| Non-motoring > NHS Changes in England | Miscellaneous |
| Thread Author: Lygonos | Replies: 81 |
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Mon 23 Jan 12 02:10
NHS Changes in England - Lygonos
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Just a question: Anyone think these reforms are designed to do anything other than make GPs the 'bad guys' for all the crap/privatisation that's about to happen in the NHS in England, diverting attention from the Govt/DoHealth? Reminds me of privatisation of the water companies at a time when huge infrastructure investment was required, thus letting HMG off the hook. My gut suggests the new consortia will need to look at more private provision/income to balance the books - maybe that explains the slipping in of NHS hospitals being able to earn 49% of their income privately. Then again, maybe the same won't happen with health as it did with dentistry 20 years ago... |
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Mon 23 Jan 12 05:14
NHS Changes in England - AnotherJohnH
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>> Anyone think these reforms are designed to do anything other than make GPs the 'bad guys' >> for all the crap/privatisation that's about to happen in the NHS in England, >> diverting attention from the Govt/DoHealth? Probably not, if this is the calibre of ammunition they're wheeling out: Terrorflag link (to a dailywail story).... tinyurl.com/7hn7yhc |
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Mon 23 Jan 12 07:10
NHS Changes in England - PeterS
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My interpretation is that it's an attempt to undo some the expensive (but unforseen due to being poorly planned...) changes introduced by the last Government, and to try and limit/control the further growth in health spending. No particular blame likely to be directed at the GPs by me I haven't looked into the reforms in much more detail yet though, but my experience over the last 15 years as the partner of a 'heavy user' of the the NHS (dialysis/transplant/dialysis/associated stuff) is that while the nursing staff on the front line are, on the whole, absolutely fantastic, the organisation itself is the most inefficent and arrogant , and least customer focussed, organisation I've had the misfortune to deal with. It also really doen't like being questioned or challenged by patients and is not in the slightest bit interested in their thoughts, all IMO. So I'm not surprised that any suggestion of change from above is derided or ridiculed - the best form of defence appears to be attack :-) The sad fact is we can't afford the NHS to grow uncontrolled; haven't been able to for a while now, but no one has tackled it. I hope we do, so that we can 'save' it in a controlled way, but there are too many vested interest to make it work I fear. The worst possible outcome is an organisation that refuses to change while the world moves on around it... Genuine Q (I only have limited experience); has the privatisation of the water companies decreased or improved service/cost in your area? We moved a few years ago, and have a couple of properties. I haven't noticed a huge rise in bills, and the service appears to be at least as good, if not better than before. Now of coure, I expect its owned by the French ;-), but what other downsides have there been? Just my thoughts Peter |
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Mon 23 Jan 12 07:16
NHS Changes in England - PeterS
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>> Then again, maybe the same won't happen with health as it did with dentistry 20 >> years ago... Oops... Missed this bit. I quite like the way dentistry works round our way. There are NHS practices if you want them, or there are private ones. The choice is yours, and it is a choice; there are places at NHS surgeries if you want them. You just have to accept you might have to travel a couple of miles, which seems reasonable to me. Maybe as a result (pure hypothesis) of this competition the service seems to be fine which ever way you go. I can't remember the last time I heard any complaints about dentistry provision. More recent magazines and a cup of coffee if you go private though ;-) |
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Mon 23 Jan 12 10:20
NHS Changes in England - Stuu
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>>Anyone think these reforms are designed to do anything other than make GPs the 'bad guys' for all the crap/privatisation that's about to happen in the NHS in England, diverting attention from the Govt/DoHealth?<< Yes, thats paranoid. The reforms do seem abit iffy and may well not be the right ones, Im far from convinced and id rather like it if they were dropped and someone new came in with a clean sheet of paper. But I think assuming its a passing the buck exercise because one doesnt like what they are proposing is being reactionary. Ive not yet heard one doctor on TV proposing better, more effective reforms, which just reinforces the idea that vested interests are more important than having a better system, which is why reforms like this get pushed through - if all people do is oppose and dont offer serious alternatives, you end up getting things decided for you, which seems to be happening. May not seem very right-wing ( coming from me ) but I dont like any privatisation of the NHS and it seems to me the only reason it has crept in is because those who run the NHS havent or cannot get their house in order and be as cost-effective as private providers. |
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Mon 23 Jan 12 11:19
NHS Changes in England - MJM
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As an outsider it seems to me that the NHS will always be on a loser until “someone” gives it some boundaries. Unless restrained it will always expand to meet what it sees as its duty. The current furore over the failed breast implants is an example. The way things tend to get pushed these days the NHS (us, in effect) will pay for replacement implants whether the original operation was done by it or not. It should be made clear to those who indulge in vanity surgery, for want of a better description, that the NHS will not do it and will not foot the bill for subsequent medical treatment, if required, either. The same should apply, in my opinion, to fertility treatment. The NHS should be about diagnosing and prescribing treatment for UK taxpayers and their dependents, not trying to be an foc cure-all for anyone and everyone. I found this to be a good tic take on it. www.annaraccoon.com/politics/the-price-of-empire-building/ |
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Mon 23 Jan 12 11:35
NHS Changes in England - Old Navy
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| the NHS could save a bit by not treating "medical tourists". I have no problem with emergency treatment but deliberate travel to the UK for free treatment is abuse of the system, same as benefit cheats. I know they are supposed to pay but how many do? |
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Mon 23 Jan 12 12:08
NHS Changes in England - Bromptonaut
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>> I found this to be a good tic take on it. >> >> www.annaraccoon.com/politics/the-price-of-empire-building/ >> And who does la raccoon think provided district nurses, convalescent homes etc? There are plenty of private places for births - where the WAGs and others'too posh to push' go. Same for elective surgery up to and including major procedures like coronary bypass or hip replacement - BUPA etc. Those whose cases go wrong of course are carted off to the NHS lickety split. Anna writes very engagingly but as on Mental Health issues her take here is, to put it kindly, off beam. Last edited by: Bromptonaut on Mon 23 Jan 12 at 12:09
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Tue 24 Jan 12 01:22
NHS Changes in England - Lygonos
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www.bbc.co.uk/news/health-16690273 Chaired by a former Tory minister. Will this issue be the one that Clegg will use to try to prevent LD annihilation at the 2015 election? If he doesn't engineer a major break-up of the coalition at some point during the parliament his party is set for the abyss I think. (I actually think even with a schism the LDs are fubar'd already). Last edited by: Lygonos on Tue 24 Jan 12 at 01:25
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Tue 24 Jan 12 07:29
NHS Changes in England - madf
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"Will this issue be the one that Clegg will use to try to prevent LD annihilation at the 2015 election?" Well much LD support was from Labour voters who were fed up with Labour and attracted to the LDs' promises of more spending (tuition fees etc) without pain. They've gone and will never come back.. 10% points out of 25% ... approx. |
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Fri 3 Feb 12 14:26
NHS Changes in England - Lygonos
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www.bbc.co.uk/news/health-16861672 Must say I'm a bit surprised by this - the RCGP are generally non-political, and are certainly not a trade union type organsiation like the BMA. I would imagine if the RCGP says they feel the bill needs to be scrapped it won't be long til the other Colleges (surgeons, physicians, etc) play their hand also - a couple of weeks ago the DOHealth had to intervene to prevent them signing up to a letter stating the same - looks like they feels too little has been offered. Not sure how the govt will play this - obviously as legislators they can 'do as they please' but without a good portion of the professions in a supportive role this may be a catastrophe for the NHS (and the govt) if they do push through reforms. Can't say the govt haven't been told this since the Bill was made... |
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Fri 3 Feb 12 22:52
NHS Changes in England - Lygonos
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Here's where it will end:- "The Health Secretary Andrew Lansley is also facing a hearing in March where the Information Commissioner will seek to force Mr Lansley to release a secret government report on the risks of the NHS reforms." Game Over. |
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Sat 4 Feb 12 00:08
NHS Changes in England - PeterS
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>> Not sure how the govt will play this - obviously as legislators they can 'do >> as they please' but without a good portion of the professions in a supportive role >> this may be a catastrophe for the NHS (and the govt) if they do push >> through reforms. >> >> Can't say the govt haven't been told this since the Bill was made... >> But if they do nothing it's a catastrophe for the NHS and the country anyway. As I said before, I do hope that the Government is able to reform the NHS, but fear there are too many people protecting their own turf to look at the problem with an open mind... We'll up with the worst of all worlds then IMO |
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Sat 4 Feb 12 00:47
NHS Changes in England - Lygonos
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GPs should treat the patient in front of them as the priority. GPs also being in charge of the rationing of care to patients, in my humble opinion, is a massive conflict of interests. |
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Sat 4 Feb 12 09:18
NHS Changes in England - PeterS
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>> GPs also being in charge of the rationing of care to patients, in my humble >> opinion, is a massive conflict of interests. Replace "being in charge of the rationing of" in your sentence to "being able to source from a wide range of suppliers the" is another way of conveying the intention, but with somewhat less emotive language... As I say, I fear that resistance to change is too high among too many in the NHS for radical reform to happen, but it needs to. I just hope that the patients' voice and needs are not ignored in this whole thing by those defending the status quo. That might work for those working for the NHS, it doesn't necessarily work for it's users who, after all, do pay for it :-) |
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Sat 4 Feb 12 09:35
NHS Changes in England - Dutchie
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The people who work in the NHS also pay for the service.NHS is a emotive subject. Iam suspicious if so many Doctors are against the reforms why pushing it through? |
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Sat 4 Feb 12 09:40
NHS Changes in England - CGNorwich
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| Many doctors were very much against the NHS when it was founded Dutchie, despite what they might now have us believe. |
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Sat 4 Feb 12 10:20
NHS Changes in England - PeterS
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>> Many doctors were very much against the NHS when it was founded Dutchie, despite what >> they might now have us believe. >> Exactly! |
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Sat 4 Feb 12 10:22
NHS Changes in England - Zero
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| That'l be the same doctors who said smoking was good for you. |
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Sat 4 Feb 12 17:59
NHS Changes in England - Lygonos
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Anyone who thinks that having lots of small user groups and providers vying for every item of service will lead to a more streamlined NHS with less layers of management must button up the back. The decision of what is, and what is not going to be funded (= provided) in any area shouldn't be in the hands of the GPs - it should be independent (as NICE is, relatively speaking). Postcode lottery? You betcha - in spades. |
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Sat 4 Feb 12 18:25
NHS Changes in England - Armel Coussine
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Yes, there were doctors' bills when I was a child. The NHS was a wonderful idea and has generally worked well for a lot of people including me. Dentistry was the first element to slip off the shelf. But dentists were always a bit of a law unto themselves. They sometimes reminded me of a German doctor character in Burroughs's Naked Lunch who says something like: 'Ze human body has too many organs. They are too close in together crowded. They need lebensraum, like the Vaterland...' My teeth were like that, and dentists trashed them all with a will (with a good deal of help from me I have to admit), latterly making me pay as they did so. I have no opinion on whether the NHS is 'no longer affordable'. But I don't like the way Conservative politicians approach it. Obviously it has to be managed, as hospitals and even large GP practices do. But I don't trust overpaid philistine bean-counters to manage something as complex and subtle as that. I would like medical professionals to do it, as they used to. I look with horror on the US, where the majority view is ostensibly that any form of national health service is tantamount to 'communism', complete with forced abortions and euthanasia for your granny. Private health over there is a very, very powerful lobby clearly. Stronger than a well-meaning president it seems. Last edited by: Armel Coussine on Sat 4 Feb 12 at 18:27
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Sat 4 Feb 12 18:59
NHS Changes in England - PeterS
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>> Anyone who thinks that having lots of small user groups and providers vying for every >> item of service will lead to a more streamlined NHS with less layers of management >> must button up the back. >> Is that another example of the 'doctor knows' best attitude that endears the medical profession to it's patients ;-) I don't see how the scenario you describe is ever going to be an outcome. I thought what was being proposed was giving the power to Commissioning Groups (which are not individual GP practices as I understand it) to source what they needed from the most appropriate provider. I also can't see where the wholesale fragmentation of the supply side is going to come from. Sure there'll be small 'start-up' providers, but they won't succeed unless they provide a service people want. >>The decision of what is, and what is not going to be funded (= provided) in any area shouldn't >>be in the hands of the GPs - it should be independent (as NICE is, relatively speaking). But its not going to be in the hands of GPs is it? It is supposed to be overseen by a national Commissioning Board that sets priorities for the Commissioning Groups >>Postcode lottery? We already have one of those... I think what frustrates many people is that though there is widescale recognition that the current system is unsustainable, large swathes of the medical profession won't engage in a constructive debate about how to reform (=improve). It seems to be easier for them to criticise any proposal made by those who see the need to change and want (or have...) to do something about it. No ones stopping the GPs, or other medical professionals for that matter, coming up with solutions As one of my bosses said to me once, don't come to me with problems, come with solutions :-) Just my thoughts... Peter |
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Sat 4 Feb 12 19:29
NHS Changes in England - Stuu
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>>As one of my bosses said to me once, don't come to me with problems, come with solutions :-)<< It was 'suggested' to me that it may be most effective to let my physical issues get worse and be passed over to the DWP, presumably so im on their books rather than the NHS. I suppose passing the buck is one solution. Further physio was resisted ( we cant do any more for you were the exact words ) so I have had to fund private physio instead. So Im comissioning my own care. Doesnt seem right to me but there seems to be a point at which your written off and they want to pass you onto another department. |
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Mon 6 Feb 12 10:17
NHS Changes in England - Armel Coussine
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>> the same doctors who said smoking was good for you. My middle daughter got whooping cough as an infant because her mother was persuaded by the scare stories about the immunization for it. The doctor who came to examine her was smoking as he did so. |
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Sat 4 Feb 12 18:09
NHS Changes in England - Bromptonaut
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>> Many doctors were very much against the NHS when it was founded Dutchie, despite what >> they might now have us believe. Which is true but perhaps not as far from today's scenario as it seems. In 1948 Doctors did not want to be agents/employees of the state doing HMG's business for it. In the end Bevin conceded and allowed them to be self employed contractors. Leap forward 64 years and argument is about Doctors doing the government's deeds in an environment where treatments are likely to be rationed. Change comes round again!! |
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Sat 4 Feb 12 19:51
NHS Changes in England - Dutchie
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In my opinion you can't run the NHS like a bussiness.Whichever way the government wants to cut it.Just a report out today a big increase in cancer patients is expected in the future the money has to be found for treatment. If treatments are rationed where will it stop. |
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Sat 4 Feb 12 20:04
NHS Changes in England - CGNorwich
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The other side of the coin is to ask If treatments aren't rationed where will it stop. The demand for health care is virtually unlimited and treatments become more and more expensive every year. We could easily double or treble the amount spent on healthcare in this country but how would it be paid for? At the end of the day some limit has to be put on how much we spend on the NHS. That inevitably means someone has to decide whether or not a particular treatment is given. |
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Sat 4 Feb 12 20:20
NHS Changes in England - Dutchie
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But if that particular treatment can save your live or one of your family you will fight tooth and nail to get it. I think over the last ten years more has been spend on the NHS to the good.Wating list have come down for certain operations, at least it has stopped people travelling abroad for a hip operation. My treatment has been A1 in a modern hospital with all the facilities I could have wished for. Top surgeons and back up staff.But what has been said before don't let the service become a lottery. |
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Sat 4 Feb 12 20:00
NHS Changes in England - Lygonos
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The NHS isn't inherently doomed as Peter seems to suggest - it's no more expensive than most other industrialised nations' health provision. There's nothing inherently wrong with Commissioning Groups either, as the provision of choice is vital to push an efficient delivery of service. Where it will fail is when the CGs are being forced to slice out bits it can't or won't want to pay for. The IT implications alone are immense - expect 10s of billions to be thrown at a one-size-fits-all IT system as currently there are several different systems in use. I'm not being emotive describing provision choice as "rationing" - that's exactly what it is - it needs to be seen and discussed as that, in the same way as all the world's ills relate to population growth, yet no-one grasps the nettle of limiting population growth at a high level. My feeling is that an independent body, answerable to government (a quango I guess) should determine what the NHS should provide not small groups who will vary their decisions geographically or simply upon the perceptions of local practitioners. The majority of people on the Commissioning boards are GPs who still work in General Practice. As advisors to a higher power I have no problem with this, but as the user AND provider of services I feel this is absolutely not right. My expectation is that these changes will never move north of the border as we have a smaller population density - I have no vested interest in what happens in England (unless I have to move there after Independence turns us into Zimbabwe 2.0) ... which it won't even if it happened ;-) |
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Sat 4 Feb 12 20:05
NHS Changes in England - PeterS
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>> The NHS isn't inherently doomed as Peter seems to suggest - it's no more expensive >> than most other industrialised nations' health provision. I'm not saying it's doomed at all. What I'm saying is that it has reached a size where it's so inefficient that just throwing more money at it isn't the solution. We can't afford to throw more and more money for diminishing returns; rather we need to get as much out of the money we do spend. Let's face it, eventually those living under communism realised that trying to plan everything centrally led to delivering precisely what no one wanted ;-) |
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Sat 4 Feb 12 20:13
NHS Changes in England - Lygonos
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Some central control/responsibility is vital in an organisation eating up 70 billion a year. Since the focus has sharply shifted from providing 100% best available treatment to providing 100% value for money, you'll see that GPs, and to a lesser extent hospital doctors, are already trimming ££££ off NHS costs. Many of the forum members will already have had their medicince switched around to cheaper ones which are not significantly less effective. I think the wheels are already in motion to streamline the NHS - the monumental changes in the Bill do not come without very large risks (which will be made public in March perhaps...) Already the changes implemented largely by Labour are starting to bear fruit - a significant fall in premature heart disease deaths is being seen as a result of mass medication for high blood pressure, cholesterol etc. The flip side of this is 60 year olds who were going to die from a heart attack will now live another 10 or 20 years to finally succumb to dementia or cancer. The biggest lie of the 20th Century was that by spending money now (1948) we would save money in the future by having a healthier nation - we've simply extending the period of ill health and retirement (pensions cost more than the NHS...) |
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Sat 4 Feb 12 20:07
NHS Changes in England - Iffy
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...(unless I have to move there after Independence turns us into Zimbabwe 2.0)... Under your new leader Robert Mcgabe. |
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Sat 4 Feb 12 20:15
NHS Changes in England - PeterS
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>> I'm not being emotive describing provision choice as "rationing" - that's exactly what it is >> - it needs to be seen and discussed as that, in the same way as >> all the world's ills relate to population growth, yet no-one grasps the nettle of limiting >> population growth at a high level. Provision choice in itself is not rationing though, is it? I can chose from any number of dentists, opticians, lawyers, supermarkets etc etc that I like. There's a choice in everything. I am able to chose the combination of products/services/features/benefits that I want and can afford. In the case of the proposals regarding the NHS, my understanding is that the 'afford' bit will be governed by the minimum level of service that has to be delivered, and that'll be the same across the country. The rationing will still be carried out centrally, as it is today. If some areas are able to offer more from the same per capita spend, then they must be doing something right! That's to be encouraged surely? Let's not forget that under the current system there are already huge variations across the country in terms of what delivered in terms of healthcare |
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Sat 4 Feb 12 20:30
NHS Changes in England - Lygonos
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Anyone who thinks that the NHS performance has not improved since 1997 is also grossly mistaken. In 2000 it could take up to 2 years for one of my patients to receive a new hip/knee from the time of referral - not it is generally about 4 months. If one of my patients may have a cancer (eg. bleeding from their bum) I can now have a telescope checking the 'dark side of the Moon' within 2 weeks. Diabetics/heart patients/dementia sufferers all receive a much better deal than they did before the millenium. One problem is there are more diabetics, demented, chronic heart patients, etc which costs even more to maintain. Increasing costs is partially due to successful medical intervention. If services will be entirely determined by the lowest bidder, be prepared to see a wholesale rise in private provision who can offer a second tier of care. My personal views are more righ-wing than left-wing: I support individual choice, advancement through merit, etc. I also, however, feel that education and health care are a vital part of social welfare provision - I have no problem with private healthcare or education (and would even suggest those choosing either should get a small rebate for not burdening the public purse) but I feel the basic standard offered by the State should be very high, not lowest common denominator. The baby and the bathwater are going to be thrown out with this bill - talk about arrogant bankers? The hubris shown by govt trying to push this massive change to the NHS without proper studies, consultation, or piloting has landed Mr Csmeron et al where they deserve to be. |
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Sat 4 Feb 12 20:35
NHS Changes in England - Armel Coussine
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| You're cool Lygonos. Good stuff. |
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Sat 4 Feb 12 20:51
NHS Changes in England - Armel Coussine
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People need to regress a bit and understand, as they used to, that death is inevitable and part of life. Prolonging 'life' for as long as possible at all costs is perverse in some way. Its 'quality' as it is quaintly called can decline so far that you can't really call it life any more. Why be a burden on people you love in your miserable declining years? But wimpish modern people won't look at it hard enough to understand. 'I owe it to the children to extend my drooling witless dotage.' In a pig's ear you do. The novelist Aldous Huxley wrote a horror story novel, After Many a Summer, on this matter. It's not all that good but it does make a point. My excellent late mother-in-law, dying in her nineties, opened one eye to say firmly: 'No operation.' She just couldn't be bothered any more, and had the brains and guts to realise it. |
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Sat 4 Feb 12 20:59
NHS Changes in England - Lygonos
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I have the mixed fortune of being involved in the end of many people's lives - the majority of people do find peace before they go. I've also seen the odd few of the 'no operation' mentality who go on for another 2 or 3 years when weeks or months were expected - the human will can be simply fantastic (and humbling) to behold at times. The most inspiring people, ironically enough, are often the guys who care little for doctors and interventions - more than once I've remarked to bereaved family "the reason he/she was still going strong at 80/90 was they would never do what they were told" - which is usually received by a variety of sage nods and outright laughter. Last edited by: VxFan on Sun 5 Feb 12 at 00:39
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Sat 4 Feb 12 21:04
NHS Changes in England - henry k
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Groups of GPs pratices are being actively hoovered up by big business. They are on the hunt now. This alone will start to influence how things progress. |
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Sat 4 Feb 12 21:18
NHS Changes in England - Lygonos
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I don't see medicine at the GP level as remotely like a commodity - it is a relationship (whether the doctor or patient realise that varies!) and very difficult to spread out into a purely business transaction. Hospital interventions are a bit easier to cost financially, but I'd still rather have an experienced consultant rummaging around in my giblets than A.N.Other Newguy - so to pretend the hip replacement you get in one place is identical to the one you get in another place is a bit laughable. If it boils down to the cheapest hip replacement (and it will do as Commissioning is about holding the pursestrings with a finite amount in the purse), you can bet your bottom dollar there's more risk you don't get the consultant (who will be earning more corn operating privately on those with the funds). Scaremongering? I don't know - there's not good pilot data to go on. Whose fault is that? |
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Sat 4 Feb 12 22:50
NHS Changes in England - PeterS
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I don't disagree with much of what you say, the infrastructure of the NHS has definitely got better since '97, and waiting lists for most things are down. The level of service though at some levels, from a 'customer' perspective is worse. My experience, as the partner of a patient who requires treatment across multiple disciplines is that its much harder to get joined up care than it used to be. Might not be everyone's experience, but its definitely ours, and across 3 seperate health authorities over the last 15 years too. There's an awful lot of being passed from pillar to post, and an unwillingness to get involved - "not my area". My question still stands though; what's the alternative? Where are the ideas from the profession on improving service, increasing efficiency etc? |
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Sat 4 Feb 12 23:20
NHS Changes in England - Roger.
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| Perhaps the "Soylent Green" solution will come to be? |
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Sat 4 Feb 12 23:29
NHS Changes in England - Stuu
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Joined up care is hit and miss. With my nan dealing with so many agencies, you need to be a care manager just to keep on top of things and especially to pass information between them - district nurses dont even communicate very effectively with surgeries so more than once we have had to act as go between and often find we know more than anyone. Id certainly like to see some form of manager assigned to individual cases ( a sort of medical social worker type role ) who are at risk of disjointed care, so they can spend the time making sure there is continuity and everyone knows whats going on rather than the current expectation there seems to be that the patient should be the one to do this. When my dad was in hospital with his heart issues, moving hospital, almost no information was passed between them when he moved - they discovered internal bleeding before he moved yet when he arrived at Oxford they preceeded to try and pump him full of blood thinniners - only his own intervention and refusal to accept the treatment avoided a whole new set of problems. Massive room for improvement in that area, it was wholly unacceptable but the attitude you get back is woeful if you expose their mistakes. Its all covering peoples backsides, patients come a distant second. |
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Sun 5 Feb 12 00:01
NHS Changes in England - Lygonos
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Communication is by far the biggest failing I see in the NHS (and also private medicine). The centralisation and "efficiency-saving" measures being concocted by some in management simply exacerbate this. For example, we have district nurses attached to our practice (with a little overlap such as covering if another practice's nurse is off sick) meaning the same nurse sees the same patient day after day. Some genius "nurse manager" (those who can - nurse, those who can't - manage) thought it would be fun to have several towns pool the DNs so that they could work more efficiently. Nothing patients love more than to see a different stranger every day.... Fortunately this idea appears to have crawled back under a rock for now. My vision of the NHS? Not something I've devoted masses of time to, as I'm not a cog in medical politics, but the base has to be stable General Practice (not drop-in clinics - what an utter waste of time and money they are/were) at a relatively small level (practices of 5-15,000 patients perhaps working from premises containing 1-4 practices) with attached DNs/health visitors/health care assistants/physiotherapists/podiatrists, with hospital care mostly being delivered in very large University-type hospitals (covering populations of 200-300,000) where most specialities are on site. Smaller, more local hospitals should be relegated to providing day surgery, investigations, rehabilitation. Full A&E departments will likely only be at the very large hospitals, with 'minor injury units' at the District General Hospital level:- if I was mangled in a car crash I want to go somewhere that can resuscitate and patche me up asap. Of course these changes are already well underway - I don't see what the commissioning changes will bring to the table other than a significant risk of more chaos and more managers pushing money/figures from one pot into another. |
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Sun 5 Feb 12 10:48
NHS Changes in England - swiss tony
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>> Smaller, more local hospitals should be relegated to providing day surgery, investigations, rehabilitation. >> >> Full A&E departments will likely only be at the very large hospitals, with 'minor injury >> units' at the District General Hospital level:- if I was mangled in a car crash >> I want to go somewhere that can resuscitate and patche me up asap. >> >> Of course these changes are already well underway - I don't see what the commissioning >> changes will bring to the table other than a significant risk of more chaos and >> more managers pushing money/figures from one pot into another. >> >> Pity they can't get even that right, where I live. I live in High Wycombe. A large town, just off the M40, close(ish) to the M25 link. We have (had) a general hospital, on the outskirts of town, built in the 60's and the building has been allowed to rot. Basically its a dump now. Just off the M40, is a sports centre, that was also built in the 60's, which the local council keep wanting to knock down and build a new sports centre / a coach station / houses / what ever the flavour of the day is..... Many of us think that a new hospital should be built there - close links to the motorway network, not that far from town. very close to the local park and ride, etc. Instead... all hospital services are slowly being transferred to Stoke Mandiville. Thats 14 miles away, through the center of town, down a bumpy single carriageway road. Google Maps, (and the local health service) report its do-able in 22 minutes. RUBBISH! Blues and twos will help a little, but the fastest Ive ever done the journey are as follows (both late evening - very little traffic about ) 2.5 V6 car - 35 mins. 750cc sports motorcycle 25mins. People are dying - babies are being born in an ambulance - on the side of the A4010. BTW, there is an accident blackspot on the M40 at Loudwater, that adds another 5 miles onto the run to the hospital. Last edited by: VxFan on Sun 5 Feb 12 at 17:41
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Sun 5 Feb 12 11:02
NHS Changes in England - Lygonos
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If you're within 30 minutes of death due to injuries a small A&E unit with no on-call trauma surgeon waiting for you is about as useful as popping into McDonalds. In Scotland there are huge areas that are an hour or more from good hospital cover - the answer is to have sufficient very highly trained paramedics available who can stabilise you for the vital first hour or so. Hospitals are extremely expensive - people need to choose cake or cost-savings. Even the large increases of expenditure in the 90s/00s barely touched on the suspended animation of hospital stock (and schools) largely evident through our 80s 'boom years'. Don't expect any improvement with the current mob - as I mention in the OP I think it is a sneaky ploy to make people become upset at GPs/commissioners rather than govt for a failure to upgrade and improve services at a time of austerity (expect 5-10 years of this). |
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Sun 5 Feb 12 17:54
NHS Changes in England - Dutchie
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www.supplymanagement.com/news/2011/hospital-purchasing-slammed-by-auditors-as-poor-value-for-money/ Picked up this article regarding spending maybe changes could be made here. |
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Sun 5 Feb 12 18:34
NHS Changes in England - Manatee
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I can confirm that Wycombe to Stoke Mandeville is a horrible journey, having done it many times. It can take half an hour to get through West Wycombe using the A4010 without blue lights. Good luck with Stoke hospital. My wife was sent to A&E recently by her GP who was pretty sure that a large contusion on the nether parts caused by a fall three weeks earlier harboured an infection. After 3 hours and 50 minutes a surgeon looked at it and said there couldn't be an infection as the skin wasn't broken, she could go home. My wife was feeling quite ill and running a temperature, and the bruise was warm to the touch (which is what the GP had noticed). But wife is a Stoic and suffers in silence. I told the surgeon that we were not happy and some investigation was needed to explain the illness and raised temperature. A polite argument ensued, which was ended by a sidekick suggesting a blood test (about 11pm by now) and wife was admitted. Results back in the small hours, wife put on intravenous antibiotics immediately. The following morning, a different surgeon came to look, declared there couldn't be an infection as the skin wasn't broken, the blood results must be due to something else "go home". A further discussion ensued, which was resolved by the surgeon suggesting an MRI "to be sure". The MRI revealed an infected abscess at the site of the bruise. Wife was put on nil by mouth and surgery planned. The surgery took place around midnight 18 hours later. She was returned to the ward at about 2am, where she was kept awake all night by a sadly doolally woman in the bed opposite. I was told to fetch her at 9am. She was clearly unfit to leave, having just had her first meal for 30 hours and no sleep that night. We decided to cut our losses, I got her home and she went straight to bed and slept for 12 hours. Quite by chance, this came up in conversation last night when we were out with friends, and my wife shocked me by saying that she would have died had I not resisted the sending home - we'll never know, thankfully. I hadn't realised myself quite how ill she felt at the time. As far as I am concerned, her GP was the one who saved her - I just saw no reason to prefer the surgeon's opinion. Hospitals are dangerous places! |
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Sun 5 Feb 12 18:40
NHS Changes in England - Iffy
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...kept awake all night by a sadly doolally woman in the bed opposite... I had next to no sleep during my week in hospital due to a man in the next bed who spent most of his time talking gibberish. We got on quite well. |
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Sun 5 Feb 12 19:54
NHS Changes in England - swiss tony
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>> I can confirm that Wycombe to Stoke Mandeville is a horrible journey, having done it >> many times. It can take half an hour to get through West Wycombe using the >> A4010 without blue lights. >> Good luck with Stoke hospital...... Thanks for your confirmation... I have seen the operation of Stoke Mandiville from both sides, a patient, and a visitor, and have not been impressed. Its all nice, shiny and new, but badly designed and laid out, as well as - how can I put it? - not instilling confidence.... I was an inpatient at Stoke with chest pains (luckily no more than stress) but I felt that no-one listened to what I said, I was continually repeating the same things to Doctors, nurses etc - in fact often the same thing to the same person. |
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Sun 5 Feb 12 23:05
NHS Changes in England - Lygonos
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You chaps are re-confirming what I already know:- I'll never want to work in a hospital again! |
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Sun 5 Feb 12 23:35
NHS Changes in England - Stuu
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The way my nans district nurse describes Northampton General ( your nan is at serious risk of death in that place, take her there as a last resort and get her back out as quick as possible ), she makes it sound like a 3rd world outfit. My grandfather was poorly treated while there, nobody fed him or gave him a drink ( stroke ), it was incredibly hot on the ward and he caught numerous infections in his 6 month stay before mercy prevailed and he died. It varies of course, but NHS hospitals can be quite horrendous and it seems barely possible that it isnt more of a national scandal. |
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Mon 6 Feb 12 02:12
NHS Changes in England - Iffy
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...but I felt that no-one listened to what I said... Listening to the patient is the last resort for many in the medical profession, not just those who work in hospitals. |
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Mon 6 Feb 12 09:48
NHS Changes in England - CGNorwich
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| Too many hypochondriacs , not enough time. |
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Mon 6 Feb 12 10:09
NHS Changes in England - Iffy
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...Too many hypochondriacs , not enough time... I'd much rather have had an imagined knackered hip than a real knackered one. |
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Mon 6 Feb 12 10:32
NHS Changes in England - CGNorwich
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I'm sure you would but the you asked whys so many health professional don't really listen to what their patients are saying. They know that a substantial proportion, (the majority?) have nothing wrong with them and prefer to rely on tests to establish the facts rather than accept as fact the patient's self diagnosis and tale of woe. It might be wrong but there are simply not enough hours in the day to do otherwise. |
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Mon 6 Feb 12 11:18
NHS Changes in England - Iffy
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...simply not enough hours in the day... To be fair to my GP, she always gives me plenty of time. Although I think she's more interested in hearing about the latest inquests and death and injury stories I've done than she is in hearing about my medical condition. |
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Mon 6 Feb 12 11:31
NHS Changes in England - Lygonos
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>> They know that a substantial proportion, (the majority?) have nothing wrong with them and prefer to rely on tests to establish the facts rather than accept as fact the patient's self diagnosis and tale of woe. It might be wrong but there are simply not enough hours in the day to do otherwise. If this is your experience of doctors I'd find a new doctor if I were you. 90% of the information required will be gleaned from the history and examination. Tests are mostly used to confirm/refute a hypothesis/diagnosis, or to cover your bum in case something more sinister could be at play. (eg. "Doc, I've noticed blood in the toilet after I poo the last few days. It's something I've noticed a few times in the past few years." *after pleasant examination* - "well the story sounds like piles, so I'll give you this ointment to try, but since you're 66 and have never had this looked at before let's just make sure we're not missing something nastier and get a camera up yer jacksy.") My experience of most patients is that once they're passed 40 (20 for Rats...) they'll worry that any lumps/bleeding is cancer, or chest pain is heart disease, even if they don't say it directly. Dozens of books exist on 'consultation technique' - it's a lot more complex than having someone come in and tell you the diagnosis! |
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Mon 6 Feb 12 11:47
NHS Changes in England - Iffy
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When I did motorway breakdowns, as much, if not more, information could be gleaned about the problem by skilful questioning of the driver, than from examining the vehicle. A common difficulty was drivers who would not give information, or who gave false information. Good GPs, which I suspect are in the majority, will know how to question the patient and how to interpret the responses. |
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Mon 6 Feb 12 12:44
NHS Changes in England - CGNorwich
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I'd find a new doctor if I were you. Not too easy. Normal wait for an appointment is now 2 weeks at my surgery and the other practice down the road is no better. Chance of seeing my actual doctor about zero. In fact I think I have only ever seen him once in fifteen years. |
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Mon 6 Feb 12 14:00
NHS Changes in England - Lygonos
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2 weeks seems excessive, but as I've remarked before England gets a worse deal than Scotland for GPs - more patients per doctor. Flipside from the English GP's point of view is they make more money as practice income is related to the numbre of patients on its books. This situation can only worsen if the govt pushes more people out of GP-land either through making hospital/locum work more attractive, emigration more attractive, or early retirement more attractive - which they are succeeding at quite nicely so far. |
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Mon 6 Feb 12 15:55
NHS Changes in England - Dutchie
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About a week to wait to see a Doctor Norwich.Unless a emergency same day.The problem is with a emergency got a doctor once who didn't have a clue about my situation. Sometimes better to ring for a ambulance to get to A & E. |
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Mon 6 Feb 12 20:06
NHS Changes in England - swiss tony
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>> Normal wait for an appointment is now 2 weeks at my surgery >> and the other practice down the road is no better. Round here we can't book an appointment in advance - we have to get on the phone the second they open... If we miss getting a morning appointment, we have to phone back after lunch, and hopefully get an afternoon one. If we miss that, its back on the phone next morning....... |
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Mon 6 Feb 12 20:11
NHS Changes in England - Lygonos
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That's thanks to a rather cynical response to the previous government penalising practices who can't be shown to offer a routine appointment within 48 hours. The answer especially from practices with relatively high populations was to do what ST mentions above. There's always appointments available the following day - just you can't get them until the day in question. England needs more GPs sharing the same pie, but the current system is distorted to have a few partners and lots of 'salaried' doctors so the partners keep more pie. |
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Mon 6 Feb 12 23:18
NHS Changes in England - Dutchie
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Have the Scots got a better system then than the Englanders? Strange. |
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Mon 6 Feb 12 23:29
NHS Changes in England - Lygonos
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| Virtually the same system, but more doctors per skull of population. |
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Tue 7 Feb 12 09:02
NHS Changes in England - L'escargot
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>> Round here we can't book an appointment in advance - we have to get on >> the phone the second they open... We do too. |
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Tue 7 Feb 12 09:32
NHS Changes in England - Focusless
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>> >> Round here we can't book an appointment in advance - we have to get >> on >> >> the phone the second they open... >> >> We do too. Same here - and no queuing system on the phone either, so you just have to keep trying, and trying, and trying ... Right pain. |
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Tue 7 Feb 12 09:43
NHS Changes in England - CGNorwich
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Round here we can't book an appointment in advance - we have to get on >> the phone the second they open... That's because 1 Seeing the doctor is free at point of use creates unlimited demand. A large proportion of those visiting the doctor have a trivial complaint that does not need medical intervention. 2 Because the NHS is free at point of use doctors and hospitals do not see patients as "customers". Would any garage,hotel,or vet run their business that way. No they would be out of business in a month. |
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Tue 7 Feb 12 10:09
NHS Changes in England - Meldrew
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| CGN re your point 2 I disagree - doctors, at least, have loads of patients, most of who couldn't go to an alternative one if they wanted to. The problem is handling the contact and communication with these patients. I am lucky in that I am on the books of a small husband and wife practice and there isn't a problem. Yesterday I rang at 0830 and got an appointment for 1220. I do not know what it is like at a nearby practice, the largest in UK with 17 GPs. |
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Tue 7 Feb 12 10:16
NHS Changes in England - CGNorwich
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Tehy don't need to go to an alternative doctor. There's nothing wrong with half of them. Imposing some sort of up front charge, as in the French system, would deter those who rush to the doctors every time they sneeze or they bang their toe. It would also go some way to making doctors perceive their patients as the source of their livelihood rather that an annoyance to be processed. |
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Tue 7 Feb 12 10:26
NHS Changes in England - Meldrew
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| You are quite right about attendance for trivial matters. I suggest a halfway house approach - upfront fee of £20 refundable if the visit is deemed appropriate, tests needed, scrip issued etc! |
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Tue 7 Feb 12 10:23
NHS Changes in England - Bromptonaut
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Blimey I thought the poor GP service my colleagues report was a London thing. In quasi-rural Northants the process is ring, wait in queue system ( one that tels you waiting time) and speak to receptionist. He/she takes details referring most calls to the Doc who prioritises and calls you back to triage; either prescribes over phone or gives you an appointment later same day. Non urgent 'convenience' appointments or follow ups are negotiated with 'twilight' sessions available 'til 21:00 two nights a week. |
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Tue 7 Feb 12 11:13
NHS Changes in England - Dutchie
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What I have done in the past if I needed a doctor gone to the surgery and wait to see somebody. The problem is some symptoms men have they leave untill its to late.I always felt a sissy seeing a doctor.In general women are more health consciences than men. |
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Tue 7 Feb 12 17:36
NHS Changes in England - smokie
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www.bbc.co.uk/news/uk-politics-16930980 "No 10 insists Andrew Lansley has David Cameron's "full support", despite a Downing Street source reportedly saying the health secretary "should be taken out and shot"." Didn't Clarkson get in trouble for using a similar phrase recently? |
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Tue 7 Feb 12 22:21
NHS Changes in England - borasport
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I have a close relative, in his mid eighties, currently in hospital. His symptoms appeared in the week before Christmas, and were such that he was asked to attend a pre-op on the 23rd, so that he could be treated the following week if there was a cancellation, so he turned up at 8 am on Christmas eve, and despite the hospital being pretty much empty, hadn't been seen after 2 1/2 hours, and by all acounts, neither was anybody else, despite asking the nurse i/c why they were called in that early if there was no one to deal with the. Then his daughter arrived, made it clear to the staff she was a medical professional, and within 20 minutes he was seen. Then nothing for a month, then a request from the hospital for him to visit his GP as she had raised concerns about the notes she's had from the hospital. It turns out that despite it being by all accounts, a very quiet day, Dec23rd, they have had two 'Mr Smiths' and manage to swap their notes Then he gets the call to go in for treatment today - when he arrived at 08:30, he was told to go and wait in a day room which was already full to standing (he's in his mid eighties). Eventually an adjoining day room was opened, which was soon filled, then a nurse opened the door adjoining the two rooms 'So you can all hear me' and anounced that 'When I came to work this morning we had three beds, but now we have eleven patients...' When the doctor came to discuss his issue, which is of a personal nature, this discussion took place, at some volume, as he is rather deaf, in the corridor. Whe he asked if there was somewhere else they could have the discussion, the doctor walked five steps down the corridor Is this as good as we can expect from the NHS - in my families recent experience, it's par for the course, and whilst I have no great confidence that moving power into the hands of GP's will improve things, I have precious little confidence in the current system. There needs to be change, and that change should not be direct or controlled by those with a vested interest in the status quo |
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Wed 8 Feb 12 00:14
NHS Changes in England - Dutchie
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A shame to hear about a story like this.But is this the fault of the NHS?Some doctors and nurses might need retraining how to deal with patients. My mother years ago now had a bad fall she was in her eighties.Igot a phonecall in the UK to come and see her she was very ill.When I saw her she was covered in bruises a lot of them in her face.The male nurse or junior doctor can't remember wanted her home they needed her bed.I told him that she was in no fit state to go home and that she needed a few days more rest in hospital.This was a Dutch hospital so the NHS is not alone in giving sometimes poor service. |
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Thu 23 Feb 12 14:48
NHS Changes in England - Lygonos
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www.bbc.co.uk/news/health-17142643 Bumping the thread, I know, but I expect all of the remaining 'Royal Colleges' will follow suit. About time for the Bill to be abandoned and reform to be made in the correct manner - consultation followed by legislation, rather than the other way around. Not a snowball's chance in hell Holyrood will attempt to copy England's 'reform bill'. |
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Thu 23 Feb 12 14:57
NHS Changes in England - Armel Coussine
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Saw Michael Portillo, who seems OK to me as Tories go, on Newsnight a week or so ago saying that the important thing about the reform was 'competition'. Obviously competition between doctors or areas for patients is a terrible idea. But are they talking about competition between suppliers of medicine, equipment and buildings to the NHS? That seems a much better idea as the NHS like other governmental or quasi-governmental bodies (MoD is a big sinner) sometimes seems insanely wasteful and extravagant. If this is what they mean when they talk about 'competition', there must be other areas of the proposed reform package that these professional healthcare bodies, which one assumes to be well-meaning and knowledgeable about healthcare 'delivery' (yuck!), don't like. It's all a bit of a mystery to me. |
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Thu 23 Feb 12 15:17
NHS Changes in England - Lygonos
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My big concern is that 'competition' will bring 2 things:- - the bare minimum being done, by the least experienced, for the lowest cost - fragmentation of provision with consequent failures in communication - this is difficult enough to maintain when a service is under one roof, let alone when dozens/hundreds of separate companies are supplying 'services'. Communication failure, by far, is the biggest cause of serious coq-ups in the NHS (and the business world at large I imagine). Last edited by: Lygonos on Thu 23 Feb 12 at 15:18
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Sun 26 Feb 12 19:29
NHS Changes in England - Lygonos
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Oh, and I forgot concern number 3: www.bbc.co.uk/news/uk-17161210 If you think that's a scandalous use of public money, wait til you see what Dave's mates can make on the side from tendering for DoHealth cash. ".... it was revealed that its shareholders were paid £11m in dividends while all of its £160m-£180m UK turnover last year came from government contracts." I think I read somewhere else that Emma Harrison is one of the 5 (FIVE) shareholders, and has an 87% stake in the business. Last edited by: Lygonos on Sun 26 Feb 12 at 19:32
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Sun 26 Feb 12 19:38
NHS Changes in England - Dutchie
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| One fiddle after another and they get away with it.Crime pays. |
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Sun 26 Feb 12 19:43
NHS Changes in England - Lygonos
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The fun bit is she very likely has done nothing criminal. The arrests last week were of people lower down the food chain. Last edited by: Lygonos on Sun 26 Feb 12 at 19:44
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