NHS not been invested in for years

[winkie]

On 12/11/2019 at 04:27, MarkG said:

And the rest of the day, those trains are pretty much empty.

Yes, London needs a subsidized rail system to bring millions of people into the city every day. Why does it need a subsidized rail system to bring millions of people into the city every day? Because, for decades now, it's had a subsidized rail system to bring millions of people into the city every day, so millions of people commute into the city every day.

Remove the subsidies, let the free market work, and companies would move their offices from London to where people actually want to live. Which would be bad for London, but good for the rest of the country.

Fair point......why will we need more capacity?.......why would more want to travel into London 20 mins faster?

Digital will see to that.....100 billion cost, can only imagine how much a weekly ticket will cost!

Regards doctors GPs, so many now only work part time hours, it doesn't pay them to work full time.....other consultants work privately Ltd as well as for the NHS......how can you put your 100% into a job that you share??

[cica]

21 minutes ago, MancTom said:

I think that is because they assume we will go the American route, not the European one.

The European route is more American than ours.

[MancTom]

9 minutes ago, cica said:

The European route is more American than ours.

Sure, but thats not what I meant. The European and American systems are not the same at all as far as I understand in that only in America do they not have universal coverage. This is what people opposed to privatisation always seem to go on about as far as I can tell.

[cica]

Just now, MancTom said:

Sure, but thats not what I meant. The European and American systems are not the same at all as far as I understand in that only in America do they not have universal coverage. This is what people opposed to privatisation always seem to go on about as far as I can tell.

Yeah, exactly so universal coverage and privatisation are completely independent things. It's effectively impossible to have this conversation.

[Riedquat]

37 minutes ago, winkie said:

Fair point......why will we need more capacity?.......why would more want to travel into London 20 mins faster?

Digital will see to that.....100 billion cost, can only imagine how much a weekly ticket will cost!

Things might change but at the moment current routes are rather crowded. I'm thoroughly against just about absolutely everything to do with HS2, every time I see anything to do with it my stomach turns (and I'm not exaggerating for effect there, although it applies to virtually anything anyone wants to build), but taken just in isolation the capacity argument has merit right now.

[kzb]

 

Despite this massive real budget increase over time, there are only about 60% of the hospital beds there were at peak (in 1970's). 

The UK has about the poorest beds/population ratio in Europe.

The NHS budget is not the entirety of the picture either.  Charities contribute and many more employers now provide the option of BUPA cover. 

NHS dentists are now tax-collectors, returning more money to the NHS than they get from it.

 

[Riedquat]

Health spending, well, there are a lot more people to spend it on. And as medicine gets more effective it gets more expensive. I doubt people would accept only having treatments that were available in the 1970s (even though they were reasonably effective for most of us then - health wasn't the game of luck it would've been).

I suppose the point I'm making is that a lot of consideration needs to be given to how the money is being spent. The lack of beds is disturbing, and smacks of shiny new stuff over getting the basics right. You need to be able to do those before you can justify spending on the cutting edge stuff IMO. And accept limited resources, because there's always more that could be spent usefully on healthcare.

[winkie]

2 minutes ago, Riedquat said:

Things might change but at the moment current routes are rather crowded. I'm thoroughly against just about absolutely everything to do with HS2, every time I see anything to do with it my stomach turns (and I'm not exaggerating for effect there, although it applies to virtually anything anyone wants to build), but taken just in isolation the capacity argument has merit right now.

Come on, first things first....sort out the dire infrastructure East to West first....invest money into the North and South West....all road lead to Rome, look what happened to Rome.?

[MancTom]

39 minutes ago, cica said:

Yeah, exactly so universal coverage and privatisation are completely independent things. It's effectively impossible to have this conversation.

Yes, but most people in Britain think the two are inherently the same thing as far as I can tell.

[Riedquat]

9 minutes ago, winkie said:

Come on, first things first....sort out the dire infrastructure East to West first....invest money into the North and South West....all road lead to Rome, look what happened to Rome.?

And by "invest" in it you mean do what exactly? I'm very wary of "investing" these days. It usually seems to be shorthand for "make a hideous, ghastly mess that appeals to the chronically impatient type who are also distracted by anything shiny but appear to have absolutely no appreciation of the world they live in." Sure, less overcrowding would be nice but that never seems to last for long, so in the long run you usually end up with simply a more unpleasant world than the one you started with.

Shaving 20 minutes off a journey to London is just silly but most of the "invest in railways in the north" stuff usually seems to come from people who have exactly the same attitude - chronic impatience - they just want to travel between Manchester and Leeds instead of Birmingham and London. Just pick one and stop rushing about all the time. I get the impression that those peoples' idea of improvement is anything that makes it easier to ignore the world. It's a plus point for this part of the world that those cities are still (at least relatively) self-contained and independent. They've still got some steel and concrete chains but overall the best that could be said of adding more is it's managed decline rather than improvement.

I'd fear, rather than welcome, investment into my local railway (which is a minor line in to Manchester that I do sometimes use).

You've pointed out various issues with modern life from time to time yet on this one you're arguing for exactly the sort of thing that's created that!

[MancTom]

23 minutes ago, kzb said:

 

Despite this massive real budget increase over time, there are only about 60% of the hospital beds there were at peak (in 1970's). 

The UK has about the poorest beds/population ratio in Europe.

The NHS budget is not the entirety of the picture either.  Charities contribute and many more employers now provide the option of BUPA cover. 

NHS dentists are now tax-collectors, returning more money to the NHS than they get from it.

 

Also its not really universal anymore - e.g. my employer has to pay for my regular eye checks because I use a computer screen. If they did not I would have to pay, the NHS certainly would not. Any treatment (lenses) has to be paid by myself (again not by the NHS). Same with dentists - have to pay for it all, even as a NHS patient.

[kzb]

18 minutes ago, Riedquat said:

Health spending, well, there are a lot more people to spend it on. And as medicine gets more effective it gets more expensive. I doubt people would accept only having treatments that were available in the 1970s (even though they were reasonably effective for most of us then - health wasn't the game of luck it would've been).

I suppose the point I'm making is that a lot of consideration needs to be given to how the money is being spent. The lack of beds is disturbing, and smacks of shiny new stuff over getting the basics right. You need to be able to do those before you can justify spending on the cutting edge stuff IMO. And accept limited resources, because there's always more that could be spent usefully on healthcare.

Granted.  But I wanted to give some perspective to the claim the NHS has not been invested in for years.

Huge amounts have been thrown at it, but the effectiveness of that is very questionable.

25% of budget goes on its "internal market".

I'm not even sure if that graph includes PFI or not.

 

[kzb]

Just now, MancTom said:

Also its not really universal anymore - e.g. my employer has to pay for my regular eye checks because I use a computer screen. If they did not I would have to pay, the NHS certainly would not. Any treatment (lenses) has to be paid by myself (again not by the NHS). Same with dentists - have to pay for it all, even as a NHS patient.

But wouldn't you always have had to pay for eye checks and lenses?  I'm not sure that has changed.

On the NHS dentsts, yes I am sure this has got much more expensive in real terms over the years.

[onlooker]

Several issues raised on this thread. I am not a expert, but I do remember some of the news items and debates in the past. The NHS does have a low number of beds, compared to other EU countries. I seem to remember this being debated 20-25 years ago, when increasingly operations and recovery times were being successfully compressed. Many procedures nowadays require only short stays or even done in one day. There were a lot of empty beds.

Beds are of little use without the nursing staff to support them. Particularly intensive care. So there was a move for more intensive bed use.

The problem now is that because of the failure of care for the elderly, hospital bed blocking by the very elderly/infirm is now a serious issue, and will not be resolved until more care home places are provided.

Regarding opticians and dentists charges. To a certain extent people should be encouraged to look after their eyes, cut dwon drastically on sweet things and alcohol, and reduce obesity by eating less and getting more exercise. Successive Govt campaigns seem to have achieved nothing in this direction. So I don't see why people cannot make a modest contribution to their own health costs. Aslo an employer almost certainly pays for eye tests not because they worry about your eyesight, but because they don't want to be sued 10 years down the line for eye damage which might, or might not, have been due to the work you did for them.

[kzb]

10 minutes ago, onlooker said:

Several issues raised on this thread. I am not a expert, but I do remember some of the news items and debates in the past. The NHS does have a low number of beds, compared to other EU countries. I seem to remember this being debated 20-25 years ago, when increasingly operations and recovery times were being successfully compressed. Many procedures nowadays require only short stays or even done in one day

But this reason would apply across the whole developed world !  Yet our beds/capita ratio is one of the worst.

The truth is people are being turfed out of hospital before they are ready, and care responsibility put onto the relatives.  This is cost-shifting.  A friend's 94-YO father was turfed out at 04:00 a.m. to an empty house and just left there, last year.

Basically "the customer" is getting less for their money than they used to.

[MancTom]

22 minutes ago, onlooker said:

Several issues raised on this thread. I am not a expert, but I do remember some of the news items and debates in the past. The NHS does have a low number of beds, compared to other EU countries. I seem to remember this being debated 20-25 years ago, when increasingly operations and recovery times were being successfully compressed. Many procedures nowadays require only short stays or even done in one day. There were a lot of empty beds.

Beds are of little use without the nursing staff to support them. Particularly intensive care. So there was a move for more intensive bed use.

The problem now is that because of the failure of care for the elderly, hospital bed blocking by the very elderly/infirm is now a serious issue, and will not be resolved until more care home places are provided.

Regarding opticians and dentists charges. To a certain extent people should be encouraged to look after their eyes, cut dwon drastically on sweet things and alcohol, and reduce obesity by eating less and getting more exercise. Successive Govt campaigns seem to have achieved nothing in this direction. So I don't see why people cannot make a modest contribution to their own health costs. Aslo an employer almost certainly pays for eye tests not because they worry about your eyesight, but because they don't want to be sued 10 years down the line for eye damage which might, or might not, have been due to the work you did for them.

They pay for eye tests because legally they are required to.

[kzb]

Figure 4: Average number of beds available by category, 1987/8–2016/17

JavaScript chart by amCharts 3.4.71987/881989/901991/921993/941995/961997/981999/002001/022003/042005/062007/082009/102011/122013/142015/16050,000100,000150,000200,000250,000300,000Number of bedsShow all

JavaScript chart by amCharts 3.4.7General and acuteMental illnessMaternityLearning disabilityDay only

Source: NHS England 2017

Please note I don't think 1987/88 was the peak of bed numbers either.  This chart just shows a continuation of the decline from the 1970's.  There used to be a chart available from this time but of course that has been edited from current version of reality.

[kzb]

Sorry that obviously didn't work ! 

[kzb]

https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers

 In 1974 the health service maintained almost 400,000 beds (Macfarlane et al 2005, p 264); by 1979/80 the number had dropped to around 350,000 (Appleby 2013). 

Between 1987/8 and 2016/17, the total number of NHS hospital beds fell by approximately 52.4 per cent – from 299,364 to 142,568 (see Figure 2).1 Within this total number, there are different categories of bed across which the scale of change has varied considerably. 

The number of overnight general and acute beds has fallen by 43.4 per cent between 1987/8 and 2016/17 – from around 180,889 to 102,269. However, within this category beds for the long-term care of older people fell more substantially.2  Between 1987/8 and 2009/10 – when beds for older people were recorded separately – numbers fell 60.8 per cent, from more than 53,000 to slightly less than 20,900. The number of acute beds reduced by only 21 per cent over the same period.

So total number of beds down from peak of 400,000 to 142,568 by 2016/17.  We now only have 36% of the hospital beds we had in 1974.

In that same time period, the NHS budget has increased by more than a factor of 4  in real terms, and the population has increased by about 20% (the number of old people has risen by a larger percentage of course).

Some people must be making a fortune out of this !

 

 

[onlooker]

I'm not defending the continuing reduction in number of beds, but there are reasons:

The NHS has been reducing the number of beds for decades: since 1987/8, the total number has more than halved from around 299,000 to 142,000. Within that, the numbers of beds for people with learning disabilities and mental health problems have fallen more substantially – by 96 and 72 per cent respectively. Several changes in the way that care is provided have made these reductions possible. For example, care for people with mental health problems and learning disabilities has gradually shifted from institutional settings into the community; technical improvements in surgery have meant more patients undergo day surgery – in cataract surgery almost all operations are now day cases; and average length of stay for hospital patients has fallen from eight to five days over the past 15 years thanks to developments in clinical practice and how patients are managed. (https://www.kingsfund.org.uk/blog/2017/09/hospital-bed-numbers)

However, it looks like the trend is levelling and will need to rise in future because of the increase in population, increase in elderly infirm, and increasing use of A&E becasue the general practice/family doctor system is creaking and breaking down.

[kzb]

19 minutes ago, onlooker said:

I'm not defending the continuing reduction in number of beds, but there are reasons:

average length of stay for hospital patients has fallen from eight to five days over the past 15 years thanks to developments in clinical practice and how patients are managed. (1)

However, it looks like the trend is levelling and will need to rise in future because of the increase in population, increase in elderly infirm, and increasing use of A&E becasue the general practice/family doctor system is creaking and breaking down.

(1) What do you think these words mean in actual practice !?

There is no real democratic accountability in NHS Trusts.  They can spend their money how they want, they are effectively private businesses but on the taxpayer tap.

It's an industry.  It's been gradually converted from the idealistic model of the 1940's into yet another industry where an elite prospers by farming the population.

 

[onlooker]

4 minutes ago, kzb said:

(1) What do you think these words mean in actual practice !?

There is no real democratic accountability in NHS Trusts.  They can spend their money how they want, they are effectively private businesses but on the taxpayer tap.

It's an industry.  It's been gradually converted from the idealistic model of the 1940's into yet another industry where an elite prospers by farming the population.

 

What do the words mean? I have no inside knowledge, but of recent cases among my friends and family, I know that gall stone ops done with keyhole surgery require minimal stay, a knee replacement was paid by the NHS, but actually carried out in a private hospital, so that private bed was not recorded as an NHS one. Glaucoma and other eye ops are now done on a production line type arrangement, in record time. In my case early NHS screening showed up a problem that would have lead to me having a stroke within a year or two, so I am now on medication, and have saved the use of a bed.

When the NHS was founded, it was a case of putting people into hospital, where they either lived or died. The range of treatments available was very limited. Nowadays, it is a modern miracle what can be done for most sick people, and often they can be turned around in record time.

[ebull]

On 11/11/2019 at 18:07, winkie said:

Why the push to get people onto statins?.......

Many elderly people must feel fearful of their failing health.....when they see the service is not providing them with the service they thought they could rely on in their time of need it must be quite frightening for them.....we must respect and do what we can to help those that are now finding it hard to help themselves......?

Having a guess that some private co. has a contract from either GP or CCG under which they get a payment for each patient signed up.

Around here they had a dodgy looking bloke and woman in the leisure centre trying to get sign ups for a health check. I'd already had one recently but I sure as hell would not be signing up with these chugger-breakdown-insurance-sales types.

My GP also offers yearly asthma measurements for those diagnosed even with a mild occassional inhaler need. They wrote to me about it and followed up pushing for an appointment. The current first available GP slot is currently JANUARY !

Doctors are excellent when I have needed them - the same in all countries I have needed help. Of the four countries I have used health services [three as a resident] , the NHS is by far the worst and definitely not the envy of the world when it comes to GP services. The solution is NOT imo pouring more mountains of dosh into this failing mess.

[winkie]

The NHS is not failing it is badly managed...I think as said before it is being used to make profits for private companies, consultants...too many parts that do not coordinate themselves effectively, doubling up on unnecessary work and not efficient enough....the biggest issue is a lack of forward planning, training of staff required in years to come and especially with a growing elderly population... and I have never worked for them, just an observer....This country does not want to go down the American health insurance way...keep it free at the point of need......Long term elderly care is slightly different, there should not be a dementia tax, some have never had dementia in their family and some families are prepared to look after their family as a joint effort....why would they want to pay an insurance/tax? some might be happy to use a property or savings to pay for future care....nothing should be compulsory. But agree long term care for those that can should pay for it.?

[onlooker]

5 minutes ago, winkie said:

The NHS is not failing it is badly managed...I think as said before it is being used to make profits for private companies, consultants...too many parts that do not coordinate themselves effectively, doubling up on unnecessary work and not efficient enough....the biggest issue is a lack of forward planning, training of staff required in years to come and especially with a growing elderly population... and I have never worked for them, just an observer....This country does not want to go down the American health insurance way...keep it free at the point of need......Long term elderly care is slightly different, there should not be a dementia tax, some have never had dementia in their family and some families are prepared to look after their family as a joint effort....why would they want to pay an insurance/tax? some might be happy to use a property or savings to pay for future care....nothing should be compulsory. But agree long term care for those that can should pay for it.?

Have you evidence for it being badly managed? There is the PFI hospital issue, but that is not really an NHS problem as a Govt procurement scandal.

I am not close enough to what goes on to tell whether the NHS resources are badly managed. What I do see is a lot of patients who are mentally challenged, who I understand cannot take medicines properly, who miss appointments without telling anyone, and don't have the self control or intelligence to avoid unhealthy lifestyles. It must be a nightmare looking after the nations health with that clientele.