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The NHS
January 10, 2018

Joined: May 5, 2014
Posts: 676
The NHS

January 10, 2018

Channel 5 News (aka "We hate the NHS") seem to take great delight in slamming the NHS almost on a daily basis. Sure there are problems, which I accept must invariably occur in such a mammoth organisation, but there are also many, many great deeds performed daily by those who work in the NHS. Faults ? - the fact that WINTER seems to catch the management by  surprise every year - they must know it comes around annually !?! In my local area, 3 separate hospitals (admittedly the smaller ones) closed wards thus losing valuable bed spaces, in October / November, just before  the onset of winter ! When I asked who makes such decisions I was told it was the CCG ( Clinical Commissioning Group), a body I believe made up of NON Medical people, probably the same ones now puzzled by the pressures on the NHS ! I happen to agree incidentally, that to cancel all non urgent operations for the month was good management, freeing up resources whilst giving those patients decent notice of the cancellation rather than the hitherto last minute notice as in previous years. On the plus side, I know of 2 people ( my sister one of them) currently receiving top notch care for breast cancer, my son-in -law's Dad undertaking heart surgery this Friday (despite Channel 5 stating all operations were cancelled in January), and my own wife having been able to see a doctor without problems 3 times since Christmas. So, I say to Channel 5 News, look beyond your headline grabbing fault finding,  and say something GOOD about the NHS, especially for the great front line staff who daily perform wonders. John (JKW)

January 10, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 10, 2018

The NHS was born in 1948 and its ethos and aims have hardly changed since. It’s management is outdated and archaic. It is beset with top heavy, ludicrously highly paid executives, phenomenal waste and a lack of properly invested money. Add in very low morale, post code lottery healthcare, people living far longer with many more lifestyle induced chronic illnesses, hugely expensive drugs that are developed and contribute to people’s longevity, social media induced greater expectations by folk, massive abuse of A&E and the problems are easy to discern. Let’s not even go into Health tourism!  The NHS is NOT a national health service. In England it is a series of Clinical Commissing Groups, comprising local GPs and non executive members along with 3/4 executive officers. These CCGs  plan and purchase  healthcare for their local populations from strictly defined budgets set by the Government according to age/poverty/demographic criteria. Different CCGs fund different services, what may be available as an NHS funded procedure in one area is not necessarily so in another CCG area. Like I said, no National Health Service. CCG budgets are thrown into disarray almost every year when ‘winter pressures’ mount but Government targets on waiting  times etc still have to be met. Instead of planning a decrease in elective procedures during the winter pressure months hospitals are made to struggle on until the elastic band of feasibility finally snaps and thousands of operations HAVE to be cancelled. These cancellations are mainly caused by a lack of available hospital beds. That lack of beds is partly a result of a series of systematic ward closures by both main parties to save money. The ward closures were meant to be supported by a care in the community system and social care packages that allowed folk to be discharged from hospital as soon as they no longer needed hospital care. It has been a disaster, bed blocking prevails throughout the country because there is no where to discharge vulnerable patients who no longer need in-patient care but do need home care or intermediary care. Factor in the winter pressure patients, the old and the infirm, the increase in  respiratory patients, the falls patients AND the normal elective patients and you have the end result, NO BEDS. Nowhere for A&E patients to be admitted, so something has to give; that something is elective surgery. We are way behind many European countries in cancer survival times, we are way behind many of them in access to diagnostics, we have fewer doctors and hospital beds per capita than many European countries and our average waiting times for elective surgery are generally not as good. BUT, we have a service completely free at the point of delivery, a service generally provided by dedicated clinicians and support staff, I watched in amazement a TV programme on BBC about surgeons in QE Birmingham the other evening, truly world class care, care that saved and transformed lives. In 2007 when I retired from the NHS I was one of the ludicrously overpaid executives I mentioned in my opening paragraph. After 13 years of rising through the local NHS ranks I became the Acting CEO of our local Primary Care Trust. I have witnessed first hand the issues I speak of, I have beaten my gums trying to change archaic practices, run up against brick walls trying to get managers to treat people as human beings rather than numbers, faced huge dissent in trying to tackle waste and finally took the cowardly way out and retired early, not broken but well wounded. Our NHS is on the VSI list, I am reminded of the German General who spoke of our armed forces, “lions led by donkeys! The remedies? Centralised management so that the unprecedented levels of highly paid management structures can be dismantled and so that everyone is afforded the same level of service and care. How can it be right that life prolonging cancer drugs are available on the NHS in Scotland and Wales but not in England!! Secondly, the NHS needs more PLANNED investment, cut out the waste first and then invest in services that are lacking. We will need to accept either a rationing of healthcare OR an increase in taxes if the NHS is to be able to meet peoples’ needs, let alone their  expectations!! Thirdly we need to have a complete mindset change about A&E services. I estimate at least 50-60% of folk attending A&E fit neither category of accident or emergency. We need legislation that allows hospitals to turn away people who are not in genuine need of those services. Drunks should be billed for their care!  Finally, the NHS cannot be all things to all people. There will NEVER be enough money to do that. Cosmetic surgery, IVF, breast enlargement, sterilisation reversals, the list of non clinically necessary procedures available to some people in some areas is staggering, it needs to stop. Anyone who doesn’t accept that patients die because of systemically badly run health services is kidding themselves. That is the truth of it all. Sadly.

January 11, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 11, 2018

January 11, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 11, 2018

Another lost post. Um, might be me! Anyway I said that after watchin* today’s news I am drawn to the conclusion some politicians must have read my long post  of yesterday. Lol. Sad they didn’t listen 10 years ago when I was still working in the NHS.

January 15, 2018

Joined: May 12, 2014
Posts: 31
The NHS

January 15, 2018

Bloody Hell Dave, if it took you that long every time you made a point, no wonder the NHS is grinding to a halt. A&E stands for ACCIDENT & EMERGENCY so why is everyone surprised when they have accident and emergency cases coming in, and if the management spent more time on the floor helping to sort out cases as they come in. things might move along faster. I might be missing the point but if you add hundred and thousands of immigrants every year since 2005 is it any wonder the hospitals can't cope, why is it that every one refuses to blame this influx and puts the blame on the old, easy target are we not? also we will never have enough houses, especially when councils are forced to house immigrants over the locals who were born and raised by parents who were born in England. Fini! PS. Why don't all the doctors who are MP's volunteer to help?

January 15, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 15, 2018

Just trying to give folk a proper explanation of how the NHS really functions from an insider insight. Difficult to do that in a few words Charlie. The immigration issue DOES need addressing and DOES cost the NHS £millions but it isn’t the main cause of the problems we face. Short and to the point!  

January 15, 2018

Joined: May 5, 2014
Posts: 676
The NHS

January 15, 2018

I fully appreciated your "proper explanation" David, and apart from learning from it , agree with your suggested solutions to stop non clinically necessary operations. It would not only free up valuable resources ( staff, beds & operating theatre slots) but would save millions in the process. To blame immigration as the  source of the NHS problems is to divert attention from the root causes - gross mismanagement by senior NHS staff with their heads stuck in the sand and unwilling to face reality. The bean counters do need to account for the money , but closing wards just before the onset of Winter causing the acute shortage of beds with the resultant ambulance queuing & corridor "wards" is not the way to save money  - sometimes I feel SERVICE is forgotten in the National Health Service hierarchy these days in their misguided pursuit of " economy saving". John (JKW)

January 17, 2018

Joined: May 8, 2014
Posts: 1300
The NHS

January 17, 2018

The one thing that is forgotten in the NHS equation is that it was designed for about 50 million people who worked for the country , now with a population of over 65 million and quite a few just holding their hands out and not getting a feckin job . Yes the UK is the land of milk and honey and benefits,and instead of being a good citizen they just want everything for nothing and that includes a) new boobs,b) children they can't feed ,c ) rent free homes . Do you get my drift .

January 18, 2018

Joined: May 14, 2014
Posts: 1010
The NHS

January 18, 2018

Too many incomers from all those "POOR"  peopled countries coming here for FREE hospital treatment when they seem to have enough money to travel from their far away places of birth to get here, and yet can not afford to pay for all sorts of medical/mental treatments which they seem to be "TOO POOR" to pay for in their own country. I may be cynical but they are the major cause of bed blocking and "treat me first" attitudes,so this country should therefore make it impossible for anyone with NO right for treatment to be refused entry at their point of entry. Full Stop!!!

January 18, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 18, 2018

In the past 30 years the number of available acute hospital beds in England has decreased from just under 300,000 to about 144,000. Numbers of patients being treated rose exponentially over the same period. Most other advanced health care systems have also reduced bed numbers over this period but England consistently has one of the lowest available beds per 1000 population ratios in the western world. Some, about half, of the shortfall created by the bed decreases has been met by increased day care procedures and some care in the community programmes but about half of the replacement infrastructure necessary to compensate for the “missing beds” is not in place due to funding shortfalls. In 2016/17 many hospitals in England experienced 90%. bed occupancy rates with some on 95% bed occupancy rates, well above  acknowledged safe levels. It is a natural propensity to blame immigration and health tourism on the, now annual, winter crisis in the NHS, the media is in no small part to blame for that misunderstanding. Immigration and health tourism certainly does add to the woes of the NHS and needs to be addressed but bad planning, funding shortfalls and increased demand are the major culprits. Bed blocking is almost entirely caused by elderly residents of the UK having no safe place to be discharged to. Bed blocking causes part of the bed shortage issue in the winter. But; trying to run a normal elective programme in hospitals besieged with winter emergency patients (often needing longer stay hospital beds) in an environment where bed numbers have been so drastically reduced, is bad planning at its worst. That bad planning is a result of one thing, a political fear of admitting the overstretch in our hospitals and drastically reducing planned admissions BEFORE the onset of winter.

January 19, 2018

Joined: May 5, 2014
Posts: 676
The NHS

January 19, 2018

Has the enormous PFI bill now having to be repaid not contributed massively to the funding shortfall ? The huge interest rates imposed have surely crippled any hopes of the NHS ever getting sorted without a radical re think on it's funding policies. Corbyn's lot want to throw money at the NHS which, unless it was used to pay off the PFI bill thereby releasing funds for sensible & logical planning of resources, would be tantamount to throwing good money after bad....just a thought. John (JKW)

January 19, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 19, 2018

It certainly has John. The PFI bill for building and running NHS hospitals stood  at about £11:8 billion when it was halted. BUT ; It will cost an estimated £79 billion over a total of 31 years to clear. The NHS pays an annual £2 billion to keep up with a PFI repayments. The top 10 PFI built NHS hospitals alone repay over £500 million pa to clear those debts. The DOH’s own figures forecasts a £22 billion black hole in NHS funding over the next 5 years. Extra money to pay off the PFI bill won’t really help because there are water tight contracts in place that ensure early repayment penalties would be invoked.We are locked into those contracts! Puts  the estimated £5-8 million annual health tourism costs into perspective doesn’t it. If the nation actually KNEW the ineptitude that goes on in the NHS and other departments, yes the MOD as well, they would be astonished. And all while we continue to pay £12 billion pay in overseas aid. If you put it forward as a film script it would be rejected for being too improbable.

January 21, 2018

Joined: May 5, 2014
Posts: 676
The NHS

January 21, 2018

"ineptitude in the NHS & the MOD too" can also be added HM Prison Service ! For example, as an SQMS in a former life I was shocked to discover when a jailed inmate peed his mattress it was exchanged without quibble or cost to him, plus when I suggested that cell occupants should be fined for leaving their tv's, lights & radio's switched on when going to work or the exercise yard I was informed it would be " too difficult to apportion blame to any individual". When I further suggested fining BOTH cell occupants that was considered unfair !! John (JKW)

January 21, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 21, 2018

I seem to recall the most recent report on Liverpool Prison states it was in the worst state in memory. HM Inspector of Prisons said he had never seen a worse prison, over 2000 repairs outstanding for a start! I thought of you JK whilst watching it on the news. Meanwhile, East of England Ambulance Service notched up 40 patients coming to harm or dying in a 3 week period in December/Early January due to late or non arrival of an ambulance when requested. This desperately sad and alarming fact didn’t even make headlines! The police reported to them a man sat outside in need of an ambulance. Because he was breathing and not unconscious no ambulance was sent. The man died, frozen to death, 16 hours later when medics DID turn up. The police apparently never checked on him again after being refused an ambulance for him. What sort of society are we living in when human life is so cheap that so many people are dying completely unnecessarily? In one of my previous posts I highlighted this as a fact that many people were unaware of, I’m saddened that so soon afterwards I was proven right. Some people are waiting 23 hours to be admitted via A&E, waiting for a bed, parked in corridors, desperately ill. Third world treatment in a first world country. Labour’s answer?  Raise an immediate £5/6 billion by increasing taxes on the top 30% (?) of earners and throw it at the NHS. No planning, no concept of addressing issues that will take time to fix, no understanding of the time scales needed to reopen closed wards, train more staff, put in place necessary infrastructures. The ONLY immediate feasible solution is to stop ALL elective surgery not associated with high pain levels for 3 months at least. The NHS needs recovery time, the staff need to be given the breathing space to deal with acute illnesses and surgical procedures. During that time someone needs to start devising a longer term strategy that will better equip the NHS in the future to cope with winter pressures. That strategy should include inter alia; an annual curtailment of elective surgery during the 4 worst winter months, consideration to the resurrection of some of the closed wards, more rigorous enforcement of A&E entrance requirements eg refusing treatment to people who patently aren’t in need of Accident or Emergency treatment, doing away with the graduate only nursing career and reverting to the ‘on the ward’ training scheme that not only produced excellent nurses but ensured there were enough of them. And of course funding the NHS better. There will NEVER be enough money to meet everyone’s expectations of the NHS but we should NEVER ever allow people to die for want of basic medical care.

January 24, 2018

Joined: May 5, 2014
Posts: 676
The NHS

January 24, 2018

Just one problem with your otherwise excellent suggestions David ;  the annual curtailment of elective surgery for the 3 worst winter months would surely just pile enormous pressure on ALL surgical operations for the remaining 9 months, thereby just "moving the goal posts" as it were - catching up would be nigh on impossible, although agreed, the winter problems would certainly be eased. PS - HMP Liverpool - If the drones continue to be flown in with mobiles, drugs etc, the Prison will need it's own Air Traffic Control Centre to ensure safe arrivals !! John (JKW)

January 25, 2018

Joined: May 12, 2014
Posts: 809
The NHS

January 25, 2018

John, you make a good point but I deliberately said curtailment rather than cessation of all elective surgery. I mean restricting elective surgery in the bad winter months to those procedures necessary to alleviate pain or distress. That would have the effect of reducing elective surgery in that period  by about 60%. Then, using the money saved from not operating on that 60%, do what  Labour did during their last tenure of office, buy up the spare private sector capacity using block contracts. That would get rid of about  half of the 60% of the missed electives. The remaining half of the 60% could be accommodated by relaxing the maximum 18 week wait. By that I mean prioritise elective surgery by how necessary it is. Some procedures are more time constrained than others and clearly should be completed at least within the 18 week wait rule but other procedures would cause no added pain or distress by waiting a bit longer. We forget that only a couple of decades ago waiting times for routine elective surgery  was anywhere up to a year. It would take some careful planning, some judicious contracting with the private sector and a lot of thought but the NHS is awash with planners and contracts managers, it should be possible.


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