UKC

Just spent the day in A and E with my mum (who will be OK).  An eye opener. The main reception area was rammed. And the corridors where lined with really ill people in beds waiting to be seen. My mum was being looked after by a ‘Corridor Nurse’, and she was in ‘corridor space 9’.  

Maybe they should turn the wards into corridors, and hence treat more people. 

FFS.  Thanks for listening. Rant over. And hats off to the staff, as usual. 

In reply to Bottom Clinger:

Yes.

In reply to Bottom Clinger:

I haven't been to A&E for years and it was grim then. This sounds much, much worse. Hope your mum's OK. 

In reply to nastyned:

It’s just normal these days, even in summer. It’s a wonder more people don’t die as a result. The worst part is the understaffing and the stress on all those working there of knowing they can’t provide the care people need, or deserve. And the government likes to pretend it’s a combination of mismanagement and people using it inappropriately. The latter happens, of course, but hospitals are getting pretty good at redirecting most people speedily. The mismanagement thing is a straw man imho in most cases. Of course management is too short sighted, but it’s forced to be by political pressures and a complete lack of resource for any long term planning or investment. Set up to fail.

Edit: glad your mum is ok, that’s what matters in the end!

In reply to minimike:

I spoke with the ‘Corridor Nurse’ who said it was way busier the other day! Over the last decade or 2  I’ve been a patient a few times in A and E myself. The difference floored me. And my brother too (he was in loads with rugby injuries etc) - his words were ‘it’s nearly as bad as seeing hospital in Gaza on the news’. Underfunding is close to 100% the problem. 

In reply to minimike:

Some are. Because they can't get to see a GP. That's not the patients' fault...

In reply to captain paranoia:

True, but there’s still a (small) minority who know they could wait for a GP in a few days but don’t. It’s much less of an issue than the media suggest, but it exists.

In reply to Bottom Clinger:

Hope your mum is OK. It's really not a time to be needing the NHS.

Mother in law fell backwards down the stairs just before chrimbo. Bashed herself properly badly and thought she had broken her hip. Lives alone so lay there for 2 hours in her nighty hoping someone would knock on the door and help her.

Realised noone would be there soon so dragged herself across the hall, pulled the landline phone off by the cable. Of course problem no 1, noone has landlines so noone remembers mobile phone numbers now. So she couldn't call family immediately.  Typical old person (compliment) decided that she didn't want to be any trouble despite the near hypothermia and potential broken hip so called 111 instead of 999.

They rightly called an ambulance. 

Anyway, long story short,  family alerted and there quickly then ambulance there in 4 hours or so.

Local A&E closed to admissions, so instead of 10 min drive, potentially 2 hr drive to nearest open A&E.

Although they couldn't actually say it, the wonderful paramedics hinted that she was ok to be taken to A&E by car, by which admission could not be "closed". So that's what we did. Story and wait staggeringly longer and boring after that.  She's OK thankfully. 

NHS and A&E properly properly busted right now sadly.

Morale of the story. All the families mobile numbers programmed into her landline and written in big numbers by the phone on the wall.  

In reply to Bottom Clinger

Except more money than ever is thrown towards the NHS. It’s easy to believe more money will solve the problem, reality has shown this is not true. We need a frank and grown up conversation about how the NHS works so that those who most need it do not lose out.

In reply to Wainers44:

If she is of an age and stage where falls are becoming more likely, maybe worth seeing if you can get her a fall alarm. I presume this service exists everywhere, I'm working for our local one just now. She can choose to wear a pendant round her neck or a bracelet one. They can trigger with the motion of a fall, or the wearer can press the button if they need help too. This triggers a care provider (not NHS, well not in our area anyway) to come and see her. In her case, the care provider couldn't have done much as she needed an ambulance, but would at least have got warm layers to her fast to stop the hypothermia and would have ensured the ambulance was called asap. 

In reply to sourthern_softy:

It might be worth asking where that goes. There is already a great deal of privatisation.

In reply to captain paranoia:

I strongly suspect that a very large portion of money invested into the NHS ends up in the pockets of the shareholders of the swathes of privatised services. Money that could alternatively have been used investing in equipment, training and fairer pay.

In reply to captain paranoia:

Also worth noting that as funding has been stripped away from other areas A&E is seen as the only option and the only place that can't say no.

No mental health provision? A&E it is.

No beds on the wards? Discharge too early and back in A&E a few hours later.

No room in the custody suite? Send them to A&E to sleep it off.

No access to a dentist? A&E when the toothache gets too much.

No GP appointments this week? A&E can't say no.

Yep, we're spending more on the NHS, but we're spending proportionately less in other areas. At the same time, the number of treatment options are increasing, the population is increasing, the population is ageing and the population is getting sicker.

So yeah, that's where the extra money is going but it suits the Tories privatisation agenda to pretend otherwise while reducing service provision to the point that enough of the public will stop caring about a free public health service

... and once that's been achieved, the PPE snouts in the trough debacle will look like small change.

In reply to sourthern_softy:

Over the last 75 years healthcare technology has changed beyond recognition. Many more conditions can be treated, treatments are mostly much more effective, but at greatly increased cost. We are also older on average, though this is a less important effect: we cost the NHS by far the largest amount in the last 6 months of our life, this applies if we are 65 or 85 years old.

All this has increased the cost of healthcare across the developed world and healthcare systems are creaking. A sure sign that someone doesn't know what they are talking about, or is choosing to ignore evidence that doesn't fit their political dogma, is when they imply the healthcare funding crisis only applies to the NHS and all would be solved by moving to a different funding model.

Until 2010 NHS funding has steadily increased as proportion of GDP.  Unprecedentedly it has been reducing as a proportion of GDP for the last 13 years. Healthcare technology has not stopped increasing in capacity or cost over this time. The recent deterioration in NHS services is largely due to this reduction in funding in real terms. 

In reply to Stichtplate:

I wonder what the cost of last diagnosis is? Detecting cancer, for example, early must be more cost effective and have better outcomes than further down the road.

A Spanish friend of mine was surprised when she moved here that we don't do comprehensive checkups on an annual basis. She pays for them privately when she visits family back home and has had a couple of medical issues resolved without drama. In all likelihood she wouldn't have known about them until much later if she just relied on the NHS.

In reply to broken spectre:

Exactly.

In reply to Kalna_kaza:

I saw the lovely advert on the TV, prompting people to get tested if they are worried. And said out loud "yeah, and then have to wait a year before not getting treatment, and die..."

In reply to captain paranoia:

Can't speak for all trusts, but ours treat the 62/31 day cancer targets extremely seriously, and a breach of those targets I would say are not that common. And where we do breach, its usually just a few days due to stuff like diagnostic scans not having be taken and reported on time.

A quick fact check suggests around a third don't meet the 62 day wait (presumably waiting for diagnostics) and 1 in 10 don't meet the 31 day target from decision to treat to treatment.

https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting...

Your years wait scenario is a massively inaccurate exaggeration thankfully. 

In reply to Stichtplate:

And bed blocking due to lack of social care in the community is a big one too. 

I am doing some work for a care company at the moment as a first responder, and we see the effects of people being sent home earlier than they should be and going back to A and E.

The care crisis could be partly aided with more money, as wages could rise and the job becomes more appealing. However, like any messy job, there will always be an uphill struggle to convince people that it's a job that they want. I'm not sure there's an easy solution.

In reply to The Norris:

Fair enough.

But we don't do very well, comparatively.

https://www.theguardian.com/society/2024/jan/11/uk-cancer-survival-rates-de...

https://worldpopulationreview.com/country-rankings/cancer-survival-rates-by...

https://news.cancerresearchuk.org/2019/09/11/measuring-up-how-does-the-uk-c...

In reply to broken spectre:

and the ways they find to sneak money into private health provision are fiendishly underhand.

How about this common wheeze: demand is rising, service provision is failing and there’s broad public support for more funding. What to do if your endgame is privatisation?

Announce a couple of hundred million in new funding but don’t make it a permanent addition to annual budgets. Instead parcel it out to individual NHS trusts in 6 and 12 month tranches. 

It’s not year on year funding so NHS trusts can’t invest it on facilities and permanent staff so they use it to buy in more expensive private health providers to firefight where core provision is stretched thinnest.

The government can then crow about all that extra funding but NHS services still failing. And all the while public funds are used to expand the capacity of private health so they can eventually point and say “look, viable alternative system ready to step in”

In reply to Kalna_kaza:

I've got a horrible feeling in some cases it may save the NHS money if detection is left too late to be effective.....

In reply to Bottom Clinger:

A year ago I panicked and went to A and E for the first time (it was about 3 am).

A doctor saw me straight away. He examined me, took bloods, reassured me and gave me pills to stop me vomiting. I left after about three hours.

Brilliant service from NHS in Fort William, but it must be hard in bigger hospitals.

In reply to Cog: likewise , I’ve taken my kids to our local A and E several times and the treatment has been excellent but a couple of years ago I took my mum to her local A and E and it was like something from a disaster movie . Four police had two knobheads who were covered in blood waiting to be treated , I knew one of the police vaguely who quietly told me what he thought should be done with his charge. After a four wait Turned out my  mum was ok but she said that next time she would take her chances and stay at home in bed .

In reply to Bottom Clinger:

Last time I visited the place was overflowing, much like the various descriptions above, and also with 16 ambulances queuing outside, unable to offload and therefore unable to get back out and do their jobs. There were not enough chairs in the waiting room so the nurse had to ask any relatives/friends of patients to stand. We were there for 11 hours. One bloke slashed his arm open as a way of jumping the queue. 

In reply to Kalna_kaza:

I think it probably depends and what kind of annual checkup it is. 

Just Doing tests each year leaves you open to false positives. https://youtu.be/BJ9soFmzYO8?si=c4PkfoVSnmFB6KS1

Just a time for patients to mention, 'oh, I just wanted to mention this' could well be more useful'. And if you have the same doctor, then maintaining that open  dialogue. 

Capacity for this in the UK would be the issue. 

In reply to girlymonkey:

This saved my mother's life on one occasion. Strongly recommended

In reply to captain paranoia:

These are survival rates you are quoting, so you need to take late diagnosis into consideration. My experience is limited to people I've known, but I was under the impression that once diagnosed, cancer was one of the things the NHS was pretty good at dealing with quickly. I think suggesting that once you're diagnosed you are left for a year without treatment and then die is unfair. 

In reply to nikoid:

Perhaps in some rare situations, however early detection is going to be much cheaper, end of life care often drags on a long time. An early diagnosis of testicular cancer for example is going to be a few scans and a simple operation with some follow up testing. A year down the line before detection and you might be looking at a couple of years of end of life care along with invasive surgeries and expensive treatments.

In reply to Sharp:

I agree; it was an emotional response to the advert, reflecting my feelings on how this government is undermining the NHS. My criticism is not directed at those struggling to work in the NHS; they have my wholehearted support.

In reply to hang_about:

Yes, they are excellent. You get such a range of different alarms too. One lady has one which triggers if she gets out of bed at night, another had one which triggers if the bed is wet, another triggers if the house temperature drops too low. So many different options for people's needs. 

One problem though is that some people of that generation "don't want to bother you", so will struggle on rather than press their button. So rather than using the button to request help to the toilet (very much within our remit), they will try to go themselves and have a fall trying to get there. I often reassure them that my shift passes quicker if I am out helping people than sitting in the office, so requesting help to the toilet etc is doing me a favour as I get less bored. Sometimes they take it on board, often not though!

In reply to nikoid:

Were it not for a superinjunction I’d provide evidence decisions of this nature are made by management.

In reply to Stichtplate:

Also worth looking at the right to choose process and poor provision of diagnostic services for things like autism and ADHD. 2 Years wait on the NHS, or 6 months for a private provider? As a service user there is no competition, as a taxpayer? I wasn't happy with the route I was forced to take.

In reply to spenser: 

2 years is “good”, took 4 years for our son to get an Autism assessment (which was actually from a referral for a full neurodevelopmental assessment), they said he needed an ADHD one during this….so we rang up to get that arranged….sorry that’s another queue and the wait is 3.5 years. We had no option but to go private.

Despite having a diagnosis of ADHD to NICE  guidelines (I.e. same standard as NHS) we had a massive battle to get the NHS to enter into a shared care agreement, most people where we live don’t succeed with this and have to pay for any mediation required privately as well (and it’s not cheap) 

Absolutely outrageous, if someone had a private hip operation and then developed complications the NHS wouldn’t refuse to treat them. 

In reply to DizzyT:

I would have thought there was such overwhelming obviousness that something like this is so squarely in the public's interest it couldn't be at all suitable for an injunction.... but I guess I'm naïve.

In reply to Bottom Clinger:

Back in less safe times, when several times more people were dying in accidents and a corresponding number injured, hospitals coped far better with tiny resources. 

Clearly, there are a number of factors affecting both supply and demand. I think we are overdue for a serious look at what we expect from these services and what we commit to providing. Amongst highly developed nations (are we still?) we are a low spender on health care and probably that needs to change since every one of their 'customers' is a component of the economy and is economically well worth reurning to full function.

In reply to sourthern_softy:

I have had the same, non complex, procedure privately and nhs. Less than half the staff privately. Same kit, same Drs. Go figure.

A&E. Memories of my morphined mother screaming in pain as an incompetant nurse tried to pull a compression sock of a freshly busted hip while two other nurses less than ten feet away chatted away.

I could go on and on with similar examples. 

The best thing about the NHS is it's not the American system, but look East and there are millions of people getting excellent health care, better than ours, without worrying about how they will pay for it. 

In reply to Jim Fraser:

Unfortunately, the ethos/culture in the UK is that we demand high quality services but we refuse to accept higher taxation to provide that level of quality.

And because of the adversarial nature of our politics, neither of the 2 main parties dare to rock the status quo about this. I suspect the Tories would have political problems with such an increase anyway but Labour can't advocate it because they would get so much flack about it, which is absurd when you consider how much better healthcare and social care systems would improve the UK.

In reply to Michael Hood:

It's not just the taxation, it's how it's structured. Better functioning health systems are better funded but also typically not structured like the NHS and they usually involve some form of copayment or deductable. For example the Netherlands has a similar system of primary and secondary care but the structure and funding are very different:

https://www.commonwealthfund.org/international-health-policy-center/countri....

The NHS system functions by making people wait. Even back in the Labour years the target for a first outpatient appointment was 18 weeks and this was only met in 2008. In the Netherlands it's 4 weeks. Where I am, waits for suspected cancer referrals in many specialties are longer than that.

Unfortunately, no-one will rock the status quo of this either. Wes Streeting (Labour shadow heath secretary) went to Australia and thinks they have the answer, but he didn't mention that about half of the population has private health insurance and there are lots of other costs - for example the average out of pocket cost to see a GP is £20 (medicare covers the rest) and most states you pay for ambulance cover out of pocket too.  

As you see now we're ending up in the worst of both worlds, an unplanned private system by default (for anyone that can afford it), US-style heath insurance that excludes pre-existing conditions and a dysfunctional public system with long waits and overcrowding for which any increase in funding will only provide a temporary reprieve. 

In reply to mik82:

One of the many artificial problems is the political interference into the NHS structure and operation.

In reply to Bottom Clinger:

FWIW in the last year I’ve taken a child (broken arm) and an adult (appendicitis) to two different A&E departments and on both occasions the service has been close to flawless. Assessment, radiographs and dressing in an hour with the child and theatre in a few hours with the adult. I accept this isn’t the norm though.

In reply to captain paranoia:

Well... it is a government department!

In reply to wittenham:

Yes but it's meant to be operationally at "arms length" - not sure that politicians know what that means 

In reply to sourthern_softy:

As always, the answer here is not straight forward. I think those always asking for more money perhaps dont see how the money is spent. I'm not convinced that money is the only issue, we just need to make sure that the money, when it gets into the NHS, is spent appropriately.

For the best part of 20 years I have been involved commercially with products which end up in NHS Trusts, both IT and medical devices. I'll give you two examples I am am personally aware of, but consider I am one person so there will be countless other examples I am unfamiliar with.

1. Data Storage - All NHS Trusts have an IT dept and host a data centre (although many are using cloud more and more). One NHS Trust in the West Midlands bought a SAN for hosting their on-prem applications, at a cost of £350k. It was bought because the IT dept would have lost its budget the following year if it hadnt spent its allocation, also known as 'use it or lose it'. It was never switched on and by the time they needed to migrate onto it, it had become obsolete, then being used as dumb storage, not high performance storage, for which it was purchased.

2. Orthopaedic Implants - All major teaching hospitals and many other smaller hospitals will carry out common or garden hip and knee replacements, and some majnor units will carry out complex revision (replacement of failed primary replacements) operations. Hospitals therefore need to carry stock, and they often have multiple manufacturers' stock 'on the shelf' to cater for surgeon preference and patient sizing. Just in time delivery is difficult. Common sizes get used up frequently and are replaced but there are many situations where stock rotation of less common sizes/SKUs doesnt get managed properly by theatre staff. Manufacturers can take items back if they are not out of date from sterilisation date to be used elsewhere but staff are either too busy or not properly organised to ensure that parts dont go out of date, which then have to be paid for. This wastes £millions per year.

TLDR: The NHS wastes too much (COVID PPE showed this) and so this should be removed before more money is invested.

In reply to minimike:

Yep

DOI A&E doctor here.

Everyday I see patients who openly admit they come to A&E because it is inconvenient for them to wait to see GP. 

In reply to Bottom Clinger:

So what is this wonderful government doing about it? CUTTING FUNDING TO THE NHS AND REDUCING TAXES FOR THE BANKS. Grrrrr

In reply to sourthern_softy:

We spend the lowest proportion  of our GDP on the NHS than any other European country. So yes funding is the issue. Any other system will involve some level of insurance that will mean a huge increase in red tape and admin costs. The right wing press willmhave you believe the NHS is poor value. In terms of the money spent and the outcomes its fantastic value. It just needs more funding and fewer private firms making a fast buck from it.

In reply to Michael Hood:

Taxation does not pay for the government spending of a monetarily sovereign nation state. At devolved administration level and local authority level it may do to a limited extent. Taxation is principally a money supply tool that prevents rampant inflation. 

The UK Govt could simply create sufficient money to pay for any level of health spending it liked and so long as the supply side was sufficient; medical education, medical device manufacture, PPE, and so on (not a given, currently); there would be no down side. A greater number of components of the economy (people) would be fully economically functional. The real economy would benefit from both the supply side investment and the availability of labour.

In reply to Jim Fraser:

Can you expand on this?

In reply to Root1:

 

terribly sorry but this simply is not true: https://gateway.euro.who.int/en/indicators/hfa_566-6711-total-health-expend...

If the NHS model is so good, how come no other sensible country has completely socialised healthcare with no insurance model? Why has no one copied us? The rest of Europes healthcare is partially privatised with much better health outcomes on nearly all key metrics.

In reply to sourthern_softy:

Not sure if it's just me but it looks like there are a lot of countries with data missing for recent years in that link. So the UK is pretty high in that data set at the moment, coming behind Belgium, but if you look at other comparable Western European countries the UK was lower when there was last data available.

ETA: sorry I misread your post and thought you were saying the UK is one of the highest, not just pointing out that it certainly isn't lowest

In reply to nickinscottishmountains:

Unlike France or other Eurozone countries but similar to Norway or the USA, the UK has monetary sovereignty over its free floating currency the pound sterling. That has existed for just over 50 years this time round but, rather ridiculously, not to mention unsuccessfully, successive British governments have continued to behave as though the Bretton-Woods agreement or the gold standard were still in place. Our currency is a unit of measure used for credit (Dunning-Macleod/Mitchell-Innes). The BoE's controls on that currency help to maintain its value in relation to other currencies. 

In a market where the supply side of the economy is in good order and there are plenty of goods and services freely available for people to spend money on then the government can freely spend money into the economy well in excess of the tax it pulls out of the economy (erroneously called deficit spending: it expands the private sector). In those circumstances, relaxed banking regulations allow private licensed bank to also create new money through lending. The overall effect is economic growth. 

In the reverse situation, when the supply side is disabled, perhaps by poor regulation, restrictions on imports, restrictions on immigration, withdrawal from a major free trade organisation, or a major health emergency, or combination thereof, excess money supply cannot find a home and inflation may result. Prevention of excessive inflation requires restriction of the money supply and pulling more money out of the economy using taxation (sometimes called operating a surplus, but it constrains commerce). The only viable way forward is government action that first reverses the supply side problem. That may include some simple stuff like health care that helps maintain the labour market, anything that makes life easier for low and medium level earners who operate the essential infrastructure, and sensible free trade agreements with neighbouring similar economies. 

Trad economics, often based on famous books written during Bretton-Woods or previous similar eras, when world trade was a much simpler thing, that could be easily manipulated by a few influential empires, goes off on a completely different tack, largely about interest rate and unemployment. Remember that most politicians in the early 20th century didn't give a flying £#<k about how many of the plebs were unemployed and their private incomes were largely dependent on interest rates, over which they would endlessly obsess, and those factors have somehow become entrenched in economic thinking even 100 years later. All b0110cks unfortunately, but still the stock in trade of headline writers at the Mail or Telegraph, whose owners, surprise surprise, are still people whose lives are run on similar lines to those early 20th century politician referred to above. 

https://www.waterstones.com/book/the-deficit-myth/stephanie-kelton/97815293...

In reply to Jim Fraser:

Other economic models are available!

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3767562

In reply to sourthern_softy:

They have.

https://www.nuffieldtrust.org.uk/news-item/why-has-the-nhs-not-been-copied-...

In reply to bruxist:

first paragraph: here where it has been copied.

second and rest of article: This is how they are not the same.

In reply to MG:

They may be available but the reason there are so many of them and that there is so much written about them is because they don't work. 

There are two important things people need to understand about Modern Monetary Theory (MMT).
1. It is not modern. The Confederacy lost the American civil war because they didn't use it but the Union did. In fact, war is usually the very best demonstration of how it operates. It worked for the UK in 1914 and it regularly works for the USA today. There is always enough money for war but somehow never enough for caring.
2. It is not a theory. It is a description.

In reply to Bottom Clinger:

Had a few visits in last couple of years due to mother having various emergencies, last one was gram salmonella, I got her to A&E for 11am. We were seen in about 45mins, poss due to urgent care appointment and being Sunday morning much of the madness already dealt with. Temp taken and the nurse freaked out, we got rebooked into to A&E rather than urgent care (don’t know why). Saline IV and antibiotics administered. Bloods taken, 4 hours later X-ray and scan. By 8pm she was in a ward. Long day, but not as long as the staffs day. They are legends. 

In reply to Andrew Breckill and the thread:

All good with my mum. She did enter her third day on Corridor Ward, but quickly got moved to Medical Assessment where she spent a short day then back home. My guestimate is they have the capability for maybe 25 corridor beds. Things must vary both between hospitals and within each hospital. Her nurse said it had been much busier the previous week !!

In reply to Bottom Clinger:

Glad to read your mums ok, mine also made full recovery, in rapid time, doc initially said delirium could take many weeks to recover from, but she was discharged in under three weeks with a six week in home care package. 

In reply to Bottom Clinger:

This simply cannot be true, Boris promised 40 new hospitals and £350M Pete week, surely the problem is solved?

In reply to Ennerdaleblonde:

And if the problem isn't solved then Sunak could simply pass legislation to state that there are no hospital waiting lists, they have all disappeared.

In reply to Bottom Clinger:

Not too many years ago patients on corridors were a National scandal, then it was normal but only at the height of Winter pressure. It’s now completely normal year round.

The height of covid saw a new scandal rear its head in the form of holding patients outside A&E on the backs of ambulances. This is now becoming the new normal and it’s horribly under reported. This is currently happening at all my local hospitals. 
 

One unfortunate patient recently found themselves held outside a local hospital for 16 hours….16 hours.  The news reports I’ve seen have all been talking about waits of just a couple of hours max. If only.
 

In reply to Andrew Breckill:

The false memory and confusion caused by lengthy delirium does seem to take some time to clear.