.

[Terry - Somerset]

Decades ago, my grandmother had a stroke. Her recovery program included rehabilitation support - 3x30 min sessions per week. To have a reasonable chance of success 2 hours per day was needed. Ultimately events took their expected course - care home then coffin.

The demand for health services is several times that which is (or can) be provided. This is driven by the illusion that all ills can be solved, and that with treatment we may live forever.

We need to be clear about the health service we are prepared to pay for. Current budgets may suffice for good quality basic health care where treatment can save or extend a good quality life.

Social and elderly care is underfunded - we need to be more explicitly honest - either cough up additional funding or recognise the futility of extending life beyond the point at which there is any real prospect of improvement or quality of life.

I accept that there will be a diversity of views - but for me "life" is the capacity to enjoy the company of friends and family, appreciate a fine wine or meal, enjoy a film or book etc. It is not the capacity of a heart to circulate blood and keep a body warm when all other stimuli are absent.

Incidentally most research into comparative health systems worldwide seems to show:

• UK spending on health care as a % of GDP is fairly much in the middle of developed country ranges - the US spends most
• the performance of UK health care is nothing exceptional - better than some in part, worse in others
• the NHS is one of few that are completely free at the point of use - many other countries make partial charges for services - see a GP, hospital stays etc
• the UK makes amongst the least use of private healthcare - but there is no evidence that the basis of funding or the public/private split has a material impact on the quality of services provided
• Bismark in the 19th century is usually regarded as the founder of the welfare state by introducing a system of universal health insurance

What does all this mean - "there is more than one way to skin a cat" - other approaches to healthcare work and may even improve upon current UK practice. A failure to embrace new ideas risks leaving the UK with a very average health service.

 

[Dibs-h]

Some people get trainers, some people get an iphone.... i want a mini digger

I'm with Kev!

 

[Jameshow]

This did shock me yesterday. I've known this chap for nearly eight years, he's about 40 something and has done very well for himself financially (UK).

"We found my Dad dead on Friday at 8am. I called an ambulance and was told it would be about 45 minutes."

"Eight hours later, a funeral director arrived to take the body away. No Doctor involved. And no ambulance."

Fast forward to Wednesday:
"I've been running around trying to get a Death Certificate to register his death.
At some point, someone asked me: 'What do you think he died of?'"

(The son must have been quite stressed at this point, but he would not have made that up)

On a separate note. a colleague had met with a Paramedic this week. We are not certain of the size/location but the Paramedic said:
"We normally get around 5,000 calls per day. Yesterday it was 8,000."

Sorry and shocked to hear it.

Had your friend said my dad is dying the ambulance might have arrived.

Iirk...

A doctor would be expected to see the body and a PM done if not seem by Dr 2 weeks prior. Then a 2nd Dr to sign part 2.

 

[D_W]

You can't get a mortgage if you are unemployed and/or on benefits. OTOH you aren't expected to go homeless if you find yourself destitute and with a mortgage, or a landlord, around your neck

Benefits are pretty minimal and if prices go up benefits need to keep pace


You could end up in the same boat if you lose your job

Plain inevitable if you are living on the (shifting) breadline

I don't know why so many have it in for the poor, but it's very traditional.
Governments like it because it transfers blame from themselves to people on the edge. The right wing media help enormously.
Everybody knows the list of people they want you to hate/blame: the unemployed, the homeless, single mothers on benefits, immigrants, students, unions, Corbyn, witches, homosexuals, muslims, black people especially black women wearing hijabs, travellers, and so on - and on and on.
But these people are not responsible for the state of the economy - you'll find them at the top of the heap; in fact mostly wealthy old Etonians, for various historical reasons!

Really bizarre reasoning, Jacob. You're always fast to argue ideals that never play out in reality. Outcomes. Is it the fault of the rich that the per capita GDP on a real basis has slipped enormously? This is a really odd thing for the wealthy to root for given that likely affects their personal wealth.

 

[Blackswanwood]

This did shock me yesterday. I've known this chap for nearly eight years, he's about 40 something and has done very well for himself financially (UK).

"We found my Dad dead on Friday at 8am. I called an ambulance and was told it would be about 45 minutes."

"Eight hours later, a funeral director arrived to take the body away. No Doctor involved. And no ambulance."

Fast forward to Wednesday:
"I've been running around trying to get a Death Certificate to register his death.
At some point, someone asked me: 'What do you think he died of?'"

(The son must have been quite stressed at this point, but he would not have made that up)

On a separate note. a colleague had met with a Paramedic this week. We are not certain of the size/location but the Paramedic said:
"We normally get around 5,000 calls per day. Yesterday it was 8,000."

I’m not disputing that ambulance response times are bad (it’s had a lot of news coverage) but I do not believe an undertaker could move a body without death first being certified by a doctor.

 

[John Brown]

I’m not disputing that ambulance response times are bad (it’s had a lot of news coverage) but I do not believe an undertaker could move a body without death first being certified by a doctor.

I think this has been mentioned before, but don't blame the ambulance service. I spent some time in hospital recently, waiting for a triple bypass, and there were 17 ambulances lined up outside at one point, because there were either no beds, or no staff for the beds. I took two trips in an ambulance, one from Gloucester to Cheltenham, and one from Cheltenham to Bristol, and the paramedics were fantastic. It's not their fault if there's nowhere to unload patients.

 

[Flynnwood]

I’m not disputing that ambulance response times are bad (it’s had a lot of news coverage) but I do not believe an undertaker could move a body without death first being certified by a doctor.

Neither could I. Hence being shocked by it. I would have thought there was a legal basis for same.
Neither could I disbelieve this chap though. His financial status is secure and no reason to lie to me.

 

[Jameshow]

You should cling to your anecdotes about care believing the outcomes and level of care in the NHS are better than the american system.

I'm guessing your tax contributions are far less than your cost to the NHS system, so it's pretty easy to be a big fan of it. I think folks in this situation should do a little more to recognize that someone else is paying the way for them.

Here's a more realistic story from people I know - they moved to london for work for four years. One of their kids had a broken bone, they went to a hospital and the hospital sent them to another one because they first didn't have xrays. It ended up taking most of their day for something routinely handled here (stabilizing the break, doing the work and discharging the patient kind of all in a row). The only thing they didn't like about England was the health care. I'm sure they didn't love the costs, either, but if you live in NYC here, it's barely different.

If you are a payer in the US system, the care here is better. The system is overwrought with confusion in costs and excessive costs and utilization, but the care quality is high and the wait times are pretty much nothing. It's not easy to get good data on actual quality of care or outcomes because most rankings apply a very fat factor to whether or not care is public (which is not an outcome, but treated as if it is) when assessing care quality.

Which hospital was that?

I'm guessing the one with No A+E in big read letters outside the entrance?!!

 

[Dibs-h]

I’m not disputing that ambulance response times are bad (it’s had a lot of news coverage) but I do not believe an undertaker could move a body without death first being certified by a doctor.

I think it's a case of it can't be buried or cremated (or anything else classed as disposal of a body) without a doctors cert.

Other than that, some places will have mortuaries and therefore the remains will be released to an undertaker after the death cert has been signed. In other places - I suspect the situation is a bit more "out-sourced" and the remains will be with the undertaker until the death cert comes and only then burial\cremation\etc.

 

[baldkev]

I want a Giant Hadron Kaleidoscope.
You can't always get what you want.

Thats just plain greedy! I hope you won't try to get the dss to pay for it

I think this has been mentioned before, but don't blame the ambulance service. I spent some time in hospital recently, waiting for a triple bypass, and there were 17 ambulances lined up outside at one point, because there were either no beds, or no staff for the beds. I took two trips in an ambulance, one from Gloucester to Cheltenham, and one from Cheltenham to Bristol, and the paramedics were fantastic. It's not their fault if there's nowhere to unload patients.

I know a paramedic. Its so bad that if the hospital dont have any beds, the paramedics keep the patients at home and stay there for the entire shift. So a bed shortage literally takes an ambulance out of service for a whole shift, for every patient that needs a bed.... in april we went to derriford paediatrics a and e on a wednesday might. Carnage. I wouldnt want to be stuck there with a seriously ill child and the staff must dread going to work

 

[D_W]

Which hospital was that?

I'm guessing the one with No A+E in big read letters outside the entrance?!!

Not sure I could manage to squeeze the name of the hospital out of them without them saying "why?"

"well, because I wanted to put your story online...I'll use your real names, too...no problem right?" hah

It came up when I asked them about the health care setup and I said something like "I heard it's not as bad as it's described here, aside from another English fellow I know who lives here and gushes about the american system, but he's of means".

The friend mentioned here (not English) said "I don't, know, we didn't use it. it's terrible, here's how we figured that out".

It was a break sustained in club soccer, so maybe outside of the city? Every single small office here that treats walk ins has an xray for income generation purposes, so I was stunned that a medical center there wouldn't have an xray. the explanation was something along the lines of "it doesn't make fiscal sense to have Xray available at every location".

It does in the US because every location wants the revenue from the Xray.

(if i could pay half as much for health care, I'd travel to another location for an Xray - that was their interpretation, not mine).

 

[mikej460]

Not sure I could manage to squeeze the name of the hospital out of them without them saying "why?"

"well, because I wanted to put your story online...I'll use your real names, too...no problem right?" hah

It came up when I asked them about the health care setup and I said something like "I heard it's not as bad as it's described here, aside from another English fellow I know who lives here and gushes about the american system, but he's of means".

The friend mentioned here (not English) said "I don't, know, we didn't use it. it's terrible, here's how we figured that out".

It was a break sustained in club soccer, so maybe outside of the city? Every single small office here that treats walk ins has an xray for income generation purposes, so I was stunned that a medical center there wouldn't have an xray. the explanation was something along the lines of "it doesn't make fiscal sense to have Xray available at every location".

It does in the US because every location wants the revenue from the Xray.

(if i could pay half as much for health care, I'd travel to another location for an Xray - that was their interpretation, not mine).

mmm, I get the same offer from my dentist, every time I visit they say 'we just need to do an Xray as you haven't had one for a while' which I politely refuse as it is expensive and usually unnecessary. Here in the UK dentists are mostly private; there is a recognised lack of nhs dentists so we either pay per visit or opt for an insurance scheme aka the US system which the Government is reluctant to change.

 

[D_W]

mmm, I get the same offer from my dentist, every time I visit they say 'we just need to do an Xray as you haven't had one for a while' which I politely refuse as it is expensive and usually unnecessary. Here in the UK dentists are mostly private; there is a recognised lack of nhs dentists so we either pay per visit or opt for an insurance scheme aka the US system which the Government is reluctant to change.

Xrays are part of basic dental service here, usually done once a year. Dental isn't very expensive here if you're insured, at least not until you get into semi surgical type work, but it's probably more expensive than it would need to be.

Cosmetic stuff is common., Neither of my kids needs braces, but both are getting them -sign of the times.

My dentist said more or less that the xrays allow them to see things they can't see or feel just picking at teeth.

For whatever reason, basic services are almost the same nominal cost here as they were when I was a kid 30 year ago (about $70 for a cleaning and exam every 6 months - cost for the claim to the insurer, none for me. Not sure if the xray is added and I haven't noticed due to no copay).

I'm sure there are extensive cost studies for NHS dental stuff and they've consciously made that choice. A friend here has a spanish wife, and he's opting to do what they do in spain - when you get older (i've had a pair of root canals and crowns, which can be expensive since it's not usually 100% covered), he said in spain if teeth cause an issue, instead of RCT, let alone things like implants, they just pull the teeth. Which is also cheap here, but usually the option chosen by uninsured folks.

Not to mention the lower cost services offered at local medical/dental schools, but not sure if you're the beta tester there.

Dental tries to do medical style cost/service pushes, but the general public just doesn't care that much about vision and dental.

 

[mikej460]

I think the same attitude exists here to some extent, happy to pay £60 a month for Broadband/TV/Landline but only pay for teeth if something goes wrong. I'm guilty as charged...

 

[Spectric]

There was someone on Tv who said one of the issues with the NHS is not that it is underfunded but that it overspends on stuff that does not contribute to medical care, ie to many pen pushers rather than scalpel wavers and employing people on stupid money to manage diversity and other nonsense which is not the role of a hospital.

 

[Dibs-h]

mmm, I get the same offer from my dentist, every time I visit they say 'we just need to do an Xray as you haven't had one for a while' which I politely refuse as it is expensive and usually unnecessary. Here in the UK dentists are mostly private; there is a recognised lack of nhs dentists so we either pay per visit or opt for an insurance scheme aka the US system which the Government is reluctant to change.

They don't ask at mine, they just take them - but there is no charge for them thankfully. But it's a private dentist who charges a monthly "fee" but it get's a check-up with the dentist every 6 months and a visit to the hygienist (he's a flippin sadist but that's a different topic) as part of all that.

 

[Jacob]

There was someone on Tv who said one of the issues with the NHS is not that it is underfunded but that it overspends on stuff that does not contribute to medical care, ie to many pen pushers rather than scalpel wavers and employing people on stupid money to manage diversity and other nonsense which is not the role of a hospital.

The story generally told is exactly the opposite; that one reason why the NHS is highly cost effective is precisely because it does (or did) not have excess admin and a surplus of managers. It was regarded as a exemplary that it could function with so much self-management.
This has changed in recent years as the intrusion of privatisation has made it less efficient and more costly.

Interesting how the general drift of threads like this is to find fault and complain. It's part of the process of undermining state-run institutions, as conducted by the right wing media, in pursuit of profit for "investors" i.e. taking these public assets from ourselves and giving ownership to financial gamblers and other sharks, out of our control.

 

[Jacob]

They don't ask at mine, they just take them - but there is no charge for them thankfully. But it's a private dentist who charges a monthly "fee" but it get's a check-up with the dentist every 6 months and a visit to the hygienist (he's a flippin sadist but that's a different topic) as part of all that.

Mine still does excellent NHS service. It's a small part of their business but even dentists have a social conscience! It involves a crude charging system of several bands of treatment. I'm not sure how the dentist recoups their costs, or if they just get the paid fees.

 

[Jacob]

I think this has been mentioned before, but don't blame the ambulance service. I spent some time in hospital recently, waiting for a triple bypass, and there were 17 ambulances lined up outside at one point, because there were either no beds, or no staff for the beds. I took two trips in an ambulance, one from Gloucester to Cheltenham, and one from Cheltenham to Bristol, and the paramedics were fantastic. It's not their fault if there's nowhere to unload patients.

It's deliberate but disorganised under-investment designed to break up the NHS and make sure the parts don't work well together, so they can be sold off to the usual pirates.

 

[sawdust1]

Around here all the small towns had small cottage hospitals, all these have been closed down and sold off so now everyone has to travel miles to the main big hospital in the city for any treatment. Before this happened patients could be discharged to one of these local hospitals (easier for loved ones to visit) now they cannot be discharged if they have nowhere to go thus leading to bed blocking.