Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
They also had a much better economic inheritance untainted by Covid and Ukraine costs.
Unfortunate for Sunak but there are a lot of opportunities for the opposition with this problem. Perhaps 'Brexit isn't working'.
Whatever Sunak is (ie the size of an Amiibo) he isn't so stupid so he must know what's up. That time he had to go on TV and say, "I believe in Brexit" he looked like he was on the verge of starting to cry.
Struggling to see how nurses going on strike for an above inflation payrise inmediately screams 'Brexit' to you folks, but I suppose all is possible in terminal stage remoanerism.
Brexit has impacted on staffing vacancies, not only by FoM but also by losing recognition of qualifications. A Greek Doctor or Portuguese Nurse can no longer start next week, but rather takes 6 months to get their qualifications recognised. They now go to Germany or France instead.
After all, a large part of the purpose of Brexit was to force payrises for working Britons by reducing foreign competition. It is a feature not a bug of Brexit.
In short the conversation goes like this:
Brexiteer: "We have to ban foreign workers so we can take care of our own."
Our own: "I need a pay rise in order to pay my bills."
Brexiteer: "F*** Off!"
Either a Greek or Portuguese qualification needs 6 months of poring over, in which case it was bad and dangerous that this didn't happen before Brexit, or, more likely, they don't, which makes it solely a British NHS issue that it's taking 6 months. Perhaps you should consider apportioning some blame your desk jockey colleagues, who make up over half the NHS workforce, and whose whole job is meant to be sorting this stuff out.
Part of FoM was mutual recognition of qualifications, and that has now ended. Nearly all foreign graduates now have to apply for recognition of their qualifications the same way, whether Nigerian or Portuguese, and that is both expensive and time consuming.
I agree that it is unnessecary red tape, but that is Brexit and exiting the Single Market for you.
Incidentally the NHS doesn't have the power to recognise qualifications, that is a statutory responsibility of the GMC. Neither does the NHS issue work visas, as that is a statutory role of the Home Office.
No, it isn't Brexit or leaving the single market for you - Brexit provides us (and the EU) with a choice as to whether to continue to recognise these qualifications automatically or not. It is the EU's choice whether to recognise UK medical qualifications, and ours whether to recognise theirs. We choose whether to introduce red tape, or not to. If it has been introduced with grim enthusiasm, maybe we should consider whether those introducing it have an ideological axe to grind.
We chose to introduce the red tape by voting to leave the EU. This is not a surprise. Or do you propose we let anyone with a piece of paper that says 'nurse' enter the country?
Can't see why it's Sunak's fault. Excess deaths are probably indirectly caused by Covid 19 and the lockdown.
The NHS was never locked down. The deterioration in performance preceeded Covid, though was accelerated by it, as was the staffing crisis.
We are seeing what happens when services lack capacity. It doesn't matter if you have BUPA cover or not when you have a heart attack as private hospitals do not have emergency departments.
Those charts are stark. Worryingly no sign of a turnaround. It’s going to get worse before it gets better.
At present there is no reason for it to turn around. Things might abate a bit in the Spring as the flu epidemic fades, but this is no longer a winter crisis, but a full year one. The staffing crisis is likely to worsen significantly if the mooted 2% pay rises for the coming year are implemented.
Why does this government accept a permanent crisis? It’s clearly sortable. It’s a question of political will more than anything (and an absence of political won’t).
It's a question of money.
The NHS has had a nominal increase every single year since 2010; it was the only HMG department protected from austerity.
Some of these years the increases were 2-3% each year but that equated to "0%" in real terms, and the NHS needs an increase in real-terms, each and every year, because with an ageing population, drug price inflation, the increasing treatability of conditions, wage demands and competition for labour in the market you have to run just to stand still. What's the price? Probably of the order of 4-6% pa, depending on the year.
It doesn't take long to see how that compounds and becomes unsustainable in the long-run, particularly since it 'crowds out' spending in other HMG departments and creates an almost irresistible demand for expansion of the overall tax burden to fuel it, progressively suffocating consumption & investment in the wider economy.
Genuine question: are other comparable countries suffering the same issues as the UK?
I believe the other day someone referred to problems in France related to ambulance delays - here in spain there have been long-running strikes among doctors and nurses in Madrid and some other Autonomous communities. Looking from outside there is an understandable but incredibly Brit-centric view that all our economic and social woes exist solely within the borders while the grass everywhere else and especially within the EU gets ever greeener. As I say understandable but really not true - here in Spain, which is among the best overall in the EU currently prices in supermarkets are continuing to rise well above the nominal rate of about 7% -in many cases double or triple that. New measures have been introduced to limit rises for the basics but we have just lost the 20cent petrol subsidy which will have a big impact in my part of the world where the average local earns around 12k€ p.a.
I think that is just human nature. The grass is always greener, or conversely we are always better, rather than a balanced view and I suspect generally remainders and brexiteers are both biased in each of the opposite directions.
I, of course, was a remain voter and a respecter of democracy.
I asked at our Medical School the feasibility of this, as I do the Undergraduate interviews. It simply is impossible to double the number of Undergraduate teaching placements overnight, and to do so requires more front line staff to move into a teaching role. It makes staff shortages worse before they get better.
A planned expansion is needed in the long term, but in the short term there is a need to increase retention, and Streeting has no more answer for that than Barclay, just telling Nurses and Junior doctors to suck it up and accept deteriorating pay and conditions.
If there was a need for a 6 month process, it should have been in place before Brexit. If there isn't a need, there's absolutely no reason why existing recognition couldn't have been rolled over
But we "Took Back Control"
This is what control looks like.
You seem to be implying Brexit was a total fucking waste
This witless post totally (unintentionally) captures the quangocrats' attitude we're talking about. A grim determination to make sure it doesn't work, and rub words like 'control' in people's faces.
But control means choice. The responsible organisation has the choice to recognise qualifications that yesterday it was airily waving through, or not to. If a 6 month checking process is necessary now, it is dereliction of duty that it did not happen then. If it isn't necessary, why is it happening now? You can't answer other than in meaningless slogans.
The quangocrats can't act against the politicians. Our government has made these choices.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The last Labour Government also pushed the introduction of the Liverpool Care Path which resulted in hundreds of unnecessary and premature deaths of people against their will and with increased suffering. My own father included.
A planned expansion is needed in the long term, but in the short term there is a need to increase retention, and Streeting has no more answer for that than Barclay, just telling Nurses and Junior doctors to suck it up and accept deteriorating pay and conditions.
Presumably their answer is the second part, tax non-doms to pay for it
Unfortunate for Sunak but there are a lot of opportunities for the opposition with this problem. Perhaps 'Brexit isn't working'.
Whatever Sunak is (ie the size of an Amiibo) he isn't so stupid so he must know what's up. That time he had to go on TV and say, "I believe in Brexit" he looked like he was on the verge of starting to cry.
Struggling to see how nurses going on strike for an above inflation payrise inmediately screams 'Brexit' to you folks, but I suppose all is possible in terminal stage remoanerism.
Brexit has impacted on staffing vacancies, not only by FoM but also by losing recognition of qualifications. A Greek Doctor or Portuguese Nurse can no longer start next week, but rather takes 6 months to get their qualifications recognised. They now go to Germany or France instead.
After all, a large part of the purpose of Brexit was to force payrises for working Britons by reducing foreign competition. It is a feature not a bug of Brexit.
In short the conversation goes like this:
Brexiteer: "We have to ban foreign workers so we can take care of our own."
Our own: "I need a pay rise in order to pay my bills."
Brexiteer: "F*** Off!"
Either a Greek or Portuguese qualification needs 6 months of poring over, in which case it was bad and dangerous that this didn't happen before Brexit, or, more likely, they don't, which makes it solely a British NHS issue that it's taking 6 months. Perhaps you should consider apportioning some blame your desk jockey colleagues, who make up over half the NHS workforce, and whose whole job is meant to be sorting this stuff out.
Part of FoM was mutual recognition of qualifications, and that has now ended. Nearly all foreign graduates now have to apply for recognition of their qualifications the same way, whether Nigerian or Portuguese, and that is both expensive and time consuming.
I agree that it is unnessecary red tape, but that is Brexit and exiting the Single Market for you.
Incidentally the NHS doesn't have the power to recognise qualifications, that is a statutory responsibility of the GMC. Neither does the NHS issue work visas, as that is a statutory role of the Home Office.
No, it isn't Brexit or leaving the single market for you - Brexit provides us (and the EU) with a choice as to whether to continue to recognise these qualifications automatically or not. It is the EU's choice whether to recognise UK medical qualifications, and ours whether to recognise theirs. We choose whether to introduce red tape, or not to. If it has been introduced with grim enthusiasm, maybe we should consider whether those introducing it have an ideological axe to grind.
We chose to introduce the red tape by voting to leave the EU. This is not a surprise. Or do you propose we let anyone with a piece of paper that says 'nurse' enter the country?
That was happening before?
It was for EEA staff. There was mutual recognition of professional qualifications in the SM. That never applied to India, Phillipines or Africa, though there are good nursing schools there.
Four days ago my 83 year old mother had a fall outside my sister´s house. The Ambulance did not come. She lay for six hours before she could be moved and then was taken by taxi to A&E where she spent all night with my 85 year old father, who himself has been undergoing chemotherapy. She was not admitted, but diagnosed with a broken shoulder and sent home at 8am after a two hour wait for a wheelchair accessible taxi.
This is not normal and is not acceptable. Neither is it unique, indeed there is a growing perception that the NHS has already collapsed in critical areas.
This crisis has been foretold in countless warnings and the Conservative government has brushed aside these warnings.
PB Tories, please explain why anyone at all should vote for the shiftless shower of shi%te that you laughingly call a government.
We got a call early on the 26th from our elderly neighbour saying she had 'a problem'. Mrs DA scrambled me to go round there and, while I am no medical expert, it was readily apparent to me that the problem was blood pouring out of her octogenarian arsehole.
I threw her in the back of the 335d (I'll get round to taking the interior out and burning it next weekend) and took her to A&E. Luckily I am a veteran of many very bloody casevacs in Basra and have read Tolstoy's Sevastapol Sketches so I was inured to the scene of uncontrolled misery and chaos that greeted us.
I was relieved on station by Mrs DA after 6 hours and after 11 hours elapsed somebody who was either a doctor or the hospital's Staples account manager diagnosed a burst Chalfont St. Giles and sent them away.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government. Though the current bunch truly, truly are bad, we seem to have a problem with our whole system. This is a crisis 40 years in the making.
I've already posted that I don't expect radical change - and we need that. But what would change is simple - a government that actually cares about people.
This government - its ministers, and its remaining supporters - do not give a Rat Fuck about people. They blame the people who are suffering for their suffering. And its disgusting.
The reason why voters appear to want to not just vote out this government but to hurt them is disgust.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The inference you are drawing there, however, is that it will only take a change in administration and that happy state will subsequently be restored.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
There is always a winter crisis in the NHS and has been my entire life no matter how many billions are thrown at it and whether Labour or the Conservatives are in government.
Yes nurses could be paid a bit more to stop them going on strike but fundamentally the health service needs reform
Can't see why it's Sunak's fault. Excess deaths are probably indirectly caused by Covid 19 and the lockdown.
The NHS was never locked down. The deterioration in performance preceeded Covid, though was accelerated by it, as was the staffing crisis.
We are seeing what happens when services lack capacity. It doesn't matter if you have BUPA cover or not when you have a heart attack as private hospitals do not have emergency departments.
Those charts are stark. Worryingly no sign of a turnaround. It’s going to get worse before it gets better.
At present there is no reason for it to turn around. Things might abate a bit in the Spring as the flu epidemic fades, but this is no longer a winter crisis, but a full year one. The staffing crisis is likely to worsen significantly if the mooted 2% pay rises for the coming year are implemented.
Why does this government accept a permanent crisis? It’s clearly sortable. It’s a question of political will more than anything (and an absence of political won’t).
It's a question of money.
The NHS has had a nominal increase every single year since 2010; it was the only HMG department protected from austerity.
Some of these years the increases were 2-3% each year but that equated to "0%" in real terms, and the NHS needs an increase in real-terms, each and every year, because with an ageing population, drug price inflation, the increasing treatability of conditions, wage demands and competition for labour in the market you have to run just to stand still. What's the price? Probably of the order of 4-6% pa, depending on the year.
It doesn't take long to see how that compounds and becomes unsustainable in the long-run, particularly since it 'crowds out' spending in other HMG departments and creates an almost irresistible demand for expansion of the overall tax burden to fuel it, progressively suffocating consumption & investment in the wider economy.
Genuine question: are other comparable countries suffering the same issues as the UK?
I believe the other day someone referred to problems in France related to ambulance delays - here in spain there have been long-running strikes among doctors and nurses in Madrid and some other Autonomous communities. Looking from outside there is an understandable but incredibly Brit-centric view that all our economic and social woes exist solely within the borders while the grass everywhere else and especially within the EU gets ever greeener. As I say understandable but really not true - here in Spain, which is among the best overall in the EU currently prices in supermarkets are continuing to rise well above the nominal rate of about 7% -in many cases double or triple that. New measures have been introduced to limit rises for the basics but we have just lost the 20cent petrol subsidy which will have a big impact in my part of the world where the average local earns around 12k€ p.a.
The article you refer to quoted 150 excess deaths in France for the whole of December due to delays in emergency treatment. Which orders of magnitude less than the 500 per day in the UK, even if it's not apples to apples.
There are stresses in other systems - my German doctor friend complains about these - but it does look like only the UK system is in a state of actual collapse compared with countries we might see as peers. My belief is that there is no resilience in the UK systems. In recent years we have struggled along close to breaking point, now we have gone past it. The root cause is mostly funding and policy decisions by the UK Conservative governments. Healthcare provision was relatively better under the previous Labour government, so I think there are things to learn from them. And no, they didn't inherit a benign situation from the previous government. They inherited a poorly functioning healthcare system, which they improved.
SNP ministers are providing “no political direction” in the NHS crisis, leaving doctors to make crucial decisions about rationing treatment, a leading GP has said.
The tories inherited an NHS in almost rude health, that they have let it get to this state, is entirely down to them, in 12 years they have just let it go to the dogs, voters should be reminded of this at the next GE, the Tories dont believe in it, never have, from Thatcher onwards, they would love to sell it of to their mates
There is always a winter crisis in the NHS and has been my entire life no matter how many billions are thrown at it and whether Labour or the Conservatives are in government.
Yes nurses could be paid a bit more to stop them going on strike but fundamentally the health service needs reform
I think it is pretty undeniable that the crisis now is worse than it has been at any time in the past. Saying 'this is always the case in winter' seems to me to be both inaccurate and unhelpful in the extreme.
The tories inherited an NHS in almost rude health, that they have let it get to this state, is entirely down to them, in 12 years they have just let it go to the dogs, voters should be reminded of this at the next GE, the Tories dont believe in it, never have, from Thatcher onwards, they would love to sell it of to their mates
And yet they never do. This constant refrain about selling off the NHS needs to stop. You can argue that they have underfunded it, but where is the evidence of a desire to sell it off?
“ EXC: Rishi Sunak has shelved plans for a ‘big bang’ overhaul of the childcare system drafted by Liz Truss
Truss was looking at an extra 20hrs of free childcare + scrapping staff-child ratios. Due to be revealed pre Xmas
But reforms delayed + scaled back”
I genuinely don’t see why the conservatives are bothering being in power any longer. Would have been one of those sensible policies for parents locked out of work via childcare costs. A mystery why people aren’t having children..
Sunak comes across as a caretaker PM. Truly terrified of taking any sort of bold action on anything
Sunak is the Invisible Man.
Overall we are seeing what happens when for a year we have chaotic, incompetent government obsessed by court politics and infighting. There is no overall strategy of government, just unstable lurches from one direction to another.
The government had taken its eye off the ball on health, with no plan for the current situation, ignored the energy price crisis until it got whacked in the face by it in October, and even now has no thought on the problems in education, criminal justice, Social Care, Northern Ireland etc etc
It is a Zombie government stumbling through a minefield.
There was an interesting article by an A&E doctor in the Scottish version of the ST yesterday. It spoke to the same problems. An overwhelming demand, an inability to clear people out of A&E to somewhere more appropriate, people dying on trollies who might well have died anyway but leave this world in an undignified fashion without proper care.
The Scottish system is better funded than England although this is offset by the larger areas they have to cover. The Scottish government has had responsibility for health for a very long time now with one hapless health minister after another. What does this tell us? Firstly, that money is not the simple answer to this. An increase in English NHS funding to Scottish levels will not, of its own, make this go away. Secondly, the acute problems in A&E are not some kind of Tory plot or neglect but a consequence of a system that is no longer fit for purpose. The idea that this will be somehow "better" if the minister wears a Labour rosette is frankly stupid.
We need a much more grown up discussion about where and how we spend our resources and where personal responsibility begins and ends. I think the medical profession is gearing up to start that discussion, this story is a part of that, but it cannot just be doctors speaking to bureaucrats. It needs to be much wider.
The tories inherited an NHS in almost rude health, that they have let it get to this state, is entirely down to them, in 12 years they have just let it go to the dogs, voters should be reminded of this at the next GE, the Tories dont believe in it, never have, from Thatcher onwards, they would love to sell it of to their mates
I know that "why haven't they privatised it then" was a defence posted upthread. But why bother? They have marketised it, added vast layers of competition and complexity and contracts. A huge feeding trough for their mates. Best of all they can say "record spending in the NHS" knowing that they more cash they tip in, the more that actual front line medicine starves whilst the trough gets fuller.
And in a world where we also need to up defence spending,
On the Tuesday before Christmas the RAF used 2 x AGM-114 (cost £60,000 each) fired from an MQ-9 (cost £11.2 million and £4,000/hour to operate) to destroy "a building" in Northern Syria.
While the MoD can afford to do that they've got enough money.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
SNP ministers are providing “no political direction” in the NHS crisis, leaving doctors to make crucial decisions about rationing treatment, a leading GP has said.
As I have said, this problem is the same north and south of the border. The failure of politicians to recognise or address the issues is because they are difficult and demonstrating progress in a politician's timescale are poor. But it needs to be done.
The tories inherited an NHS in almost rude health, that they have let it get to this state, is entirely down to them, in 12 years they have just let it go to the dogs, voters should be reminded of this at the next GE, the Tories dont believe in it, never have, from Thatcher onwards, they would love to sell it of to their mates
I know that "why haven't they privatised it then" was a defence posted upthread. But why bother? They have marketised it, added vast layers of competition and complexity and contracts. A huge feeding trough for their mates. Best of all they can say "record spending in the NHS" knowing that they more cash they tip in, the more that actual front line medicine starves whilst the trough gets fuller.
The optimum position for private health companies is to have the government not the patient as the purchaser. This gives all the profiteering the private sector desires, without the inconvenience of needing to treat patients nicely. Contracting out combines the poor service of a monopoly and the lucrative contracts for politicians mates and their lobbyists. Hence Crapita etc, which no individual consumer would choose.
Can't see why it's Sunak's fault. Excess deaths are probably indirectly caused by Covid 19 and the lockdown.
That's incumbency for you.
You rock with the good times and roll with the bad. You can't claim your Ukrainian victory over the Russian bear if you won't take responsibility for bad things happening on your watch.
The tories inherited an NHS in almost rude health, that they have let it get to this state, is entirely down to them, in 12 years they have just let it go to the dogs, voters should be reminded of this at the next GE, the Tories dont believe in it, never have, from Thatcher onwards, they would love to sell it of to their mates
We seem to be spoilt for choice with little Sir Echoes of the Labour herd these days.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
GPs are often migrating to eConsult forms. We have used this and it has worked well for us, with good access to doctors when needed. It's not always obvious the best way to get help, but the model of ringing the surgery seems broken everywhere .
And in a world where we also need to up defence spending,
On the Tuesday before Christmas the RAF used 2 x AGM-114 (cost £60,000 each) fired from an MQ-9 (cost £11.2 million and £4,000/hour to operate) to destroy "a building" in Northern Syria.
While the MoD can afford to do that they've got enough money.
Is this a different Dura Ace to the one that laments how the Tories are the party of defence cuts and, if we funded it properly, "we could have such a lovely navy" ?
“ EXC: Rishi Sunak has shelved plans for a ‘big bang’ overhaul of the childcare system drafted by Liz Truss
Truss was looking at an extra 20hrs of free childcare + scrapping staff-child ratios. Due to be revealed pre Xmas
But reforms delayed + scaled back”
I genuinely don’t see why the conservatives are bothering being in power any longer. Would have been one of those sensible policies for parents locked out of work via childcare costs. A mystery why people aren’t having children..
Sunak comes across as a caretaker PM. Truly terrified of taking any sort of bold action on anything
Sunak is the Invisible Man.
Overall we are seeing what happens when for a year we have chaotic, incompetent government obsessed by court politics and infighting. There is no overall strategy of government, just unstable lurches from one direction to another.
The government had taken its eye off the ball on health, with no plan for the current situation, ignored the energy price crisis until it got whacked in the face by it in October, and even now has no thought on the problems in education, criminal justice, Social Care, Northern Ireland etc etc
It is a Zombie government stumbling through a minefield.
And there are another two years or so of this to go. Very late Major was painful to watch, but not like this.
Really, the best thing for British Conservatism as an eternal movement, as an ideal, would be to bail out pronto and leave the Other Lot to try to solve the problems. It won't happen, natch, because the best thing for current Conservatives is to hang on and pray for a lamentation of black swans.
I would say after my couple of months in hospital, which ended just before Christmas, that the majority of non-British nursing and care staff were Filipino (or Filipina)!
Yep my experience as well.
Same when I was in hospital in for six months in 1979/80.
3 years ago when my wife was in hospital for 6 weeks all nurses were Scottish or English, a few of the Doctor's were not but still majority. likely different in Glasgow or Edinburgh mind you.
Mr. Pioneers, unlike Labour's wondrful value for money PFI splurges to keep the spending off the books?
And that's before we get to the electorate and media's bizarre zealous belief in the national religion whch makes discussion very difficult.
Huh? I attacked Labour's PFI earlier. So again, why can't we build schools and hospitals in this country which are fit for purpose and not a massive rip-off? Everyone else manages it.
Thing is though, you can attack the NHS as a national religion, and you have a point. But how does dissatisfaction with the system justify the deliberate run down of front-line medicine and now Tory MPs blaming the nurses?
Own it - if you want people to suffer and die in order to smash the national religion then man up. Otherwise, how about we actually try and treat people whilst we have the discussion you and I both want? The Tories are smashing things alright - NHS is buggered, trains are buggered, courts are buggered etc etc etc. How do they then expect to be re-elected having demonstrated their incompetence and indifference?
“ EXC: Rishi Sunak has shelved plans for a ‘big bang’ overhaul of the childcare system drafted by Liz Truss
Truss was looking at an extra 20hrs of free childcare + scrapping staff-child ratios. Due to be revealed pre Xmas
But reforms delayed + scaled back”
I genuinely don’t see why the conservatives are bothering being in power any longer. Would have been one of those sensible policies for parents locked out of work via childcare costs. A mystery why people aren’t having children..
Sunak comes across as a caretaker PM. Truly terrified of taking any sort of bold action on anything
Can't see why it's Sunak's fault. Excess deaths are probably indirectly caused by Covid 19 and the lockdown.
The NHS was never locked down. The deterioration in performance preceeded Covid, though was accelerated by it, as was the staffing crisis.
We are seeing what happens when services lack capacity. It doesn't matter if you have BUPA cover or not when you have a heart attack as private hospitals do not have emergency departments.
Those charts are stark. Worryingly no sign of a turnaround. It’s going to get worse before it gets better.
At present there is no reason for it to turn around. Things might abate a bit in the Spring as the flu epidemic fades, but this is no longer a winter crisis, but a full year one. The staffing crisis is likely to worsen significantly if the mooted 2% pay rises for the coming year are implemented.
Why does this government accept a permanent crisis? It’s clearly sortable. It’s a question of political will more than anything (and an absence of political won’t).
It's a question of money.
The NHS has had a nominal increase every single year since 2010; it was the only HMG department protected from austerity.
Some of these years the increases were 2-3% each year but that equated to "0%" in real terms, and the NHS needs an increase in real-terms, each and every year, because with an ageing population, drug price inflation, the increasing treatability of conditions, wage demands and competition for labour in the market you have to run just to stand still. What's the price? Probably of the order of 4-6% pa, depending on the year.
It doesn't take long to see how that compounds and becomes unsustainable in the long-run, particularly since it 'crowds out' spending in other HMG departments and creates an almost irresistible demand for expansion of the overall tax burden to fuel it, progressively suffocating consumption & investment in the wider economy.
Genuine question: are other comparable countries suffering the same issues as the UK?
I believe the other day someone referred to problems in France related to ambulance delays - here in spain there have been long-running strikes among doctors and nurses in Madrid and some other Autonomous communities. Looking from outside there is an understandable but incredibly Brit-centric view that all our economic and social woes exist solely within the borders while the grass everywhere else and especially within the EU gets ever greeener. As I say understandable but really not true - here in Spain, which is among the best overall in the EU currently prices in supermarkets are continuing to rise well above the nominal rate of about 7% -in many cases double or triple that. New measures have been introduced to limit rises for the basics but we have just lost the 20cent petrol subsidy which will have a big impact in my part of the world where the average local earns around 12k€ p.a.
The article you refer to quoted 150 excess deaths in France for the whole of December due to delays in emergency treatment. Which orders of magnitude less than the 500 per day in the UK, even if it's not apples to apples.
There are stresses in other systems - my German doctor friend complains about these - but it does look like only the UK system is in a state of actual collapse compared with countries we might see as peers. My belief is that there is no resilience in the UK systems. In recent years we have struggled along close to breaking point, now we have gone past it. The root cause is mostly funding and policy decisions by the UK Conservative governments. Healthcare provision was relatively better under the previous Labour government, so I think there are things to learn from them. And no, they didn't inherit a benign situation from the previous government. They inherited a poorly functioning healthcare system, which they improved.
They inherited a benign economic situation which allowed for the funds to be applied. That will not likely be so in the near future.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
A sad story, and I have heard many similar ones, though not all with such bad outcomes.
Politicians need to notice that all those waiting for ambulances, waiting in ambulances and in corridors or A&E have votes and voting families. Their lived experience will trump whatever spurious guff the government comes out with next GE.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The last Labour Government also pushed the introduction of the Liverpool Care Path which resulted in hundreds of unnecessary and premature deaths of people against their will and with increased suffering. My own father included.
My father in Law as well, absolutely shocking. Unfortunately we were on holiday as he had been looking like he would be fine and getting out of hospital and they just bamboozled the family members left and he was put on LCP at a weekend by a junior doctor and that was it.
And in a world where we also need to up defence spending,
On the Tuesday before Christmas the RAF used 2 x AGM-114 (cost £60,000 each) fired from an MQ-9 (cost £11.2 million and £4,000/hour to operate) to destroy "a building" in Northern Syria.
While the MoD can afford to do that they've got enough money.
Is this a different Dura Ace to the one that laments how the Tories are the party of defence cuts and, if we funded it properly, "we could have such a lovely navy" ?
Funding it properly involves, among other things, stopping wasting a lot of money to act as the air force of Assad.
The reason they've done it is transparently obvious. If Op Shader isn't regularly putting warheads on foreheads somebody is going to ask exactly what the point of Op Shader is. And if Shader goes then questions are going to be asked about Crab Air's Club Med at Akrotiri.
Unfortunate for Sunak but there are a lot of opportunities for the opposition with this problem. Perhaps 'Brexit isn't working'.
Whatever Sunak is (ie the size of an Amiibo) he isn't so stupid so he must know what's up. That time he had to go on TV and say, "I believe in Brexit" he looked like he was on the verge of starting to cry.
Struggling to see how nurses going on strike for an above inflation payrise inmediately screams 'Brexit' to you folks, but I suppose all is possible in terminal stage remoanerism.
Brexit has impacted on staffing vacancies, not only by FoM but also by losing recognition of qualifications. A Greek Doctor or Portuguese Nurse can no longer start next week, but rather takes 6 months to get their qualifications recognised. They now go to Germany or France instead.
After all, a large part of the purpose of Brexit was to force payrises for working Britons by reducing foreign competition. It is a feature not a bug of Brexit.
In short the conversation goes like this:
Brexiteer: "We have to ban foreign workers so we can take care of our own."
Our own: "I need a pay rise in order to pay my bills."
Brexiteer: "F*** Off!"
Either a Greek or Portuguese qualification needs 6 months of poring over, in which case it was bad and dangerous that this didn't happen before Brexit, or, more likely, they don't, which makes it solely a British NHS issue that it's taking 6 months. Perhaps you should consider apportioning some blame your desk jockey colleagues, who make up over half the NHS workforce, and whose whole job is meant to be sorting this stuff out.
Part of FoM was mutual recognition of qualifications, and that has now ended. Nearly all foreign graduates now have to apply for recognition of their qualifications the same way, whether Nigerian or Portuguese, and that is both expensive and time consuming.
I agree that it is unnessecary red tape, but that is Brexit and exiting the Single Market for you.
Incidentally the NHS doesn't have the power to recognise qualifications, that is a statutory responsibility of the GMC. Neither does the NHS issue work visas, as that is a statutory role of the Home Office.
No, it isn't Brexit or leaving the single market for you - Brexit provides us (and the EU) with a choice as to whether to continue to recognise these qualifications automatically or not. It is the EU's choice whether to recognise UK medical qualifications, and ours whether to recognise theirs. We choose whether to introduce red tape, or not to. If it has been introduced with grim enthusiasm, maybe we should consider whether those introducing it have an ideological axe to grind.
A Brexit Tory government with an Ideological axe to grind?...surely not....
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
“ EXC: Rishi Sunak has shelved plans for a ‘big bang’ overhaul of the childcare system drafted by Liz Truss
Truss was looking at an extra 20hrs of free childcare + scrapping staff-child ratios. Due to be revealed pre Xmas
But reforms delayed + scaled back”
I genuinely don’t see why the conservatives are bothering being in power any longer. Would have been one of those sensible policies for parents locked out of work via childcare costs. A mystery why people aren’t having children..
Sunak comes across as a caretaker PM. Truly terrified of taking any sort of bold action on anything
Sunak is the Invisible Man.
Overall we are seeing what happens when for a year we have chaotic, incompetent government obsessed by court politics and infighting. There is no overall strategy of government, just unstable lurches from one direction to another.
The government had taken its eye off the ball on health, with no plan for the current situation, ignored the energy price crisis until it got whacked in the face by it in October, and even now has no thought on the problems in education, criminal justice, Social Care, Northern Ireland etc etc
It is a Zombie government stumbling through a minefield.
Ministers could have had their eye on the ball in all those departments. They could have been doing an impeccable job for all we know. None of them was allowed to do it because they've been moved, repeatedly, for purely internal Party reasons. That is a major part of why we are here. And that is unforgivable Tory self-indulgence. Regardless of any other contributory factors at play.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
My brother-in-law collapsed before Xmas - he was in hospital within 30 minutes, and kept in for OBS until the next day. Currently undergoing monitoring for a possible heart condition. This in Sunderland. Anecdotes tell many stories .
Mr. Pioneers, I didn't see your earlier attack on Labour's PFI, apologies for the question being null given that prior comment. In turn, I have often attacked the cuts to the judicial system which is a clear case of cutting too much to obviously detrimental effect.
That being said, your implication that I want people to suffer and die to break the national religion of the NHS could politely be described as imaginative.
Healthcare needs to change. But anything other than throwing money at it gets immediately attacked. Money is never unlimited and is particularly tight now, so for any party to find a real way out (Labour's non-dom claim is perhaps optimistic) is going to be challenging. Unfortunately, I have no idea how to really achieve that, but discussion is needed without mindless, reflexive attacks by journalists or political opportunism constraining debate.
“ EXC: Rishi Sunak has shelved plans for a ‘big bang’ overhaul of the childcare system drafted by Liz Truss
Truss was looking at an extra 20hrs of free childcare + scrapping staff-child ratios. Due to be revealed pre Xmas
But reforms delayed + scaled back”
I genuinely don’t see why the conservatives are bothering being in power any longer. Would have been one of those sensible policies for parents locked out of work via childcare costs. A mystery why people aren’t having children..
Sunak comes across as a caretaker PM. Truly terrified of taking any sort of bold action on anything
Keeping the seat warm for BigDog?
It's becoming pure farce so the return of Johnson would be wholly appropriate.
Mr. Pioneers, I didn't see your earlier attack on Labour's PFI, apologies for the question being null given that prior comment. In turn, I have often attacked the cuts to the judicial system which is a clear case of cutting too much to obviously detrimental effect.
That being said, your implication that I want people to suffer and die to break the national religion of the NHS could politely be described as imaginative.
Healthcare needs to change. But anything other than throwing money at it gets immediately attacked. Money is never unlimited and is particularly tight now, so for any party to find a real way out (Labour's non-dom claim is perhaps optimistic) is going to be challenging. Unfortunately, I have no idea how to really achieve that, but discussion is needed without mindless, reflexive attacks by journalists or political opportunism constraining debate.
This crisis, like those in other domains of government, requires both a short term and a long term solution. Simply talking about a "Swiss Style Insurance System" or similar will not deal with the next months. Neither will spending a fortune on agency staff and private hospitals address the long term issues.
Mind you, a government with a plan for either would be a step up from a government with a plan for neither.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
David, I think the social care and more GP's / trained nurses up front would be the biggest aids. Why they cannot have decent 24x7 medical centres locally to take a lot of teh burden off A&E seems crazy to me. Then the F***ed up social system meaning shedloads of beds are bunged up with people fit to be discharged just beggars belief.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
My brother-in-law collapsed before Xmas - he was in hospital within 30 minutes, and kept in for OBS until the next day. Currently undergoing monitoring for a possible heart condition. This in Sunderland. Anecdotes tell many stories .
Yes it seems to be a real postcode lottery at present and also time/day of when you turn ill. Certainly not a good time to take ill or have an accident.
Given we're told the 65+ age group are the most heavily Tory voting demographic, you'd think the Government would want to sort the immediate NHS problem with whatever short-term measures might be feasible, otherwise it's their own voters who will be dying in pain on trolleys. But like other posters, I agree it's clearly not fixable quickly, if at all, given the complexity of factors (some own goals) converging to generate this crisis.
The tales of distress emerging both here and elsewhere are heart-rending and it's hard not to be angry - we are one of the wealthiest countries in the world at the start of the 21st century. People should not be dying through neglect or lack of care or stuck on a trolley for hours in pain.
We should and have to be so much better than this.
It's easy to fall into the "you can't keep throwing money at the NHS" line - there is an argument over whether those who can afford to pay for healthcare should or at least make some contribution. As Mrs Stodge reminds me, in New Zealand, you pay to see the GP. Yet we don't want financial concerns to deter people from seeking medical help when they need it or as a preventative measure.
We know there are problems with vulnerable people who remain in hospital because there are no arrangements for their care in place. This is, I think, our biggest issue - how do we provide adequate and reliable post-hospital care so beds can be freed up for genuinely urgent cases? It's not just a question of inter and intra-agency provision - we don't have the networks and mechanisms in place. It seems to fall between the individual's family, the local authority, the NHS and others and no one seems able to grasp this problem.
As an ageing population, more need low levels of continual care - that usually means care at home (including adaptations) or perhaps re-locating to Extra Care or Supported Living accommodation. There's a lot more to it than this but the thinking on this has barely started and the crisis is upon us.
Freeing up hospital bed space may help to free up ambulances and return response times to where they should be.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
David, I think the social care and more GP's / trained nurses up front would be the biggest aids. Why they cannot have decent 24x7 medical centres locally to take a lot of teh burden off A&E seems crazy to me. Then the F***ed up social system meaning shedloads of beds are bunged up with people fit to be discharged just beggars belief.
Happy New Year Malcolm. I completely agree. There must be room for a lower level A&E who can deal with cuts, burns and other minor injuries that need medical attention but are not a matter of life and death.
On Hogmanay I had X-rays of my knee and shoulder in Dundee. Very efficient service. I was out again by the time my appointment was due. Nice piece of kit. Results in 2 weeks from the GP, apparently. Its not all bad and it can work well but the pinch points are causing really negative outcomes for the unlucky.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
GPs are often migrating to eConsult forms. We have used this and it has worked well for us, with good access to doctors when needed. It's not always obvious the best way to get help, but the model of ringing the surgery seems broken everywhere .
Just before Christmas you couldn't even get through to our local surgery on e-consult. Even early in the morning it said no appointments available.
Interesting debate here on the NHS today. But no-one has mentioned the demand side. We have become an overweight, lazy nation. Anyway, I have my walking boots on - going to take advantage of a nice sunny crisp (-2 degrees) day and go for a walk - see you in a bit.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The inference you are drawing there, however, is that it will only take a change in administration and that happy state will subsequently be restored.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
To govern is to choose.
We are well past the point where restricting NHS pay is saving us money, it is costing us money.
Big increases in agency pay, which will get exponentially worse as more leave and morale drops amongst the permanents - this is a vicious circle that needs to be avoided. Loss of experienced staff creates inefficiencies that require more staff to do the same work Increase in training costs to replace those leaving Millions off sick unable to work and pay tax instead receiving welfare whilst waiting years for operations - such a long gap will see a proportion of those needlessly economically inactive ongoing Crumbling UK infrastructure in health, travel and education will see investment across our economy well below where it could have been
This is not being done to save money, but out of ideological belief that public sector pay needs to be tightly restrained. Which to be fair, it normally does, but now is absolutely the wrong time to be doing it.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
Mr. Pioneers, I didn't see your earlier attack on Labour's PFI, apologies for the question being null given that prior comment. In turn, I have often attacked the cuts to the judicial system which is a clear case of cutting too much to obviously detrimental effect.
That being said, your implication that I want people to suffer and die to break the national religion of the NHS could politely be described as imaginative.
Healthcare needs to change. But anything other than throwing money at it gets immediately attacked. Money is never unlimited and is particularly tight now, so for any party to find a real way out (Labour's non-dom claim is perhaps optimistic) is going to be challenging. Unfortunately, I have no idea how to really achieve that, but discussion is needed without mindless, reflexive attacks by journalists or political opportunism constraining debate.
In my case I am supporting neither Labour nor the Tories. I am not agitating for a labour government for ideological reasons, so I'm not saying anything on the grounds of political opportunism.
A government that gives a shit would see the growing medical crisis and do whatever it could to find a solution. You are very clear that your desire for a long-term solution doesn't justify all of the short term death and suffering - I am glad to hear it! Problem is that so many of the remaining right-wingers show such disdain to the problem and the suffering and the misery. You may not agree with Lee Anderson that the blame lies with nurses, but you do support the party and the government, so...
At which point do you attack the people to blame for the acute immediate crisis and their refusal to even admit there is a crisis?
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
The charts I have seen of late suggest that we are now moving up to the EU average on health care. I don't think that your 20% is correct. Otherwise I agree.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
But what should they get. The average package for a nurse outside of London is £50k although they only get paid £35K.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The inference you are drawing there, however, is that it will only take a change in administration and that happy state will subsequently be restored.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
To govern is to choose.
We are well past the point where restricting NHS pay is saving us money, it is costing us money.
Big increases in agency pay, which will get exponentially worse as more leave and morale drops amongst the permanents - this is a vicious circle that needs to be avoided. Loss of experienced staff creates inefficiencies that require more staff to do the same work Increase in training costs to replace those leaving Millions off sick unable to work and pay tax instead receiving welfare whilst waiting years for operations - such a long gap will see a proportion of those needlessly economically inactive ongoing Crumbling UK infrastructure in health, travel and education will see investment across our economy well below where it could have been
This is not being done to save money, but out of ideological belief that public sector pay needs to be tightly restrained. Which to be fair, it normally does, but now is absolutely the wrong time to be doing it.
Again, I ask the question: how will you pay for it?
I'm not sure you're arguing it's self-funding I strongly disagree - most users of the NHS are the old and chronically unwell; it's about as self-funding as Liz Truss's tax cuts.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
GPs are often migrating to eConsult forms. We have used this and it has worked well for us, with good access to doctors when needed. It's not always obvious the best way to get help, but the model of ringing the surgery seems broken everywhere .
Just before Christmas you couldn't even get through to our local surgery on e-consult. Even early in the morning it said no appointments available.
This is something that could be solved tomorrow by an early application of AI
The machines are getting REALLY good at diagnosis. In some ways they are already better than human doctors
“Algorithm That Detects Sepsis Cut Deaths by Nearly 20 Percent
Over two years, a machine-learning program warned thousands of health care providers about patients at high risk of sepsis, allowing them to begin treatments nearly two hours sooner”
“doctors 🩺+ AI🤖 = 🤯
NEW state of the art AI scores 67% (up from 50%) and surely will improve to head to 90%+ in relevant + accurate answers for medical diagnosis + recommendations.
Full paper: (via DeepMind + Google Research teams) arxiv.org/pdf/2212.13138…”
An AI GP will be available 24/7; it could see 4m patients every 9 minutes. This technology is available NOW and will only get better
Of course there will be many cases requiring physical inspection, they can be handed on to human docs but anyone requiring an e-consult could be sorted right now. Why aren’t we doing it?
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
On the first bolded point, this has been obvious for so long you have to wonder why we aren't seeing progress on it. What going wrong here? Is it simple want of money in the right budget? Some organisational failure? Cost of housing making it hard to increase supply of nursing house spaces?
On the second bolded point, there is an interesting article by PB's bete noire Devi Sridar in the Grauniad yesterday on at least half that point. It includes this simple, and perhaps obvious sentence: "If you add physical activity to a balanced diet, sleep and friends, that is a recipe for good physical and mental health."
If you were to put that sentence at the centre of government policy I wonder what changed priorities it might imply? What might government be able to do that doesn't cost £bns, but that would make it easier for people to live their lives in such a way?
Can't see why it's Sunak's fault. Excess deaths are probably indirectly caused by Covid 19 and the lockdown.
The NHS was never locked down. The deterioration in performance preceeded Covid, though was accelerated by it, as was the staffing crisis.
We are seeing what happens when services lack capacity. It doesn't matter if you have BUPA cover or not when you have a heart attack as private hospitals do not have emergency departments.
Those charts are stark. Worryingly no sign of a turnaround. It’s going to get worse before it gets better.
At present there is no reason for it to turn around. Things might abate a bit in the Spring as the flu epidemic fades, but this is no longer a winter crisis, but a full year one. The staffing crisis is likely to worsen significantly if the mooted 2% pay rises for the coming year are implemented.
Why does this government accept a permanent crisis? It’s clearly sortable. It’s a question of political will more than anything (and an absence of political won’t).
It's a question of money.
The NHS has had a nominal increase every single year since 2010; it was the only HMG department protected from austerity.
Some of these years the increases were 2-3% each year but that equated to "0%" in real terms, and the NHS needs an increase in real-terms, each and every year, because with an ageing population, drug price inflation, the increasing treatability of conditions, wage demands and competition for labour in the market you have to run just to stand still. What's the price? Probably of the order of 4-6% pa, depending on the year.
It doesn't take long to see how that compounds and becomes unsustainable in the long-run, particularly since it 'crowds out' spending in other HMG departments and creates an almost irresistible demand for expansion of the overall tax burden to fuel it, progressively suffocating consumption & investment in the wider economy.
Genuine question: are other comparable countries suffering the same issues as the UK?
I believe the other day someone referred to problems in France related to ambulance delays - here in spain there have been long-running strikes among doctors and nurses in Madrid and some other Autonomous communities. Looking from outside there is an understandable but incredibly Brit-centric view that all our economic and social woes exist solely within the borders while the grass everywhere else and especially within the EU gets ever greeener. As I say understandable but really not true - here in Spain, which is among the best overall in the EU currently prices in supermarkets are continuing to rise well above the nominal rate of about 7% -in many cases double or triple that. New measures have been introduced to limit rises for the basics but we have just lost the 20cent petrol subsidy which will have a big impact in my part of the world where the average local earns around 12k€ p.a.
I think that is just human nature. The grass is always greener, or conversely we are always better, rather than a balanced view and I suspect generally remainders and brexiteers are both biased in each of the opposite directions.
I think you might expect at least some Brexiteers to have the humility to accept that it hasn't worked out well. It's clear from the polls that the public in large numbers can see what's obvious.
It's Just the jutting jawed PB right wingers screaching NO SURRENDER who remind the rest of us quite what ridiculous figures they cut.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The inference you are drawing there, however, is that it will only take a change in administration and that happy state will subsequently be restored.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
To govern is to choose.
We are well past the point where restricting NHS pay is saving us money, it is costing us money.
Big increases in agency pay, which will get exponentially worse as more leave and morale drops amongst the permanents - this is a vicious circle that needs to be avoided. Loss of experienced staff creates inefficiencies that require more staff to do the same work Increase in training costs to replace those leaving Millions off sick unable to work and pay tax instead receiving welfare whilst waiting years for operations - such a long gap will see a proportion of those needlessly economically inactive ongoing Crumbling UK infrastructure in health, travel and education will see investment across our economy well below where it could have been
This is not being done to save money, but out of ideological belief that public sector pay needs to be tightly restrained. Which to be fair, it normally does, but now is absolutely the wrong time to be doing it.
Again, I ask the question: how will you pay for it?
I'm not sure you're arguing it's self-funding I strongly disagree - most users of the NHS are the old and chronically unwell; it's about as self-funding as Liz Truss's tax cuts.
I think the cost of not doing it is significantly greater than the cost of doing it, yes.
And anyway we will end up paying something closer to 8-10% anyway as the govt wont survive otherwise, so the options are:
Have three to six months of strikes through the winter, losing more staff to low morale and strikes and then pay the increases anyway
Pay them now and have (slightly) better healthcare through the rest of the winter but more importantly improve morale and retention.
The idea we can convince NHS workers to stay in their jobs and recruit 100k+ extra of them whilst reducing their real pay by 15% or so over 2 years, having them work through the collapse of the service, and see ex colleagues rake it in on bloated agency pay is simply for the birds.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
The charts I have seen of late suggest that we are now moving up to the EU average on health care. I don't think that your 20% is correct. Otherwise I agree.
It depends on how you measure it, % of GDP, PPP, actual money spent, whether you include out of pocket expenses and so on. These figures are from 2018; another calculation in the same report reduces the gap to about 15%. As I say I don't think the UK systems are underfunded across the board. They are very underfunded in certain critical areas.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The inference you are drawing there, however, is that it will only take a change in administration and that happy state will subsequently be restored.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
To govern is to choose.
We are well past the point where restricting NHS pay is saving us money, it is costing us money.
Big increases in agency pay, which will get exponentially worse as more leave and morale drops amongst the permanents - this is a vicious circle that needs to be avoided. Loss of experienced staff creates inefficiencies that require more staff to do the same work Increase in training costs to replace those leaving Millions off sick unable to work and pay tax instead receiving welfare whilst waiting years for operations - such a long gap will see a proportion of those needlessly economically inactive ongoing Crumbling UK infrastructure in health, travel and education will see investment across our economy well below where it could have been
This is not being done to save money, but out of ideological belief that public sector pay needs to be tightly restrained. Which to be fair, it normally does, but now is absolutely the wrong time to be doing it.
Again, I ask the question: how will you pay for it?
I'm not sure you're arguing it's self-funding I strongly disagree - most users of the NHS are the old and chronically unwell; it's about as self-funding as Liz Truss's tax cuts.
Again, I ask the question: how will you pay for the cost of not paying for it?
The cost of waiting lists is a workforce where millions are long term sick, or suffering chronic pain. Low productivity is a big problem with a big cost. Then we have the economic cost of people working full time and having not enough money to pay their bills never mind consume. That costs jobs, which cuts consumption which costs more jobs.
You cannot rationally say "how will you pay for it" - not paying for it also has a cost.
This is something that is really cutting through to people. A major topic of conversation at local U3A meetings, book groups, coffee mornings etc. is how it is nearly impossible to get through to local surgeries. If by some fluke you do, you'll be lucky to get a phone consultation with a nurse. Forget seeing a doctor. A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead These are not scare stories. People are worried it could be them or a loved one next.
My brother-in-law collapsed before Xmas - he was in hospital within 30 minutes, and kept in for OBS until the next day. Currently undergoing monitoring for a possible heart condition. This in Sunderland. Anecdotes tell many stories .
So what? Every case should be like that. What weight does a single one which is, carry?
In the end we will need far fewer doctors. Machines will do it all - and do it better
This NHS crisis is yet another debate which is happening in a vacuum. As if AI isn’t around the corner. But it is
“#PLOSDigitalHealth: Predicting dementia from spontaneous speech using ChatGPT”
“AI technology triples stroke recovery”
“The world's first #AI cancer diagnosis robot, developed by an #OVC company, will provide free cervical cancer screening for 10,000 women in Pakistan.🔬🤖
The robot has performed detection for over 10 million women in China and #BRI countries, and has saved 60,000+ lives.💪”
“Testing out @OpenAI to see how #ChatGPT handles writing up dictated GP consults. Only a matter of time before we have strong AI assisting us in practice. Could also ask it questions about differential diagnosis, treatment and safety netting - try it!”
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
One way to address the staff shortages is via improved productivity, so as to reduce the demand for staff. In practice this means shorter but more capital intensive stays or appointments.
Instead capital budgets have been stripped bare for years to fund day to day spending.
One way to reduce demand is serious intervention in public health, along the lines of the Marmot Report 2010.
Instead public health budgets have also been stripped for day to day spending on front line services.
Staff retention and motivation would be helped by investment in skills and personal development, and also improve productivity.
Training and Education budgets have also been stripped bare, and teaching sessions cancelled so staff can be sent as fodder for the crisis of the day.
Many of the demand, productivity and quality issues are not intrinsic to the structure of the NHS or a private system but rather due to lack of investment and interest in the long term picture by management with very narrow horizons. Not unique to the NHS of course, but common to many aspects of life.
But control means choice. The responsible organisation has the choice to recognise qualifications that yesterday it was airily waving through, or not to. If a 6 month checking process is necessary now, it is dereliction of duty that it did not happen then. If it isn't necessary, why is it happening now?
It was part of our membership of the EU.
Membership mandated recognition.
Now we are not members.
If the Brexiteers want mandated recognition, they need to legislate for it.
This is a Brexit fuck up. Even you know it, but aren't ready to admit it.
We'll talk about being ready to admit things when you've stopped editing your quotes to remove criticism of your posts shall we?
In the end we will need far fewer doctors. Machines will do it all - and do it better
This NHS crisis is yet another debate which is happening in a vacuum. As if AI isn’t around the corner. But it is
“#PLOSDigitalHealth: Predicting dementia from spontaneous speech using ChatGPT”
“AI technology triples stroke recovery”
“The world's first #AI cancer diagnosis robot, developed by an #OVC company, will provide free cervical cancer screening for 10,000 women in Pakistan.🔬🤖
The robot has performed detection for over 10 million women in China and #BRI countries, and has saved 60,000+ lives.💪”
“Testing out @OpenAI to see how #ChatGPT handles writing up dictated GP consults. Only a matter of time before we have strong AI assisting us in practice. Could also ask it questions about differential diagnosis, treatment and safety netting - try it!”
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
The charts I have seen of late suggest that we are now moving up to the EU average on health care. I don't think that your 20% is correct. Otherwise I agree.
It depends on how you measure it, % of GDP, PPP, actual money spent, whether you include out of pocket expenses and so on. These figures are from 2018; another calculation in the same report reduces the gap to about 15%. As I say I don't think the UK systems are underfunded across the board. They are very underfunded in certain critical areas.
Per capita spending on healthcare almost has to be lower in the UK than in many other European countries, because our per capita GDP is also lower. You can't spend what you don't earn.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
On the first bolded point, this has been obvious for so long you have to wonder why we aren't seeing progress on it. What going wrong here? Is it simple want of money in the right budget? Some organisational failure? Cost of housing making it hard to increase supply of nursing house spaces?
On the second bolded point, there is an interesting article by PB's bete noire Devi Sridar in the Grauniad yesterday on at least half that point. It includes this simple, and perhaps obvious sentence: "If you add physical activity to a balanced diet, sleep and friends, that is a recipe for good physical and mental health."
If you were to put that sentence at the centre of government policy I wonder what changed priorities it might imply? What might government be able to do that doesn't cost £bns, but that would make it easier for people to live their lives in such a way?
Hunt seemed to get the point in his latter stages as Health Secretary and brought Health and Social Care under the same roof. It was politically easier to spend more on social care if it had a "health" departmental labelling. Unfortunately he was not in post for long after that and the government fell apart. Thereafter Covid dominated and probably made it even more difficult to get care packages together when bed blockers moved out en masse caused a lot of Covid in homes. I suspect safeguards that are built in to make sure this "never happens again" will make moving people out even more difficult. I am very concerned the inquiries will make this worse, not better.
In many ways we were probably already too exacting in the care packages. If every box was not ticked people stayed in hospital at the cost of X thousand a day. We need to be careful about creating such barriers for the best of intentions.
Unfortunate for Sunak but there are a lot of opportunities for the opposition with this problem. Perhaps 'Brexit isn't working'.
Whatever Sunak is (ie the size of an Amiibo) he isn't so stupid so he must know what's up. That time he had to go on TV and say, "I believe in Brexit" he looked like he was on the verge of starting to cry.
Struggling to see how nurses going on strike for an above inflation payrise inmediately screams 'Brexit' to you folks, but I suppose all is possible in terminal stage remoanerism.
Brexit has impacted on staffing vacancies, not only by FoM but also by losing recognition of qualifications. A Greek Doctor or Portuguese Nurse can no longer start next week, but rather takes 6 months to get their qualifications recognised. They now go to Germany or France instead.
After all, a large part of the purpose of Brexit was to force payrises for working Britons by reducing foreign competition. It is a feature not a bug of Brexit.
In short the conversation goes like this:
Brexiteer: "We have to ban foreign workers so we can take care of our own."
Our own: "I need a pay rise in order to pay my bills."
Brexiteer: "F*** Off!"
Either a Greek or Portuguese qualification needs 6 months of poring over, in which case it was bad and dangerous that this didn't happen before Brexit, or, more likely, they don't, which makes it solely a British NHS issue that it's taking 6 months. Perhaps you should consider apportioning some blame your desk jockey colleagues, who make up over half the NHS workforce, and whose whole job is meant to be sorting this stuff out.
Part of FoM was mutual recognition of qualifications, and that has now ended. Nearly all foreign graduates now have to apply for recognition of their qualifications the same way, whether Nigerian or Portuguese, and that is both expensive and time consuming.
I agree that it is unnessecary red tape, but that is Brexit and exiting the Single Market for you.
Incidentally the NHS doesn't have the power to recognise qualifications, that is a statutory responsibility of the GMC. Neither does the NHS issue work visas, as that is a statutory role of the Home Office.
No, it isn't Brexit or leaving the single market for you - Brexit provides us (and the EU) with a choice as to whether to continue to recognise these qualifications automatically or not. It is the EU's choice whether to recognise UK medical qualifications, and ours whether to recognise theirs. We choose whether to introduce red tape, or not to. If it has been introduced with grim enthusiasm, maybe we should consider whether those introducing it have an ideological axe to grind.
We chose to introduce the red tape by voting to leave the EU. This is not a surprise. Or do you propose we let anyone with a piece of paper that says 'nurse' enter the country?
That's exactly what we appear to have done when we were in the EU, so why not?
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
But what should they get. The average package for a nurse outside of London is £50k although they only get paid £35K.
Simple answer is "whatever it costs to recruit and retain nurses in sufficient quantities and of sufficient quality to run the service we want to provide".
I don't know how much that is. Neither do you, or Robert Colvile. Indeed, the experience of the 1970s is that trying to answer that question with a specific number is a mug's game.
But what is painfully clear is that the answer is "quite a bit more than is on offer now."
In the end we will need far fewer doctors. Machines will do it all - and do it better
This NHS crisis is yet another debate which is happening in a vacuum. As if AI isn’t around the corner. But it is
“#PLOSDigitalHealth: Predicting dementia from spontaneous speech using ChatGPT”
“AI technology triples stroke recovery”
“The world's first #AI cancer diagnosis robot, developed by an #OVC company, will provide free cervical cancer screening for 10,000 women in Pakistan.🔬🤖
The robot has performed detection for over 10 million women in China and #BRI countries, and has saved 60,000+ lives.💪”
“Testing out @OpenAI to see how #ChatGPT handles writing up dictated GP consults. Only a matter of time before we have strong AI assisting us in practice. Could also ask it questions about differential diagnosis, treatment and safety netting - try it!”
Prediction algorithms will help with certain diagnoses long-term but unlikely to reduce the number of doctors, certainly not nurses or carers.
How will the AI wipe your bottom or change your sheets?
How does AI deal with mental health? This is the unspoken spectre looming behind a lot of chronic (and chronically expensive, in both money and time), physical health conditions.
In the end we will need far fewer doctors. Machines will do it all - and do it better
This NHS crisis is yet another debate which is happening in a vacuum. As if AI isn’t around the corner. But it is
“#PLOSDigitalHealth: Predicting dementia from spontaneous speech using ChatGPT”
“AI technology triples stroke recovery”
“The world's first #AI cancer diagnosis robot, developed by an #OVC company, will provide free cervical cancer screening for 10,000 women in Pakistan.🔬🤖
The robot has performed detection for over 10 million women in China and #BRI countries, and has saved 60,000+ lives.💪”
“Testing out @OpenAI to see how #ChatGPT handles writing up dictated GP consults. Only a matter of time before we have strong AI assisting us in practice. Could also ask it questions about differential diagnosis, treatment and safety netting - try it!”
Prediction algorithms will help with certain diagnoses long-term but unlikely to reduce the number of doctors, certainly not nurses or carers.
How will the AI wipe your bottom or change your sheets?
Delusional. Of course they will replace doctors. AI will revolutionise health care; from robot surgeons to ChatGPs (see what I did there). Anyone with a brainstem can see this is inevitable. I am mystified by those that are apparently incapable of this foresight
Ironically (and this is true across many professions) they will come for the more educated specialist roles FIRST (against expectations). The lower end physical tasks - the bottom wipers - will be the hardest to automate. Perhaps impossible
Imagine your children wiping bottoms forever. That is the future for us all
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The inference you are drawing there, however, is that it will only take a change in administration and that happy state will subsequently be restored.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
To govern is to choose.
We are well past the point where restricting NHS pay is saving us money, it is costing us money.
Big increases in agency pay, which will get exponentially worse as more leave and morale drops amongst the permanents - this is a vicious circle that needs to be avoided. Loss of experienced staff creates inefficiencies that require more staff to do the same work Increase in training costs to replace those leaving Millions off sick unable to work and pay tax instead receiving welfare whilst waiting years for operations - such a long gap will see a proportion of those needlessly economically inactive ongoing Crumbling UK infrastructure in health, travel and education will see investment across our economy well below where it could have been
This is not being done to save money, but out of ideological belief that public sector pay needs to be tightly restrained. Which to be fair, it normally does, but now is absolutely the wrong time to be doing it.
Again, I ask the question: how will you pay for it?
I'm not sure you're arguing it's self-funding I strongly disagree - most users of the NHS are the old and chronically unwell; it's about as self-funding as Liz Truss's tax cuts.
Again, I ask the question: how will you pay for the cost of not paying for it?
The cost of waiting lists is a workforce where millions are long term sick, or suffering chronic pain. Low productivity is a big problem with a big cost. Then we have the economic cost of people working full time and having not enough money to pay their bills never mind consume. That costs jobs, which cuts consumption which costs more jobs.
You cannot rationally say "how will you pay for it" - not paying for it also has a cost.
The truth is, as the population ages, we are all going to be a lot poorer.
Two main options as far as I see:
1) Use the resource in the housing stock to fund the investment required in social care. Clearly the Conservative Party does not want to upset the voting bloc who owns it. Therefore Labour must.
2) Place more emphasis on the traditional safety net undertaken primarily by the wider family unit. Unfortunately we have an incredibly atomised society = not possible. Therefore the social safety net for us all is, compared to say Japan, considerably more expensive.
To me, this graph suggests growing polarisation by age and Brexit partisanship over the issue of "Stay out" vs "Rejoin". Potentially a source of growing political pressures and frictions over time https://twitter.com/UKandEU/status/1609859259822481411
There are so many things wrong with that article that I don’t know where to begin.
But the idea that you can switch pension savings into immediate income without creating long term problems (due to lack of pension saving) does have a big flaw in it.
Anyways. It's finally not raining for what seems like the first time in a week. The Sun is out at a time when I'm not inside at work for the first time in months. So I'm going for a long walk. Which will aid my mental and physical health. As a responsible citizen, I think I'll do a loop around a two mile radius of the walk-in hospital urgent care centre. And hope I don't have a heart attack, fall or get hit by a car or some such.
In the end we will need far fewer doctors. Machines will do it all - and do it better
This NHS crisis is yet another debate which is happening in a vacuum. As if AI isn’t around the corner. But it is
“#PLOSDigitalHealth: Predicting dementia from spontaneous speech using ChatGPT”
“AI technology triples stroke recovery”
“The world's first #AI cancer diagnosis robot, developed by an #OVC company, will provide free cervical cancer screening for 10,000 women in Pakistan.🔬🤖
The robot has performed detection for over 10 million women in China and #BRI countries, and has saved 60,000+ lives.💪”
“Testing out @OpenAI to see how #ChatGPT handles writing up dictated GP consults. Only a matter of time before we have strong AI assisting us in practice. Could also ask it questions about differential diagnosis, treatment and safety netting - try it!”
Prediction algorithms will help with certain diagnoses long-term but unlikely to reduce the number of doctors, certainly not nurses or carers.
How will the AI wipe your bottom or change your sheets?
Delusional. Of course they will replace doctors. AI will revolutionise health care; from robot surgeons to ChatGPs (see what I did there). Anyone with a brainstem can see this is inevitable. I am mystified by those that are apparently incapable of this foresight
Ironically (and this is true across many professions) they will come for the more educated specialist roles FIRST (against expectations). The lower end physical tasks - the bottom wipers - will be the hardest to automate. Perhaps impossible
Imagine your children wiping bottoms forever. That is the future for us all
I have expertise in this field. I'm telling you it will aid with certain things but with many other things it won't.
It's not going to do much to help people falling over and ending up in hospital, people who can't breathe very well as they have Covid or flu or people who are too demented to wipe their own bottoms.
Things in general are not as uniformly amazing or disastrous as you tend to point out. There are bits in between. I understand that's hard to grasp for someone with such a manic personality.
Firstly: why these numbers? Who settled on these suspiciously round numbers as the right level for a target? Are these numbers based on clinical need or cost? What treatment fields are the priority? Are there enough positions in training facilities and universities to train this number? If not, how do you propose to address this?
How much is the non-dom tax leak? What are the sources for this number? What is the NAO and HMRC view? What are the tax losses for scrapping the non-dom status for overseas citizens? Is there even a net gain to the exchequer from doing this?
Glib slogans backed by thin cheer pieces from a biased media is the kind of garbage that got us into the Tory mess.
Why would it be different from Labour?
Our problems are not just with the particular party of government, bad, thought the current bunch truly, truly are, we have a problem with our whole system.
The last Labour government did, of course, deliver a tangible improvement in NHS services. In stark contrast to the current mob.
The last Labour Government also pushed the introduction of the Liverpool Care Path which resulted in hundreds of unnecessary and premature deaths of people against their will and with increased suffering. My own father included.
My father in Law as well, absolutely shocking. Unfortunately we were on holiday as he had been looking like he would be fine and getting out of hospital and they just bamboozled the family members left and he was put on LCP at a weekend by a junior doctor and that was it.
Very similar case to ours. They never told us what they were doing, never sought permission and just said he was beyond help. He had walked into hospital 2 weeks earlier with a heart condition. It was only afterwards that we found they had put him on the LCP and a review showed he had not received the treatment he should have which may (obviously I understand only 'may') have saved his life. We were there every day and were continually questioning what was happening but got fobbed off, initially with claims they were treating him and things were progressing and then being told there was nothing they could do.
After the event we should have made a stink but at that point we were not really interested in that as it wouldn't have changed anything.
Mr. Pioneers, I didn't see your earlier attack on Labour's PFI, apologies for the question being null given that prior comment. In turn, I have often attacked the cuts to the judicial system which is a clear case of cutting too much to obviously detrimental effect.
That being said, your implication that I want people to suffer and die to break the national religion of the NHS could politely be described as imaginative.
Healthcare needs to change. But anything other than throwing money at it gets immediately attacked. Money is never unlimited and is particularly tight now, so for any party to find a real way out (Labour's non-dom claim is perhaps optimistic) is going to be challenging. Unfortunately, I have no idea how to really achieve that, but discussion is needed without mindless, reflexive attacks by journalists or political opportunism constraining debate.
This crisis, like those in other domains of government, requires both a short term and a long term solution. Simply talking about a "Swiss Style Insurance System" or similar will not deal with the next months. Neither will spending a fortune on agency staff and private hospitals address the long term issues.
Mind you, a government with a plan for either would be a step up from a government with a plan for neither.
I keep agreeing with you, it's terrifying (for us both I am sure). In the medium term (I don't think it can be in the short term), massive capacity of 'recuperation' beds needs to be made available to shift bed blockers to and unclof the system without endangering people. More care staff than medical staff. And of course the pay issues must be settled. Longer term reforms can then be looked at once the immediate crisis is over.
@malcolmg and @Richard_Tyndall sorry to hear about the losses you both experienced; please accept my condolences.
Cheers Casino. Obviously it was a long time ago now so I have long since come to terms with it. I find it difficult even to get angry about it now. Just sad.
Interesting debate here on the NHS today. But no-one has mentioned the demand side. We have become an overweight, lazy nation. Anyway, I have my walking boots on - going to take advantage of a nice sunny crisp (-2 degrees) day and go for a walk - see you in a bit.
By same token the NHS don't do much prevention, you would think a 15 minute annual check by a nurse at surgery and a few home truths etc might help. They don't even do that nowadays. My wife phoned about getting pneumonia jag only to be told she was not old enough even though she was , when she finally persuaded them to check they said they would put her on a list but as she insisted the nurse checked her records came back and said it was incredible given her recent problems that she had not had a nurse appointment in 3 years and they gave her hte jag that day. You normally get fobbed off either by the receptionist at the front or the nurse if you are lucky, a marathon to actually get to a GP nowadays.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting. We need to use the resources released in hospital to get people out of A&E much more quickly. We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting. We need to focus on early detection for better and cheaper outcomes. We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
Agree with most of these, although healthcare is undermanaged in the UK, not overmanaged.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
The charts I have seen of late suggest that we are now moving up to the EU average on health care. I don't think that your 20% is correct. Otherwise I agree.
It depends on how you measure it, % of GDP, PPP, actual money spent, whether you include out of pocket expenses and so on. These figures are from 2018; another calculation in the same report reduces the gap to about 15%. As I say I don't think the UK systems are underfunded across the board. They are very underfunded in certain critical areas.
Per capita spending on healthcare almost has to be lower in the UK than in many other European countries, because our per capita GDP is also lower. You can't spend what you don't earn.
Up to a point, yes.
One root cause of the NHS woes was Osborne's austerity policy - a policy choice other countries didn't make - which directly led to a worse healthcare system and indirectly to a relatively poorer country with less money to spend. Also whether you spend more money on healthcare and less on other things is neutral to your GDP.
Finally if you spend more money on your healthcare in general you should get better outcomes. France and Germany may be richer than the UK due to Conservative government economic and Brexit policies, it wouldn't change the facts of their healthcare services being better in that case.
Comments
A planned expansion is needed in the long term, but in the short term there is a need to increase retention, and Streeting has no more answer for that than Barclay, just telling Nurses and Junior doctors to suck it up and accept deteriorating pay and conditions.
I threw her in the back of the 335d (I'll get round to taking the interior out and burning it next weekend) and took her to A&E. Luckily I am a veteran of many very bloody casevacs in Basra and have read Tolstoy's Sevastapol Sketches so I was inured to the scene of uncontrolled misery and chaos that greeted us.
I was relieved on station by Mrs DA after 6 hours and after 11 hours elapsed somebody who was either a doctor or the hospital's Staples account manager diagnosed a burst Chalfont St. Giles and sent them away.
Mr Tyndall, terribly sorry to hear that.
This government - its ministers, and its remaining supporters - do not give a Rat Fuck about people. They blame the people who are suffering for their suffering. And its disgusting.
The reason why voters appear to want to not just vote out this government but to hurt them is disgust.
I think even you'd concede that's not true. The massive increase in funding for public services, and maintenance of Thatcher-era low taxes, was funded from 1997 through to 2007 in very benign economic conditions, and off the back of an asset boom.
We are now not in that world so, say, if Labour does want to increase spending on the NHS by, say, £30-£40bn a year in real-terms to make a material difference, how will it pay for it in stagnant economic conditions? And in a world where we also need to up defence spending, invest more in education, science and industry, and maintain the welfare safety net?
To govern is to choose.
Yes nurses could be paid a bit more to stop them going on strike but fundamentally the health service needs reform
There are stresses in other systems - my German doctor friend complains about these - but it does look like only the UK system is in a state of actual collapse compared with countries we might see as peers. My belief is that there is no resilience in the UK systems. In recent years we have struggled along close to breaking point, now we have gone past it. The root cause is mostly funding and policy decisions by the UK Conservative governments. Healthcare provision was relatively better under the previous Labour government, so I think there are things to learn from them. And no, they didn't inherit a benign situation from the previous government. They inherited a poorly functioning healthcare system, which they improved.
Same for Sturgeon.
Still grim, but facts are important.
https://www.thetimes.co.uk/article/9fb15dae-8a2e-11ed-b24e-c1aaebfbdb8d?shareToken=ac232ec7934244a710c84e86b9b1a001
Overall we are seeing what happens when for a year we have chaotic, incompetent government obsessed by court politics and infighting. There is no overall strategy of government, just unstable lurches from one direction to another.
The government had taken its eye off the ball on health, with no plan for the current situation, ignored the energy price crisis until it got whacked in the face by it in October, and even now has no thought on the problems in education, criminal justice, Social Care, Northern Ireland etc etc
It is a Zombie government stumbling through a minefield.
The Scottish system is better funded than England although this is offset by the larger areas they have to cover. The Scottish government has had responsibility for health for a very long time now with one hapless health minister after another. What does this tell us? Firstly, that money is not the simple answer to this. An increase in English NHS funding to Scottish levels will not, of its own, make this go away. Secondly, the acute problems in A&E are not some kind of Tory plot or neglect but a consequence of a system that is no longer fit for purpose. The idea that this will be somehow "better" if the minister wears a Labour rosette is frankly stupid.
We need a much more grown up discussion about where and how we spend our resources and where personal responsibility begins and ends. I think the medical profession is gearing up to start that discussion, this story is a part of that, but it cannot just be doctors speaking to bureaucrats. It needs to be much wider.
While the MoD can afford to do that they've got enough money.
A couple of months ago a friend's 80 year old ex-husband fell and hit his head. He phoned 999. When the ambulance arrived 13 hours later, he was dead
These are not scare stories. People are worried it could be them or a loved one next.
And that's before we get to the electorate and media's bizarre zealous belief in the national religion whch makes discussion very difficult.
You rock with the good times and roll with the bad. You can't claim your Ukrainian victory over the Russian bear if you won't take responsibility for bad things happening on your watch.
Really, the best thing for British Conservatism as an eternal movement, as an ideal, would be to bail out pronto and leave the Other Lot to try to solve the problems. It won't happen, natch, because the best thing for current Conservatives is to hang on and pray for a lamentation of black swans.
Thing is though, you can attack the NHS as a national religion, and you have a point. But how does dissatisfaction with the system justify the deliberate run down of front-line medicine and now Tory MPs blaming the nurses?
Own it - if you want people to suffer and die in order to smash the national religion then man up. Otherwise, how about we actually try and treat people whilst we have the discussion you and I both want? The Tories are smashing things alright - NHS is buggered, trains are buggered, courts are buggered etc etc etc. How do they then expect to be re-elected having demonstrated their incompetence and indifference?
Politicians need to notice that all those waiting for ambulances, waiting in ambulances and in corridors or A&E have votes and voting families. Their lived experience will trump whatever spurious guff the government comes out with next GE.
The reason they've done it is transparently obvious. If Op Shader isn't regularly putting warheads on foreheads somebody is going to ask exactly what the point of Op Shader is. And if Shader goes then questions are going to be asked about Crab Air's Club Med at Akrotiri.
We need to boost social care to get people out of hospitals into a cheaper and more appropriate setting.
We need to use the resources released in hospital to get people out of A&E much more quickly.
We need to ensure that highly trained paramedics do not spend half their shift, or more, sitting in a hospital carpark waiting to offload a patient whilst people who need their care die whilst waiting.
We need to focus on early detection for better and cheaper outcomes.
We need to emphasise that people can affect their own health by losing weight, drinking less, exercising more, etc and that they cannot expect the NHS to pick up the consequences of the failure to do this.
Others, such as the sums wasted on administration and internal cost allocation, are much more difficult but they are burning resource that we need and that is not acceptable.
None of them was allowed to do it because they've been moved, repeatedly, for purely internal Party reasons.
That is a major part of why we are here. And that is unforgivable Tory self-indulgence.
Regardless of any other contributory factors at play.
That being said, your implication that I want people to suffer and die to break the national religion of the NHS could politely be described as imaginative.
Healthcare needs to change. But anything other than throwing money at it gets immediately attacked. Money is never unlimited and is particularly tight now, so for any party to find a real way out (Labour's non-dom claim is perhaps optimistic) is going to be challenging. Unfortunately, I have no idea how to really achieve that, but discussion is needed without mindless, reflexive attacks by journalists or political opportunism constraining debate.
Mind you, a government with a plan for either would be a step up from a government with a plan for neither.
The tales of distress emerging both here and elsewhere are heart-rending and it's hard not to be angry - we are one of the wealthiest countries in the world at the start of the 21st century. People should not be dying through neglect or lack of care or stuck on a trolley for hours in pain.
We should and have to be so much better than this.
It's easy to fall into the "you can't keep throwing money at the NHS" line - there is an argument over whether those who can afford to pay for healthcare should or at least make some contribution. As Mrs Stodge reminds me, in New Zealand, you pay to see the GP. Yet we don't want financial concerns to deter people from seeking medical help when they need it or as a preventative measure.
We know there are problems with vulnerable people who remain in hospital because there are no arrangements for their care in place. This is, I think, our biggest issue - how do we provide adequate and reliable post-hospital care so beds can be freed up for genuinely urgent cases? It's not just a question of inter and intra-agency provision - we don't have the networks and mechanisms in place. It seems to fall between the individual's family, the local authority, the NHS and others and no one seems able to grasp this problem.
As an ageing population, more need low levels of continual care - that usually means care at home (including adaptations) or perhaps re-locating to Extra Care or Supported Living accommodation. There's a lot more to it than this but the thinking on this has barely started and the crisis is upon us.
Freeing up hospital bed space may help to free up ambulances and return response times to where they should be.
On Hogmanay I had X-rays of my knee and shoulder in Dundee. Very efficient service. I was out again by the time my appointment was due. Nice piece of kit. Results in 2 weeks from the GP, apparently. Its not all bad and it can work well but the pinch points are causing really negative outcomes for the unlucky.
But no-one has mentioned the demand side.
We have become an overweight, lazy nation.
Anyway, I have my walking boots on - going to take advantage of a nice sunny crisp (-2 degrees) day and go for a walk - see you in a bit.
Big increases in agency pay, which will get exponentially worse as more leave and morale drops amongst the permanents - this is a vicious circle that needs to be avoided.
Loss of experienced staff creates inefficiencies that require more staff to do the same work
Increase in training costs to replace those leaving
Millions off sick unable to work and pay tax instead receiving welfare whilst waiting years for operations - such a long gap will see a proportion of those needlessly economically inactive ongoing
Crumbling UK infrastructure in health, travel and education will see investment across our economy well below where it could have been
This is not being done to save money, but out of ideological belief that public sector pay needs to be tightly restrained. Which to be fair, it normally does, but now is absolutely the wrong time to be doing it.
Also: Healthcare is underfunded by about 20% compared with comparator European countries and this does show up in health outcomes. I don't think it's a case of increasing spending by 20% across the board and it will be fine. There are certain areas that are woefully underfunded, particularly capital expenditure on equipment, automated testing and so on.
Nurses' salaries need looking at. If we are to take a genuine market approach on this, they would be getting a lot more. Their jobs have changed in the last few decades and taking a lot more responsibility for clinical management but their career structure hasn't updated to reflect this.
Also need more focus on primary care. Every expert has been banging on about this years. As part of that prioritisation we probably need to close a few hospitals - difficult conversation with the public on this that politicians have no intention of having.
A government that gives a shit would see the growing medical crisis and do whatever it could to find a solution. You are very clear that your desire for a long-term solution doesn't justify all of the short term death and suffering - I am glad to hear it! Problem is that so many of the remaining right-wingers show such disdain to the problem and the suffering and the misery. You may not agree with Lee Anderson that the blame lies with nurses, but you do support the party and the government, so...
At which point do you attack the people to blame for the acute immediate crisis and their refusal to even admit there is a crisis?
https://twitter.com/rcolvile/status/1609494533783564289?s=61&t=ZbvP6fESVb41dK8NCMRTIg
I'm not sure you're arguing it's self-funding I strongly disagree - most users of the NHS are the old and chronically unwell; it's about as self-funding as Liz Truss's tax cuts.
The machines are getting REALLY good at diagnosis. In some ways they are already better than human doctors
“Algorithm That Detects Sepsis Cut Deaths by Nearly 20 Percent
Over two years, a machine-learning program warned thousands of health care providers about patients at high risk of sepsis, allowing them to begin treatments nearly two hours sooner”
“doctors 🩺+ AI🤖 = 🤯
NEW state of the art AI scores 67% (up from 50%) and surely will improve to head to 90%+ in relevant + accurate answers for medical diagnosis + recommendations.
Full paper: (via DeepMind + Google Research teams)
arxiv.org/pdf/2212.13138…”
https://twitter.com/wolfejosh/status/1608466751624450049?s=46&t=LEjJ69hWgF6PXYT4PeRRmw
An AI GP will be available 24/7; it could see 4m patients every 9 minutes. This technology is available NOW and will only get better
Of course there will be many cases requiring physical inspection, they can be handed on to human docs but anyone requiring an e-consult could be sorted right now. Why aren’t we doing it?
Lethargy, inertia and incompetence.
One suggestion from the IfS is rebalancing the package away from pensions to pay.
https://twitter.com/rcolvile/status/1609493852305473537?s=61&t=ZbvP6fESVb41dK8NCMRTIg
Public sector pensions are a time bomb not being addressed according to some, including MaxPB here.
https://www.thetimes.co.uk/article/public-sector-pensions-debt-is-a-timebomb-that-is-simply-being-ignored-l6wjj98gr
On the second bolded point, there is an interesting article by PB's bete noire Devi Sridar in the Grauniad yesterday on at least half that point. It includes this simple, and perhaps obvious sentence: "If you add physical activity to a balanced diet, sleep and friends, that is a recipe for good physical and mental health."
If you were to put that sentence at the centre of government policy I wonder what changed priorities it might imply? What might government be able to do that doesn't cost £bns, but that would make it easier for people to live their lives in such a way?
It's Just the jutting jawed PB right wingers screaching NO SURRENDER who remind the rest of us quite what ridiculous figures they cut.
https://www.thetimes.co.uk/article/0f175888-8a16-11ed-b06e-ab31665740df?shareToken=9fcc475ac40bb3175c6fb5d0460558c4
And anyway we will end up paying something closer to 8-10% anyway as the govt wont survive otherwise, so the options are:
Have three to six months of strikes through the winter, losing more staff to low morale and strikes and then pay the increases anyway
Pay them now and have (slightly) better healthcare through the rest of the winter but more importantly improve morale and retention.
The idea we can convince NHS workers to stay in their jobs and recruit 100k+ extra of them whilst reducing their real pay by 15% or so over 2 years, having them work through the collapse of the service, and see ex colleagues rake it in on bloated agency pay is simply for the birds.
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019
The cost of waiting lists is a workforce where millions are long term sick, or suffering chronic pain. Low productivity is a big problem with a big cost. Then we have the economic cost of people working full time and having not enough money to pay their bills never mind consume. That costs jobs, which cuts consumption which costs more jobs.
You cannot rationally say "how will you pay for it" - not paying for it also has a cost.
This NHS crisis is yet another debate which is happening in a vacuum. As if AI isn’t around the corner. But it is
“#PLOSDigitalHealth: Predicting dementia from spontaneous speech using ChatGPT”
“AI technology triples stroke recovery”
“The world's first #AI cancer diagnosis robot, developed by an #OVC company, will provide free cervical cancer screening for 10,000 women in Pakistan.🔬🤖
The robot has performed detection for over 10 million women in China and #BRI countries, and has saved 60,000+ lives.💪”
“Testing out @OpenAI to see how #ChatGPT handles writing up dictated GP consults. Only a matter of time before we have strong AI assisting us in practice. Could also ask it questions about differential diagnosis, treatment and safety netting - try it!”
https://twitter.com/gregjirving/status/1606610554361204736?s=46&t=LEjJ69hWgF6PXYT4PeRRmw
Instead capital budgets have been stripped bare for years to fund day to day spending.
One way to reduce demand is serious intervention in public health, along the lines of the Marmot Report 2010.
Instead public health budgets have also been stripped for day to day spending on front line services.
Staff retention and motivation would be helped by investment in skills and personal development, and also improve productivity.
Training and Education budgets have also been stripped bare, and teaching sessions cancelled so staff can be sent as fodder for the crisis of the day.
Many of the demand, productivity and quality issues are not intrinsic to the structure of the NHS or a private system but rather due to lack of investment and interest in the long term picture by management with very narrow horizons. Not unique to the NHS of course, but common to many aspects of life.
How will the AI wipe your bottom or change your sheets?
In many ways we were probably already too exacting in the care packages. If every box was not ticked people stayed in hospital at the cost of X thousand a day. We need to be careful about creating such barriers for the best of intentions.
I don't know how much that is. Neither do you, or Robert Colvile. Indeed, the
experience of the 1970s is that trying to answer that question with a specific
number is a mug's game.
But what is painfully clear is that the answer is "quite a bit more than is on
offer now."
You can't buck the market- not for long, anyway.
This is the unspoken spectre looming behind a lot of chronic (and chronically expensive, in both money and time), physical health conditions.
Ironically (and this is true across many professions) they will come for the more educated specialist roles FIRST (against expectations). The lower end physical tasks - the bottom wipers - will be the hardest to automate. Perhaps impossible
Imagine your children wiping bottoms forever. That is the future for us all
Two main options as far as I see:
1) Use the resource in the housing stock to fund the investment required in social care. Clearly the Conservative Party does not want to upset the voting bloc who owns it. Therefore Labour must.
2) Place more emphasis on the traditional safety net undertaken primarily by the wider family unit. Unfortunately we have an incredibly atomised society = not possible. Therefore the social safety net for us all is, compared to say Japan, considerably more expensive.
But the idea that you can switch pension savings into immediate income without creating long term problems (due to lack of pension saving) does have a big flaw in it.
As a responsible citizen, I think I'll do a loop around a two mile radius of the walk-in hospital urgent care centre.
And hope I don't have a heart attack, fall or get hit by a car or some such.
It's not going to do much to help people falling over and ending up in hospital, people who can't breathe very well as they have Covid or flu or people who are too demented to wipe their own bottoms.
Things in general are not as uniformly amazing or disastrous as you tend to point out. There are bits in between. I understand that's hard to grasp for someone with such a manic personality.
After the event we should have made a stink but at that point we were not really interested in that as it wouldn't have changed anything.
My wife phoned about getting pneumonia jag only to be told she was not old enough even though she was , when she finally persuaded them to check they said they would put her on a list but as she insisted the nurse checked her records came back and said it was incredible given her recent problems that she had not had a nurse appointment in 3 years and they gave her hte jag that day.
You normally get fobbed off either by the receptionist at the front or the nurse if you are lucky, a marathon to actually get to a GP nowadays.
One root cause of the NHS woes was Osborne's austerity policy - a policy choice other countries didn't make - which directly led to a worse healthcare system and indirectly to a relatively poorer country with less money to spend. Also whether you spend more money on healthcare and less on other things is neutral to your GDP.
Finally if you spend more money on your healthcare in general you should get better outcomes. France and Germany may be richer than the UK due to Conservative government economic and Brexit policies, it wouldn't change the facts of their healthcare services being better in that case.