Excreta hitting fan.

As for Monitor… I utterly despise the ex-Mckinsey parasites who now infest the NHS. 👿

We cannot just cut year after year after year and think there wont be any affect

we get what we pay for

Are we cutting year after year, I thought NHS budget had risen in real terms?

I thought this was a result of moving money into preventative and primary services rather than hospitals? Surely this is a good thing and likely to save money?

preventative and primary services

All good (provided commensurate resources are being moved into the community… cough) – but, like Rome, all roads will eventually lead to some form of acute care. And with an increasingly elderly population, that is unlikely to change. A&E is rammed – but not just because of people who “don’t need to be there.”

Imagine if the ConDems had focused upon a genuine integration of health & social/community care, as opposed to the witless (& costly) fragmentation re-org that was the ’12 HaSC Act. Imagine that!

Oh ninfan you are a right wing Hunt aren’t you 😈

It’s a systemic failure , A&E would have a fighting chance if there was somewhere for the “bed blockers” in the hospital to go, i.e a place in a care home, a care package organised by community & local social services etc, but Dave’s cuts have decimated this sector.

A move to more integrated care, which includes social services will help, but widespread change like this does not happen quickly.

The NHS budget has risen on average less than 1% per annum, but demand for services is far outstripping that increase, leaving a massive funding gap.

Recent changes in primary care that have cost £2bn and an internal market that costs a similar amount per annum to manage don’t exactly help ease funding pressures.

Junkyard – lazarus

Oh ninfan you are a right **** **** aren’t you
Posted 9 hours ago # Report-Post

Oh, that’s classic Junky, right there. Of course, Junky would never say that to his victim’s face, out on the trail, in the cafe.

Are we cutting year after year, I thought NHS budget had risen in real terms?

There’s no need to try to introduce the truth into attempts to use the NHS as a political football – shame on you.

Health, ring-fenced, my arse! (These are my own views and not that of my employer, best put that in).

I am pretty sure ninfan took that in the spirit it was meant and got the joke/pun. The emoticon may have been a hint even if it was to “subtle”* for you.

MLEH to your inevitable goads that follow

#pidegeonchess

* clearly we both do subtle eh 😉

There’s no need to try to introduce the truth into attempts to use the NHS as a political football

But the acute budget has been cut and they say they can no longer do what is asked with what is provided.

Yes , in real terms it has increased, but so has demand and this NHS area has been cut as the link discusses.
Probably better to discuss whether they can deliver what they have been asked to with another round of cuts rather than say that the overall budget has increased , and this is critical, theirs has not it has been cut.
IMHO if the apolitical providers tell you they cannot do it then you need tp park your politics and listen.

Its is fair to say that using the NHS as a political football does not help us get a better service.

A move to more integrated care, which includes social services will help, but widespread change like this does not happen quickly.

Pretty sure this has been discussed my entire adult life.

Or at least the last 10 years:

Moving patient care out of acute hospitals and into the community has been a UK-wide priority for over a decade; however despite national commitments made to encourage this shift, there is limited evidence to show a tangible investment in the community. Moreover, our Frontline first campaign has highlighted concerning examples of service and staff cuts and the impact of these short-term savings on patient safety and overall quality of care. The RCN is very supportive of moving care closer to patients? homes, where it is clinically appropriate to do so; however we believe that more community investment is needed to facilitate this shift.

http://www.rcn.org.uk/__data/assets/pdf_file/0006/523068/12.13_Moving_care_to_the_community_an_international_perspective.pdf

Too many vested interests also, from suppliers to unions to management. If it costs more to keep someone in a bed in a hospital than a care-home surely all you need to do is more the % from one budget to another? Ah, now I understand why it hasn’t happened…

My fairly basic understanding is that acute and emergency care is probably adequately funded, but everything else has gone to rat shit and is having to use it for services it isn’t intended to cover.

I’m happy to be corrected by those who actually know.

It’s not the NHS that needs to be properly funded, it’s social work that needs more funding. Fund social work properly and the NHS will suddenly have a metric f**tonne of extra cash as they are no longer providing a shed load of quasinursing home beds and quasipackages of care. My ward as present has 29 patients, 16 of whom are medically fit to go but are wating for social work issues. Social work simply dont have the resources, so the NHS bears ths cost while the folk wait.

the root cause of the current problems has been long in the making and most of the “solutions” being proposed won’t actually fix the problems.

1. The NHS is still poor at caring for the patients with long term conditions. Too many of them still land up in A&E because their conditions aren’t proactively managed, and many of them repeatedly go back through A&E because even there the poor management of LTCs isn’t sorted properly 1st time. As the population ages, more people have LTCs and the problem is just going to get worse (and more expensive).

2. Under the last government the NHS budget rose from c£65B to £100B+ and some 400,000 extra staff were hired. Despite this the National Audit Office found that productivity fell every year for 10 consecutive years.

A lot of noise is being made now about the £20B efficiency saving programme (that was actually designed under the last government rather than the current one), but this still only recovers half of the productivity gain that should have been achieved naturally as a result of the additional staff that were recruited and doesn’t make any headroads into getting treatment right first time and improving flow, both of which avoid waste / rework / cost.

3. As the recent analysis of HES data by Deloitte shows, Bed blocking is in the majority of cases the direct result of poor management within the hospital and lack of effective communication between specialities.

Where it’s arising because of delays in discharge to social care / residential care the root cause is often the significant reduction in residential care home places under the last government – for years councils paid below the going rate for care homes with the result around 25% closed.

4. The “not invented here” mindset.

If we were starting out afresh, few people would design the NHS structure / organisations the way it’s currently set up.

The very design of the NHS results in massive duplication of non clinical roles and poor utilisation of extremely expensive buildings and specialist skillsets.

We need more care closer to home and more money going into primary care. As long as clinicians, politicians and the public are wedded to massive hospitals that we don’t actually need now given reductions in length of stay etc, the NHS is doomed to secondary care sucking in the majority of the funding and primary care services getting worse and worse.

Despite this, the majority of NHS staff and trade unions won’t accept the need for change and simply dismiss the learnings from other health systems where innovation and patient centred pathways have enabled better clinical outcomes to be achieved at lower cost.

We need a design for a new NHS based on evidence and learning from the best approaches worldwide. This represents our best chance for maintaining healthcare free at the point of use but with delivering improvements to clinical outcomes and equally importantly carrying the potential to re-create a great place to work for the many NHS staff who are currently overworked and feel unable to deliver the quality of care that gives them job satisfaction.

McKinsey’s report for the last government offers some good pointers for the sort of change that’s required:

http://www.nhshistory.net/mckinsey%20report.pdf

Despite this, the majority of NHS staff and trade unions won’t accept the need for change and simply dismiss the learnings from other health systems where innovation and patient centred pathways have enabled better clinical outcomes to be achieved at lower cost.

Any evidence to back up this claim?

just5minutes – christ which conservative MP script did you regurge that from?

1. I think everyone would agree that better LTC’s care would help prevent use of secondary care, but he is going to fund it? + the older people turning up in A&E are old with multiple problems as people are living longer, not just because LTC’s are not being managed properly.

2. The £20bn saving restructure was a farse. It has increased burocracy, waste , cost and allows gov to blamce the Doctors (CCG’s) when it goes wrong.

3. Agree with the 2nd Paragraph. 1st wasnt highlighted at our Trust

4. Sorry I disagree, staff realise the system needs to change and want it to change. However as you state above it can not just be done via the NHS, it needs to be council/public health too, and they appear less interested.

Lot of valid points. Community resources huge issue.

Saw a patient the other day in clinic. Not managing at home due to injury. Required no inpatient medical care.

Social services involved – no capacity.

Solution – admit to hospital despite needing no medical care.

Isolated example but like using a missile to crack a walnut!

I worked in a large mental health hospital,just as care in the comunity was starting, patients who where in hospital as their only home, eg long stay, been there for many years, where suddenly shunted out into the so called community, living in a large house the neighbours didnt want for mental health patients on their street, falling house prices etc, they where then looked after by a transient underpaid staff, who would boot them out during the day to wander the strets, no adult mental health day centres where built to save cash, so these ex patients where now roaming the streets, drinking and being a nuisance due to having nowhere to go.

What the big insitutions had was work or ocupations for these patients,canteens etc, large grounds for then to wander and enjoy, staff to listen and care for them, good food and treatments, sadly all destroyed now adays, some ex patients are lucky to see a psychie nurse every few months, medication is not checked its been taken, and a lot end in prison.

ninfan – Member
Are we cutting year after year, I thought NHS budget had risen in real terms?

Real terms compared to general inflation levels is one thing. Real terms increases in relation to costs of health care and levels of demand are very different.

Project, we can’t forget that one of the key drivers behind deinstitutslisation was the repeated scandals over levels of care and abuse in those facilities throughout the sixties (eg. Ely) seventies (eg. Normansfield, Brookwood) and eighties (eg. Stanley royds)

Real terms increases in relation to costs of health care and levels of demand are very different.

Is managing demand a reasonable response? Would it be unreasonable to tell someone who turns up at A&E with a three week old headache that they are just not going to be seen? Thats before we get onto cosmetic boob jobs and gender reassignment treatment on the NHS.

The whole thing needs to be looked at to get a little more efficient.

I was referred to one department for some fairly worrying issue. I had a number of visits with the consultant and various doctors to tell me what was up. Then another visit to be told it wasn’t their problem and I needed to be ‘transferred’ (i.e. dumped) to another department.

I then went to see the SAME consultant with his department ‘B’ hat on and did the same routine of wasting a day off work to be told the same things.

Then to add insult to injury the consultant (bear in mind he’d seen me in two different departments) said it wasn’t department Bs problem either so off to department C for me.

And repeat.

I hope I’m not representative but if this practice is typical then they must be p****g moeny up the wall like no mans business.

ninfan – Member
Is managing demand a reasonable response? Would it be unreasonable to tell someone who turns up at A&E with a three week old headache that they are just not going to be seen? Thats before we get onto cosmetic boob jobs and gender reassignment treatment on the NHS.

I think who gets seen is a clinical issue and not one for laypeople on a message board to decide, no matter how hard they try to troll.

Regarding boobs jobs – “In rare cases, a clinical commissioning group (CCG) may decide that cosmetic surgery is required to improve a person’s health, although NHS resources are limited and waiting times are usually long. For this reason, most people pay to have cosmetic surgery privately,”

And what is the issue of people with gender dysphoria undergoing treatment for their condition?

THere are 2 big issues with emergency departments

1. Too many patients turnning up. This is because there isnt anywere else for them to go. People are naturally lazy, therefore the path of least resistance has to be the path that you want patients to follow. At the momment that isnt the case. If you think you need medical treatment you have 2 options. Goto A&E and get seen in about 4 hours, if it is minor you will wait 4 hours and you will get bumped by more severe / urgent need. Or you can get on the phone and get an appointment with your GP. For most people this is a challenge. First of all you have to get through on the phone and then you have to get an appointment. Now here is the rub. Because there is no such thing as an NHS GP practice, they are all small private businesses, each practice operates how it likes within the vague terms of its contract. As a result you get a fw very good practice, a few very poor and the bulk in the middle. So there is no consistency in what a paitent can expect when they ring the practice.

So they take the path of least resistance and most certainty and goto A&E.

The other problem is discharge. In order to admit patients others need to leave. Now the truth is that most people in hospital are elderly and so often need local authorities to set up social care packages for them. But they have had the funding reduced so delay to save money. As a result beds dont get freed up.

McKinsey’s report for the last government offers some good pointers for the sort of change that’s required:

Given their McKinsey’s hand in much of the disastrous reform inflicted upon the NHS, I’d say that they (and all their ilk, via the DoH revolving door – Milburn is a classic example) are half the problem. It’s funny how heavily-involved they were in the HaSC Act – and the muddle-headed commissioning process now engulfing CCGs. Contra the assessment that NHS staff are resistant to change, IME the frontline is fine with “change” provided it represents a quantifiable improvement in patient care – but who could really claim that is true of Lansley’s nonsensical re-org? Don’t confuse opposition with stagnation. On a side note, I’d like to extract some “productivity” from seconded management consultants, perhaps via the use of physical force. 😈

Better-resourced community/social care would go a long way towards alleviating the current pressure in acute settings – but you’d have to be divorced from clinical reality to claim that those same acute settings need to lose more beds.

Meanwhile in Edinburgh – I tore my meniscus a couple of days ago. I gave it a day to settle down, phoned up the GP this morning, got an appointment for this morning, got a MRI booked for early next week and onward referral to the relevant knee orthopod soon after. Can’t complain at that.

phoned up the GP this morning, got an appointment for this morning

It’s quite amusing what has happened at my surgery, in days of yore everyone used to moan that you couldn’t get an appointment on the day you rang. Now you can only get an appointment on the day you ring up…In other words, you ring before 8am, they ring you back at some point to triage, then you get an appointment later that day.

Took 3 calls to try and explain that I didn’t need an urgent appointment – nor could I spend time off work waiting for them to sort this all out, and why couldn’t they book me in for next week! Maybe I’m being unreasonable in wanting to help them manage their workflow…

@justfiveminutes

3. As the recent analysis of HES data by Deloitte shows, Bed blocking is in the majority of cases the direct result of poor management within the hospital and lack of effective communication between specialities.

That report is actually really good – dispassionate and based on data. However as usual with matters of the NHS it gets ignored by those who constantly defend the status quo and think money is the only answer.

think money is the only answer.

There are better ways to spend money than the ongoing trainwreck that is the NHS internal market.

As for “more money…” – good luck solving challenges in social care without improved resourcing.

http://uk.businessinsider.com/an-american-uses-britain-nhs-2015-1

We have the most or one of the most coat effective systems in the world.

Issue is rising demand. Yes it has inefficiencies. Many other systems have greater ones.

There is a big debate on the horizon – spend more or ration more.