NHS – will it survive?

[kerry]

I watched a very interesting interview on TV last week where a hospital consultant said the government were actively trying to make the NHS fail in order to get public support for privatization long term,

I don’t know what I think about this but there is a serious crisis happening.

Last week my dad was hospitalised after a stent procedure caused complications. He was vomiting blood in the car park after he was discharged – and as there were no staff in the unit they had to wheel him to a&e. He was then sat in a corridor (no trollies) for four hours with seriously low blood pressure and still vomiting blood. Eventually he was admitted to a acute medical ward jut before midnight. It’s not the staffs fault. They just don’t have enough people or beds or capacity. The irony is my dad was a nurse and worked in the NHS for 50 years. He’s given his whole life to an organisation crumbling when he needed it.

So what is the solution?

What will happen after Brexit (I know London hospitals rely heavily on EU nurses)

Who will train to be a nurse now bursaries have gone?

How safe are we when we are very sick?

The NHS is such a precious thing we have… But for how much longer?

[blurty]

Hopefully there will be some improvement when the £100m per week (at least!) – the Brexit dividend – is added to NHS spending. I’m stunned by reports that Theresa May “slapped Boris Johnson down” for his requests for this extra spending.

[bella]

The situation now is unprecedented. That means that this level of demand has never been seen before in the NHS, and it’s due to huge numbers of people with flu.

I’m sorry about your Dad, but there is no way that we can run the NHS with enough resources to cope with unprecendented demand, because the rest of the time – almost all the time – it would mean empty beds, unused equipment and staff without enough work to do.

Just because we are having a flu problem right now doesn’t mean the NHS is about to die itself.

The NHS is a victim of its own success in keeping old people alive longer, and a victim of people not taking care of their own health and getting too fat.

Last year 44,000 people applied to train as nurses but only 23,000 were accepted, so I doubt if there will be a problem filling training places now it’s changed to student loans like every other career.

[notherngal]

Politically I wobble about in the middle, but I have to agree with @bella that the Welfare state has enabled a large section of society to see no need for self care and to just rely on the good old NHS when their obesity/diabetes/heart disease etc needs sorting. Add that to a growing and ageing population and something has to give.
I also agree with @kerry that seeing anyone neglected as her father was is very distressing. No, it is not the staffs fault (although I think less managers and more less qualified nurses would be a massive help) but nor am I sure that money can fix the state we are in. Boris’ £100m is needed though.

[karen]

@notherngal I really don’t think that people were healthier before the NHS, which would be the logical conclusion from what has just been said. There have been massive improvements in treatments, over the last 70 yrs, with drugs that no-one had even dreamed of before WWII. And, of course, improved access to whatever treatments are available. Lifespans have increased because preventative medicine has developed alongside treatments and screening programs for early detection of major illnesses. Just think of the improved survival rates for cancer patients, premature babies, diabetes patients etc, etc. and the diseases that have been eradicated, such as diphitheria

I agree with the consultant cited in OP, the NHS is being set up to fail and various News organizations are either a) accidentally playing into the Gvt’s hands by highlighting the problems without really explaining why they are happening or b) deliberately supporting the campaign to talk the NHS into oblivion.

There may be more people than usual with flu this year, as the vaccine didn’t target the correct strain (why not? – the children’s version did) but the main reason for the shortage of beds, isn’t unprecedented demand, or ‘bed-blocking’ (horrible term), it is closure of beds/wards/hospitals in the name of ‘efficiency’. It isn’t efficient it simply saves money which is disgraceful, when UK spending on healthcare is the lowest percentage of GDP than any other European country.

There are any number of ways to find the money that could be spent on the NHS if it wasn’t wasted on ridiculous vanity projects. I could save a fortune out of the education budget, simply by stopping the program of Academisation, never mind some of the other nonsense that wastes the education budget, such as national phonics testing for 6 yr olds, piloting of ‘baseline’ tests by 3 different private organizations, in thousands of schools, which was then abandoned. I am sure that those who know than I do about other gvt departments could also find easy ways to make savings.

[Emma]

This is a subject very close to my heart, my career is within the NHS frontline.
I’ve been in it long enough to see a decline in how it copes. Crisis management is the norm now, every single day.
Politically I’ve gone from a staunch labour supporter, so a reluctant Tory. Though I’m disappointed with the current cabinet.
Politics and hidden agendas with unscrupulous back handed deals are at the core of this demise. It can be stopped, it can be rectified. But it will mean very tough decisions, and firm leadership.
The amount of wasted time and money is mind blowing, and sadly a lot of it is due to arrogance and nepotism at all levels.
Attitudes need to change, and the staff valued.
I’m wont be politically correct either, and few won’t like my next point, but those who come and abuse the system are part of the problem. Healthcare tourism is real, happening every day, and it costs us immensely. They should pay at point of use.
Abusive patients should be fined, and refused treatment ( obviously non-life threatening ).
Nurses should be salaried as students.
Their salaries should reflect their skills and experience.
There is a lot of waste in the nhs very often due to poor organizing and managing of situations.
I could go on all night, but I hear from my colleagues every day how they are not listened to, respected or valued by management.

I wonder if I could be the dictator in a totalitarian NHS state…………

[fi]

The reform of the NHS is a revolving door and a band wagon that everyone thinks they can do better. In the short term extra money will do no good as there are not enough people to fill vacancies, if they recruit agency staff, they will have to pay more, just to tempt people to do more hours. Most NHS employers do not pay overtime. I went for two NHS interviews last week and I got offered both jobs. I should be retiring. The other alternative are doctors and nurses from the outside the EU, Ipswich are already recruiting the Philippines because people from the EU are now not so happy to work here.
I think health tourism is a very small problem compared to care of the elderly who are often in hospital because either their admission could have been prevented or they have no suitable place to be discharged to. Separating the pot of money for social care and health care isn’t working, and its strange we all say we want to support the NHS but when you ask people to pay for their own social care, if they can afford it, everyone soon starts say we have worked for our money we should keep it/ pass it on to our children.
Over the last few years there has been the introduction of the nurse specialist who are not ‘managers’ but effectively do not do hands on nurses, then we have bed mangers etc. So yes they are employing more nurses and less managers, but the nurses are essentially doing roles which were never over seen by nurses before.
No government of what ever color has had a long term solution for the NHS, and I have worked in it under most of them.

[kaz]

I watched a very interesting interview on TV last week where a hospital consultant said the government were actively trying to make the NHS fail in order to get public support for privatisation long term,

@kerry Absolutely – that’s what they did with the railways too – foment union strife and service withdrawal and then privatization looks like an attractive option

We need a complete refresh in Wedstminster and we need the Tories out. I always voted Tory until Cameron and I am ashamed of that. I do not know how anyone with any degree of social conscience can vote for Conservative

[katykaty]

Absolutely – that’s what they did with the railways too – foment union strife and service withdrawal and then privatisation looks like an attractive option

@kaz That isn’t my recollection at all. I don’t remember union dissent, I just remember filthy old trains running so late that I would always catch at least one train earlier than the meeting I was supposed to be at should have needed.

If you want to talk about union dissent on the railway, how about the current nonsense about trains with no guards? There are trains running all over the place with no guards, and DLR doesn’t even have any drivers.

We need a complete refresh in Wedstminster and we need the Tories out. I always voted Tory until Cameron and I am ashamed of that. I do not know how anyone with any degree of social conscience can vote for Conservative

When your alternative is a fiscally incontinent Momentum led Corbyn government, who will support unions striking over things like running trains with only a driver, there seems to be no viable alternative to keep the country running to produce the taxes to pay for my social conscience to be delivered.

[mel]

I would like to see a breakdown of spending on PFI vs actual patient care. I suspect a great deal of front line money is going to private service providers and their shareholders (or not, as in the case of Carillion, who took the profits and left the risk to the taxpayer). And VERY swish buildings – our local hospital has beautiful frontage and entrance lobby, but is struggling with patient care and targets. And highly paid managers who think perception and appearances are important. But you can’t ask them to sort out the issues, they are hardly going to tell it like it really is.
On a brighter note, I don’t think the public would stand for privatisation as per the insurance system in the USA, and the politicians know it

[janey]

When I started nursing at 18 even I could see no logic in selling off satellite hospital units where older patients were sent to recover, sell them off where do these people go,
which leads me on to management, too many chiefs not enough Indians, chiefs with no clinical experience , how can they make balanced decisions about patient care?
training, of course every ‘old’ nurse will say their training was the best way, but from week 8 of my training I was on the wards learning my trade, and earning a reasonable living, nurse training should be hands on you need carers who are able to report potential problems with their patients who they have direct contact with, learn on the job, be part of the staffing numbers, after three years I was capable of taking charge of a ward they day I received my ‘blue stripe’ on my paper hst ( so pleased when they ditched the caps, dreadful infection risk)
charge people for care from countries who have no reciprocal health care
publish costs for keeping patients in a bed, wasted unattended appointments, make people think how much is wasted
I really cant see how contracting in house services, catering, cleaning etc can be cheaper with companies like Carillion, lets see the historical figures, in house verses contracting out
Try and keep the drunks out of a and e over the weekend, more triage tents with staff able to give fluids outside of the hospital
Make social care easier for families, more help available to care for ailing elderly in extended family setting
treating conditions and quicker diagnosis would safe millions, can’t tell you how many times I have waited years for diagnostic scans which done sooner would have saved so much money and increased productivity in different spheres, by reducing sick time (this when employed by the NHS)
education of the public, and a change of attitude needed by the public to take responsibility for their health and well being ( living in cloud Cuckoo land here) eat better drink less alcohol
Alter staff working hours to allow more flexibility, 12 hr shifts are just too long, shorter shifts for people who can work them to cover the known busy times, especially in a and e

I could continue, but I was never listened to while I worked in the NHS why should things change now?

[don]

@janey I vote for you for the next PM! My OH says that whereas all animals are evolved purely to pass on their genes, politicians have evolved solely to get voted back in, and they do not care about anything or anyone as long as they achieve their aim.

[ellen]

A lot of the systems in the NHS seem broken to me. Yesterday, my OH was booked in at short notice for minor surgery after an appointment the previous day highlighted an issue.

He spoke to the surgeon before we left on Monday evening and we duly arrived at 10am yesterday. He was then told that surgeon was not working that day but someone else would deal with him.

We sat around for four hours before he was told the original surgeon was working and was now out of theatre and would see him and sort the issue, which he duly did but said that he was very cross because he had arranged for another surgeon to see OH at 10am.

Meanwhile, I spent some of the time at the hospital trying to rearrange another appointment for OH who had two booked on the same afternoon but at hospitals 20 miles apart and with no chance of being able to attend both, although both organized by the same NHS Trust.

I was massively frustrated because I am the bread-winner and self-employed so lost a days work because I had driven him to what I thought was going to be a shortish appointment. We could have used patient transport, at the additional cost to the NHS, or I could have dropped him off and gone back later.

I have no criticism of the staff who saw him or the ones I spoke to to try to unpick various arrangements but it is clear that the systems in place don’t work and there is a massive knock-on effect for staff, patients and relatives.

I know money is needed for clinical care but I do see time wasted like this every time we visit the hospital (which is frequent at present) and I think a bit more investment in “systems” might help ease the workload for many by reducing the number of mares’ nests they have to untangle on a daily basis.

Rant over…

[scarysue]

and I am ashamed of that

@kaz Why, you did what you thought best at the time? I am a floating voter. I will not be tied to any particular party, I choose whoever I think is best at the time. I couldn’t believe my grandparents who used to vote for the Labour party because of what they had done 30/40 years previously – what they were doing at the time of voting was irrelevant to them. And OH’s grandmother voted for a party because her husband always had despite the fact he had been dead 20 years.

The NHS has so many areas which it could improve because so much time is wasted due to their inefficiency. The communication between departments is abysmal.

My father had a minor stroke a couple of months ago, he was told he had an appointment later that day for some tests, as it was 5 hours later he asked if they could go home (20 mins) and come back. That was fine so my parents went back home only to get a call from the hospital to ask where he was as they had got him booked in for the morning. He has also been given appointments and got to the hospital to find they didn’t have the appointment on record. He said they weren’t happy with him despite the fact he showed them the letter with the ‘appointment’ details.

My experience with the hospital staff was fine – they were brilliant. Once again it was the administration and lack of communication which was the problem. This was exacerbated by the fact that only the consultant’s secretary would deal with his calls and she only worked Tuesday afternoon and Wednesday morning. So when I phoned up on Wednesday afternoon to find out where my promised results were I had to wait nearly a week to get them. That was one of the most worrying 6 days of my life.

I hope the NHS does survive but it needs a huge shake up and I’m not sure any of the parties would be willing to do what needs doing.

[kath]

My dad was self employed for most of his life, he was a builder. In the 70’s about a year before he died he realised my mum would be better off if he died is he was working for someone else. So he got himself a job with the council based in the local yard doing repairs on council houses.
He was asked by his colleagues not to work so fast, so in a morning after he left the yard he would sleep for an hour before he started work. He would arrive at the job with a work sheet, finish the job on the sheet, then ask if anything else needed fixing and do that as well. He was still doing more work than any one else. This was a man that was not really fit to work.
I grew up with a most of my family working for the coal board and some of the things they did to get out of working a full shift would make Dell Boy look like a saint.
The idea that just because a company is owned by a government it will be run more effectively and everyone will work together for the greater good, is unfortunately not based in reality. The tendency is for people to think they are owed a living and as they a shareholders they are only robbing themselves. Looking a projects that the governments have procured the fact that they can not even control budgets for large projects when they have no physical control over gives me no confidence in them running companies. The pension bill would increase because nearly all government workers have better wages than any one else, funny that.
The NHS is not free. That seems obvious but amazingly people take things from it because they do not see the financial consequences of taking things from it they do not need, or using staff as servants, ‘I’ve paid for this, I pay your wages’. The NHS has become the cure all for every single problem, no one wants to pay if they can get it free. People are like children wanting more, its free so why not have it.
As everything is now electronic it might be an idea to ‘bill’ people so they are aware how much their care would have cost if they had to pay.
I pay for dental treatment, I have a chequered past with NHS dentists. I get more time with a private dentist. People often say to me its expensive, but women will pay £80 to get their hair dyed and £35 every two weeks to get their nails gelled, which has no impact on their health. People do not seem to want to invest in their own health care and see it as something the government does and how little we have contributed to it we are entitled to take as much out as we can.

[Melissa]

The issue the NHS is so huge it’s diffcult to change it in any fundamental way.
People living longer will destroy the NHS unless we get a wiggle on and solve the problems caused by vast numbers of older people.
We have to deal with the system for the elderly so that the care is seamless and there’s no pinch points leaving people in hospital which are not a suitable or cost effective way to care for older people after injury or when they are long term ill.
I don’t think that a system where 100% of the people employed are employed by the state is healthy or efficient it needs to a mixed economy .
I will never ever think again about the health service after the apalling treatment and ghastly hygiene standards I observed when I was unfortunate to end up in a hospital for three weeks .
I would love to think that free at the point of use model would survive but unless some radical change happens soon we are running out of time.
I would have supported the plan where the cost of elderly care up to a limit was recovered from the estate of a person after their death something drastic needs to be done and it’s unfair On the Young just to raise taxes to cover the cost of this elephant in the room.
And yes we need to take care of ourselves better eat well exercise not get fat and Etc etc.
It seems to me that for most of use the most use we make of the NHS will in the last 10% of our lives we need to really think through elderly services and provide them quickly and efficiently and in a way that keeps the old person well and with as much independence as possible for as long as possible.
We can’t solve this issue by just pouring money at it it just won’t work yes it needs more money but it need money that leads to a better system not the same system with more money as that just won’t do it.
On another note from my observation I am not sure that longer life expectancy is really such a great thing if you go through it without the right timely care you need in extreme old age.

[kaz]

I pay for dental treatment, I have a chequered past with NHS dentists. I get more time with a private dentist. People often say to me its expensive, but women will pay £80 to get their hair dyed and £35 every two weeks to get their nails gelled, which has no impact on their health. People do not seem to want to invest in their own health care and see it as something the government does and how little we have contributed to it we are entitled to take as much out as we can.

Quite. I actually have no problem paying for some things on the NHS, and being a 40% tax band payer I contribute far more than many people do

What I do object to is a percentage of that going to “shareholder value” – is the current government really naive enough to think that we believe it will be cheaper to deliver care privately, usually in the first wave of contracts it is more “cost effective” until the private companies “own” the value chain and then costs escallate and service declines – the gap between the two delivering “shareholder value”.

I used to work in the NHS – Reg Psych Nurse back in the 80’s. Things were tight back then too, but there was a level of pride in the system that isn’t there now. Unless you’ve actually worked in the NHS and been on the coalface you don’t really have a notion of what nurses do and face each day and what a 13 hour nightshift on an admission ward feels like on night 4.

When your alternative is a fiscally incontinent Momentum led Corbyn government, who will support unions striking over things like running trains with only a driver, there seems to be no viable alternative to keep the country running to produce the taxes to pay for my social conscience to be delivered.

Ah yes, I forgot you were one of the blinkered Corbyn haters who really genuinely believe that Austerity works and the Tory party is really out to deliver an NHS that is delivers to the people rather than their shareholding donors and supporting corporations.

The monetary system is broken, very seriously broken, but there is not a global visionary that can fix it

[katykaty]

The monetary system is broken, very seriously broken, but there is not a global visionary that can fix it

@kaz You are absolutely right there. The damage is done with huge companies ruling the world and the disconnection of money from anything tangible, and I don’t see how it can be undone without the collapse of the western world. If I had kids like you do, I’d be very frightened for them.

Short term-ism in politics is the other destructive force, with governments doing what they need to do to get re-elected, instead of what actually needs doing.

I don’t hate Corbyn, Bruce, I admire his principles. I just don’t believe that his socialist vision for the country will work. I wish it would, but nobody can point me to a country operating the level of socialism that he would like to see with a population the size of ours which works effectively.

We desperately need a center left Labor government as a viable opposition to the Tories.

By the way, I absolutely love communism as an ideal. I just wish human nature inherited from our earliest ancestors would allow it to work.

From each according to his ability. To each according to his needs.

Now wouldn’t that be something worth having?

[kaz]

Maybe it’s time for some principles? You won’t get them from May, Hunt, Gove or Barking Boris, it’s all about privatisation for them. In my humble opinion privatisation and health service are mutually exclusive and irreconcilable – some things just are not suitable for being privatised, the motives of the private company is not geared to public service.

Communism never worked and will never work simply because of corruption, people are venal and always want more.

[summo]

The health service is broken.
It needs someone with the courage to admit this, and restart it.
It was designed many years ago when people’s lives were different and that wasn’t such a high population. If it were a profit making business, it would have gone bust.
The government. Can chuck money at it, but because it doesn’t have shareholders, and doesn’t have to justify – in the same way- where the money goes, much of it is wasted away from the front line imho.
Successive governments – Tory and labour- have failed to find a resolution, and I really hope Corbyn doesn’t get in, as he will almost certain make it even worse as he has no clear policy to protect it while making it efficient and modern.
Imho, there are too many people drawing on it, not enough contributing and those who do don’t contribute enough.
France has a system whereby they charge €5 for every appointment made, which is refunded if you turn up. I believe this has been a great success and saved a considerable sum of money.
New Zealand, I was told by a consult who had worked there, had a 2 tier system. Those who earned under a certain amount paid less, those who earned over paid extra, but were scooped out of the nhs and put into a private system, taking the strain off their nhs. However, many of the private and nhs hospitals shared the same sites and this meant sharing skill set and equipment and therefore saving money.
Nothing is perfect, but it’s time the dinosaur was overhauled.
Also, what annoys me, is that you don’t get the same service at different hospitals. If it were a profit making business, you would within reason.
I go to Moorfields eye hospital in London, a specialist hospital and they are perfect. They are also had training in “customer service” and you are treated as well as you are in the service industry. My local hospital is Stoke Mandeville and it’s the polar opposite of Moorfields. Again, it’s a specialist hospital, spinal and burns but with general wards and specialists attached. However, it seems unless you have a spinal or burn issue, the customer service is minimal, has a high staff turnover and it’s somewhere I have been worried about coming out alive from.
They should be the same, but are not. Why? Because th8gns aren’t implemented NHs wide, good practices are rarely shared and people are still afraid to complain for fear of retribution.

[amy]

I look at Jeremy Corbyn and think, bless. But actually he is as dangerous as the fool they have in the USA. They sell a message that seems simple told in a manner that appeals to a lot of people who want a simple solution for what are problem they feel there is, when nothing in life is as black and white as we would like it to be.

The reason why each Trust was devolved was apart from making the people who spend the money be accountable for how much they spend, but the political theory that local people should be in control of local resources.
The great and the well meaning, some elected representative get put on the board with the ideal that local people need the best services, which lead to new hospitals, extended services with often no cooperation with the Trust next door, so there is an over supply in certain departments in that area. Operations and A&E times have quantifiable targets , so they could be seen to do well. When really at the back of the queue the people who do not have an illness with a nice tidy target get ignored, if you can not prove it you can not make a case for funding.
There is the law of unintended consequences, for you and me better expressed as s**t happens. We are just not as clever as the people on the boards, when really they are not clever at all. One of our local Trusts left the VAT out of the calculation, so it collapsed. How did they do that?
So now some Trusts are evolving back into combined Trusts, to save money and overlap, but they have already bought buildings they do not need, and the people who had a local A&E do not want to give it up protest. And so the wheel turns again.

The only positive thing I can say in this whole recurring nightmare, is the people who work on the front line have always tried their hardest, in 40 years in the NHS I have never worked with a nurse I did not think was trying their best for the patient.
Do you know a nurse can be sacked for making a cup of tea for themselves if its hospital property, ie a tea bag and milk? Professional staff are treated like potential thieves and not a valued resource and young people like my daughter who has only been qualified two years already wants to leave

[ritchy]

It’s been so interesting to read this thread. It’s such a difficult issue and I agree accountability needs to be key. My dad earned such a small salary as a nurse with a life time experience. A friend of mine in his 30’s is a manager in communications in the NHS and earns just short of A Three figure salary. It’s all wrong.

I’d happily pay for some services. Last time I couldn’t get a doctors appointment I used push doctor and had a FaceTime consultation. Chest infection dealt with quickly and prescription ordered for £20 (plus prescription). I’m a teacher – I don’t earn loads but I will pay If I need to.

Health tourism most certainly needs dealing with. Bursaries for student nurses need to come back otherwise we won’t have the future staff we need. My partner is a student nurse and has just finished a 2 month placement – working 3 – 4 long shifts (7.30am – 8pm) every week on a ward. Who is going to pay £9k a year to do that??

Oh and putting Jeremy Hunt in charge of social care as well as health I think is just awful.