# Discussion on today's 1:00 news



## graduate_owner (6 Jun 2017)

Just listening to a discussion on the BBC news at 1:00. regarding NHS funding between a doctor and a retired doctor. This retired doctor stated - this issue of a shortage of hospital beds is nonsense. People don't want to be in hospital, they want to be back in their own homes. ( Not verbatim)
I thought that was just unbelievable. We don't need more beds? Closing wards is not a problem? What about people having to stay in ambulances because there are no beds for them? What about people having to wait far too long for emergency ambulances because the ambulances are still waiting outside hospitals because of those patients still in them? And this, as I said, was from a retired doctor.

OK, rant over.

K


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## Phil Pascoe (6 Jun 2017)

I was in a bay of six people, I was lucky, I got sent home eight days after a leg amputation but two others were waiting for a bed in a community hospital. The last time I was in that community hospital I was in a bay of four - three of the four were bed blockers because the council couldn't sort their property or old people's home places out. So, yes - he is 100% correct.
We could throw the GDP of the Country at it and it would still have problems. As my consultant, a brilliant surgeon, said when I pointed out something that potentially cost the hospital £100,000s p.a. - the management don't listen to us, we're only consultants. It's badly run.


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## woodenstx (6 Jun 2017)

phil.p":f30miiic said:


> We could throw the GDP of the Country at it and it would still have problems. As my consultant, a brilliant surgeon, said when I pointed out something that potentially cost the hospital £100,000s p.a. - the management don't listen to us, we're only consultants. It's badly run.



Agreed.
Likely it needs more money to keep it moving, but the major issue is you could give it all the money in the world and it would still function exactly the same as it does right now (allbeit with more managers taking the pish)


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## DoctorWibble (6 Jun 2017)

Bed blocking is a growing problem but that doesn't mean it cant be fixed. Care outside the NHS falls to family and to local authorities and for a variety of reasons neither are able to step up in the way they used to. The second could be fixed at least. If the electorate are bothered enough to vote to fund it.


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## Phil Pascoe (6 Jun 2017)

All necessary care should be funded by the NHS - it would stop the wrangling on who should pay for what - one Trust and another, one trust and the local council. I left hospital without a cushion on my wheelchair because the wars manager decided the other hospital should pay for it - that's how petty it gets. Imagine the wrangling about a month or months long stays.

Wars manager...probably a good title, but I meant ward manager.


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## deema (6 Jun 2017)

I believe there are a number of issues, some of which are highly controversial.

The population is aging, operations are now being carried out in people over 80 that a few years would never have been done as it was too risky. Most admissions to hospitals I understand are for the elderly. With the population predicted to have an ever older profile and will have more people retired than working it's likely to be a situation that no party can resolve.

There is a lack of doctors and nurses due to a reduction in places at teaching hospitals a number of years ago. This will take time to fix as it takes a number of years to train people. There are lots of beds, the wards didn't disappear just closed / moth balled!

The care needed for when a person can leave hospital is in short supply causing bed blocking. Relatives / family in general no longer feel any obligation to look after their family as they once did, preferring to live their lives and have the state provide. Care homes and care at home is expensive and with the prospect of people being charged higher levels is likely to push people into 'staying 'in hospital longer.

The culture of blame and litigate has created a lot necessary paperwork that didn't previously exist. It also depletes funds fighting spurious claims.

The cap on pay for civil servants has created an artificial market that isn't attractive for highly talented managers. It's very popular to blame 'fat cat' managers however, few people understand the complexities or could manage a £1+ billion budget and 20K staff. The size of a large trust. That's larger than most FTSE 100 companies, the directors of which earn a factor of at least 10 more than a typical NHS CEO. Most people don't seem concerned about what a foot ball player or pop star earns, but god help anyone earning more than £140K in the NHS. The result of this artificial market is that the best most talented people will naturally go for the appropriate reward....,the private sector. It's a global market for those who have talent. Foot ball players move to clubs around the world that pay the most, so do highly creative, value creating managers. 

There is a lot of money about that could fix most of it. Overseas aid is massive, and it's a decision to increase it that was made a few years ago that was missed by most in the manifesto that included it. The proliferation of government to meet the aspiration of local accountability carries a high cost. The UK has four parliaments (London, Ireland, Wales, Scotland), and the introduction of local Mayer's is also being rolled out.


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## Jacob (6 Jun 2017)

phil.p":21nlno2h said:


> All necessary care should be funded by the NHS - ...


We aren't even high spenders compared to the rest of Europe. The yanks pay even more per capita for their very ineffective medicare set-up, being demolished by Trump.
To keep up we need to spend more and tax more. The money goes around the economy, businesses benefit, we employ more and we have better health - it's a no brainer.


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## DoctorWibble (6 Jun 2017)

deema":1nnw81wa said:


> The culture of blame and litigate has created a lot necessary paperwork that didn't previously exist. It also depletes funds fighting spurious claims.



Dead right. I've never understood why someone doesn't simply propose legislation to grant all public services -NHS, Schools etc blanket immunity from the ambulance chasers and opportunists.

Its not just the claim costs it's that hospitals and schools are now obliged to document every action to a standard that withstands potential scrutiny in court. An insane waste of time and money and a great way to erode staff motivation. If I had to diarise my every move I think I'd simply stay in bed.


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## pip1954 (6 Jun 2017)

Hi my wife spent time in hospital, and on her ward there was her and three other elderly lady patients who could not go home and had no other place to go ,where is all the after care now .
I to was in hospital recently and there where a lot of people stuck in hospital waiting for local authorities to sort out places for them to go , you are to well to be in hospital and to I'll to go home, I wonder if it is after care bit that is the that is missing.? 
Every body knows how to fix we must all be experts in how to run our NHS. :lol:


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## Jacob (6 Jun 2017)

pip1954":1g661e60 said:


> ..
> I to was in hospital recently and there where a lot of people stuck in hospital waiting for local authorities to sort out places for them to go , you are to well to be in hospital and to I'll to go home, I wonder if it is after care bit that is the that is missing.?
> E...


Yes definitely - it's been talked about at length. They are called 'bed blockers' - people ready for discharge - still in need of care but having nowhere suitable to go. The system isn't joined up. The NHS should cover ALL care so that these bottle necks are taken out.


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## RogerS (6 Jun 2017)

Jacob":8wxfqgg8 said:


> phil.p":8wxfqgg8 said:
> 
> 
> > All necessary care should be funded by the NHS - ...
> ...



Anyone reading that statement would think that there was a huge disparity between our expenditure and the rest of Europe. In fact the truth is that there is only a marginal difference which the OECD figures show.


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## DoctorWibble (6 Jun 2017)

pip1954":16z6sjun said:


> ....where is all the after care now ?



Local Authorities always get the brunt of central gov't budget cuts. Westminster figures it can easily enough duck the blame for any consequences. They've been playing that game since at least the early 1980's. And of course the cost of anything that needs physical space (eg residential elderly care, high speed railways) has gone through the roof along with house prices. Voters it seems rarely join the dots.


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## AJB Temple (6 Jun 2017)

Very erudite post from Deema I thought. With an ageing population, UK headcount growing, and all the other factors mentioned, it is a very difficult problem. There is a left wing media / political tendency to say put more money in. Tax the rich etc. It is beyond naive. The top 1% of earners pay 40% of all income tax. The top 1% of earners are the most mobile and the most desirable in other countries. 

Slice the top 5% of earners and you have covered the vast bulk of all income tax based funding for the entire population.


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## Phil Pascoe (6 Jun 2017)

DoctorWibble":dr0udm60 said:


> deema":dr0udm60 said:
> 
> 
> > The culture of blame and litigate has created a lot necessary paperwork that didn't previously exist. It also depletes funds fighting spurious claims.
> ...



I had a charming young lady doctor come to tell me that I had been put on a supplement as my kidneys weren't functioning properly. My heart sunk, my wife said J. wept, as if you haven't enough problems. Two days later the doctor came back and said cheerfully your kidneys are fine, actually ... we were looking at someone else's notes.
I hung her out to dry by mentioning it when she was with my consultant, whom I know quite well - I knew she'd suffer for it, but the girl made a mistake. It wasn't the end of the civilised world, but she must have thought oh, god, here we go, then been glad of a bolllocking. I know many who would have sued.


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## Phil Pascoe (6 Jun 2017)

Jacob":433hoqpj said:


> phil.p":433hoqpj said:
> 
> 
> > All necessary care should be funded by the NHS - ...
> ...



I wasn't making any political point about funding, merely pointing out that everything would run better if paid for from a central fund, rather than different hospitals, trusts and local authorities.


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## Phil Pascoe (6 Jun 2017)

Thinking about Deema's post - I was in hospital with a seventy nine year old man who'd had what they call a "hind quarter amputation" (the whole leg taken at the hip). I wondered whether he should have been allowed a comfortable death. Maybe he would have liked one ... but that's a no no.


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## finneyb (6 Jun 2017)

phil.p":16p09i1m said:


> Thinking about Deema's post - I was in hospital with a seventy nine year old man who'd had what they call a "hind quarter amputation" (the whole leg taken at the hip). I wondered whether he should have been allowed a comfortable death. Maybe he would have liked one ... but that's a no no.




Dangerous ground, but I agree with you. I'm fit and well for the moment but have been looking at euthanasia for the future. Basically , I want control and I also want the doctors to have one thing on their mind - keeping me alive - I want to decide when to go.

Looking on the Exit and similar websites it seems the drug of choice is Nembutal - a barbiturate cocktail. One Australian has suggested that everyone over 70 years should be given a bottle to keep in their drug cupboard. While I accept the simplicity of the concept I can well imagine some less than nice relatives suggesting that I take the drug so that they can benefit. 

Seems that Nembutal elixir has a shelf life of 20 years - the basic problem is getting hold of it and also knowing that it is what's on the label and not coloured water. Of course, I wouldn't tell anyone I had it.

Brian


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## RogerS (6 Jun 2017)

There is also the unfortunate side-effect of some of the ageing population having expectations beyond current medical capabilities. Years ago, they would have been dead due to all the various illnesses and infirmaties that, at that time medical science couldn't easily fix. Now, those have been fixed but the body is still ageing. The reality is that medical science cannot do anything to help. Or if they do, prescribe drug A (usually to shut up the patient) which then reacts with drug B and so on. 

And I know that some of the elderly treat the visit to the GP or hospital as a social occasion. Yes, they are lonely. Possible that offspring are at the other end of the country or even abroad. But still, some of the elderly carve out a network of friends and so have their own support network. And others keep calling 999 crying wolf. Very, very complex.


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## RobinBHM (6 Jun 2017)

I think its time to take the NHS out of party politics. 

Parliament has 5 year max time spans, the NHS needs a long term plan that is independant of it being a party political football.

Medical advances has meant increasing cost of cspital investment, new skilled staff needed to use the technology and an ever increasingly aged population combined with an increasing population.

Private Finance Initiatives have financed new hospitals but has lead to big loan repayments soaking up NHS money.

The bed blocking issue is also a huge problem. Ive seen this myself with a parent in hospital long term. Social services do anything they can to avoid agreeing to continuing care as its funded by a hospital trust, as its money thats paid out to a third party, even though the cost of keeping somebody in hospital is far more expensive, but the cost doesnt show as its already in the cost and cant be avoided.

At some point free at the point of entry cant continue. Also nursing and home care help has to be funded properly. Its a contoversial subject, but it needs to be discussed.


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## Phil Pascoe (6 Jun 2017)

Another problem - it is said of our local large hospital that if you don't have an infection when you go in, you'll have one when you come out. This is why my consultant says the last he wants his patients is in hospital. That's why I was home eight days after a leg amputation.


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## iNewbie (6 Jun 2017)

phil.p":1qrzp5ka said:


> Another problem - it is said of our local large hospital that if you don't have an infection when you go in, you'll have one when you come out. This is why my consultant says the last he wants his patients is in hospital. That's why I was home eight days after a leg amputation.



Its the same for all hospitals, Phil. Old people are more susceptible to infections. The heatings always up - a breeding ground for germs. And for some who just stay in bed its a chance for pneumonia. 

My dad had Prostate cancer - terminal stage. He had a fall, and a few months later contracted hospital acquired pneumonia. He went in a walking man. He wasn't after 6 weeks in bed - they say for every week in bed you lose a months fitness. The consultant wanted him out, too. 

I do voluntary work in my local, 2 days a week - I visit the majority of the wards. Its full of old people.


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## Phil Pascoe (6 Jun 2017)

I've had double pneumonia twice, I've had the jab now. They haven't yet come up with a jab for the MRSA, though.


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## DoctorWibble (6 Jun 2017)

In my younger days I worked as a hospital porter. In a few hospitals but the one that stands out was Springfield mental hospital in Tooting. Been demolished now I think. Anyway there were a few very old patients there who (I was told) had come as orphan children. At the time there was presumably nowhere else to put them (no-one any longer really knew) They stayed, became institutionalised, eventually became actually mentally ill and permanent life long residents. Easy to imagine the original hospital administrators trying to move them on, to a church run orphanage or maybe a workhouse, but struggling to find anywhere with room. I often used to wonder about how they came to give up looking. It only really makes sense if they always had loads of similar cases, more than could ever be moved on.

I hope we never give up on our welfare state. Its bonkers to simply roll over and accept the argument that we cant afford what we clearly could afford in the less wealthy 1960's and 1970's. Its just a question of priorities, not affordability.


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## Jacob (6 Jun 2017)

RogerS":31xk0bdi said:


> Jacob":31xk0bdi said:
> 
> 
> > phil.p":31xk0bdi said:
> ...


We are 6th out of the G7. Italy spends less. America spends far more but is grossly inefficient.
http://visual.ons.gov.uk/how-does-uk-he ... ationally/


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## finneyb (6 Jun 2017)

We can't use spend as a measure. The more you give the NHS the more they will spend, same as any other organisation.

Neither can we use life expectancy as a measure - the measure must be quantity of quality of life. 

But, I'm not sure how we assess quality of life, or even if we can.

So any comparison is useless. 

Brian


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## Jacob (6 Jun 2017)

finneyb":31mga3uu said:


> We can't use spend as a measure. The more you give the NHS the more they will spend, same as any other organisation.
> 
> Neither can we use life expectancy as a measure - the measure must be quantity of quality of life.
> 
> ...


It's possible to assess usable measures of 'quality of life' and then put a cost to it. Lot of variations and inconsistencies of course but thats how it is, but still useful, even if not exact.
https://en.wikipedia.org/wiki/Quality_of_life

PS that link actually very interesting- it's an important subject and affects all sorts of decisions about how we regulate or invest in the world around us.


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## Phil Pascoe (6 Jun 2017)

Quality of life? I remember coming out of Wilkinsons one afternoon and seeing something that both me and my loved one thought funny - we just and split our sides laughing. I was in a wheelchair though then I had only lost one leg, when a very sad looking woman passed us going the opposite way. She shook her head as she passed and said I don't know what you can find to laugh about, you've only got one leg and you're in a wheelchair. My friend, a GP, said I should have told her to foxtrot oscar, but I just felt very sorry for her. You cannot sat say what other people have or haven't in the way of quality of life or happiness.


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## Dusty (6 Jun 2017)

I think there could be less of a problem , not totaly as every system has faults . 

from 2010 to 2014 I was involved and ran several large construction projects on several hospitals . one being my local . The more I did the more I saw money literaly being peed down the drain . I wont mention the hospital as it could get complicated but . We were there to install a "facility" that would carry out services normaly subbed out . It was a 1.5m project and was designed to not only deal with their own needs but to also provide the same service for other local trusts . The facility was functional and where it was located 90% of people would never notice it . On the outside they were determined to have multi coloured panels 3 foot square at a cost of £400.00 each , around 20 of them . the list was endless of the special requests of managers for fittings and not functional design elements that serves no purpose . The more I was involved the more I was pricing and seeing the waste . After hearing from some one I got to know , it has made very little £ difference to the hospitals budget . The money that was wasted , would of paid for several nurses for quiet some time . 



As for bed blocking , I was unfortunately in hospital around 12 years ago I was admitted on the wednesday , the doctors would make an am and pm visit . On the friday when I was due to be discharged a temp doc came round and declared he wasnt prepared to send me home as he was just taking home and that I would have to wait until monday . I felt fine and wanted to go home . Needless to say I discharged myself within an hour . I could of stayed but when a bed costs around £1000 a day , why waste it , and no doubt someone else was more in need of it . If a doctor or doctors were stationed to wards permanently maybe people could be sent home when needed , not when their shifts dictated . i am not talking about the middle of the night , there is 8 to 12 working hours in a day and people dont come into the hospital only between 9 and 5 . 

There is alot things to be looked at , but it is not the frontline staff's fault , it is the holders of the purse strings . I can vouch for that as my partner is a student nurse ( 3rd year ) and she has already made it clear she will never work on a ward in a main hospitals as when she has been on shift , they work like trojan horses ,to make up for the lack of staff . As a second year student she was on a day shift and was given 18 people , two wards who were her responsibilty . that is not only bad but moraly wrong . 

ta ta


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## mailee (6 Jun 2017)

I think the NHS is just the same as most large companies on the aspect of how they are run. Top management and the decision makers just have no idea what goes on on the shop floor. Their decisions are based on figures and plans which have no correlation to the actual work that goes on. They will mostly employ an outside company to work out the best way to run the business and spend thousands for them to come up with a system that is of no use. I have worked for a few large companies who work this way and have the ability to waste thousands of pounds on systems that just do not work. None of them ever think to ask the workforce for their opinion on how to improve or if they do they then take no notice of them! A good example is the company I now work for have made all of the supervisors re-apply for their jobs, half of them are very good at the job and have done it for years but are not so good at interviews. The other half are very good at interviews and can talk a good job, i imagine you can guess the half that got the jobs! All because someone decided to use the HR department for the interviews and not the managers on the job who know their men. :roll: Apparently they intend to spend £50,0000 on us this year but I wonder just how much of that will improve the company and how much will be wasted as usual?


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## thetyreman (7 Jun 2017)

lol won't be long before this is locked down :-"


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## Phil Pascoe (7 Jun 2017)

Only if idiots start posting in it.


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## RogerS (7 Jun 2017)

Jacob":347rmogv said:


> RogerS":347rmogv said:
> 
> 
> > Jacob":347rmogv said:
> ...



No-one is disagreeing. But the European difference is only marginal.


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## Jacob (7 Jun 2017)

RogerS":9hllxmm1 said:


> Jacob":9hllxmm1 said:
> 
> 
> > RogerS":9hllxmm1 said:
> ...


We are actually quite low spenders in terms of proportion of GDP


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## RogerS (7 Jun 2017)

Jacob":2hym02zs said:


> RogerS":2hym02zs said:
> 
> 
> > Jacob":2hym02zs said:
> ...



And so are others. But we are going round in circles here.


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## deema (7 Jun 2017)

The obvious is almost always obviously wrong is an adage that I had drummed into me many years ago. There are a lot of opinions on what should be done that is based on opinion and sound bites. Very very few of us are actually in a position where we understand the problem and can start to contribute to finding a solution. By example, the introduction of a scaled stamp duty was in general a very popular move to generate additional funds. It affects the 'wealthy' and doesn't really hit the average 'house', or at least that was how it was sold. The effect has been that revenue generated by the government has decreased since its introduction. Why, well the majority of the income was generated from the South West / higher value Homes, these people tend to be more mobile as they change their job more often / aspire for a better home. The increased tax has reduced mobility (sale of the higher value houses) and the affordability to move / upgrade people's homes. It's has therefore reduced the trickle of houses down for first time buyers, as well as reducing the funds available to be spent on for instance the NHS.

As a further example, looking at the changes to raise money from landlords who have had most of the tax perks removed, has this affected the revenues to the government, yes it has. Another popular move to stop the greedy grabbing landlords exploiting the vulnerable. However, the consequence is that landlords still want the same return in order to make their investment viable. Demand for rental property remains high......so the level of rents demanded are increasing compared to a few years ago. Those who are in rental accommodation, typically the young and those on lower incomes are now being squeezed further and actually paying a higher proportion of their income to the government. Did anyone see that coming?

The more your worth the more optional paying tax becomes. You can at a certain wealth level move to say Monaco if and enjoy a tax regime that means that you don't need a clever tax accountant to shelter your wealth. Although extremely controversial reducing tax rates, there are enough countries that operate a flat rate tax of say 15% to prove that what in fact happens is that lower taxes increase government revenues. I can't believe any party will propose to reduce taxes down to a flat rate of 15% to support the NHS.....no one would believe it was possible and would in fact alienate the majority of the normal working populous that put them into power.


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## Farmer Giles (7 Jun 2017)

graduate_owner":3grwucm7 said:


> Just listening to a discussion on the BBC news at 1:00. regarding NHS funding between a doctor and a retired doctor. This retired doctor stated - this issue of a shortage of hospital beds is nonsense. People don't want to be in hospital, they want to be back in their own homes. ( Not verbatim)
> I thought that was just unbelievable. We don't need more beds? Closing wards is not a problem? What about people having to stay in ambulances because there are no beds for them? What about people having to wait far too long for emergency ambulances because the ambulances are still waiting outside hospitals because of those patients still in them? And this, as I said, was from a retired doctor.
> 
> OK, rant over.
> ...



I'm on the train so haven't read the whole thread so somebody else may have pointed it out. The retired doctor is a fully paid up member of the tory party and has links to private healthcare. Hardly impartial, but the BBC represents him as such.


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## Phil Pascoe (7 Jun 2017)

You didn't see the whole interview - it was virtually apolitical. The retired surgeon told of a lifetime in medicine and the junior doctor told him how wrong he was.


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## Farmer Giles (7 Jun 2017)

Thanks Phil, I didn't see the interview, just heard that the BBC didn't mention his affiliations, I think all interests of interviewees should be known so their opinions can be put into context. Good to here there was some balance with a junior doctor there but I do worry about impartiality given that the head of BBC news is ex-Murdoch and he is one of George Osbournes best buddies and the political editor is clearly not impartial. Channel 4 news seems to bash both sides more evenly I find.

I forgot to mention that my father has had a couple of strokes over the last 3 months so I have been dealing with several hospitals and now the care system as he is not going to recover sufficiently for my mother to look after him. The NHS is fantastic but needs funding properly, with the funding going to care not to third party profit margins in my opinion. I work for a US company and my US colleagues without exception would love to have the NHS, but we are heading in their direction which is expensive and elitist. I will stop there!


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## RogerS (7 Jun 2017)

Elitist....as in the elite sending their children to private schools, perhaps ? Like Diane Abbot, for instance :-"


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## Farmer Giles (7 Jun 2017)

RogerS":3m0xjr4h said:


> Elitist....as in the elite sending their children to private schools, perhaps ? Like Diane Abbot, for instance :-"



No, just people below a certain income level not being able to afford health care.


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## HappyHacker (7 Jun 2017)

I know a retired senior NHS consultant, he took early retirement as he felt he was being forced to perform unnecessary operations on patients in order to meet waiting time targets. He believed he was committing assault on the patients. He took early retirement and this coupled with the politics of the NHS made him unwilling to continue.

I know of a senior consultant (another one) who joined new hospital. He went to the Chief Executive's office and asked for an appointment to see the CE. The CE's secretary said yes and organised an appointment for Wednesday. On Tuesday the consultant got a call saying the CE could not make Wednesday and his next available appointment was three months away. Three months later the consultant turns up to see the CE. In the office are a few people and the CE introduces himself and the others: Head of legal, Head of Nursing, Personnel Director, Head of Publicity, head of strategy, and a couple of others who's titles cannot remember. The CE then said "well Mr xx how can we help you" to which the consultant said "Thank you for getting all the team together, I just wanted to meet you so that if a met you in a corridor would know who you are. Now I know all the management team". From another source he learnt that in the intervening three months the management team had had endless meeting to discuss what the consultant was going to ask/complain about and they had discussed the patients who he may want to complain about and what they would jointly give as answers. Why the hospital did not have an induction programme for the senior medical staff that would have included meeting the management is unclear and why they could not have simply asked him what he wanted to talk about?

A the same hospital a consultant was suspended after one of his patients died of a pre-existing condition that was outside the consultants speciality. After three external enquires into the consultants treatment of the patient, all of which said the consultant had done everything possible, the consultant was still suspended by the hospital. Presumably to cover up the lack of care provided by the medical team who should have been treating the patients problems. A few years later the consultant resigned, while still suspended, as he did not feel competent to operate any more.

With so many example of senior management taking redundancy or payments to leave following mismanagement, who then get better paid jobs in other trusts it is no wonder that there are problems. While more money would help in a well managed organisation I do not think it is the main answer for the NHS.


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## Jacob (7 Jun 2017)

RogerS":2sa3xi1q said:


> Elitist....as in the elite sending their children to private schools, perhaps ? Like Diane Abbot, for instance :-"


She's been retired due to ill health. But yes I agree - sending your kids to private schools should be a sackable offence for a Labour politician.


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## Farmer Giles (7 Jun 2017)

My neighbour is a recently retired pediatrician, he will regale you with many stories about funding issues and also the way the NHS could improve. The truth is that each hospital or group of hospitals are not representative of the whole of the NHS and decisions like opening up the NHS to the market hasn't achieved efficiencies they promised, this is an informative read

We are not going to solve it here but selling off the assets for a one off capital injection at a cost of 10 Billion to the tax payer and farming out services to third parties is not going to solve them either. In my experience in business outsourcing = mediocrity + higher costs. For every bad story about the NHS I hear many good ones, but they are usually repressed as they don't promote the agenda. My father has had fantastic care.


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## Phil Pascoe (7 Jun 2017)

A few more for sacking? Thornberry and Milne sent their children to selective schools (as did Bliar before them), and Sham Chakrabarti sends hers to a private one. Even the supposed arch socialist . Galloway had his privately educated. But they're different, you see. Special. Their needs are not the same as my children or yours. The shadow education minister didn't even take A levels. You couldn't make it up.

FG - some things are better outsourced - why would anyone presume e.g. that a hospital manager could run an efficient large laundry?


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## RogerS (7 Jun 2017)

Segueing ever so slightly sidewards, I predict that the turnout for tomorrow's election will be one of the lowest for years.


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## Farmer Giles (7 Jun 2017)

phil.p":3tko5tfo said:


> A few more for sacking? Thornberry and Milne sent their children to selective schools (as did Bliar before them), and Sham Chakrabarti sends hers to a private one. Even the supposed arch socialist . Galloway had his privately educated. But they're different, you see. Special. Their needs are not the same as my children or yours. The shadow education minister didn't even take A levels. You couldn't make it up.
> 
> FG - some things are better outsourced - why would anyone presume e.g. that a hospital manager could run an efficient large laundry?



On schooling, if my local comprehensive has been underfunded so the buildings are damp, crowded and not attracting good teachers, like it is, then I will seek better schooling for my kids, but I would prefer to use the local comprehensive. As a parent I will look after my kids interest first, it doesn't mean I don't support a decent level playing field for all kids, we need the brains of all the gene pool in our future, not just the genes of people who can afford to send their kids to decent schools.

Totally agree on the laundry, but not front line nursing staff, all you get is more cost, less money spent on care as you are paying for one or sometimes two profit margins, less training, less accountability and more complex management.


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## RobinBHM (7 Jun 2017)

It seems that France and Germany have good models for healthcare.

3 things stick out to me:
-healthcare is a ring fenced tax
-flexible boundaries between state and private systems
-more is spent per %gdp

Germany of course has a fantastic economy with a surplus.
France and Germany have highly regulated employment and taxation systems which somewhat stifle investment from foreign companies.
Germany has almost no waiting times for healthcare

extract from article in the Daily Mail (yes I know! but still quite a good article)

The superior performance of health services in France and Germany is not simply the result of greater public investment but owes a great deal to the evolution of a hybrid system of funding medical care.
Although Britain spends less on health than its European neighbours, the set up of health care systems in France and Germany is unencumbered by the division between private and public sector that exists in the UK.
While UK health care is firmly split into NHS and private sector care --with one being paid for by the state and the latter being funded from people's savings or medical insurance - the European model keeps the boundaries flexible.
As well as spending more on health, both France and Germany impose ring-fenced health taxes, while encouraging people to take out 'top-up' private medical insurance.
A patient is free to choose to be treated in either a public sector or private hospital, with the service being paid for either through taxes, or privately, or a mixture of both.


http://www.dailymail.co.uk/health/artic ... z4jJA5tv7h


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## Jacob (7 Jun 2017)

Farmer Giles":1noafe44 said:


> .......
> On schooling, if my local comprehensive has been underfunded so the buildings are damp, crowded and not attracting good teachers, like it is, then I will seek better schooling for my kids, but I would prefer to use the local comprehensive. As a parent I will look after my kids interest first, it doesn't mean I don't support a decent level playing field for all kids, we need the brains of all the gene pool in our future, not just the genes of people who can afford to send their kids to decent schools......


Absolutely. 
We see the worst outcome of the private education system (the fast tracking into positions of power and influence), in parliament - people like Boris Johnson who are clearly stupid, talentless and incompetent.


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## Phil Pascoe (7 Jun 2017)

Back off political point scoring - I noticed in the eight weeks I've spent in hospital in the last six months that there was scarcely a day or more often a night that someone didn't turn up for work and an agency worker was called in. Surely it's not beyond the wit of the management to overstaff one or two wards so there would be staff to draw on, instead of paying through the nose for agency workers?


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## Phil Pascoe (7 Jun 2017)

Jacob, I'm sure Boris speaks highly of you.  
Mayor of London and Foreign Minister ... not doing bad for a dimwit, is he? :lol:


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## Jacob (7 Jun 2017)

phil.p":3kketx4u said:


> Jacob, I'm sure Boris speaks highly of you.
> Mayor of London and Foreign Minister ... not doing bad for a dimwit, is he? :lol:


My whole point is that privileged background and private education helps get dimwits like him into positions of power and influence well beyond their natural ability.
Not bad for the privilege system!


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## bugbear (7 Jun 2017)

phil.p":2707tpfw said:


> Jacob, I'm sure Boris speaks highly of you.
> Mayor of London and Foreign Minister ... not doing bad for a dimwit, is he? :lol:



I don't think dimwits get scholarships to Oxbridge...

The "good old, thick old Boris" thing is a very effective act that keeps fooling people.

BugBear


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## RobinBHM (7 Jun 2017)

Boris may come across as bumbling but he is very intelligent and is very good in interviews. 

Whether one agrees with his policies is another thing!



> We see the worst outcome of the private education system (the fast tracking into positions of power and influence)



-like Tony Blair for example  

or Angela Rayner sending her children to selective school


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## Farmer Giles (7 Jun 2017)

BJ is certainly academically bright, but it takes more than that. His blustering covers his shortcomings in common sense and his duplicitous nature, his only allegiance is to self aggrandisement he is certainly not bothered about making the right decisions for us.


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## Jacob (7 Jun 2017)

RobinBHM":316xtgjn said:


> Boris may come across as bumbling but he is very intelligent and is very good in interviews. .....


I don't think he is intelligent. That public school sharpness of wit often passes incorrectly for intelligence. He is good in interviews sometimes. He has been appallingly awful in interviews too. Overall his contribution to the public good is severely negative.
Many of these public school whizz kids end up in politics, finance, business management, because they don't have the skills to do a proper job but they do have privileged access.


Farmer Giles":316xtgjn said:


> BJ is certainly academically bright, ....


He's had every educational privilege possible at every point in his life so he could hardly fail. But he's not that bright at all. His book on the Romans is a good read but it's childish comedy compared to serious equivalents like Mary Beard's book.
He writes like a smart-aleck public school boy who had done his homework, can spell and has a bit of a sense of humour. But not academically bright.

He's a really good example of what wealth, confidence and privilege can do for you if you have little natural ability or intelligence.

He is also the best example going of how bad the public school system is for the rest of us - we end up with idiots controlling our lives.


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## Phil Pascoe (7 Jun 2017)

:idea: get back to the NHS before the thread gets locked. It was quite sensible and interesting before it degenerated once again to politics.


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## Phil Pascoe (7 Jun 2017)

I asked why I had a 120 mile round trip and a waste of a day and an uncomfortable ride for me and a day and a day's holiday for my wife to see a specialist consultant, nurse and physiotherapist, and what they were going to do that couldn't be done locally and I got a reply stating that it might save time in the future (whose, she didn't say) and that they had had very good reports of their services. They were very concerned with customer satisfaction, and strove to improve services. Unfortunately this was sent from an email address that didn't accept replies. Some service. Some concern.


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## Farmer Giles (7 Jun 2017)

phil.p":1frywrmq said:


> I asked why I had a 120 mile round trip and a waste of a day and an uncomfortable ride for me and a day and a day's holiday for my wife to see a specialist consultant, nurse and physiotherapist, and what they were going to do that couldn't be done locally and I got a reply stating that it might save time in the future (whose, she didn't say) and that they had had very good reports of their services. They were very concerned with customer satisfaction, and strove to improve services. Unfortunately this was sent from an email address that didn't accept replies. Some service. Some concern.



"That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital." Noam Chomsky


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## Jacob (7 Jun 2017)

phil.p":3jp1rd48 said:


> I asked why I had a 120 mile round trip and a waste of a day and an uncomfortable ride for me and a day and a day's holiday for my wife to see a specialist consultant, nurse and physiotherapist, and what they were going to do that couldn't be done locally and I got a reply stating that it might save time in the future (whose, she didn't say) and that they had had very good reports of their services. They were very concerned with customer satisfaction, and strove to improve services. Unfortunately this was sent from an email address that didn't accept replies. Some service. Some concern.


Well yes and many complain of long waits for an appointment followed by long waits in the waiting room. But arguably this makes for efficiency - it guarantees that the service is used to the full and there will be no waiting for no-shows. They aren't wasting any of their time , instead they are wasting yours!
It's been improving recently for me at least - I have to turn up for a sequence of eye tests every six months but get through the system fairly quickly. It used to be really slow


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## graduate_owner (7 Jun 2017)

Well I am glad I started his thread, the responses have been interesting and informative. I wasn't suggesting just throwing more and more money at the NHS, although I suspect most people would agree that it is under funded. The issues are indeed complex, and bed blocking is a major problem. However I just could not agree with the consultant's comments that we don't need more beds when there are such problems with waiting lists. I think we definitely need more beds, whether they are created by re-opening mothballed wards or by (somehow) solving the bed blocking problem, or indeed by whatever other means may be found. It may sound unrealistic, even simplistic to make such a statement, but I feel it is all too easy for the status quo to be allowed to continue without any authority wanting to take responsibility for formulating a solution. If solving the bed blocking problem can be done by local authorities re-opening existing care facilities, building new, or taking over existing privately run ones or whatever then perhaps that is where additional funds should be directed. The effect on waiting times would not only benefit patients, but also benefit the NHS budget in that there would be less money wasted buying in private health services in order to comply with impossible targets.
Whichever political party prepared to take on this challenge would surely be on a vote winner. Just thought I would make that comment seeing as there is a general election tomorrow. I shall vote, but I have never been less inclined to do so.

K


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## RobinBHM (7 Jun 2017)

The NHS is clearly in a massive crisis.

I dont know what the solution should be and Im not sure any political party has the courage to make any manifesto pledges of any real substance because nobody knows how to solve the crisis.

Its always easy to blame the current government but I feel the crisis is a culmination of decades of underfunding, and ever increasing number of people requiring treatment. I dont think the complete separation of state and private funding helps. 

On a side note, I do wonder if the UK should reduce the foreign aid budget to direct towards combating the terrorist threat we currently face, which to me is a fair candidate for aid and it involves foreign people


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## acewoodturner (7 Jun 2017)

It seems that every new hospital built in the last few decades to replace old ones has a big percentage drop in the number of beds. Now I know that operations etc are a lot more advanced, such as keyhole etc, but it occurs to me that with a big rise in the population due to people living longer and immigration then the bed no.s need to either stay the same or increase. The other thing is financing hospitals by PFI. The payback on them is enormous and nobody in their right mind would buy a house using the same method if it was available. Combine the interest and payments and then £200 bills to change a lightbulb and its quite easy to see where all the money is disappearing to. Apparently we also have in the UK the worst ratio of managers to staff and penpushers justifying their jobs by creating red tape. The big wonder is not that why some of it is failing but the fact that some of it actually works despite the political interference from every party who has ever been in charge!

Mike


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## DiscoStu (7 Jun 2017)

I didn't think political post were allowed on the forum? 


Sent from my iPhone using Tapatalk


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## RogerS (7 Jun 2017)

Jacob":172dc7vy said:


> .....But he's not that bright at all. His book on the Romans is a good read but it's childish comedy compared to serious equivalents like Mary Beard's book.
> .....



Wow, Jacob. I didn't realise that you were such an erudite historian with a string of qualifications after your name. Please...do point us in the direction of some of your peer-reviewed theses relating to the period. I am sure that we will all learn something.


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## Jacob (7 Jun 2017)

RogerS":i4dgt8zk said:


> Jacob":i4dgt8zk said:
> 
> 
> > .....But he's not that bright at all. His book on the Romans is a good read but it's childish comedy compared to serious equivalents like Mary Beard's book.
> ...


Try reading the books yourself Roger. You can have your own opinion you know, you don't need a degree but you must be able to read! 
Is that your problem perhaps?


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## Random Orbital Bob (7 Jun 2017)

Bye bye.....


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