A&e visits

[custard]

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

Interesting post Eric, I learnt a lot there.

 

[El Barto]

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.......

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

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

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

 

[AJB Temple]

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

 

[AJB Temple]

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

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

 

[Phil Pascoe]

" ... .... 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.

Little details of failures like yours can be annoying but in the bigger scheme of things don't necessarily amount to much.

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

 

[Phil Pascoe]

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

 

[El Barto]

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

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

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

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

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

Ps. Eric thanks for your post, really interesting.

 

[lurker]

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

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

 

[MarkDennehy]

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

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

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

 

[thetyreman]

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

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

 

[Jacob]

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

 

[Eric The Viking]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sigh.

 

[Eric The Viking]

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

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

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

 

[MarkDennehy]

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

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

 

[Phil Pascoe]

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

 

[Jacob]

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

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

 

[Stanleymonkey]

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

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

 

[RogerS]

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

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

So what were some of them and who introduced them ?

Four-hour targets - Labour

Payment by results - Labour

Choose and Book - Labour

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

Edit: My mistake £20 billion.

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

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

Source : The Guardian

 

[RobinBHM]

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

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

 

[RogerS]

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

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

Well said. Good article in wikipedia here