# A&e visits



## pip1954 (10 Jan 2017)

Hi all how many people thinks is is about time people using a&e should be vetted and if it is not an accident or emergency they should be turned away and told to go to a gp a&e are under a lot of pressure from people who should not go there with minor problems ,
Well this is my view gives you a clue as it is in the name
Pip


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## No skills (10 Jan 2017)

The problem lies at the GP stage - no pipper can get an appointment inside 7 days (prolly 2 weeks on average at our gp, which actually is an improvement on recent years). 

Sort the local surgeries out and excess a&e attendance will disappear.


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## Racers (10 Jan 2017)

The problem is what happens if they misdiagnose something like meningitis which can present as a cold/flu?

Pete


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## Gary (10 Jan 2017)

pip1954":1slj38fk said:


> Hi all how many people thinks is is about time people using a&e should be vetted and if it is not an accident or emergency they should be turned away and told to go to a gp a&e are under a lot of pressure from people who should not go there with minor problems ,
> Well this is my view gives you a clue as it is in the name
> Pip



I wonder what the factor into their statistics we have a minor injuries unit at our local hospital which doubles as an out of hours doctors.


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## RobinBHM (10 Jan 2017)

I think Jeremy Hunt beat you to it  

I heard a doctor on LBC discussing this issue, her thoughts were that yes, there a level of public visiting A&E for non emergency reasons which exacerbates the situation but it is a contributry factor, not the primary cause.

The primary cause is multi factoral, but one key problem is that social services cant and wont move patients out of hospital blocking the sytem all the way back. 

On point she did make was that on average every Monday she typically sees 4 people that have a bad sore throat but no temperature, which does not need a doctors visit to identify. These patients should be, taking advise from relatives, visiting a pharmacy, looking up on the NHS website or ringing 111. Her opinion was that todays culture is not medically savvy and dont take responsibility for their own health where minor ailnents are concerned.

I think I agree, having had staff off sick with bad backs, my advise is go and visit a private physio, sports injury clinic, osteopathe. Usually though Its always, Ill get a doctors appointment first, which is a total waste of time. My wife, I have to say had the same opinion, after 3 days of being barely able to walk I finally managed to persuade her to visit a physio clinic, half hour appointment and able to walk easily again (and exercises with an exercise ball which are fantastic for lower back pain).

I have heard that disorganised people that run out of prescription medication do visit A&E and its a common occurrance


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## t8hants (10 Jan 2017)

In the last twenty years they have halved the number of beds available and there are now double the number of patients requiring them from twenty years ago.
Bed blocking was a problem when I did my nurse training thirty years ago, until there is proper post hospital care available, or a dramatic increase in beds things wont change.


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## Phil Pascoe (10 Jan 2017)

One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.


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## RobinBHM (10 Jan 2017)

phil.p":1btxskyn said:


> One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.



And for those people the NHS should not be free at the point of entry. Travel insurance abroad does not cover for accidents whilst drunk, which foreign doctors know and wont treat anybody drunk unless they pay as the hospital wont get reinbursed by the insurers. 

So in this country if you get an injury whilst drunk, get your credit card swiped at the desk first!


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## RogerP (10 Jan 2017)

phil.p":1c1x8nk9 said:


> One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.



Alcohol now costs the NHS £3.5bn per year; equal to £120 for every tax payer

https://www.alcoholconcern.org.uk/alcohol-statistics


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## beech1948 (10 Jan 2017)

I think a few simple changes would cause a fast and irreversible alteration.

1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.

2) Anyone who goes with an illness that family, friends or workmates can diagnose and advise on treatment eg colds, flu etc should be charged the full costs of the visit.

3) Any time wasters..charge them the full costs. 

4) IVF ( it is natures way that some people are barren) and breast enlargements ( vanity) charge full costs or refer to private medicine.

5) ???? next

Typically the costs are around £250 per visit.

The NHS should also charge all of the foreign nationals who are using our hospitals for free. Even to the extent of of each visitor having to prove eligibility.

Al


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## beech1948 (10 Jan 2017)

I think a few simple changes would cause a fast and irreversible alteration.

1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.

2) Anyone who goes with an illness that family, friends or workmates can diagnose and advise on treatment eg colds, flu etc should be charged the full costs of the visit.

3) Any time wasters..charge them the full costs. 

4) IVF ( it is natures way that some people are barren) and breast enlargements ( vanity) charge full costs or refer to private medicine.

5) ???? next

Typically the costs are around £250 per visit.

The NHS should also charge all of the foreign nationals who are using our hospitals for free. Even to the extent of of each visitor having to prove eligibility.

Al


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## Phil Pascoe (10 Jan 2017)

Maybe be a little careful with the alcohol - last I went to A&E I walked home from the pub in pitch darkness in a howling gale after four or five pints . This W. Cornwall ... a howling gale is not a joke. I went into my garden the same way I went out, and stood on a six by four sheet of ply that had blown in from somebody's else's garden. It was green with algae (I found out the following morning), my feet shot out from under me, I corkscrewed around and put a steel post that was on my right side through my left palm. Fortunately it didn't sever any tendons. I think it would be rather unjust if someone had decided that was alcohol related.


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## Inoffthered (10 Jan 2017)

I had a chat with a medical consultant at a christmas party who was banging on about the need for more money in the NHS.
I said that if a Uk national required medical treatment abroad there was invariably a charge to the patient and/or an additional charge to the NHS from the country providing the treatment. There was a report over christmas that the Polish health service charge to the UK for treatment to Brits in Poland was 14 times more than the charge for treatment of poles in the Uk.(I dont remember the exact amounts but it was tens of millions).
I asked what the system was within the NHS for collecting the info to allow the necessary recharges to be made. The reply was that the job of the NHS was to treat patients not to raise invoices.

I also recounted my experience while attending a cardiac clinic with my son. While waiting for him to have an ECG, a gentleman arrived with his family (and judging from the labels still attached to his suitcase, he had recently arrived at Heathrow). He went to the reception desk and asked for an ECG. The receptionist asked for his referral letter from his NHS doctor and he got quite agitated saying he had just arrived in the country. His wife dragged him away and said they'd go to A&E.

A few hours later while waiting with my son for another bunch of tests, I saw this chap being pushed in a wheelchair by an orderly on his way to have an ECG. I have absolutely no doubt that he was a health tourist.

Two isolated examples of, perhaps, why the NHS is under pressure. If the NHS trusts were allowed to keep any money re-invoiced for treating non UK nationals then maybe the challenge of funding increasing care for the elderly may not be so acute. I fully accept that the NHS should treat anyone in urgent need of attention but I dont think the NHS should be expected to solve the worlds health problems and visitors to the UK should have some form of health insurance to cover the costs of treatment or at least make a contribution to the cost of that treatment. Also the costs of treating migrants from the EU should be recharged in the same way that the UK is charged for treatment given abroad.


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## Keithie (11 Jan 2017)

I dont know much..but I know some stuff. What I know about the NHS is that if there was an easy solution then they would have sorted it by now. It cant just be money can it?

The issue is simple ...if you cant specify the problem clearly then u aint gonna have much luck by just randomly guessing at a solution!

I doubt anyone really knows what the problem with the nhs is...sadly


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## Sheffield Tony (11 Jan 2017)

beech1948":1c6uj677 said:


> I think a few simple changes would cause a fast and irreversible alteration.
> 
> 1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.
> 
> ...



I don't think it is that simple.

I'd think carefully about the "charge drunks" idea. So the NHS should charge people who've had a couple of drinks because their lifestyle contributed to the risk. Then what about all the other hobbies and lifestyles that put you at increased risk of a health problem ? Drug abuse ? Smoking ? Contact sports ? Horse riding ? Motorcycle riding ? Woodworking :shock: ? Idleness ?

With regard relying on self diagnosis (or by friend/family) - we also hear talk from medics about the "worried well". But then we hear that early detection of serious conditions is hampered because men especially don't present early enough. You can't have it both ways.

For IVF, there is the counterclaim that the mental health problems that arise for people who can't have the children they want outweigh the cost of the treatment. Don't know whether I believe it.

IMHO, the inefficiencies of the NHS are many, and distributed in a fine grained way throughout all the systems. Not something that can be fixed at a high level by simple rule changes. It would take an army of troubleshooters shadowing every process to find and root them out. And a lot of medics would be peed off by the experience !

I'd agree with a couple of things already said though - lack of availability and cash for social care, and poor access to GP's - especially out of hours - both must contribute to A&E overload.


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## AJB Temple (11 Jan 2017)

We have become a needy society that thinks that all health care should be free at point of delivery. With a population that is expanding and getting older this is unsustainable. 
A long recession materially reduced tax take and government funds available.
Medical work is no longer a vocation and payroll costs have therefore escalated, including at GP level. 
We no longer look after our old people within the family and dump them on the state in an entitled way.
Global market for drugs pushes up prices. 
Doctors are by and large anti being involved in charging - they may see this as being too similar to private practice (in which case they may as well do that).


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## transatlantic (11 Jan 2017)

From what I have heard, it appears that the problem is _mostly_ due to timewasters and irresponsible intoxicated people. I think that these people need to be detered in some way, or simply be given a bill. As pointed out, you can be a respectable member of the public, be drunk, and still have an accident, .. doesn't necessarily mean you're irresponsible. So perhaps a warning system needs to be put in place, three strikes (within some specified time period) and you're out so to speak. You'd of course always be dealt with, but after the third strike, you'd inccur the fees?

I also keep hearing about patients "pre-booking" doctors appointments just in case they become ill ... surely this is easy to spot and put a stop to? but I should think it's a very small part of the problem. I'd hope there really aren't that many idiots doing it.


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## novocaine (11 Jan 2017)

Of course, if we didn't depend on PFI to fund it in the first place and saddle the NHS trust with massively interest laden debts thus in effect reducing the amount the individual NHS trust actual has available each year (and every year the debt goes up), then maybe we wouldn't have quite such an issue, but then no one but those working in the NHS would make any money from the funding and wheres the fun in that? 
1 year before he came to power a certain Mr Osbourne declared the PFI system broken and not to be used, the next year, he signed off on 61 new PFI contracts and saddled the NHS with massive debts, he then wiped his hands of it and let the NHS bare the brunt of the criticism over spiraling costs. Yet it doesn't get media coverage, why not? is it because bed shortages and failure to provide health care are more scandalous stories for the media to portray perhaps?

this is just one of the issue, there are many many more, and no matter what happens they system isn't going to be fixed overnight.

why is it we talk about being charged for health care if you are drunk? you are already charged for health care, we all are. are you going to prorata the amount paid by a drunk based on his tax and national insurance payments? if so, then the rich get better care than the poor, what a wonderful idea, if not, then the rich still get better care than the poor, distopian future isn't it.


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## lurker (11 Jan 2017)

My wife is a specialist practice nurse, she can do 90% of what a GP can do.
She daily sees patients who want a prescription for paracetamol.
Free prescriptions if you are on benefits
Next door is a Co-Op paracetamol are 30p a packet


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## RobinBHM (11 Jan 2017)

I hear that there are an increasing number of private GP clinics that offer same day appointments with early morning and evenings available. There are quite a few in London and for busy commuters I imagine the cost of the appointment is probably less than the cost of the loss of work.

I dont know what the answer is, it seems having health care free at point of delivery is not sustainable but the problem is that as soon as charges are introduced the issue of elitism crops up as it means that those that cant afford it wont go or will have to wait longer. I know private health care is available anyway, but that is currently kept separate (although you may go to the same hospital and see the same consultant, just 6 months quicker!)


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## Ring (11 Jan 2017)

Im sorry but call me old fashioned a nurse is a nurse not a doctor this is the problem right across the nhs ex ambulance driver of 21 years we went down this route of everyone must have a degree does not matter whether you have common sense or 2 left feet you must have it on paper and it does not work hands on is the best way to learn but the new teaching techniques does not allow this you stand and observe ffs the ambulance cadets do not even train in an ambulance or see one until they are posted to their new stations then it is down to the old style drivers/paramedics to show them how to work an a Ambulance they then can not work on their own for a year so they go about tripple crewed, talk about a backward society. I am now disabled thanks to the job I used to do and it was caused by over weight lazy young people who thought it was there given right to be carried in a chair down 3 flights of stairs /taken to A/E to waste there time and then the next day you see the same lazy pineapples walking about smoking using their mobile phones with no worries in the world [who is the daft ones here]. Now for the problems in the NHS when you are showing auxillary nurses how to draw blood/ give oxygen/take vital signs etc etc it is cheap labour no if,s or buts and it is the same right across the Nhs I get 2 spinal epidural injections a year that is all they can offer me now I have just waited 10 months on my second one of the year and when I phoned up to say I was overdue I was told that I would be lucky to have the second one within the year , I actually had it last Friday as a space popped up so grabbed with both hands that's why I can sit today and have a rant. Personally they should have dived at Sir Richard Bransons feet when he offered to take the lottery on cover his costs only and plough the rest into the NHS. Would not be a total solution but would have been better than the shambles we have today


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## Jacob (11 Jan 2017)

beech1948":hqvuuyvl said:


> I think a few simple changes would cause a fast and irreversible alteration.
> 
> 1) Anyone who goes to A&E and who is affected by alcohol over the drink drive limit should be charged the full cost of being there.
> 
> ...


What an appalling set of uncivilised anti-social suggestions. 
It's so easy to blame those at the bottom of the heap but in fact the current problems of the NHS are due to the government's deliberate under-funding. Jeremy Hunt the tory **nt in other words!


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## Phil Pascoe (11 Jan 2017)

What's the "bottom of the heap" to do with the price of fish? If they needn't be there, they needn't be there.
All foreign nationals should have adequate health insurance on entering the Country - it's the National Health Service - not the International Health Service. Even reciprocal healthcare arrangements often aren't.


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## Jacob (11 Jan 2017)

phil.p":2qplyar4 said:


> What's the "bottom of the heap" to do with the price of fish? If they needn't be there, they needn't be there.
> All foreign nationals should have adequate health insurance on entering the Country - it's the National Health Service - not the International Health Service. Even reciprocal healthcare arrangements often aren't.


If people need emergency care they should get it without question. It's called "civilisation" but I realise that quite a few people haven't cottoned on to this yet. 
One ancient and basic tenet of civilisation is extending care to travellers, strangers, foreigners, migrants etc.
Do we really want to go back to the dark ages or to have an American standard of health care?

Blame culture has no bottom line - accidents and illnesses happen and you can blame drunks, blame the fat, blame smokers, but what about blaming drivers for being on the road, swimmers for being in water, woodworkers for being careless and so on?

NB the NHS is still rated as one of the most efficient and cost effective services in the world. We spend less per head than even the yanks do on "Obama care" but our system is vastly more effective.


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## Gerry (11 Jan 2017)

I would quite happily pay a nominal charge to visit the doctors, say £10
That would deter attention seekers and hypochondriacs to a degree and provide a good influx of funds to the NHS.

I have a serious genetic heart condition but I only visit the doctors when needed and the last one was over a year ago. 

Gerry


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## Jacob (11 Jan 2017)

Gerry":35qp3h1q said:


> I would quite happily pay a nominal charge to visit the doctors, say £10
> That would deter attention seekers and hypochondriacs to a degree and provide a good influx of funds to the NHS.
> 
> I have a serious genetic heart condition but I only visit the doctors when needed and the last one was over a year ago.
> ...


It'd also deter some desperate people in need of care who didn't have the cash.


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## morturn (11 Jan 2017)

I think Jeremy Hunt is a genius, in one short parliamentary statement he already has quite a few of you dancing to his tune.

Make it fail, then find someone to blame. So now it’s the people who go to the hospital for frivolous reasons, along with the drunks, the obese and as always, the immigrants, and you swallow it like sitting ducks.

So, the answer is ‘make people pay for it’. That is exactly what Hunt and his government wants to hear. His pals in the insurance companies, the private health service providers, and facility’s companies will be thanking you all the way to the bank in the same way as the people from the Netherlands, France and Germany are with our privatised railways.

Their public rail companies have bought up most of our privatised railways so that we are now subsidising their cheap train travel. To add insult to injury, even if you never use the trains, you are still subsidising the private franchises with tax breaks, and the government wants to privatise more.

It was not the immigrants, or the benefit claimants, the drunks, the obese, lame or lazy who closed the steel industry and the mining industry, it was the government, and they did it with the blessing of the working man.


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## Phil Pascoe (11 Jan 2017)

"If people need emergency care they should get it without question. " Separate issue. 
I don't believe anyone would query that - but we shouldn't allow health tourism. Besides, I go abroad I take out good health insurance - why shouldn't others coming here?


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## Phil Pascoe (11 Jan 2017)

Morturn's magical money tree is still growing well ...


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## Phil Pascoe (11 Jan 2017)

I've just had an appointment reminder from my hospital informing me that missed appointments cost that one hospital £4,000,000 p.a. - that would be a good place to start charging.


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## beech1948 (11 Jan 2017)

Jacob":xeflsl2x said:


> beech1948":xeflsl2x said:
> 
> 
> > I think a few simple changes would cause a fast and irreversible alteration.
> ...



Jacob,

There is nothing appalling about what I wrote in my post merely common sense. It is rather your somewhat liberal mindedness using false sympathy which causes you to react like that. 

By the way No 5) ???was to be that the NHS should charge Local Authorities for failing to provide sufficient care for elderly people who are "bed blocking" at the weekly rate used to pay for residential care homes.


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## Phil Pascoe (11 Jan 2017)

There is a good case for one authority to cover everything, then this ludicrous infighting between councils and the NHS over funding wouldn't happen. Between individual trusts, as well - I got sent from one hospital to another without a cushion on a wheelchair because of a debate over which was to pay for it. If it wasn't for an experienced ambulance man ignoring them I'd probably still be there.


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## Jacob (11 Jan 2017)

beech1948":rd41dn5l said:


> ....
> By the way No 5) ???was to be that the NHS should charge Local Authorities for failing to provide sufficient care for elderly people who are "bed blocking" at the weekly rate used to pay for residential care homes.


Social services and care is being cut just the same by the government. Their only answer so far has been to suggest increasing council tax - which will of course punish poorer people in the less well off districts - no surprise there, that's exactly in line with all this government's policies across the board.


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## MrDavidRoberts (11 Jan 2017)

I think the biggest problem is too much useless staff that does absolutely nothing- like there are 5 assistants for each doctor that does something, so those 6people really could be replaced with just 2-3 that does something...or they could hire 6 people that actually does a real job.
that and all the people who just goes to doctor to have a talk or as said previously prescription for a 16p paracetamol.


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## Jacob (11 Jan 2017)

MrDavidRoberts":1msf2oje said:


> I think the biggest problem is too much useless staff that does absolutely nothing- like there are 5 assistants for each doctor that does something, so those 6people really could be replaced with just 2-3 that does something...or they could hire 6 people that actually does a real job.
> that and all the people who just goes to doctor to have a talk or as said previously prescription for a 16p paracetamol.


Sorry - wrong! 
Understaffing is the big problem, at every level. You've obviously never had much to do with A&E or anybody who has, or you would have heard an entirely different story - nearer the truth.
It's amazing how in spite of it being acknowledged as one of the most efficient and economical health services in the world, various clever dicks can see ways to making it even more so! 
Rumours of ne'er do wells and cheats are exaggerated and yet another example of how blame is directed down, rather than up; to government deliberate underfunding


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## RogerS (11 Jan 2017)

phil.p":62y503t8 said:


> One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.



Yup..I'd advocate triage in A&E. If your drunk or high on drugs then you go to the back of the queue. If you had an accident because you did something stupid then back of the queue.


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## RogerS (11 Jan 2017)

Sheffield Tony":2lhru0ru said:


> beech1948":2lhru0ru said:
> 
> 
> > I think a few simple changes would cause a fast and irreversible alteration.
> ...



It's not rocket science to know when someone is totally out of their skull with booze. Or drugs. We're not talking about someone having a couple of pints.


Sheffield Tony":2lhru0ru said:


> With regard relying on self diagnosis (or by friend/family) - we also hear talk from medics about the "worried well". But then we hear that early detection of serious conditions is hampered because men especially don't present early enough. You can't have it both ways.


It's not both ways. If someone is daft enough not to want to present themselves early enough (after carrying out some reasoned diagnosis) then that's up to them.


Sheffield Tony":2lhru0ru said:


> For IVF, there is the counterclaim that the mental health problems that arise for people who can't have the children they want outweigh the cost of the treatment. Don't know whether I believe it.


I don't.


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## MrDavidRoberts (11 Jan 2017)

Jacob":3bq19y2g said:


> MrDavidRoberts":3bq19y2g said:
> 
> 
> > I think the biggest problem is too much useless staff that does absolutely nothing- like there are 5 assistants for each doctor that does something, so those 6people really could be replaced with just 2-3 that does something...or they could hire 6 people that actually does a real job.
> ...




I have to agree to disagree!
That has been my impression whenever I have went to hospitals or have went with someone else, Maybe there's staff shortage where it really matters- maybe... but There are too much completetly useless positions and people that really do nothing at all if you really look at their every day work there, too much ''assistants'' that are just there to entertain people, or 3 persons are given a job that a 1 qualified person could do. I'm not sure why I need to go through 4-5people just for simple procedure where every one of them does a simple task which could be done by just 1person making it all go so much faster and freeing up funds to hire actual doctors not just useless staff.
Again- that is only my view and observations I have had myself not what I have seen in TV/newspapers or told by others...


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## Jacob (11 Jan 2017)

RogerS":20m8orx1 said:


> phil.p":20m8orx1 said:
> 
> 
> > One of the district nurses that I see told me she worked in A&E prior to this job, and the last NYE she worked there was not one person she dealt with that was any other than drunk.
> ...


I think they do - at least to prioritise anything obviously life threatening. But they aren't in a position to be judge and jury over somebody's stupidity and you can't necessarily tell if drunkenness or drugs is life threatening in itself, or hiding an underlying condition, or symptoms of something else entirely.
Once again the theme here is to blame the victims. The blame is with the government.


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## RogerS (11 Jan 2017)

novocaine":pw378cu2 said:


> ......
> why is it we talk about being charged for health care if you are drunk? ....



Because you're responsible for your own actions? Nothing at all to do with being rich or poor.


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## RogerS (11 Jan 2017)

Jacob":2be82hu8 said:


> phil.p":2be82hu8 said:
> 
> 
> > What's the "bottom of the heap" to do with the price of fish? If they needn't be there, they needn't be there.
> ...



So it's perfectly OK to go out and get totally rat-pineappled, cause all sorts of mayhem, fights etc and then take up time in A&E ? That's not "civilisation".
Whatever happened to taking responsibility for ones own actions?


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## Jacob (11 Jan 2017)

RogerS":19ggiass said:


> novocaine":19ggiass said:
> 
> 
> > ......
> ...


Diabetes is often related to diet. Are they to blame and should they be charged?
Pregnancy is down to unprotected sex - make them pay?
Motor accidents are due to being on the road - make them pay, they could have gone by public transport.
Woodworkers would have to prove 100% HSE compliance or pay?
Everything has a cause. Blame the victims, whether or not it is their own stupid fault, is a pointless game.
It also draws attention from the true culprit for the current state of affairs; Jeremy Hunt (the ****).


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## RogerS (11 Jan 2017)

Jacob":2i3vp6j1 said:


> phil.p":2i3vp6j1 said:
> 
> 
> > What's the "bottom of the heap" to do with the price of fish? If they needn't be there, they needn't be there.
> ...



Really is a sweeping generalisation going on here. Blame drunks ? Yes...it was their choice. Blame the fat ? Possibly...excluding those with a genetic disposition, the rest of the lard-buttocks are obese because of their own chosen lifestyle. There is enough information out there but they choose to ignore it.

Blaming drivers ? Well, now that is just silly. Of course not. But a driver who is texting while driving and causes an accident or crashes their car? Guilty as charged.

Lastly, blame woodworkers ? Again, you're being silly. Accidents can happen but if you have taken the time and trouble to try and minimise those and you get hurt then fair enough. But if you stick a chisel in your hand while trying to get a rounded bevel....well, I rest my case :lol:


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## RogerS (11 Jan 2017)

morturn":3bag46qf said:


> .....
> It was not the immigrants, or the benefit claimants, the drunks, the obese, lame or lazy who closed the steel industry and the mining industry, it was the government, and they did it with the blessing of the working man.



I'm afraid that it was something called globalisation.


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## Jacob (11 Jan 2017)

RogerS":koj9boff said:


> morturn":koj9boff said:
> 
> 
> > .....
> ...


It was the neo liberal economics of the madhouse.


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## RogerS (11 Jan 2017)

Jacob":2krc2xht said:


> ..... Their only answer so far has been to suggest increasing council tax - which will of course punish poorer people in the less well off districts - no surprise there, ....



Um, no, actually. Demographics and economics 101 time. Any increase is percentage based. Less well off districts tend to have lower council tax. So proportionally they will be affected less then those living in a house with a higher tax rate. Which could, actually be OAPs who have lived in their houses all their life and are struggling to pay their council tax on a meagre pension.


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## RogerS (11 Jan 2017)

Jacob":27d3ajcf said:


> RogerS":27d3ajcf said:
> 
> 
> > morturn":27d3ajcf said:
> ...



And I thought it was Citizen Smith.


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## RogerS (11 Jan 2017)

Jacob":3pff3t4i said:


> RogerS":3pff3t4i said:
> 
> 
> > novocaine":3pff3t4i said:
> ...



You're rambling now, Jacob, and in the words of Dragon's Den.

I'm out.


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## selectortone (11 Jan 2017)

When did they start to fill up A&E with drunks? When I was a young adult, back in the 60s, if you got falling down drunk your mates carried you home and left you on the doorstep. Happened to me a few times. What a bunch of wusses.


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## finneyb (11 Jan 2017)

phil.p":1kcssc7p said:


> I've just had an appointment reminder from my hospital informing me that missed appointments cost that one hospital £4,000,000 p.a. - that would be a good place to start charging.



Phil,

My CCG was whining about missed GP appointments - I asked how many - the answer was 6%. 
My response so 94% turn up as planned - tell me what other target have you achieved 94% ? Silence !!

Brian


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## RogerS (11 Jan 2017)

There is, of course, one way to get a huge amount of money free of charge back into the NHS. And that is to ban ambulance-chasing lawyers. Now that is one thing that the Tories promised and never delivered much to my anger.

One quarter of the NHS budget is set aside for negligence claims. That is £26 billion. True...some claims are valid. Many are not

http://www.telegraph.co.uk/news/health/ ... laims.html


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## RobinBHM (11 Jan 2017)

I understand that the NHS is struggling and I understand the viewpoint that introducing charges is likely to impact on people with less money.

I get all that but, I do think there is a real binge drinking culture in this country that on every Friday and Saturday night A&E staff end being the ones faced with having to deal with the result of that culture, by way of abuse, assault and important resources stretched.

I also think that like anything 'free', the NHS is abused and too many people will book a doctors appointment without making any attempt to sort out the problem themselves. If people had to pay for an appointment, I wonder how many people would then think twice before going......

Back problems, torn muscles and similar injuries can often be dealt with very effectively privately. Ive had discussions about with people and Ive often had the response, £50 for an appointment, Ill go to the doctor first and see. So what is doctor going to do about a typical lower back pain caused by a torn muscle? Ibuprofen or referral would be the answer. 

I forget how many young people Ive known have suffered 'anxiety'. Is life that more stressful these days.......


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## acewoodturner (12 Jan 2017)

For years I have advocated that participating in sport should be free to all ages and particularly targeted at young people. They should be building sport centres and pitches all over the UK and staffing them with sports coaches and pe teachers. If anyone wants to spend a whole day doing a variety of sports, brilliant. Its a pretty radical idea, but if you look at my reasoning for it, then it kind of makes sense.
Young people who get hooked on sport tend to continue to participate throughout their teens and adulthood and when they have their own kids encourage them to do the same.
Sports people tend to watch their diet and eat healthier options rather than shoving pies and pizzas down their throat.
Active sports participants tend to be happier people and therefore less likely to suffer from depression and require various drugs to remedy it.
If young people are involved in sports they are not vandalising public buildings and committing crimes in the holiday periods when boredom takes over.
Sports participants as well as eating healthier are less likely to be over indulging in alcohol (rugby players excepted here!) and therefore less crime is committed.
There may be a large capital cost to implement this policy, but not in every area, just look at the number of school buildings that are shut at half past three and are closed at the weekend. Sports centres everywhere shut early and our local pools used to shut for 4 weeks in December for maintenance - just when it was cold, dark and miserable outside, absolutely crazy.
Of course not everyone is into sport, so the same should be replicated with music and other activites.
Within a few years the sports/music etc bill will be smaller than the additional costs to local govt, nhs etc, so from an accountants point of view it makes sense. Looking at the bigger picture isn't having a happier and healthier population with reduced crime figures something that is worth working towards!

Mike
The long term affect on the criminal justice system, public buildings vandalism bills, nhs etc would be huge


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## Jacob (12 Jan 2017)

RobinBHM":swelibhi said:


> ....
> I also think that like anything 'free', the NHS is abused


But anything paid for is also abused by those who have enough cash, but those without are excluded


> and too many people will book a doctors appointment without making any attempt to sort out the problem themselves. If people had to pay for an appointment, I wonder how many people would then think twice before going......


You don't know this to be true - and the trouble is that some people who really should be going would be deterred especially if they couldn't afford it - a lot of people live on the breadline nowadays


> ....I forget how many young people Ive known have suffered 'anxiety'. Is life that more stressful these days.......


Nowhere near as stressful as it would be under an american healthcare system


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## Jacob (12 Jan 2017)

acewoodturner":1f9156ge said:


> For years I have advocated that participating in sport should be free to all ages and particularly targeted at young people. They should be building sport centres and pitches all over the UK and staffing them with sports coaches and pe teachers. If anyone wants to spend a whole day doing a variety of sports, brilliant. Its a pretty radical idea, but if you look at my reasoning for it, then it kind of makes sense.
> Young people who get hooked on sport tend to continue to participate throughout their teens and adulthood and when they have their own kids encourage them to do the same.
> Sports people tend to watch their diet and eat healthier options rather than shoving pies and pizzas down their throat.
> Active sports participants tend to be happier people and therefore less likely to suffer from depression and require various drugs to remedy it.
> ...


Absolutely agree. It's another part of "investment in human capital"


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## Phil Pascoe (12 Jan 2017)

finneyb":j8tw61rm said:


> phil.p":j8tw61rm said:
> 
> 
> > I've just had an appointment reminder from my hospital informing me that missed appointments cost that one hospital £4,000,000 p.a. - that would be a good place to start charging.
> ...



You can make statistics say what you want them to. Some years ago I read an article on a new DeWalt factory where it very proudly said that they only had a failure rate of 0.00013% (or something like that) which sounded phenomenal until it was pointed that if that was the failure rate of airplanes there would be a major air disaster every day.
My favourite statistic is that the average human being has 1.97 legs.


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## MarkDennehy (13 Jan 2017)

RobinBHM":2zo7ib8q said:


> I forget how many young people Ive known have suffered 'anxiety'. Is life that more stressful these days.......


I dunno about "young" Robin, because I'm forty and married and a father; but my life is definitely more stressful than my father's was in several ways. And my son's will be worse than mine in some ways no matter what I or my wife do. And the people I see in the ages in between those extremes, I'm seeing coming out of college owing more in student debt than my father ever owed in his entire life (and that was for his house), paying twice or more in rent than what we paid for mortgage on the house I grew up in, with job prospects that are a lot less certain than they were even when I was in school, let alone when my father was. They have to find more money, by doing more hours, than I ever saw when I was starting out. The public healthcare system that was there for my father and for most of my life is now being pushed towards a US system (which you'll be familiar with if you ever read Dickens). The pension my father will enjoy in a few years is one I can't even buy for love nor money because it's defined-benefit and they just don't do those anymore, these days you save up and hope you die before the money runs out. And we're seeing the effect of all of this stress on this side of the Irish sea in the same way you are on yours - more food banks than ever before and now the people going there are not unemployed, they're working full-time white-collar office jobs but they can't make ends meet because wages and the cost of living aren't keeping pace. The number of homeless people is currently a national crisis here that nobody wants to talk about for fear they'd have to fix it and the number one cause of death in men under the age of 30 is no longer traffic accidents, but suicide. For teenagers, we've now got a worse suicide rate than _Finland_, for pineapple's sakes. 

This whole "generation snowflake" dung we hear the US nazis slinging around is a particularly nasty sort of insult, it's like watching the loadsamoney types laughing at miners strikes and the like, knocking back champagne while the people they're laughing at are wandering off to the barn with a length of rope.


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## Eric The Viking (14 Jan 2017)

Its a post-truth health ministry*.

So this morning, my already-stressed wife, my spouse of 32 years and a GP for about 27 of those, wakes to hear yet another bit of "stuff" from Jeremy *unt's PR factory, again about "lazy" GPs daring to close their surgeries during the working day.

Just for the record, as many on this thread don't seem to know how GP's operate:


Surgeries that are only open for limited times are mostly BRANCH surgeries, staffed part-time: the only reason those exist at all is GPs trying to make it easier for people to get to them.

If GPs are not seeing patients face-to-face in surgery all the time they are at work, it is because they have to:
Check test results as they come in, so they can act on urgent/important matters
Do telephone triage, to try to minimise unnecessary attendances at surgery, and to ensure truly urgent but misunderstood issues get urgent attention. Frequently during any working week, my wife and colleagues get ambulances dispatched to patients after a phone conversation - not to shirk responsibility but_ because it's obvious they need to go straight to hospital._
Write referral letters, and deal with other correspondence, including double-checking documents that have been scanned-into the electronic system by clerical staff.
Deal with staffing and other administrative matters.
Make housecalls (yes, they still do that).

My wife, nominally three years off retirement, is already working 11.5 hour days routinely (she's nominally part-time). Her "full-time" partners work longer hours.

Her medical reading and some professional training (which she is required to do) takes place outside "working hours".

Her practice has merged twice in recent years, in both cases trying to maintain commercial viability. There are now 14 GPs, partners and salaried (and "registrars", ie trainees) working in the health centre. The latest financial insult is that NHS Estates, which owns the building, has increased their rent and service charges, and this, combined with removal of some deprivation payments means a loss of income around £290,000 annually*, ramping to the full amount in five years (and continuing at that rate - these are not one off costs). They are going to arbitration and possably to court, both requiring legal representation (they have to fund this) as the rental issue affects several practices in the city. When the full amount is reached they may well close, as the practice will no longer be viable. She estimates it will be earlier however, possibly within three years. They serve 18,000 patients presently.

In our city, Bristol, we have already seen two practices close down, as the GPs simply resigned the NHS contract and walked away. One of them had two attempts to sustain it before it was finally shut. The other one is now being operated by Virgin Healthcare, who are slowly buying up practices nationally, as GPs throw in the towel.

My wife's practice is understaffed by two GP posts: as they cannot recruit at a rate to match resignations. They lost another GP last week (stress). Each attempt to hire costs significant amounts, to advertise in the medical journals is very expensive (it's no cheaper on-line) and/or use a recruitment agency, and the additional costs of interviewing, etc. When they do this sort of thing, they get in locums to cover surgery commitments, too. More expensive still are those they hire who only stay a few months then walk away because of the workload.

Partners are far harder to recruit now than salaried GPs. This is because their practice has been unprofitable for about a decade. There has been no partnership profit distribution at all during most of this period, 2016 seeming to be an exception (and the sums are not large). Practices nearby have survived through insurance payouts and other windfalls.

My wife's practice is considered efficient in the evaluations it gets, yet it is slowly slipping under the water. They recently had to give up the last bit of independent private medicine they did, as they had no resources to put into marketing. So that's one less bit of self-subsidy... GP "independence" does NOT mean "run your business efficiently, as you wish to" - they have all the disadvantages of self-employment (i.e. risk) with very little control. For example, they have to accept and pay for alterations to the building (owned by the NHS), even though they don't want the changes made, there is no evidence for why they might improve service, and they undergo disruption whilst they happen.
(This one angers me particularly) GPs have their IT provided and managed by the NHS. Freedom of Information Act requests indicate this is done in a very expensive way (between 4x and 7x the cost of provision sourced locally and independently), and the service is abysmal. Patients see downtime as the fault of the surgery, not the hidden NHS bureaucracy, and simple things like electronic data exchange with local hospitals, is primitive and erratic. GPs have almost no choice in the systems they use, and no choice at all in the provider.. 

Whatever lies *unt tells, the rate of doctor training generally, and GPs particularly, is far too low to cover the rate of baby-boomer retirements. There are _fewer_ trainees to go round now than ten years ago (there are GP trainees and trainers in my wife's practice; she teaches and mentors medical students at Bristol university (again some of this is "out-of-hours")). The NHS is recruiting in third-world countries, doctors often with poor English and "different" qualifications to here. These doctors cannot serve the countries they came from any more (obviously), and the quality of training abroad often leads to issues here (read the papers).

Australia and New Zealand and Canada are all actively trying to 'poach' GPs from here. Given what they can offer in salaries and lifestyle options, it's magnetic for younger GPs and hospital consultants. My own GP and his wife (a consultant) left for Australia last year.

Finally (and obviously), extended hours means extended costs. Support services: admin, specialist staff (such as treatment room services), social services, district nursing services, and even some hospital liaison activities (outpatient and external services such as blood tests, and x-ray, transport, etc.) would all have to be provided to varying extents, otherwise it's pointless. The lion's share of this would be borne by GPs themselves, and there is no extra money available (there was in the few select pilots though!).

In my wife's case, the biggest single cause of increased pressure on services is not age demographics but immigration. This presents itself in a multitude of ways, but the upshot is that recent immigrants are high-demand NHS users. In her area, as in most inner cities, she has a lot of them. Until recently this was acknowledged, with subsidy, which went some way towards covering the additional _per capita_ costs. That is being withdrawn too.

My wife says her biggest personal source of stress is the financial uncertainty - the game rules change too often. She also asked me to mention that many of their smaller funding streams are simply left owing by the big contractor, Cxxxxx, who are supposed to handle payments to GPs but seem to be "out of their depth". GPs waste a lot of admin time on chasing trivial incomes that should be rolled up into the NHS main contract (but added together amount to a lot).


I've recently returned to work part-time, as we cannot afford to keep our youngest at university in London without additional income. We intend to move and downsize as soon as practical. 

*Edited as I had the numbers wrong (had been told the 5-year figure in one case and misunderstood it as annual, and excluded another significant clawback).
* post-truth? Headline article in the BMA's news review which arrived yesterday. I wonder if Virgin Medical made any political donations at the last election...


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## Phil Pascoe (14 Jan 2017)

" ... simple things like electronic data exchange with local hospitals, is primitive and erratic."
Or non existent. I was asked to visit the surgery for a blood test for lipids and a blood pressure check. I said I had just come out of hospital where I had had 156 blood pressure checks, daily blood tests and major vein and artery surgery and that if there was anything remotely suspect it would have been dealt with. Ah, yes ... but we have no record of that, came the reply. So I have to waste my time (and my wife's working time) and go for another blood test to keep them happy - which will entail another three or four stabbings as they attempt to find a usable vein. The cost to the system is ridiculous, let alone the inconvenience and discomfort. Communication and the NHS shouldn't be mentioned in the same sentence.


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## Jacob (14 Jan 2017)

phil.p":3a9vyrel said:


> " ... .... The cost to the system is ridiculous, let alone the inconvenience and discomfort. Communication and the NHS shouldn't be mentioned in the same sentence.


Except the cost of the NHS is exceptionally low (per capita) compared to most other countries, and is even less than the primitive and inadequate american Medicare. 
Little details of failures like yours can be annoying but in the bigger scheme of things don't necessarily amount to much. The worrying thing is how so many people complain nowadays like turkeys voting for christmas; they'll be even less happy if the planned privatisation gets carried through.


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## custard (14 Jan 2017)

> Just for the record, as many on this thread don't seem to know how GP's operate:



Interesting post Eric, I learnt a lot there.


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## El Barto (14 Jan 2017)

RobinBHM":2v29upfv said:


> I understand that the NHS is struggling and I understand the viewpoint that introducing charges is likely to impact on people with less money.
> 
> I get all that but, I do think there is a real binge drinking culture in this country that on every Friday and Saturday night A&E staff end being the ones faced with having to deal with the result of that culture, by way of abuse, assault and important resources stretched.
> 
> ...



I don't really care for this thread but your comment on young people suffering from anxiety is incredibly short sighted, and like so many people, you're part of the problem surrounding mental illness. It has been well documented that when young people, men especially, reach their early twenties, many of them suddenly face these problems of anxiety and depression and they don't know why. "Life these days" is a lazy generalisation but seeing as you brought it up, life for a young person (and all of us, in fact) over the past ten or fifteen years has changed beyond recognition, at an astonishingly fast rate. 

Long story short, to dismiss anxiety in young people the way you have is to do them a great disservice - you're also effectively dismissing mental illness altogether. To anyone suffering any kind of mental illness, that pain is relative and for that person is the realest thing in the world at that moment.

On another note, every problem the NHS faces is based on government cuts and lack of investment. It's our most vital service yet it is a shadow of its former self, and whether people abuse it or not, they aren't the ones causing its underlying problems.


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## AJB Temple (14 Jan 2017)

Absolutely excellent post Eric. I have very close friends in GP practice as well (both women) and their stories are remarkably similar. I think the remarks from Mrs May today are crass beyond belief.


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## AJB Temple (14 Jan 2017)

The anxiety post is an interesting one. My business recruits probably ten people each year: part growth and part replacement. In the past few years we have seen several new recruits (usually graduates) take time off for anxiety. Eventually, when we get to the bottom of this, there is some history that has not been disclosed. We recently recruited a young woman of 21. She joined in December. We have not seen her yet since the new year as she has been signed off work by her doctor with anxiety. 

Experience of this kind of thing as an employer eventually hardens you as there are without doubt some people who take advantage of the system. Hence, I will probably instruct HR to dismiss her next week. Whilst I agree that mental health is important, I do think some of the youngsters of today could do with a bit more backbone and resilience.


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## Phil Pascoe (14 Jan 2017)

Jacob":3ponknyf said:


> phil.p":3ponknyf said:
> 
> 
> > " ... .... The cost to the system is ridiculous, let alone the inconvenience and discomfort. Communication and the NHS shouldn't be mentioned in the same sentence.
> ...


Multiply what that one instance cost by millions and it does.


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## Phil Pascoe (14 Jan 2017)

A good friend , a nurse of 33 years experience took early retirement. One thing that spurred her on was finding out that the "Pillow Manager" earned more than she did.


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## El Barto (14 Jan 2017)

AJB Temple":12jp8w0d said:


> The anxiety post is an interesting one. My business recruits probably ten people each year: part growth and part replacement. In the past few years we have seen several new recruits (usually graduates) take time off for anxiety. Eventually, when we get to the bottom of this, there is some history that has not been disclosed. We recently recruited a young woman of 21. She joined in December. We have not seen her yet since the new year as she has been signed off work by her doctor with anxiety.
> 
> Experience of this kind of thing as an employer eventually hardens you as there are without doubt some people who take advantage of the system. Hence, I will probably instruct HR to dismiss her next week. Whilst I agree that mental health is important, I do think some of the youngsters of today could do with a bit more backbone and resilience.



I'm sorry to hear you'll be dismissing her and while I can understand your initial response of young people needing backbone and resilience, the fact remains that the problem goes deeper than that and I have to believe that these people aren't merely being pussies. You're right that often there are histories that can lead to problems later in life but not always.

The pressures on young people now are not the same as they used to be because the system has failed them for many reasons. The notion that you go to school, go to college, go to university and then go into work no longer exists. Graduates can't get jobs. Funding for education is drying up. Student debt, and debt in general, has increased. Social media and the information society has created impossible standards in lifestyle, beauty, everything. And these things weren't created by young people but they are the ones living with them.

On a personal level, when I was 21 I moved to London like so many people do. I was working whatever rubbish jobs I could get until I got lucky and landed a reasonably good job (relatively speaking) as a runner. Then out of the blue on the first day of a new and better job I was hit by this wave of dread. That's the only way I could describe it, I had no idea what it was or why I felt that way. I was walking to the bus stop and suddenly couldn't think clearly. It went on like that for at least a year, every day thinking I was going mad and it made no sense and it was completely terrifying. I've never been so scared in fact. Through various forms of counselling and anti-depressants I learnt to cope with it and live with it but 9 years on it is still very present and I can tell you it is utterly horrible. Talking to my therapist about it and reading more about it I learned that it's much more common than society/people would have you believe - I was just one of many people experiencing the same problems - and that's because there's still so much stigma around mental illness, not helped by the negative view that these young folks should just pull themselves together. If this kind of thing has always been going on and has always been so widespread and older generations did in fact suffer but just got on with it then yeah, maybe they have a right to say that, but I suspect that's not the case.

Ps. Eric thanks for your post, really interesting.


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## lurker (14 Jan 2017)

Part of the problem with *unt and his ilk is any silly person can be a MP
The supply of potential recruits exceeds demand by a thousand fold.

They don't realise other professions can't operate in a similar way
GPs are required not only to be fairly clever but also well trained ( a good ten years I understand) so where are the numbers going to come from to maintain let alone expand the service.
Even GPs who can't retire (cos they need the dosh) are just leaving the job and becoming locums and are working hours they want, no admin., no worry. But no continuity for the poor old patient either.


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## MarkDennehy (14 Jan 2017)

phil.p":3t5khr41 said:


> " ... simple things like electronic data exchange with local hospitals, is primitive and erratic."
> Or non existent. I was asked to visit the surgery for a blood test for lipids and a blood pressure check. I said I had just come out of hospital where I had had 156 blood pressure checks, daily blood tests and major vein and artery surgery and that if there was anything remotely suspect it would have been dealt with. Ah, yes ... but we have no record of that, came the reply. So I have to waste my time (and my wife's working time) and go for another blood test to keep them happy - which will entail another three or four stabbings as they attempt to find a usable vein. The cost to the system is ridiculous, let alone the inconvenience and discomfort. Communication and the NHS shouldn't be mentioned in the same sentence.


That one's actually not an NHS thing though phil, there's not a hospital in the world that has solid working electronic data exchange even amongst its own departments, let alone with any other external unit. It's a rather large market and R&D area in software engineering (which is my day job). Couple of years back, I was working on a training tool for nurses; one of the problems the nursing school had was training nurses to doublecheck records because you couldn't depend on a transferred record being correct. I thought this was silly and then after my brother broke his leg rather badly, found that they got his name wrong on every single outpatient visit - they'd take his name at reception and send it up to orthopaedics, who consistently had it wrong by the time he got there. 

And it's been like this since the 1970s...


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## thetyreman (14 Jan 2017)

don't forget WHO is to blame for all of this, Jeremy Hunt, rhymes with....

this government are to blame for the NHS mess, not GP's, not hospital staff, the people who run it need to be held accountable, but no, it's never their fault, their voters also don't think it's their fault either.


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## Jacob (14 Jan 2017)

https://data.oecd.org/healtheqt/hospital-beds.htm


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## Eric The Viking (14 Jan 2017)

MarkDennehy":38sbrzzt said:


> [snipped purely for brevity]... There's not a hospital in the world that has solid working electronic data exchange even amongst its own departments, let alone with any other external unit. It's a rather large market and R&D area in software engineering (which is my day job). Couple of years back, I was working on a training tool for nurses; one of the problems the nursing school had was training nurses to doublecheck records because you couldn't depend on a transferred record being correct. I thought this was silly and then after my brother broke his leg rather badly, found that they got his name wrong on every single outpatient visit - they'd take his name at reception and send it up to orthopaedics, who consistently had it wrong by the time he got there...


Aye, and then there's one of our local hospitals here who had to hire a warehouse to take its misplaced files, because it was filing things, not by patient record, but in date order. They lost around fifteen years of my x-rays (I have a progressive disease, so these, though old, were important). My consultant asked questions, which the administration wouldn't respond to, and his request for a formal apology to me elicited nothing either. That was relatively recent. 

Ironically, your NHS number is considered a better-quality 'key' (a database term, meaning a unique identifier of your records) than any other number, including NI numbers.

We're veering off topic a bit but... The Cabinet Office (who own national governmental IT strategy) has declared its enthusiasm for open source. It is proven, almost beyond question, that, when properly used in public services, it is more efficient and vastly cheaper. As of two years ago, the NHS had over one million PCs still running Windows XP when long-term support ended. You can't blame Microsoft - the NHS only had about ten years' warning. 

I went to a medical IT exhibition & conference about four years ago where the health department spokespeople were extolling open source. They spoke with forked tongues: giving lip-service to what is required, but actually not putting top-down reforming pressure on NHS entities at all (as far as I could see at the time). 

On the ground, critical software continues to be developed at great expense in-house or commercially, and clincians (including GPs) find themselves locked-in to stuff that frankly is often abysmally badly written. Obviously this is secondhand information, but...

... There used to be a government purchasing framework covering GP patient administration software: five years ago, five companies had products available, so there was some competition (on quality as well as cost). That framework has expired. Even before that point companies were walking away. In England there are, IIRC, now only two companies left, one of which has a vast monopoly market share, and the other a limited number of customers south of the border. If the health department upset the monopolist there would be big trouble - this is a wholly unacceptable situation for a public service as strategically important as that. 

Behind the scenes there are a number of IT departments which used to be part of Primary Care Trusts (now abolished), but which continue to deliver "support" _and do proprietary development work_, although their budgets and use of resources are now more arcane than ever. Yet we, as users of primary care. depend on their services, and GPs, as I said, are forced to use them for provision of IT support and key infrastructure services.

In the USA, in contrast, development work done by government agencies is often considered public property. A good example of that is NASA's records, photographs, software, etc. That organisation, and many other US agencies, has a commitment to open source. It is reducing cost and mistakes/failures.

Here we continue to hand money to very large commercial operations, with dubious track records but persuasive sales teams. There is a long history of failed NHS IT projects, mostly far too grand or far too complex, and the companies involved continue to get public money.

There are areas of healthcare spending, such as IT, that *unt could usefully get a grip on, and huge operational savings to be made. The trouble is that those areas are politically unacceptable to touch. Ask any GP or hospital clinician: they'll all have horror stories of profligate waste and mismanagement. And that's largely the trouble: the NHS is _mismanaged_, and things have been outsourced that simply shouldn't be (why, for example is a big contractor, whose name crops up everywhere in public sector outsourcing, and which probably has no previous experience, doing the accounting and payments side of the GP contracts?).

GPs themselves are furious with *unt and cohort, as are hospital juniors. Both groups see the waste, but are powerless to gain traction on it, whilst at the same time they are managed and pushed around by people with little or no medical training.

We have a long-retired friend, who was the Chief Exec of one of our large hospitals locally. He was a clinical consultant before taking the post. His first major change after taking the job was to eliminate five (yup, FIVE) tiers of middle management. Every measurable efficiency statistic improved immediately, including staff morale. 

All those tiers are back again now, and the tail is gleefully wagging the dog. 

So IMHO, only part of the answer is more money. There also needs to be a cull of management, and clear objectives set from the top down to minimise bureaucracy with a view to empowering clinicians again. 

But I cannot imagine who I might vote for who would sort it all out - both the red ones and the yellow ones seem to be useless at effective management, and the current lot's agenda, increasingly overt, is simply privatization as fast as possible, using all means necessary.

Sigh.


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## Eric The Viking (14 Jan 2017)

Jacob":6p374fhi said:


> https://data.oecd.org/healtheqt/hospital-beds.htm



It's not a wholly valid comparison, especially as we use our facilities a lot more efficiently than some of the "leading" countries do, although it makes a very strong point.

The worse stat seems to be MRI scanners - the USA has almost six times as many as we do, yet we invented the things, and they undoubtedly improve efficiency.


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## MarkDennehy (14 Jan 2017)

AJB Temple":3l7c5ulg said:


> she has been signed off work by her doctor with anxiety.
> ...
> I will probably instruct HR to dismiss her next week. Whilst I agree that mental health is important, I do think some of the youngsters of today could do with a bit more backbone and resilience.



Honest question, have you ever had an anxiety attack yourself?


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## Phil Pascoe (15 Jan 2017)

Some years ago the NZ economy took a dive and there was serious job pruning. There was at the time a waiting list of something like nine months for a driving test, and the NZ government decided the Dept of Transport needed sorting out - an ideal opportunity. They employed a senior management guy from Honda (no, I don't know why, either) who abolished whole tiers of management - they had tiers whose sole purpose was to manage another tier - and within a few few months had the waiting list down to six weeks.


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## Jacob (15 Jan 2017)

phil.p":xrpiem6y said:


> Some years ago the NZ economy took a dive and there was serious job pruning. There was at the time a waiting list of something like nine months for a driving test, and the NZ government decided the Dept of Transport needed sorting out - an ideal opportunity. They employed a senior management guy from Honda (no, I don't know why, either) who abolished whole tiers of management - they had tiers whose sole purpose was to manage another tier - and within a few few months had the waiting list down to six weeks.


NHS was regarded as something of a miracle in days of yore - that it could function with so little management. 
Management was brought in progressively from 1979 to improve and rationalise things (but really to break it up into self managed units which could then be sold off) and it's been downhill ever since.
What we need to do is hand it back to the medical profession to manage, and fund it properly.


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## Stanleymonkey (15 Jan 2017)

There are a lot of people who simply don't know how to deal with a sprained ankle or bent finger and go into A&E looking to be treated.

There is a steady percentage of people who visit A&E all the time for injuries that just need an ice pack or a lemsip!


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## RogerS (15 Jan 2017)

Over-managed? Not according to the Kings Fund. So let's dig a little deeper, shall we.

Over the last decade or so there have been a lot of NHS reforms. There didn't seem to be a month that went by without a new 'initiative' aka knee-jerk reaction by the Government. And of course all these reforms need to be managed.

So what were some of them and who introduced them ?

Four-hour targets - Labour

Payment by results - Labour

Choose and Book - Labour

And let's not forget how much was it that that silly person Bliar squandered with his ego-boosting NHS IT white elephant ? Over £100 million.
So not really to do with this myth of slicing and dicing to bring in privatisation as some of the more deluded would have us believe.

Edit: My mistake £20 billion.

_The government's £20bn investment in new IT systems for the NHS in England could turn into a white elephant unless ministers work harder to involve doctors in developing it, parliament's spending watchdog will warn today. The National Audit Office is expected to say the scheme - the biggest civilian IT programme in the world - is two years behind schedule. But it has not run over budget like other jumbo computer schemes.

The report is expected to criticise the government for not winning the support of the profession at an earlier stage. Sir John Bourn, head of the NAO, told the Commons public accounts committee in March that the NHS's Connecting for Health programme "has not won the hearts and minds of those who are being required to use it". He criticised the Department of Health for "failure to take the people in the NHS with the system"._ 

Source : The Guardian


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## RobinBHM (15 Jan 2017)

I understand that many hospitals struggle to balance their books because of massive debt caused by the private finance initiative. A scheme created by Tory government and expanded greatly by the Blair government.

I am sure that the NHS is underfunded, but Im not sure more money will help or that there are enough funds available. Its always easy for opposition governments to argue about terrible austerity measures, cuts in services etc, but overspending over many years increases debt that causes problems for future generations.


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## RogerS (15 Jan 2017)

RobinBHM":3sze93as said:


> I understand that many hospitals struggle to balance their books because of massive debt caused by the private finance initiative. A scheme created by Tory government and expanded greatly by the Blair government.
> 
> I am sure that the NHS is underfunded, but Im not sure more money will help or that there are enough funds available. Its always easy for opposition governments to argue about terrible austerity measures, cuts in services etc, but overspending over many years increases debt that causes problems for future generations.



Well said. Good article in wikipedia here


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## Jacob (15 Jan 2017)

RobinBHM":125jp3a1 said:


> .......
> I am sure that the NHS is underfunded, but Im not sure more money will help


_If_ it is underfunded _then_ more money will help - by definition. This is simple logic.


> or that there are enough funds available. ......


We have astronomical accumulations of wealth amongst the mega rich. We have historically unprecedented (in the last 100 years or so at least) high differentials in earnings.
In spite of this we nearly all have a much higher standard of living and quality of life than our parents generation and all previous generations. 
The country is awash with wealth. 
Raising the money would be simple and easy; we have historically low levels of taxation and high levels of tax avoidance/evasion. 
It's a simple political choice. The only obstacle is the austerity delusion.

Corbyn's latest wheeze is a goodun; no government contracts to firms with tax avoiding offshore accounts. That'd screw Branson. :lol:


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## iNewbie (15 Jan 2017)

AJB Temple":3r1n19ao said:


> The anxiety post is an interesting one. My business recruits probably ten people each year: part growth and part replacement. In the past few years we have seen several new recruits (usually graduates) take time off for anxiety. Eventually, when we get to the bottom of this, there is some history that has not been disclosed. We recently recruited a young woman of 21. She joined in December. We have not seen her yet since the new year as she has been signed off work by her doctor with anxiety.
> 
> Experience of this kind of thing as an employer eventually hardens you as there are without doubt some people who take advantage of the system. Hence, I will probably instruct HR to dismiss her next week. Whilst I agree that mental health is important, I do think some of the youngsters of today could do with a bit more backbone and resilience.



Have a bit of compassion. You never know whats going on or happened in peoples lives. She could be taking advantage, or it could be genuine. Maybe one of your staff pulled her aside and gave her a bit of bullying, you know, pecking order tactics, etc. Most of us have had that in some form or another. 

Strange you keep taking people on and they're _all_ off for anxiety. The common denominator is your department. :-k 

Its not backbone and resilience they need. Its for some to understand Mental Health issues are a part & parcel of life. Some people deal/cope with things differently and sometimes their background story hard to bare when they tell you it. Rape/Abuse etc. Yep, theres a big grey area between that Black & White point of view.


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## Jacob (15 Jan 2017)

iNewbie":fqhosrx2 said:


> .....
> 
> Strange you keep taking people on and they're _all_ off for anxiety. The common denominator is your department. :-k .....


 :lol: 
Yep. Maybe you should be taking a closer look at your management - it sounds like you are wasting a lot of talent and missing opportunities. it only takes one rotten apple in the team - and that could be the manager!


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## Phil Pascoe (15 Jan 2017)

Jacob - I bet there are no Labour MPs, Union bosses or Party donors with offshore cash? Just like there are no Labour MPs employing people on zero hour contracts ... :? 
Corbyn will never be in a position to solve anything, so he can say what he likes.


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## El Barto (15 Jan 2017)

Jacob":1zqvnqel said:


> iNewbie":1zqvnqel said:
> 
> 
> > .....
> ...



Agreed. Have you (AJB Temple) tried talking to these people, this girl for instance? And I mean really talking to them, making an effort with them. Maybe their feedback could be conducive to a better working environment. While perhaps you aren't to blame for their anxiety and subsequent time off work, you likely have nothing to lose from hearing what they have to say and either making sure that you aren't part of the problem or, if you are, working to eliminate that problem or its contributing factors. Just a thought.


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## RobinBHM (15 Jan 2017)

> If it is underfunded then more money will help - by definition. This is simple logic.



If only it was that simple. A bottomless pit of funding is neither sustainable nor a solution. There are plenty of health professionals that say the NHS has multi factorial issues, of which funding is one aspect and would not on its own be a solution



> We have astronomical accumulations of wealth amongst the mega rich. We have historically unprecedented (in the last 100 years or so at least) high differentials in earnings.
> In spite of this we nearly all have a much higher standard of living and quality of life than our parents generation and all previous generations.
> The country is awash with wealth.
> Raising the money would be simple and easy; we have historically low levels of taxation and high levels of tax avoidance/evasion.
> It's a simple political choice. The only obstacle is the austerity delusion.



Unfortunately Robin Hood ideology does not provide a solution, it is naive rhetoric. Increasing higher rate taxes does not translate into great increases in revenue. 

Hhigh taxation means high state intervention and high regulation. However it is low regulation and low taxation that encourages businesses to come to the UK and to develop in the UK.


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## Jacob (15 Jan 2017)

phil.p":14w1tj8q said:


> Jacob - I bet there are no Labour MPs, Union bosses or Party donors with offshore cash? Just like there are no Labour MPs employing people on zero hour contracts ... :?


No some of them are complete a***holes. Being a Labour MP doesn't make you a saint (though god will probably be on your side  )


> Corbyn will never be in a position to solve anything, so he can say what he likes.


Too soon to say. We live in interesting times.
NB Oddly; blind surveys suggest majority support for almost everything that Corbyn proposes, including this last one.


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## Jacob (15 Jan 2017)

RobinBHM":zlgi23do said:


> .... Increasing higher rate taxes does not translate into great increases in revenue.....


 :lol: 
Oh yes it does!!


> low regulation and low taxation that encourages businesses to come to the UK and to develop in the UK.


Another popular delusion and blatantly untrue. British industry has all but disappeared under neo liberal poilicies (and USA ditto).
Unless of course you think there is some sense in having power, rail, motor industry, etc. all owned and run by foreign companies for the benefit of foreign shareholders, though some of them nationalised. It works for them, but not for us, except as a low age third world economy.


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## Phil Pascoe (15 Jan 2017)

Anxiety, depression and back backs are unfortunately very difficult to prove, which works against the genuine. I remember on dozens of occasions being called in to work on my days off to cover for the guy I worked opposite who had gone of sick with either a bad back or depression, when he was no more depressed than I was and way healthier - he'd just hit the bottle a bit too hard. If I genuinely went sick and he got called in he would go sick immediately he returned to work.
Strange how the last time the higher rate tax was reduced the tax take went up?


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## Phil Pascoe (15 Jan 2017)

Of course there is support for Corbyn - it's called "idealism". People are very happy with idealism so long as they know it will never happen. "Virtue signalling" is a good expression for much of it.


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## Jacob (15 Jan 2017)

phil.p":1a93dcby said:


> ...
> Strange how the last time the higher rate tax was reduced the tax take went up?


When was that then, in a dream?
So even lower taxes will bring in even more money?
Have you been reading "Alice Through the Looking Glass"?


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## El Barto (15 Jan 2017)

phil.p":1rhieuvs said:


> Corbyn will never be in a position to solve anything, so he can say what he likes.



As a Labour member and supporter of Corbyn I do have to agree with you on that front and it's very frustrating. What is it about him that the public does not like and has so little faith in? On paper he should be a regular Bernie Sanders.

Recent surveys indicate that public interest has shifted from Brexit and the circus surrounding it to the NHS crisis and health in general. This might lead one to believe that public faith in the Conservatives might be fading. And yet in those same polls, Theresa May and her party have a commanding lead over Corbyn and Labour. That is completely insane but alas the people seem happy to let the Tories keep chipping away at their rights.


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## RogerS (15 Jan 2017)

El Barto":3j2gvf11 said:


> .... What is it about him that the public does not like and has so little faith in? .....



How about the fact that he spouts absolute gibberish and is a . ? A right proper little Citizen Smith.


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## El Barto (15 Jan 2017)

RogerS":1uxn7r23 said:


> El Barto":1uxn7r23 said:
> 
> 
> > .... What is it about him that the public does not like and has so little faith in? .....
> ...



Can you back that up a little though, maybe give some context? I'm not trying to be rude, I just want to hear more than "he's a ."; it's not very helpful is it? From where I stand he speaks for the people he serves, and that is backed up by his history of good decisions as a politician, as this article suggests.


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## RogerS (15 Jan 2017)

El Barto":538q6zg9 said:


> RogerS":538q6zg9 said:
> 
> 
> > El Barto":538q6zg9 said:
> ...



Not really. Every time he starts to speak I feel the bile rising and so switch off. Anyway, he's made Labour unelectable while he is in charge and so no complaints on that score.

Links to Gruniad vox-pop pieces do very little for me, I'm afraid. Their constant hand-wringing brings me out in a rash.


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## Phil Pascoe (15 Jan 2017)

Jacob":2gwpx4e1 said:


> phil.p":2gwpx4e1 said:
> 
> 
> > ...
> ...


2013 - 2014


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## RobinBHM (15 Jan 2017)

Apparently Jeremy has just had a re-boot!

It rather seems to me that Jeremy and the far left are doing their very best to bury New Labour Left of centre, which gave them their most time in power for many many decades.

The Socialist ideology of Jeremy etc is popular only by a minority. The vast majority of the public dont have any real political ideology, so any such preaching falls on deaf ears.

Since Jeremy Corbyn has been leader, he has hardly been in the media at all. I know he gets an overly negative press, but he also does not make enough effort to appear on the major tv and radio programmes. 

Generally opposition parties get big wins in byelections, not this time!


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## Jacob (15 Jan 2017)

El Barto":3t0k9qsk said:


> RogerS":3t0k9qsk said:
> 
> 
> > El Barto":3t0k9qsk said:
> ...


I think people simple mindedly want charisma. Blair had it, Trump has it , Thatcher had it, Hitler had it, all in in their own ways. They were all (Trump will be) disasters.
Corbyn is no Schwarzenegger, not a knight on a white horse, not the cavalry coming over the hill. But neither was Attlee.


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## Jacob (15 Jan 2017)

phil.p":3m7t0stk said:


> Jacob":3m7t0stk said:
> 
> 
> > phil.p":3m7t0stk said:
> ...


Details please. Was this the only time in history or is it generally true that lower taxes bring in more tax?


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## El Barto (15 Jan 2017)

RogerS":qfhqvhhp said:


> Not really. Every time he starts to speak I feel the bile rising and so switch off. Anyway, he's made Labour unelectable while he is in charge and so no complaints on that score.
> 
> Links to Gruniad vox-pop pieces do very little for me, I'm afraid. Their constant hand-wringing brings me out in a rash.



"He's a . who sprouts gibberish but I can't give an example". Interesting. See this is part of the problem - "Oh, The Guardian, no I won't read that tosh. Better to insult it instead". Lack of interest in listening and reading what politicians are actually saying, whether that's through laziness, a lack of interest or blind dismissal of the opposition. I feel the same way when Theresa May starts to speak but it's important to listen anyway. It's a shame really but the malaise surrounding British politics is unsurprising. I know all of this is falling on deaf ears and ffs I'm talking politics on a forum on the internet but man, the laziness and stubbornness is so stupid.

Edit because I posted afterwards: re. charisma Jacob yes I agree.


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## thetyreman (15 Jan 2017)

morturn":tp3mvz1j said:


> I think Jeremy Hunt is a genius, in one short parliamentary statement he already has quite a few of you dancing to his tune.
> 
> Make it fail, then find someone to blame. So now it’s the people who go to the hospital for frivolous reasons, along with the drunks, the obese and as always, the immigrants, and you swallow it like sitting ducks.
> 
> ...



he's more like a psychopath than a genius, but I see where you are coming from, he made people blind to the fact the government are clearly giving the working man the worst deal, and not many people seem to want to acknowledge it.


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## Jacob (15 Jan 2017)

Corbyn on NHS. Who could disagree with any of this? 

"The Conservatives are privatising our NHS by stealth despite the repeated failures and costs of private provision.

It saddles us with an expensive and unnecessary internal market. It puts tax avoidance, not patient care, at the heart of its management. It also promotes excessive boardroom pay and grotesque inequality.

Health privateers are earning huge sums at taxpayers’ expense, while health workers have faced a pay freeze.

When health services are privatised, the brakes come off the pay of the executives in charge."

He could also have added that, thanks to limited liability, when private health firms fail (and they do) it's we the tax payers who bear the cost, not the shareholders.
For us it's lose, lose.


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## Jacob (15 Jan 2017)




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## RogerS (15 Jan 2017)

Bloody hell, Jacob, what on earth is that hospital thinking about? There's room for at least three more !

Seriously, we might jest but the NHS is in dire straits and it is not as simple as either bunging in more money or left-wing rhetoric and tub-thumping.

Good cartoon, though, Jacob, me old cobber.


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## n0legs (15 Jan 2017)

This is happening right now. 
Yesterday morning dad got up with what he described as a a "rash" on his left leg. It was painful to the touch, extremely hot and he could not stand on it.I was unobtainable so he got one of the neighbours to take him to A&E at the Royal Gwent. 
To quote him "I felt like a bloody fool turning up with a rash on my leg". The first nurse to see him called for the doctor asap.
This is how it went from this point.
Get that leg elevated, now!
Get some blood out of him and up to the lab, asap.
Get his vitals.
Get a saline drip into him.

Well as you can imagine the old man gets a little sweat on at this point, "I think you'd better call my son"
So I get a call and I'm now fully embroiled in this little drama.
Well he's gone and got a bad case of Cellulitis. His leg is freaking red, I mean scarlet red. His left lower leg is bright red from ankle to kneecap.
Blood has gone to lab for confirmation and has come back as expected, this was obviously yesterday. 
Consultant Dermatologist was in yesterday and again today. Antibiotics in drip form are being run in at a crazy rate, at visiting time today (3-5pm) he was on his forth bag (looks to be about 200-300ml) of the day so far.
To my point.
I asked the nurse, with this topic in mind, has Dad done the right thing bothering you guys. 
Nurse's answer, "It could have been a big mess if he waited until Monday to go to the GP".


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## thetyreman (15 Jan 2017)

n0legs":3fl6vp7r said:


> This is happening right now.
> Yesterday morning dad got up with what he described as a a "rash" on his left leg. It was painful to the touch, extremely hot and he could not stand on it.I was unobtainable so he got one of the neighbours to take him to A&E at the Royal Gwent.
> To quote him "I felt like a bloody fool turning up with a rash on my leg". The first nurse to see him called for the doctor asap.
> This is how it went from this point.
> ...



 I hope he's ok, sounds like the nurses are doing an amazing job, despite all the NHS negativity.


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## n0legs (15 Jan 2017)

thetyreman":23r6ijv3 said:


> I hope he's ok, sounds like the nurses are doing an amazing job, despite all the NHS negativity.



Thanks TTM. 
They are mate, absolutely sterling treatment he's receiving.
I'm not getting into this topic except for these few entries, but I will say family wise we've been fortunate (or unfortunate because of the need, depends on your view point) to have used both private and NHS over the years. In this instance I do not believe private could perform any better.


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## RogerS (16 Jan 2017)

El Barto":29lo2qqi said:


> .....
> Recent surveys indicate that public interest has shifted from Brexit and the circus surrounding it to the NHS crisis and health in general. This might lead one to believe that public faith in the Conservatives might be fading. .....



Not at all. I can't see any link between the two. Reason why Joe Public is bored with Brexit is because it is going to drag on and on and on and on. Those who voted 'Out' seemed to think that it could be done as easily as switching off a light.


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## Phil Pascoe (16 Jan 2017)

Not that easily, but they could have at least made a start in the seven months they've had.


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## El Barto (16 Jan 2017)

RogerS":6x47zo6e said:


> El Barto":6x47zo6e said:
> 
> 
> > .....
> ...



Hmm I don't think I understand your point Roger. Although I do agree with the public being bored of Brexit now I don't know what you mean about a link between the two. Link between what? Do you mean a link between the NHS crisis and public faith in the Tories?


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## Sheffield Tony (16 Jan 2017)

n0legs":1fiki84j said:


> To my point.
> I asked the nurse, with this topic in mind, has Dad done the right thing bothering you guys.
> Nurse's answer, "It could have been a big mess if he waited until Monday to go to the GP".



Therein lies the problem. For many of us, there is no other way to get seen by someone after the GP surgery closes. They are effectively expecting us to self diagnose, to decide if it is safe to leave until Monday morning. Yes, a common cold is not a major concern, but lots of things that are a concern have similar initial symptoms.

A while ago got a splinter under a fingernail - not woodworking, but from a door frame. Couldn't sort it myself easily, and had just missed closing time at the GP's on Friday evening, or I'm sure the nurse there could have sorted it. Practice answerphone gave me a number for "Out of hours" service, which sounded identical to what I have used as "NHS Direct" before. They said it can't stay in there until Monday, the one out of hours clinic open won't have the equipment to deal with it ( :shock: ?) go to A&E. Feeling a bit of a fool, I do as instructed. Get the least capable doctor I've ever met, who tries to remove it with forceps looking as fine as a pair of electricians pliers. Gives up, and sends me away with a prescription for antibiotics instead. Thinking this can't be for the best, I drove to work, and got out my illuminated magnifier and surface mount electonics tweezers, disinfected with IPA. Out in a couple of minutes of careful probing. Should have done that in the first place.

If we need to take the pressure off A&E, there needs to be in place a better alternative than self diagnosis and DIY treatment !

Hope your Dad gets sorted n0legs.


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## Jacob (16 Jan 2017)

Sheffield Tony":1anylxxw said:


> .... Thinking this can't be for the best, I drove to work, and got out my illuminated magnifier and surface mount electonics tweezers, disinfected with IPA. Out in a couple of minutes of careful probing. Should have done that in the first place...


That's OK it's a learning curve! If you leave a splinter long enough (a few days) it gets expelled by a burst of pus, unless it is very deeply lodged. Best thing is to cover it with Micropore plaster and let nature take it's course.


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## RogerS (16 Jan 2017)

El Barto":2pycxyi8 said:


> RogerS":2pycxyi8 said:
> 
> 
> > El Barto":2pycxyi8 said:
> ...



I was referring to your post in quotes. I read it to mean that the public shift from Brexit to NHS was down to possible lack of faith in the Conservatives by some parts of the public. That's where I couldn't see a causal link.


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## RogerS (16 Jan 2017)

Sheffield Tony":1p2c6amt said:


> n0legs":1p2c6amt said:
> 
> 
> > ..... disinfected with IPA. .....



I usually drink my IPA down the pub :wink:


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## Jacob (16 Jan 2017)

RogerS":24tqqxd4 said:


> El Barto":24tqqxd4 said:
> 
> 
> > RogerS":24tqqxd4 said:
> ...


The link is that the tories are failing disastrously on both fronts. Pretty obvious to everybody, whatever their own position, does it really need explaining?


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## RogerS (16 Jan 2017)

Jacob":3502uqvi said:


> RogerS":3502uqvi said:
> 
> 
> > El Barto":3502uqvi said:
> ...



Yawn.


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## El Barto (16 Jan 2017)

RogerS":3k0sap7u said:


> I was referring to your post in quotes. I read it to mean that the public shift from Brexit to NHS was down to possible lack of faith in the Conservatives by some parts of the public. That's where I couldn't see a causal link.



Ok got it I think. Although I wasn't actually suggesting a link between anything, it was more a trail of thought. To summarise my original post:

- Public interest has shifted from Brexit to NHS (either because NHS crisis is a legitimate concern or, as you said, because they're bored of Brexit
- One could then assume that concern for the NHS consequently means fading support for Tories
- This is not the case; Tories still very popular
- Cue confusion


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## RobinBHM (16 Jan 2017)

How can the Tories be failing on Brexit, it hasnt happened yet? -of course its failing in the eyes of remainers it always will.

As far as the NHS is concerned, It has been failed by all parties for many years, it hasnt been helped in the last few years but it is always easy to put the entire blame on the incumbent party. It makes me think the NHS should be tackled by a cross party honest process instead of always using it for political point scoring. The 5 years of a parliament is not sufficient to make the changes to the NHS and leads the NHS to be treated as a short term political issue. Each party gets in power, stamps its new ideas on the NHS, wastes loads of money, then the next party gets in, spends loads of money with some new initiative, dumps some of the previous changes and so it goes on. There has been operating theatres built, then mothballed due to lack of available budgets to run them, what a waste of money.

The reality is that it is too big and too expensive to continue in its present form and we are seeing that the problems the NHS are facing are all ending up channelled towards A&E which cant cope.


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## El Barto (16 Jan 2017)

RobinBHM":1zklrps8 said:


> How can the Tories be failing on Brexit, it hasnt happened yet? -of course its failing in the eyes of remainers it always will.
> 
> As far as the NHS is concerned, It has been failed by all parties for many years, it hasnt been helped in the last few years but it is always easy to put the entire blame on the incumbent party. It makes me think the NHS should be tackled by a cross party honest process instead of always using it for political point scoring. The 5 years of a parliament is not sufficient to make the changes to the NHS and leads the NHS to be treated as a short term political issue. Each party gets in power, stamps its new ideas on the NHS, wastes loads of money, then the next party gets in, spends loads of money with some new initiative, dumps some of the previous changes and so it goes on. There has been operating theatres built, then mothballed due to lack of available budgets to run them, what a waste of money.
> 
> The reality is that it is too big and too expensive to continue in its present form and we are seeing that the problems the NHS are facing are all ending up channelled towards A&E which cant cope.



Honest question: it sounds like you're for Brexit, do you feel like it's going well at the moment? I just can't see how anyone can think it isn't failing really, no matter which side you're on. There's no plan, Leave's key pledges have been dropped, only soundbites like "red, white and blue Brexit" and "hard Brexit" remain. Where is the substance? They don't have a clue.

It's also pretty lazy to liken this government and its treatment of the NHS to others before it. To quote your own post "There has been operating theatres built, then mothballed due to lack of available budgets to run them, what a waste of money." Whose fault is that? Come on bruh.


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## Fitzroy (16 Jan 2017)

Sheffield Tony":3boa05ku said:


> Thinking this can't be for the best, I drove to work, and got out my illuminated magnifier and surface mount electonics tweezers, disinfected with IPA. Out in a couple of minutes of careful probing. Should have done that in the first place.
> 
> If we need to take the pressure off A&E, there needs to be in place a better alternative than self diagnosis and DIY treatment !



I wonder if actually there does need to be...........

I'm 40 and so have lived through the internet revolution, i'm of the opinion that pre-internet, pre-nhs 24/direct, etc a sizeable splinter would have been dealt with precisely as you have done, then if it'd gone nasty you'd have been down the doctors to deal with the aftermath. Now post-internet, we live in a much more risk-averse world, if you look-up anything on the internet you will only find worst outcomes, social knowledge (ie mother/grandmother etc) is largely ignored, and NHS 24/direct cannot be seen to miss anything due to liability. All of these factors drive an increased demand on immediate and more thorough medical assessment/treatment.

My father was a pharmacist and I recall him often looking at some old dear with a nasty wound or bump, giving them a some ointment etc and telling them to see the doctor in a week if they didn't improve. I went to the pharmacist with a rash a few years back, covering a good portion of my whole body, and wanting some antihistamines and they said I should go to A&E. 

Until technologies ability to diagnose catches up with it's ability to worry us i think the whole matter will only get worse.

F.


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## RogerS (16 Jan 2017)

El Barto":3jevbx3w said:


> RogerS":3jevbx3w said:
> 
> 
> > I was referring to your post in quotes. I read it to mean that the public shift from Brexit to NHS was down to possible lack of faith in the Conservatives by some parts of the public. That's where I couldn't see a causal link.
> ...



I think that it is all media driven and depends what is on the front page.


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## RogerS (16 Jan 2017)

RobinBHM":1xyvqrjf said:


> How can the Tories be failing on Brexit, it hasnt happened yet? -of course its failing in the eyes of remainers it always will.
> 
> ....



A 20% drop in sterling against the US dollar is a pretty good reason to say Brexit is failing.


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## RobinBHM (16 Jan 2017)

RogerS":27gpitrs said:


> RobinBHM":27gpitrs said:
> 
> 
> > How can the Tories be failing on Brexit, it hasnt happened yet? -of course its failing in the eyes of remainers it always will.
> ...



Exiting Europe is not going to happen overnight, the markets understandably are reacting to uncertainty. It is no proof that Brexit is failing at all.


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## Jacob (16 Jan 2017)

RobinBHM":28t5m5qr said:


> How can the Tories be failing on Brexit, it hasnt happened yet?


Cameron promised immediate implementation of article 50. Instead he resigned. So far nothing has happened. It's failing from whichever point of view you hold


> -o...it is always easy to put the entire blame on the incumbent party.


That's because the remedy is in their hands. But it's not that simple - running down the NHS is tory policy


> .....
> The reality is that it is too big and too expensive to continue in its present form and we are seeing that the problems the NHS are facing are all ending up channelled towards A&E which cant cope.


It's still one of the cheapest in the civilised world and exceptionally good value. We spend far less per capita than the yanks do on their pathetic Medicare. 
There is no good reason for saying the NHS is too expensive, unless of course you see health care for all as not worth paying for.


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## Inoffthered (16 Jan 2017)

RogerS":393dro8h said:


> RobinBHM":393dro8h said:
> 
> 
> > How can the Tories be failing on Brexit, it hasnt happened yet? -of course its failing in the eyes of remainers it always will.
> ...



The government has been printing money (QE) since the financial crash, devaluation and inflation are the inevitable result.
There is an argument that Sterling was overvalued anyway.

The Greeks would love to be able to devalue their currency but they can't, they are stuck in the Euro.

It is interesting to note however, that the Bank of England (through Carney who is a big Remainiac) now says that Brexit is not the biggest challenge facing the UK, but that Brexit is the biggest risk facing the EU economies. This could explain why now Project Fear has been exposed for the lie that it always was , have changed their tune somewhat saying that post Brexit the EU must still have access to London financial markets. The german auto industry and French agriculture will insist on a free trade deal.

Brexit will be a success.


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## Phil Pascoe (16 Jan 2017)

It's still one of the cheapest in the civilised world? There isn't another Country with the same system, so it cannot be judged against them. If it is such a success why are there another 195 Countries who do not copy it?
I rely on it very heavily - but I've seen far too much of it to believe that it is perfect.


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## Jacob (16 Jan 2017)

phil.p":263zzhxv said:


> It's still one of the cheapest in the civilised world? There isn't another Country with the same system, so it cannot be judged against them. If it is such a success why are there another 195 Countries who do not copy it?
> I rely on it very heavily - but I've seen far too much of it to believe that it is perfect.


Nobody would say it was perfect. But other countries all run national health services to some extent - some very similar to the NHS and some not. 
It is not impossible to compare and contrast them. Start here http://www.economist.com/blogs/economis ... xplains-16 then google for more.


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## Inoffthered (16 Jan 2017)

Jacob":2um84gri said:


> phil.p":2um84gri said:
> 
> 
> > It's still one of the cheapest in the civilised world? There isn't another Country with the same system, so it cannot be judged against them. If it is such a success why are there another 195 Countries who do not copy it?
> ...



Comparison of the spend per head is meaningless in isolation. When you compare outcomes and see how countries that spend less per head than the UK have better survival rates for strokes, cancers and heart attacks you realise that the NHS model may not be fit for the 21st century and the blind defenders of the NHS that refuse to acknowledge its shortcomings and just demand more money are the health service equivalent of Luddites.


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## MarkDennehy (16 Jan 2017)

Bit dangerous to go too far on either side of that pendulum swing though Fitzroy; there's an internet meme that goes around every few months, it's some kid on a tricycle mid-jump, saying "back when we were kids we did all these things that now are too dangerous, woooo....". 

Thing is, the CSO (the statistics office in Ireland) releases mortality rates regularly here and someone looked it up. The child mortality rate (not _infant_ mortality, which is strongly tied to maternal hospital care levels and so on, but child mortality, meaning basically toddler to teenager) back when we did all that fun stuff, was ten times what it is today. 

I mean, there's being a worrywort, and then there's being ten times more likely to have to buy a small white coffin. So these days, I see that meme and I honestly think _"y'know lads, I think you're forgetting some of the other stuff that went on back then..."_


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## RogerS (16 Jan 2017)

Inoffthered":r6hr2twk said:


> .....
> Brexit will be a success.



:-"


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## RobinBHM (16 Jan 2017)

To go back to the OP's point about A&E visits, whatever the cause, there is no doubt the result is that A&E departments are really in crisis. 

Working in A&E deparyments must be very stressful and tiring, so It is terrible that staff face abuse from drunk people. 

I see there is a campaign to make attacking medical staff a criminal offence (GEMS guard medical emergency staff)

http://www.lbc.co.uk/radio/presenters/n ... -campaign/


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## Jacob (16 Jan 2017)

Inoffthered":3az8jh3e said:


> Jacob":3az8jh3e said:
> 
> 
> > phil.p":3az8jh3e said:
> ...


So what's you solution then? Sell it to Branson? Or Tesco?
NB defenders of the NHS are not blind, or stupid.


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## RobinBHM (16 Jan 2017)

Its too late Blair and Brown sold most of it years ago


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## Fitzroy (16 Jan 2017)

MarkDennehy":3815qwod said:


> Bit dangerous to go too far on either side of that pendulum swing though Fitzroy; ..., shortened see above for full quote
> 
> I mean, there's being a worrywort, and then there's being ten times more likely to have to buy a small white coffin. So these days, I see that meme and I honestly think _"y'know lads, I think you're forgetting some of the other stuff that went on back then..."_



Oh I agree, it's not obvious, I just don't think you can separate the perception of service and success, from the social norms of the time. We want more, quality, service levels, rigour, investigation, etc etc that drive down illness, mortality etc etc but there seems to be an expectation we can have it at the same cost per head normalised for inflations yadiyay as in the day when far fewer people made 70, 80, 90 etc. 

F.


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## finneyb (17 Jan 2017)

It is important to differentiate between the NHS as a Healthcare system and the NHS as the provider of care - there is a difference . 

The NHS as a healthcare system is the best by far ie the compulsory insurance premium we all pay thro income tax does spread the load and is the most cost effective from an administrative viewpoint. I was watching CNN the other night about Obama's time in Office - Joe Biden, US Vice President, recently lost his 46 years old son to cancer - Michelle Obama offered to pay his medical bills if that would help. Do we want ill people to have financial worries as well as health worries? Our healthcare system is the best by far.

The NHS as a provider of care eg GP, Hospital etc is a mixed bunch, and so are the equivalents in US and other countries. We need to be careful that the press headlines eg delayed transfer to care actually applies to your locality - I'm told that locally we don't have a major problem in that respect, but of course only bad news gets a mention when the Press want to sell newspapers or cable subscriptions.

BBC Radio 4 prog NHS and Productivity http://www.bbc.co.uk/programmes/b087rx6b is worth listening to it shows that there are moves a foot to get more efficient - the NHS as a care provider like any other non-health organisation can improve. Does the organisation you worked in get it right all the time - none I worked in ever did!

Brian


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## Inoffthered (17 Jan 2017)

Comparison of the spend per head is meaningless in isolation. When you compare outcomes and see how countries that spend less per head than the UK have better survival rates for strokes, cancers and heart attacks you realise that the NHS model may not be fit for the 21st century and the blind defenders of the NHS that refuse to acknowledge its shortcomings and just demand more money are the health service equivalent of Luddites.[/quote]So what's you solution then? Sell it to Branson? Or Tesco?
NB defenders of the NHS are not blind, or stupid.[/quote]


Oh dear Jacob I suggest that you re-read my comment. No where did I say that the defenders of the NHS were stupid but that is your tactic when you have no cogent argument, ascribe insults that were never made. It really is rather juvenile you know.


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## RogerS (17 Jan 2017)

I come back to my earlier post about nearly a quarter of the NHS budget being set aside/used for negligence claims. Is the NHS that bad? I don't think so. Are large sections of the population money-grabbing chancers ? Most certainly.


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## Phil Pascoe (17 Jan 2017)

A cousin when asked when he decided to become a lawyer replied that it was the day after his brother decided to become a doctor.


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## finneyb (17 Jan 2017)

RogerS":ak5kzcbv said:


> I come back to my earlier post about nearly a quarter of the NHS budget being set aside/used for negligence claims. Is the NHS that bad? I don't think so. Are large sections of the population money-grabbing chancers ? Most certainly.


25% of the NHS budget for negligence claims - I don't think so !! NHS Litigation Authority costs, including the payment of claims is £2.6bn ie 2.5 % of the budget - someone got the decimal point wrong????
See NHS Litigation Authority Annual Report page 87 which is below http://www.nhsla.com/aboutus/Documents/ ... 014-15.pdf 

2.5% while regrettable is reasonable for any organisation, people need to be compensated if they suffer a loss.
NHS Budget is approx. £ 115bn

Brian


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## RogerS (17 Jan 2017)

Sorry Brian but you are looking at the wrong figures. I did not say 'expenditure' and neither did the article I linked to.

The fact is that they have *set aside* £26 billion for claims and potential claims. Here it is in their financial figures.





When I originally posted I should, of course, have added "....and ambulance-chasing parasitical lawyers."


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## MarkDennehy (17 Jan 2017)

They can't be setting that much aside every year though, that's got to be the overall fund. Otherwise they'd be sitting on trillions of pounds in "rainy day" money...


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## Phil Pascoe (17 Jan 2017)

In all kinds of different situations, I wonder how much money would be saved if people were just allowed to say "sorry!". Quite often that is all the wronged person wants, but because of protocol, insurances etc. it has become the unutterable word. Countless times over the years I've read or seen reports of people giving damages cheques to charity, saying all they wanted was for someone to admit negligence and apologise.
After all, if you ARE guilty your insurance is going to get caned anyway.


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## bugbear (17 Jan 2017)

RogerS":2g4krc5k said:


> Sorry Brian but you are looking at the wrong figures. I did not say 'expenditure' and neither did the article I linked to.
> 
> The fact is that they have *set aside* £26 billion for claims and potential claims. Here it is in their financial figures.



What period does that cover?

BugBear


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## Jacob (17 Jan 2017)

> > Inoffthered":131w374t said:
> >
> >
> > > Comparison of the spend per head is meaningless in isolation. When you compare outcomes and see how countries that spend less per head than the UK have better survival rates for strokes, cancers and heart attacks you realise that the NHS model may not be fit for the 21st century and the blind defenders of the NHS that refuse to acknowledge its shortcomings and just demand more money are the health service equivalent of Luddites.
> ...


"blind defenders of the NHS" is an insult is it not? It implies we are stupid.
We are neither. 
Yes there are shortcomings (with all and every organisation) but we don't believe the system is fundamentally flawed in the way you describe. 
We do think that there is a lot of pressure to believe it is broken (just look at some of the posts above) to ease the process of running it down and privatising it.


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## Sheffield Tony (17 Jan 2017)

Jacob":gdzx8x62 said:


> "blind defenders of the NHS" is an insult is it not? It implies we are stupid.
> We are neither.
> Yes there are shortcomings (with all and every organisation) but we don't believe the system is fundamentally flawed in the way you describe.
> We do think that there is a lot of pressure to believe it is broken (just look at some of the posts above) to ease the process of running it down and privatising it.



I think you'd also need some blind spots to support privatisation.

Whatever the inefficiencies of the NHS, privatising so that we can create a career for a whole tier of health insurance peddlers driving BMW's and wearing snappy suits surely can't be the best answer for most of us. There are enough of those guys living off our private pension pots.

I also seriously doubt that any privatisation of the NHS would lead to any significant drop in our tax bills either. Someone else will have it.


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## stuartpaul (17 Jan 2017)

RogerS":15a2nr30 said:


> Sorry Brian but you are looking at the wrong figures. I did not say 'expenditure' and neither did the article I linked to.
> 
> The fact is that they have *set aside* £26 billion for claims and potential claims. Here it is in their financial figures.
> 
> ...


Not sure what point you're trying to make Roger? The article you linked to showed a large set aside for 'current and future claims' and showed £1.6 bn paid in the last year. This isn't 25% of the budget is it? 

I seem to remember from my time in local government that the set aside process could lead to to high headline figures but these were in effect pro rata year on year so not one massive hit on an annual budget. Clearly £26bn would be unsustainable.

Incidentally, - you missed the 'scum sucking, bottom feeders' bit off your ambulance chasing quote!


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## bugbear (17 Jan 2017)

Jacob":2ejs2d1o said:


> "blind defenders of the NHS" is an insult is it not?



You are quite right to pick Roger up on his use of loaded language and implied insults.

We cannot let such poor behaviour pass on this forum.

By anyone.  

BugBear


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## Phil Pascoe (17 Jan 2017)

Yup. Get him up on a hate crime.  

I do think that all the people who think civilisation will end if any of the NHS is privatised should stop to find out how much of it already is.


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## Jacob (17 Jan 2017)

phil.p":bixhgxsp said:


> Yup. Get him up on a hate crime.
> 
> I do think that all the people who think civilisation will end if any of the NHS is privatised should stop to find out how much of it already is.


Plenty of info out there not hard to find:
http://www.nhsforsale.info/privatisation-list.html
https://www.theguardian.com/society/201 ... utsourcing
http://www.nuffieldtrust.org.uk/our-wor ... 0wodbGEEmA


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## RobinBHM (17 Jan 2017)

indeed, private finance initiative:

_The modern PFI is the child of John Major’s Conservative government, but it was adopted and thrived under Tony Blair and Gordon Brown. Between 1997 and 2008, 90 per cent of all hospital construction funding was under PFI agreements, which paid for 75 per cent of all hospitals built._


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## RogerS (17 Jan 2017)

stuartpaul":3midxpsd said:


> RogerS":3midxpsd said:
> 
> 
> > Sorry Brian but you are looking at the wrong figures. I did not say 'expenditure' and neither did the article I linked to.
> ...



I think the point is that this is money sitting in the bank when it could be used for front-line health care.


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## MarkDennehy (17 Jan 2017)

RogerS":k84hyb6y said:


> I think the point is that this is money sitting in the bank when it could be used for front-line health care.


My car insurance money could be paying for petrol too, but that's not a wise way to do things because it allows for no mistakes or accidents whatsoever.


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## RogerS (17 Jan 2017)

MarkDennehy":32zqc8da said:


> RogerS":32zqc8da said:
> 
> 
> > I think the point is that this is money sitting in the bank when it could be used for front-line health care.
> ...



And is also illegal to boot !


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## MarkDennehy (17 Jan 2017)

RogerS":2xngnio1 said:


> MarkDennehy":2xngnio1 said:
> 
> 
> > RogerS":2xngnio1 said:
> ...


Well, yes, but it's illegal just in case some people decided they'd be unwise "because they're really, really, really like, GREAT drivers, like, the best".


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## stuartpaul (17 Jan 2017)

RogerS":vbtcjjqo said:


> stuartpaul":vbtcjjqo said:
> 
> 
> > RogerS":vbtcjjqo said:
> ...


But it isn't 'sitting in the bank'. The £28.6bn reported in the NHS LA annual report and accounts for 2014/15 (http://www.nhsla.com/aboutus/Documents/ ... 014-15.pdf) is their net liabilities not what they have in the bank. An important difference.


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## Phil Pascoe (17 Jan 2017)

So it's worse???


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