £billions involved as a significant profit opportunity, and would like to take us back to the time of reversed priorities - profit before people.

They will exploit genuine failures such as the shameful examples of elderly care found to be wanting in an attempt to achieve those ends. They will make wild and farcical claims such as in the title of thread that [i]"The NHS isnt working"[/i]. The NHS is working. And it's working a lot better than any system which puts profit before people.