A&e visits

[RogerS]

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.
....

So it's perfectly OK to go out and get totally rat-arsed, 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?

 

[Jacob]

......
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.

Diabetes is often related to diet. Are they to blame and should they be charged?
Pregnancy is down to unprotected *** - 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 ****).

 

[RogerS]

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.

....
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?
.......

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-arses 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:

 

[RogerS]

.....
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.

 

[Jacob]

.....
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.

It was the neo liberal economics of the madhouse.

 

[RogerS]

..... 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.

 

[RogerS]

.....
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.

It was the neo liberal economics of the madhouse.

And I thought it was Citizen Smith.

 

[RogerS]

......
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.

Diabetes is often related to diet. Are they to blame and should they be charged?
Pregnancy is down to unprotected *** - 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 ****).

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

I'm out.

 

[selectortone]

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.

 

[finneyb]

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

 

[RogerS]

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

 

[RobinBHM]

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.......

 

[acewoodturner]

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

 

[Jacob]

....
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

 

[Jacob]

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

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

 

[Phil Pascoe]

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

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.

 

[MarkDennehy]

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 feck's sakes.

This whole "generation snowflake" ***** 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.

 

[Eric The Viking]

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...

 

[Phil Pascoe]

" ... 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.

 

[Jacob]

" ... .... 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.