NHS breaking point?

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Bird on a Fire
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Re: Who's next?

Post by Bird on a Fire » Tue Jul 26, 2022 11:06 pm

Millennie Al wrote:
Tue Jul 26, 2022 11:03 pm
Stephanie wrote:
Tue Jul 26, 2022 8:42 pm
Did you mean to continue the NHS discussion here?
No. Sorry. I intended to post that in the "NHS breaking point?" thread. Could any kind mod chop that bit off and graft it over there?
Done.
We have the right to a clean, healthy, sustainable environment.

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Re: Who's next?

Post by Millennie Al » Wed Jul 27, 2022 10:56 pm

Martin_B wrote:
Tue Jul 26, 2022 12:14 am
Millennie Al wrote:
Mon Jul 25, 2022 11:39 pm
One of the ways to get more money per person for the NHS is to have it treat fewer people. If we could encourage those rich enough to pay for private treatment, it would leave the NHS with the money that would have been spent on them. This would require a major change in attitude in society - rich people would have to think that they shouldn't be getting free treatment if they could pay, or that private treatment was in some way superior.
That's spectacularly naïve.

a) You are essentially advocating for the NHS to deliberately provide inferior treatment to force rich people (who have already paid taxes to keep the NHS going) to go private.
Not at all. People fly first class even though it doesn't get there any faster than economy. People buy fantastically expensive trainers, even though cheap ones are just as good. Even in the area of medicine, have a look at the shelf of painkillers, plain aspirin, paracetamol, and ibupofen are cheaply available, yet there are numerous fancy alternatives whose active ingredients are merely those drugs but made fizzy or otherwise differentiated to persuade people to pay more.
b) You don't think that the Tories, as soon as significant numbers of people start having private treatment, won't reduce the NHS funding on the basis that "The NHS funding is X per patient and if they have fewer patients then they need less funding which can go towards my new car/wallpaper/duck island"?
Unlike the current situation where they provide plenty funding for everyone?

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Re: NHS breaking point?

Post by raven » Mon Aug 01, 2022 11:19 pm

Little waster wrote:
Mon Jul 25, 2022 5:14 pm
What the f.ck is £8 a person per day going to fund? Just picking the massive UCLH as an example that has 665 beds. Assuming 100% occupancy that’s a whopping £5320 per day versus on an annual budget of £1.4bn (or nearly £4m per day).

I imagine that extra 0.00125% funding will make an earth-shattering difference to the NHS.
That rather depends on whether it's meant to help reduce costs significantly, or whether it's meant to shift the Overton window so we all get acclimatised to paying.

Expect a lot more complaints about hospital food if it happens though.

(If you really wanted to charge for hospital stays, the obvious non-clinical thing to target is food, but you might find people forgo paying for it and order in...)

To dredge up the private vs public inefficiency argument again, I've bad experiences with private providers within the NHS. I don't know if any money was being squirrelled out of the country but I had certainly long delays for appointments, staff who seemed rushed and less experienced than the ones employed directly by the NHS, no continuity of care/never saw the same person twice. Of course you can get that in the NHS too, but I'd been seen by the equivalent NHS service right before it closed and so could directly compare the two. Private provider was worse all round in that instance.

Also had a scan at a local unit that I didn't realise was privately provided until I saw the consultant who told me the scanners they used weren't good enough quality, and to book at the hospital in future. That's obviously a problem.

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Re: NHS breaking point?

Post by Woodchopper » Wed Aug 03, 2022 7:58 pm

Thread on the current problems and Covid:
https://twitter.com/paulmainwood/status ... o1l-w_ZRgw

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Re: NHS breaking point?

Post by Woodchopper » Tue Aug 23, 2022 11:15 am

Long and detailed thread on the outcomes and causes of the current crisis in NHS emergency medicine: https://twitter.com/jburnmurdoch/status ... lXmV5L2pyw

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Re: NHS breaking point?

Post by raven » Fri Aug 26, 2022 4:39 pm

Thanks for that link, Woodchopper. That guy does great analysis.

(As I said to youngest,who's a mathematician, the FT had the best coverage during Covid because they employ journalists who can count...)

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Re: NHS breaking point?

Post by Woodchopper » Tue Sep 27, 2022 11:22 am

More on the possible links between lack of NHS care and people withdrawing from the workforce.
Among adults aged 50 to 65 years that left work since the start of the coronavirus pandemic and not returned, just under one-fifth (18%) said they were currently on an NHS waiting list for medical treatment. Slightly lower proportions were reported for those that had returned to work, having left either before the pandemic (11%) or since the start of the pandemic (15%) and those that remained active in the workplace (12%).

[...]

Among those who left their previous job due to a health-related condition (stress, mental health, illness, or disability), the proportion on an NHS waiting list increased to 35%. A similar proportion (36%) reporting a health condition as a reason for not returning to work said they were on an NHS waiting list.
https://www.ons.gov.uk/employmentandlab ... emic/wave2

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Re: NHS breaking point?

Post by plodder » Wed Sep 28, 2022 11:10 am

Just wanted to muddy the waters by pointing out that Kwarteng is promising genuinely huge tax cuts and "growth opportunities" in about 6 weeks time, I just wanted this thread to be nice and warmed up to welcome the news.

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Re: NHS breaking point?

Post by Woodchopper » Sun Oct 02, 2022 10:29 am

Across England, A&E departments are overwhelmed with patients, which leads to paramedics being delayed for hours in handing them over.

In August alone, 208,000 patients were delayed longer than 15 minutes outside A&E across England, and the equivalent of 110,000 ambulance responses were lost due to handover delays — meaning 148 patients could not be attended to every hour of every day that month.

These delays are dangerous. The Association of Ambulance Chief Executives estimates 3,800 patients suffered severe harm such as a lost limb, permanent disability or death as a result of long handover delays in August.

In London, Elkeles says he has agreed a plan with hospitals to ensure ambulances can leave A&E when high-risk 999 calls are waiting. “I think the penny has dropped about what is the greatest risk in the healthcare system. It is a huge risk if you have phoned 999 and you’re at home by yourself, without care,” he said.

“If you end up in the scenario where you have hundreds of patients waiting for an ambulance and you do not have the ambulances to respond, you’re in a place where you’re causing potential harm. The bigger the mismatch between your staff and the number of patients, the more harm you’re likely to cause.”

[…]

Trusts in Nottinghamshire, Liverpool and Grimsby last week declared critical incidents or cancelled operations due to overwhelming demand and struggles with discharging patients into the stretched care system. NHS England has identified ten areas, including city regions such as Leicester, Birmingham, Plymouth and Stoke-on-Trent, that could experience “system failure” this winter.

This would mean a collapse in social care capacity that leaves hospitals unable to discharge or admit patients, leading to A&Es being overwhelmed and even being forced to close temporarily.
https://www.thetimes.co.uk/article/para ... -drzmxtbvq

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Re: NHS breaking point?

Post by raven » Sun Oct 02, 2022 11:24 pm

Woodchopper wrote:
Sun Oct 02, 2022 10:29 am
In August alone, 208,000 patients were delayed longer than 15 minutes outside A&E across England, and the equivalent of 110,000 ambulance responses were lost due to handover delays — meaning 148 patients could not be attended to every hour of every day that month.

These delays are dangerous. The Association of Ambulance Chief Executives estimates 3,800 patients suffered severe harm such as a lost limb, permanent disability or death as a result of long handover delays in August.
https://www.thetimes.co.uk/article/para ... -drzmxtbvq
We brought the army in to help out with various things during Covid, didn't we. Is 4,000 patients a month suffering severe harm enough to bring them in now?

I'm thinking have them staff triage tents outside A&E, so ambulances can at least drop off and go to the next call out within something approaching normal turn around times. Of course, you'd still have the problem of getting patients either treated in A&E or through to wards that are bed-blocked, but at least anyone unlucky enough to have a heart attack or stroke might have more chance of getting to hospital during that first critical hour.

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Re: NHS breaking point?

Post by raven » Sun Oct 02, 2022 11:37 pm

Or, as a second thought, you set something up at the other end - at discharge, where the actual problem is. So you have rehabilitation/convalescent units to discharge patients to who are ready to go home but waiting for social care to be in place.

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Re: NHS breaking point?

Post by Cardinal Fang » Wed Oct 12, 2022 1:10 pm

That was one of the purposes of community hospitals

A lot of them went due to funding cuts...

CF
Image

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Re: NHS breaking point?

Post by raven » Sat Oct 15, 2022 8:05 pm

Cardinal Fang wrote:
Wed Oct 12, 2022 1:10 pm
That was one of the purposes of community hospitals

A lot of them went due to funding cuts...

CF
I assume Thatcher and Care in the Community were to blame for quite a bit of that. (I was thinking of Sefton General in Liverpool, which did that sort of long term care and got closed.)

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Re: NHS breaking point?

Post by Woodchopper » Mon Oct 24, 2022 12:42 pm

[…] NHS figures showed that the number of empty posts in nursing across hospitals, mental health, community care and other services had reached 46,828 – the largest number ever. That means that more than one in 10 nursing roles (11.8%) are unfilled across the service overall.

While the NHS is short of almost every type of staff, service chiefs say the acute lack of nurses is a key reason why so many patients are waiting so long for A&E, cancer treatment and other care.

[…]

Patricia Marquis, the Royal College of Nursing’s director for England, welcomed the campaign highlighting of the nursing shortage. But, she added: “It is all futile until nursing staff are paid a fair salary. The only way to solve the workforce crisis and recruit and retain nursing staff is to pay them fairly.”

It is pressing ministers to award nurses a pay rise that is 5% above inflation, which would mean a 15.1% uplift.

The union said last week that members in its ballot about potential industrial action in the next few months were voting to strike. Voting closes on Wednesday. “There is anger and motivation like never before,” she added.

[…]

The Health Service Journal recently reported that a record number of NHS staff – almost 35,000 – voluntarily resigned from their posts between April and June this year, with “work-life balance” the most common reason for doing so.

Almost 40,000 nurses quit the NHS over the last year – again, the most ever – recent analysis by the Nuffield Trust found.
https://www.theguardian.com/society/202 ... -shortages

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Re: NHS breaking point?

Post by Woodchopper » Fri Nov 04, 2022 1:29 pm

[...]
the UK is now roughly three years into a steady march of chronic illness that is scything through the most vulnerable and marginalised in our population.

Beginning shortly before the pandemic but then accelerating, there has been a steep climb in rates of chronic ill health among the long-term workless. Today there are half a million more working-age people in the UK with impairing health conditions than if pre-pandemic trends had continued, and 90 per cent of them are people who have not worked in several years.

And the damage is by no means limited to the older cohort. Rates of chronic back and neck pain have risen among the over-50s, but there has also been a clear increase in mental health difficulties among the under-35s.

Economic activity rates are lower for Britons with mental health problems than for any other condition. Seventy per cent are outside the workforce, and only half of those say they will probably or definitely work again.

The data, while not conclusive, suggest a dynamic in which those whose position on the periphery of society had already exposed them to greater health risks suddenly found themselves high and dry when access to healthcare was curtailed, and are now some way down ballooning waiting lists.

[...]

The international perspective is striking. Over the past year, one in six UK adults has had a pressing need for medical examination or treatment and been unable to get access, with almost half of these cases due to the length of waiting lists. This is the highest figure out of 36 European countries and almost triple the EU average.
https://www.ft.com/content/de8fc348-002 ... 0b4bbacc8d

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Re: NHS breaking point?

Post by sideshowjim » Tue Nov 29, 2022 10:36 pm

raven wrote:
Sun Oct 02, 2022 11:24 pm
Woodchopper wrote:
Sun Oct 02, 2022 10:29 am
In August alone, 208,000 patients were delayed longer than 15 minutes outside A&E across England, and the equivalent of 110,000 ambulance responses were lost due to handover delays — meaning 148 patients could not be attended to every hour of every day that month.

These delays are dangerous. The Association of Ambulance Chief Executives estimates 3,800 patients suffered severe harm such as a lost limb, permanent disability or death as a result of long handover delays in August.
https://www.thetimes.co.uk/article/para ... -drzmxtbvq
We brought the army in to help out with various things during Covid, didn't we. Is 4,000 patients a month suffering severe harm enough to bring them in now?

I'm thinking have them staff triage tents outside A&E, so ambulances can at least drop off and go to the next call out within something approaching normal turn around times. Of course, you'd still have the problem of getting patients either treated in A&E or through to wards that are bed-blocked, but at least anyone unlucky enough to have a heart attack or stroke might have more chance of getting to hospital during that first critical hour.
Issue with that is then the tent fills up and you're back to square 1.

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Re: NHS breaking point?

Post by Woodchopper » Wed Dec 14, 2022 7:44 pm

Another thread on the dramatic rise in people who are disabled.
https://twitter.com/TomWatersEcon/statu ... zegrAO9BAg

Explanations aren't given but combined with the other things posted here it seems that this is what a failing healthcare system looks like. Manageable problems aren't treated properly and so they become serious.

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Re: NHS breaking point?

Post by Woodchopper » Fri Dec 23, 2022 6:43 pm

More data on what led to the current situation: https://twitter.com/jburnmurdoch/status ... pXeE3rQ-kg

Thread also shows how deluded is the often repeated notion that there’s no difference between Labour and the Conservatives.

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Re: NHS breaking point?

Post by Woodchopper » Sun Mar 26, 2023 7:44 pm

The NHS in England needs a massive injection of homegrown doctors, nurses, GPs and dentists to avert a recruitment crisis that could leave it short of 571,000 staff, according to an internal document seen by the Guardian.

A long-awaited workforce plan produced by NHS England says the health service is already operating with 154,000 fewer full-time staff than it needs, and that number could balloon to 571,000 staff by 2036 on current trends.

The 107-page blueprint, which is being examined by ministers, sets out detailed proposals to end the understaffing that has plagued the health service for years. It says that without radical action, the NHS in England will have 28,000 fewer GPs, 44,000 fewer community nurses and an even greater lack of paramedics within 15 years.
https://www.theguardian.com/society/202 ... tudy-finds

Assuming that Labour is to gain power next year this problem will need to be their priority. They will need start building teaching capacity first and then try to recruit far more people.

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Re: NHS breaking point?

Post by bjn » Sun Mar 26, 2023 10:41 pm

That boosts a pipeline that will only start delivering in several years, and it’s predicated on people still wanting to work in the NHS. So short term supply needs fixing (ie immigration) as well as making the profession sufficiently attractive for people to invest in the training to take such a job (ie wages and conditions). Both have political implications.

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Re: NHS breaking point?

Post by Woodchopper » Mon Mar 27, 2023 6:03 am

bjn wrote:
Sun Mar 26, 2023 10:41 pm
That boosts a pipeline that will only start delivering in several years, and it’s predicated on people still wanting to work in the NHS. So short term supply needs fixing (ie immigration) as well as making the profession sufficiently attractive for people to invest in the training to take such a job (ie wages and conditions). Both have political implications.
Immigration isn’t just a political problem for the UK. There are shortages in qualified healthcare personnel in many developed countries. Britain will be competing with the US, Canada, Germany etc

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Re: NHS breaking point?

Post by Formerly AvP » Mon Mar 27, 2023 7:14 am

Woodchopper wrote:
Sun Mar 26, 2023 7:44 pm
The NHS in England needs a massive injection of homegrown doctors, nurses, GPs and dentists to avert a recruitment crisis that could leave it short of 571,000 staff, according to an internal document seen by the Guardian.

A long-awaited workforce plan produced by NHS England says the health service is already operating with 154,000 fewer full-time staff than it needs, and that number could balloon to 571,000 staff by 2036 on current trends.

The 107-page blueprint, which is being examined by ministers, sets out detailed proposals to end the understaffing that has plagued the health service for years. It says that without radical action, the NHS in England will have 28,000 fewer GPs, 44,000 fewer community nurses and an even greater lack of paramedics within 15 years.
https://www.theguardian.com/society/202 ... tudy-finds

Assuming that Labour is to gain power next year this problem will need to be their priority. They will need start building teaching capacity first and then try to recruit far more people.
As far as medicine is concerned, recruitment will probably not be a problem. Currently at the very high entry tariff required (generally 3 As with some A stars), there are about 3 applicants for every medical school place. The high entry requirement is mediated by competition, not by necessity, and if the entry requirements were changed to AAB (which would help with widening participation also) I reckon there would be at least another 25,000 potential applicants.
The Medical Schools Council reckons an increase of 5000 places to 14,500 would be appropriate.
https://www.medschools.ac.uk/media/2899 ... r-2021.pdf
However, I do not think this can simply be done by creating new medical schools or expanding existing ones, at least in the current version of what a medical school looks like. I think new paradigms of undergraduate medical education are called for.
Much the same arguments apply to nursing in my view.
Was Allo V Psycho, but when my laptop died, I lost all the info on it...

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Re: NHS breaking point?

Post by bjn » Mon Mar 27, 2023 7:14 am

By that I meant Britain need to stop being dickheads towards immigrants, otherwise they’ll be out competed on being a desirable country as well as pay. Reversing the ‘hostile environment’ b.llsh.t is part of that.

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Re: NHS breaking point?

Post by jimbob » Tue Mar 28, 2023 1:40 pm

bjn wrote:
Mon Mar 27, 2023 7:14 am
By that I meant Britain need to stop being dickheads towards immigrants, otherwise they’ll be out competed on being a desirable country as well as pay. Reversing the ‘hostile environment’ b.llsh.t is part of that.
Absolutely.
Have you considered stupidity as an explanation

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Re: NHS breaking point?

Post by Woodchopper » Fri Apr 28, 2023 11:50 am

John Burn Murdoch again on NHS staff problems: https://twitter.com/jburnmurdoch/status ... 3216038913

Key graphic is this one on the left:
Fuy7PgwX0AI68oB.jpg
Fuy7PgwX0AI68oB.jpg (144.97 KiB) Viewed 786 times
Pay for nurses is already higher in Slovenia and will be in Poland as well in a few years (along the current trajectory). The same applies to many of the other European states that fifteen years ago British policymakers could assume would supply all the skilled healthcare workers that Britain would need.

Brexit has made the situation worse, but even if it were to be reversed European labour markets are changed.

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