Argee – folk on here are fed up of brexit discussions.  If you want to know about the advantage to scotland of independence and joining the EU pm me.  I can list dozens.  I ain’t gonna discuss brexit no more on here

*everyone breaths sigh of relief*

Someone help me with an NHS failure point of logic given by the right.

They say “people living too long is party of the problem.,”

So hang on one second. People living too long surely is indicative of a successful health system?

Both my parents in the mid 70s and they’re looking good-ish to me, neither taking too many resources as far as I can tell.

You could say you need scalability but living too long or whatever that means doesn’t imply they’re all connected to life support systems.

Tends to be more years of illhealth as well.  give your folks another 10 or 15 years and they are likely to have used a lot of healthcare.  MY parents have during their 80s

Its basically bobbins tho IMO

A quick google search on life expectancy shows it rose steadily from 1960 to 2010 from when it has largely flatlined to 2020. And from what I can see this is fairly similar for most large economies (unsurprisingly the US underperforming and lowering life expectancy from 2018).

I don’t think that this can be used as an excuse for the current problems, certainly less so than any point in the previous 50 years, life expectancy has been roughly steady for the past decade and shouldn’t be surprising to those responsible for planning healthcare.

Life expectancy doesn’t tell you the whole story, it’s about age distribution and just how many people are older. But it doesn’t come as a surprise, it should have been planned for, and that planning funded. The government dropped the ball.

Both my parents in the mid 70s and they’re looking good-ish to me, neither taking too many resources as far as I can tell.

Come back when they are in their mid 80s and tell us how much they are using the health service. May dad used it heavily before he died at 83, my mum is using is heavily at 78, my wife’s mum and dad are using it heavily at 78 etc,.

When people tended to die at 70 it was before a lot of the age related stuff kicked in.

All that is missing the point though as we have known for the last 15 years that people are a) living longer and b)require more healthcare are they age so NHS funding, staffing, social care SHOULD have increased to cater for that. That fact it didn’t is the cause of the problem.

A quick fix for bed blocking is to set up state run care facilities where people can be moved to until home care or care home gets sorted out but of course that would cost money, can’t do that because of tax payers money and all the other BS.

They say “people living too long is party of the problem.,”

Probably a controversial opinion but I think it’s much more than ‘part’ of the problem. I see no value in having hundreds of thousands or potentially millions of people sat in care homes with dementia because something else hasn’t killed them first. We desperately need a grownup debate about assisted dying. I think if you ask most people what they would like to happen in that situation the answer would be pretty obvious.

Maybe we could learn something from the Vikings… 😳

We desperately need a grownup debate about assisted dying.

Its happening.  There is a bill in Scotland going thru right now and in England there have been the first steps taken

However its actually very complex legally morally and ethically to do this with people living with  dementia due to informed consent

I did start a thread about this topic a while ago.  Might be best on that thread or a new one rather thanhere

its a topic very close to my heart for both professional and personal reasons

We desperately need a grownup debate about assisted dying.

Absolutely. But not to try and save the country money, or reduce the need for health and care service staff. Everyone (where possible) should have control over their end of life care, but let’s not start looking to a Logan’s Run style future, just because we’re not prepared to fund and staff care properly.

but let’s not start looking to a Logan’s Run style future

An aging population being blamed for the health care crisis and increasing food poverty problems, anyone fancy soylent green  for Sunday dinner?

Lol that went down a path that I didn’t expect.

But living longer generally to a point is a product of a decent standard of living/well being etc.

Surely it means for a good chunk of their lives they didn’t need health care. That’s the point I’m making.

So what folk are saying is we used to die younger – and now we’re being kept alive?

That’s a good thing in my opinion. But could be better clearly.

An aging population being blamed for the health care crisis and increasing food poverty problems, anyone fancy soylent green for Sunday dinner

That’s the Tory narrative.

But it will come down to the exchequer.

Don’t forget from their perspective they’ve been putting back into the economy for an awful long time.

Soylent Green now there was a depressing film.

They say “people living too long is party of the problem.,”

woman came to the surgery Friday morning with her family, she’s 83 in a wheelchair, is constipated. She’s on 6-7 fairly serious medications and has 4-5 co-morbidities ( heart issues diabetes etc etc) Any combination of her illness and drugs maybe causing her issues. Family was upset (put in a complaint) that 1. The GP they saw explained about the difficulties in assessing her, and 2 they didn’t leave the surgery with “a solution” there and then.  I think they were expecting to be handed a ‘script for “something…”

that’s pretty much a routine patient. Only stand out was they were upset and complained. We’re seeing more and more elderly and ( increasingly frail ) patients

the upside of NHS is longer life, but along with that expectation you have to fund the cost of care for the elderly population you create. We’re not doing that. In pretty much every speciality we’re creating issues. Monitoring for glaucoma (for instance) is something like 10% of all out patient treatment at most Trusts. That’s only going to increase. It’s not really being funded, and that’s reasonably common.

I’m a spectator to a case at the moment. The amount of resources being thrown at a 90 year old who would by any humanist caring measure be better off dead is phenomenal. I find it hard to believe the system can still provide that level of care and that the staff are motivated to provide it. Impressive but futile.

It’s motivated me to find some way of not being put through the same misery myself and finding some legal framework to make sure I’m not plugged into a battery of machines and fed a page long of medication that interacts badly to keep me alive when I’d be better off dead.

I understand why it’s happening, the fear of being accused of not providing adequate appropriate care, but FFS let the poor sod go.

I rarely let my private issues colour my contributions to this forum but there you have it.

For balance, my wife (NHS – Care at Home) has an increasingly older patient list but they’re mostly still living a happy, meaningful and sometimes very active life. The number of 90 year olds is quite staggering/encouraging. Obviously she only knows this because they still need some intervention but that is often no more than assistance with some personal care or with medication. 8ndeed sometimes it’s almost more of a social visit 🙂

The “problem” of an aging population would be easier to handle if we were attracting more, younger, working tax-payers but, you know, immigrants.

The other 90-year-old is living as you say, scotroutes, but can’t lift 70kgs, can’t change a nappy, can’t take someone incapable of movement anywhere without able-bodied assistance, can’t rely on the help of super neighbours 24/7, can’t cope with the incoherance due to yet another TIA and or blood sodium levels. At what point do you call it a day? IMO a while ago.

Hospital is curently the only solution as the services to maintain home life are unavailable/over stretched.

If society decides to keep people who’d be better of dead alive it creates anguish and misery for all around them if there isn’t the specialist home/institutional care available 24/7.

The amount of resources being thrown at a 90 year old who would by any humanist caring measure be better off dead is phenomenal.

Whats that persons viewpoint?  IMO thats the only thing that matters

If they want to fight to the end thats their right.  If they want to go in peace now thats their right

To deny either path is wrong

I have fought for the rights of people to have what I believe is futile treatment against my own instincts because thats what right morally , legally and ethically

i am also fighting hard for assisted dying right now.  Lobbying MSPs with my stories both personal and professional.  Ive been on the radio, in the mainstream press and I have met with a number of MSPs.

Can I again suggest that if we want to discuss end of life care / assisted dying and so on then we start a new thread?

Or use this one?

Dignity in Dying

I’ll answer your question here and then drop the subject, TJ as I didn’t wish to contribute to either of the appropriate threads.

The person concerned wanted to, and indeed has now signed a “do not resusitate” document but at the critical time of admission was not deemed to have sufficient capacity to make decisions so was treated without consulting any family member. All very logical and following procedure. Everyone is doing their job just fine.

What I’d like to see is the ability to have a code on my medical card that says “pas d’acharnement thérapeutique” whatever that is in English as of now (I’m 62) and “do not treat without signed consent from either the patient, his wife or his son aged over 85, if they can’t be contacted, do not treat”.

There will be I am sure some form of living will / advanced care directive / advance care plan in France

Certainly in the UK you can do this and done right its legally binding

My parents have them

Sir Keir Starmer has defended shadow foreign secretary David Lammy earning £200,000 from second jobs this parliament – but said the rules need to be stricter.

Read more: https://t.co/7RzL5mNHyn#Ridge #WestminsterAccounts pic.twitter.com/NgPNr2O5Yz

— Sky News (@SkyNews) January 8, 2023

No second jobs unless it’s my mate Lammy.

I’m sure as an upstanding member of the Labour party Lammy will just quit LBC.

Lammy should have really joined Change UK.

Thanks for the helpful reply, TJ, you are absoultely right, I could elaborate but as promised ————

I’m sure as an upstanding member of the Labour party Lammy will just quit LBC.

A London MP doing a phone in show on an Londoncentric radio channel, where the public can ask questions and debate with them? Arguably he should do it for free, but it is work that it’s worth an MP doing. Not like spending months in the Caribbean giving legal advice.

A London MP doing a phone in show where the public can ask questions? Arguably he should do it for free, but it is work that it’s worth an MP doing. Not like spending months in the Caribbean giving legal advice.

exactly. I don’t particularly like his radio host ‘fake sincere outrage’ style, but it’s absolutely justifiable to be doing this; it’s entirely within an MP’s engagement remit.

Advisory positions on private health company boards, less so…

A London MP doing a phone in show on an Londoncentric radio channel, where the public can ask questions and debate with them? Arguably he should do it for free, but it is work that it’s worth an MP doing. Not like spending months in the Caribbean giving legal advice.

Oh come on it’s a commercial radio station where he’s the host. That’s not the same as your description.

It’s this whole wishy-washy rubbish way of talking – no second jobs + followed by a heap of caveats.

Stop buying into the Starmer net of vagueness.

There are plenty of outlets MPs can appear on and not gain income.

Let’s just say they can’t have second jobs with income. I’d be happy with that.

Stop widening the net specifically for Starmer’s not committal approach to everything.

It’s not the worst crime of the century but Starmer constantly devalues any ideas he might have with a stream of poor clarity and goal post shifting.

It’s not pragmatic it’s pathetic.

.@Keir_Starmer: ‘I’m against austerity. But we’re going to have to be fiscally disciplined’

Big interview in tomorrow’s @guardian with @PippaCrerar 👇🏻https://t.co/D0yMjpO4Gh

— Wes Streeting MP (@wesstreeting) January 8, 2023

@Keir_Starmer
: ‘I’m against austerity. But we’re going to have to be fiscally disciplined’

Talk about straddling two ends of a political narrative that you simply can’t hold at the same time.

What a shambles. This is worse thank Sunak going on about Maths. This is terrible, needless austerity justification from a party and a leader that should know so much better.

how to say you are going for austerity without saying you are

how to say you are going for austerity without saying you are

Totally.

And guess what we have the previous body of work that is Tory austerity to show its impact.

I couldn’t think of a more inappropriate time than now for Starmer to take this absurd position.

Spend more on key areas, reverse some of the shifting of the tax burden towards the less well off, don’t promise the voters that you can spend an unlimited amount of money without tax changes or without it having negative consequences. In other words… we know key public services and the shift away from fossil fuels needs big investment, but we also operate in the real world, not in a theoretical bubble. That isn’t what austerity is/was. Austerity was about cutting services used by, and the real take home pay of, people who have less in order to protect the wealthy from the impacts of at first the global credit crunch, and since then Brexit, Covid, Putin, etc…

Starmer urges Sunak to put NI above ‘Brexit purity cult’

Which Sunak can’t do of course as he’s in hock to the cult.

I’m pleased to see a slight change in language from Starmer though. Anyone want to make a bet on what the daily mail/ express headlines are tomorrow?

https://www.bbc.co.uk/news/uk-northern-ireland-64256883#comments

Starmer knows that he’s gotta walk that fine line on Brexit, i can see more and more politicians talking about the damage its caused as the public turn against it.

Be interesting to see which sitting Tory will be the first- not all of them are swivel eyed populists

we know key public services and the shift away from fossil fuels needs big investment, but we also operate in the real world, not in a theoretical bubble. That isn’t what austerity is/was

We haven’t been living in the real world. We’re living in a world that has been a been skewed towards wealth for a few

And the real world is simply to not run finances like household – because that would serve the economy and society better and reverse the effects of capital over labour.

Nothing will get better until someone pushes the levers in the opposite direction.

40 years of evidence shows us that.

So you can mop up Starmer’s position time after time but he’s simply reinforcing we can’t do things.

I agree with Meadway on the thrust of this but not the mechanics as he’s a ‘borrowing’ lefty economist.

Starmer can't do "national renewal" on the cheap if he wants to last more than a single term: "The public reaction to continued austerity, especially from a Labour government, is likely to be overwhelming: in protests, strikes – and at the polls."https://t.co/jasQzpI9DP

— James Meadway (@meadwaj) January 10, 2023

It’s early days but I’m putting this forward for the shittest NHS idea of 2023.

If Sunak said this Twitter would be apoplectic. Alistair Campbell would be posting hourly zingers, James O’Brien would need to see a cardiologist because his heart rate is so high & the Guardian would publish an editorial on how the plan means end of NHS. pic.twitter.com/P26pHA7LRd

— Aaron Bastani (@AaronBastani) January 15, 2023

Also, Bastani could mention the STW Sunak thread would melt down the servers if a Tory said this.

If thats the nonsense about bypassing GPs for direct refferal then that is how many other systems work.

What Starmer fails to understand is then those people being referred to need another layer of triage to sort out the folk who are wrongly self referred or many more staff

Triaging by a non generalist isn’t always a bad first step though. Back problems is a good example: a physio will be better able to suggest the root problem than a GP, even if that means they can’t treat it themselves. They’ll likely still be able to ease the symptoms, as well as passing the patient onto a different specialist. Or bounce them to the GP if need be.

Oh, in addition, it’s also about waiting times (and needing more staff as TJ says). A GP appointment tomorrow, for any symptoms, is preferable to going direct to a specialist in several weeks time. So many things that can be (and need to be) caught quickly, whoever is first contact and doing the triaging.

In Edinburgh they have another layer of triage between GPs and orthopedic referals where you go via a senior physio who cuts out allthe nonsense that does not need ortho consultant appointments

However to do direct referals they will need a huge amount of triage which means many extra staff

I’m not saying it cannot work – it does in the Netherlands but any saving in GP time and cost is matched by extra staff needed to do the triage or extra consultants / registrars / specialist doctors

Its just pandering to the Express and wail readers who believe cumbersome bureaucracy in the NHS leads to delays.  Thats just wrong

All paths towards improvement need more staff, and retaining staff, and motivated and properly supported staff. I don’t have a problem with also changing the GP gatekeeper role, and shifting some triaging elsewhere (which also means more staff needed wherever elsewhere is, for sure). It’s only because I’ve been swayed by rants from specialists and managers working for trusts and councils though, they’re not happy with local GPs and the delays for face for face appointments and therefore referrals. I don’t speak to any GPs here though (the ones that lived local left years ago)… so you might hear the same complaints about referrals from them in the other direction, I don’t know. Either way, there is a merit to self referring… it’s a hell of a lot better than people going to A&E to try get answers and reassurance (or treatment) quicker, that’s for sure. Not ready to go with the “worst idea” conclusion that Rone and Bastini are jumping straight to. Elements of playing to the press when it comes to GPs, for sure… but also playing to the public… GP appointments are a problem for many right now, even when a specialist referral is exactly what the patient is really looking for from the outset.

The last thing the NHS needs is major change.  major reorganizations which is what this would be takes staff time and energy out of patient care.

What the NHS needs is to remove the bureaucracy of the fake internal market in england and all the nonsense that goes with it then left alone with a bigger budget