Is the NHS sustainable in its current form?

Mek

Member
I’ve held off remarking on this thread up till now but my two pennorth is, as someone who has worked in the NHS albeit many years ago. You don’t have to work in the NHS for very long to see where the money is being wasted,and it’s not on the shop floor with the doctors and nurses who are overworked and understaffed and being thoroughly demoralised.
 

Danllan

Member
Location
Sir Gar / Carms
@ollie989898 below is a case in progress, you argue against litigiousness and, presumably, would support the ideal of patient confidentiality too, but... what of professional responsibility when there is information about one individual that will have absolute consequences for others if not shared?

The linked case refers to a parent-child-grandchild matter, but similar failures to share information could have terrible consequences to siblings or within a sexual relationship. It would be all very well to place an absolute duty on individuals to have to inform others of such things, but who is to say they would?

Surely if medics have the responsibility to share such things placed on them, by law, it will relieve them of a significant area of legal risk, won't it?

Traditionally the Courts bend over backwards to avoid placing medics on the wrong side of the law - this being the main reason that you can't 'murder' an unborn child. This will be an interesting case to follow.

 
@ollie989898 below is a case in progress, you argue against litigiousness and, presumably, would support the ideal of patient confidentiality too, but... what of professional responsibility when there is information about one individual that will have absolute consequences for others if not shared?

The linked case refers to a parent-child-grandchild matter, but similar failures to share information could have terrible consequences to siblings or within a sexual relationship. It would be all very well to place an absolute duty on individuals to have to inform others of such things, but who is to say they would?

Surely if medics have the responsibility to share such things placed on them, by law, it will relieve them of a significant area of legal risk, won't it?

Traditionally the Courts bend over backwards to avoid placing medics on the wrong side of the law - this being the main reason that you can't 'murder' an unborn child. This will be an interesting case to follow.


There is nothing to defend: confidentiality is not absolute and this is widely known/accepted/acknowledged as it is not one of the pillars of ethics, preventing harm of others takes greater importance and rightly so.

I may not have explained myself correctly judging by your other replies. I will try to illustrate my thinking with these general points that I will outline below.

Medical staff may make perfectly genuine mistakes that have terrible consequences. A tiny number of bad eggs may even be negligent or irresponsible and cause a patient harm.

In light of the above the GMC and NMC etc do investigate cases that are brought to their attention. Im not convinced any of these organisations or similar would bat an eyelid at gutting any one of their members. If you can point me at a case that shows any of them giving a mere slap on the wrist by siding with a member I would be glad to read about it. I have read countless cases of people being reprimanded by them or removed from practising.

Next, I have no problem with the NHS paying sums of money -even particularly large ones- to individuals who have suffered from any of the above as compensation. Obviously in an ideal world there would never be any unintended outcomes or bad eggs or accidents or mistakes but we are not at that point. My complaint is with the over 2 billion quid the NHS is spending annually not on compensation but just legal fees which all ends up in the hands of lawyers who view medicine as a cash cow. Its a waste of time and money. As I said an independant body should oversee all complaints against the health service and investigate them accordingly. This organisation could surely be cheaper and more efficient than throwing 2 billion quid at it every year and it should not be possible to go outside of this channel with any amount of no win no fee klingons at ones disposal.

In the case you mention the textbook answer is that the relative in question should have been informed about the potential of being a huntingtons carrier or sufferer. Usually decisions regarding ethics are made by a team of people not by individuals on the spot; this is designed to ensure a single error by a single person does not have undue ethical consequences. That the father did not want the information shared with his own daughter is irrelevant regardless of his motivations and I am not surprised legal action is happening- the cost of care for the womans own child (given that she herself could well be diagnosed with it too) could well be substantial meaning the sum of £345,000 may well be considered perfectly reasonable in the circumstances with full time care being circa £2000 a week these days.

In answer to your other points, yes there is a duty of care to others and not just the patient in front of you, and no, I do not believe making nurses or doctors immune from prosecution would mean they would be able to throw caution to the wind- the CQC, police and GMC/NMC etc are all able to take action as they see fit, which is what has to happen because potentially there could be a mistake made that the patient or their family may never come to question or become aware of- a well recognised issue. In practice this means that doctors have to work not just under the watchful gaze of the GMC but their own colleagues as well; everyone with any role in providing care has a professional duty to report anyone they feel has not acted correctly. This is one of the 6 key principles of care- meaning a nurse (or even a member of the public) would be perfectly able to report a doctor to the GMC- a list of all registered doctors is on their website so it is fairly transparent.

Lastly, you can't accuse a doctor of murder for facilitating an abortion because abortion is legal and as you the law is all about clear definitions. Whilst many medical issues are often quite unpalatable the crux of each comes down to a single question, is it illegal or not?
 

Danllan

Member
Location
Sir Gar / Carms
... A tiny number of bad eggs may even be negligent or irresponsible and cause a patient harm.

In light of the above the GMC and NMC etc do investigate cases that are brought to their attention. Im not convinced any of these organisations or similar would bat an eyelid at gutting any one of their members. If you can point me at a case that shows any of them giving a mere slap on the wrist by siding with a member I would be glad to read about it. I have read countless cases of people being reprimanded by them or removed from practising...

Lastly, you can't accuse a doctor of murder for facilitating an abortion because abortion is legal and as you the law is all about clear definitions. Whilst many medical issues are often quite unpalatable the crux of each comes down to a single question, is it illegal or not?
The number of instances that don't get to a hearing are, obviously, the unquantifiable and worrying thing.

You need to switch your last bit around: abortion is legal so that doctors can't be convicted of murder.
Those who kill unborn children get the book thrown at them in every way possible but... they can't be done for murder because it would be irrational not to convict medics for killing unborn children too. Odd world, isn't it? (Bear in mind I support the right to terminate. :()
 

AFM

Member
I think NHS is way too inefficient. My dad recently damaged his knee while chasing after cattle. We went in to A and E told the receptionist what had happened, then we waited. Then we saw a nurse and told her, then we waited. Then we went to see a doctor, she then wanted to get it scanned (which was obvious) we then waited again. They could have got it scanned before we even went to see the doctor then it wouldn’t have wasted our time and her time, she could have looked at the scan and then examined his knee at the same time!

Also people would walk in with a cut on their finger, I asked the doctor how much she thought could be sorted with common sense, he said at least 30% and some days could be more like half!
 
The number of instances that don't get to a hearing are, obviously, the unquantifiable and worrying thing.

You need to switch your last bit around: abortion is legal so that doctors can't be convicted of murder.
Those who kill unborn children get the book thrown at them in every way possible but... they can't be done for murder because it would be irrational not to convict medics for killing unborn children too. Odd world, isn't it? (Bear in mind I support the right to terminate. :()


I'm not too worried about the legal-ease about it. Abortion is legal and rightly so. The whys and whats have been done to death.
 

Servac

Member
Location
Wales
One big issue is that nurses are leaving the nhs to go and work for agencies. NHS is then short of staff and have to pay the agencies three times the money for the same nurses. As an agency nurse they are paid more per hour and have less responsibilities, which puts more pressure on NHS staff who have to take those on responsibilities.

Mother works on a cardiac ward and is the only permanent member of staff on the ward most shifts.
 

Highland Mule

Member
Livestock Farmer
I think NHS is way too inefficient. My dad recently damaged his knee while chasing after cattle. We went in to A and E told the receptionist what had happened, then we waited. Then we saw a nurse and told her, then we waited. Then we went to see a doctor, she then wanted to get it scanned (which was obvious) we then waited again. They could have got it scanned before we even went to see the doctor then it wouldn’t have wasted our time and her time, she could have looked at the scan and then examined his knee at the same time!

Also people would walk in with a cut on their finger, I asked the doctor how much she thought could be sorted with common sense, he said at least 30% and some days could be more like half!

What kind of scan did he get? If it was an X-ray or similar, then it is only right that people are not irradiated unnecessarily and the correct checks and balances are there to prevent anyone with a sore bit from getting zapped. Would be interesting to understand what percentage of those who come in with a sore limb need to be scanned, and the relative costs of scanning and doctor examinations - I'm sure that your local trust look at that sort of thing as part of their management. Thinking about it more too, if your father went for his scan before he saw a doctor, then he could have been in the hospital for longer before he was examined by the doctor - something which probably counts against the trust in its government targets.

Hope he's on the mend now though.
 

Danllan

Member
Location
Sir Gar / Carms
One big issue is that nurses are leaving the nhs to go and work for agencies. NHS is then short of staff and have to pay the agencies three times the money for the same nurses. As an agency nurse they are paid more per hour and have less responsibilities, which puts more pressure on NHS staff who have to take those on responsibilities.

Mother works on a cardiac ward and is the only permanent member of staff on the ward most shifts.
This is nothing new, my mother is in her eighties, but I remember her doing 'bank' nights and agency work too. The thing is, it would be very hard to compel people to work in the NHS; it has been suggested that nurses and medics should have free professional educations in return for an obligation to work in the NHS for a period post qualification. That's great so far as it goes, but... it only guarantees 'new recruits' in the system.

There is a shortage of qualified medics and nurses and this does give them - and the agencies - a strong bargaining chip with regard to money. However, I think the NHS has an even stronger hand since it has, effectively, a monopoly on healthcare jobs; if it were to say to an agency something such as 'No, your prices are taking the p!ss, we'll not use you, thanks and bye!' I think there would be a very rapid recalculation of costs and prices by the agencies as a whole.

...Would be interesting to understand what percentage of those who come in with a sore limb need to be scanned, and the relative costs of scanning and doctor examinations...
I am in total ignorance of the cost situation here, but I can tell you - from a family friend who is a doc' there - that in Japan as soon as you go to a hospital with anything remotely serious, you are scanned while waiting to see a medic. The reasoning being that if the machines and staff are there, which they will be, the imaging effectively costs nothing and it allows for a quicker and more accurate assessment by the doc' when you see him. Time is saved, a better opinion can be given due to having more information and the patient is reassured that nothing has been overlooked.

My following comments set real emergencies in A & E aside, for I have always found the services to be superb in that regard. However, I've experienced private medicine over here and have used or been present at the use of health systems all over the world and have observed them with interest. The thing that continually astonishes me is that they can work perfectly well with fewer staff than the NHS uses, with less recognised waste than the NHS creates and - surprise, surprise - with less bureaucracy than the NHS has evolved - I write of comparable first-world health systems.
 
I have only rough costs: single digital x ray is about £30. A CT scan starts at £300 but probably stretches to £800 for whole body. MRI is £2000, probably more for cardiac or complex cases involving contrast enhancement.

Demand for medical imaging increases hugely around 8 percent per year against a general increase of 2 percent on the NHS generally.
 

Highland Mule

Member
Livestock Farmer
I have only rough costs: single digital x ray is about £30. A CT scan starts at £300 but probably stretches to £800 for whole body. MRI is £2000, probably more for cardiac or complex cases involving contrast enhancement.

Demand for medical imaging increases hugely around 8 percent per year against a general increase of 2 percent on the NHS generally.

Ollie, do the CT and MRI carry tangible health risks in the same way as an X-ray does? I know that there's strong reasons for not doing unnecessary X-ray, but does that apply to the others as well?
 

Exfarmer

Member
Location
Bury St Edmunds
I have only rough costs: single digital x ray is about £30. A CT scan starts at £300 but probably stretches to £800 for whole body. MRI is £2000, probably more for cardiac or complex cases involving contrast enhancement.

Demand for medical imaging increases hugely around 8 percent per year against a general increase of 2 percent on the NHS generally.
Does the scanning really cost that much, or is the bulk of it capitalised costs, which cost no extra if they do no hundred or one thousand.
seem to remember my wife having one done privately ( by the local NHS ) only partial, but they only charged £150
 
Does the scanning really cost that much, or is the bulk of it capitalised costs, which cost no extra if they do no hundred or one thousand.
seem to remember my wife having one done privately ( by the local NHS ) only partial, but they only charged £150


Ignore my figures above: I have confused myself with the huge raft of complex data I have- my own fault for glancing over data ages ago. Recorded NHS figures across all trusts ranged from £142 to £250 for an MRI depending on what was done, that includes contrast etc if needed.

CT scan ranged from £106 to £152 even with contrast. PET scan ranges from £400-500. Ultrasound scans are about £65-100. I was right with x rays at £43.

For comparison, a vasectomy (a surgical procedure we are familiar with) costs about £800.
 

capfits

Member
So the Conservatives are currently planning to cut employee National Insurance.
Hardly makes the NHS, social care, pensions sustainable or am I missing something?
 
This is nothing new, my mother is in her eighties, but I remember her doing 'bank' nights and agency work too. The thing is, it would be very hard to compel people to work in the NHS; it has been suggested that nurses and medics should have free professional educations in return for an obligation to work in the NHS for a period post qualification. That's great so far as it goes, but... it only guarantees 'new recruits' in the system.

There is a shortage of qualified medics and nurses and this does give them - and the agencies - a strong bargaining chip with regard to money. However, I think the NHS has an even stronger hand since it has, effectively, a monopoly on healthcare jobs; if it were to say to an agency something such as 'No, your prices are taking the p!ss, we'll not use you, thanks and bye!' I think there would be a very rapid recalculation of costs and prices by the agencies as a whole.


I am in total ignorance of the cost situation here, but I can tell you - from a family friend who is a doc' there - that in Japan as soon as you go to a hospital with anything remotely serious, you are scanned while waiting to see a medic. The reasoning being that if the machines and staff are there, which they will be, the imaging effectively costs nothing and it allows for a quicker and more accurate assessment by the doc' when you see him. Time is saved, a better opinion can be given due to having more information and the patient is reassured that nothing has been overlooked.

My following comments set real emergencies in A & E aside, for I have always found the services to be superb in that regard. However, I've experienced private medicine over here and have used or been present at the use of health systems all over the world and have observed them with interest. The thing that continually astonishes me is that they can work perfectly well with fewer staff than the NHS uses, with less recognised waste than the NHS creates and - surprise, surprise - with less bureaucracy than the NHS has evolved - I write of comparable first-world health systems.


Pretty much agree with most of this.

Went in for a CT scan early because of traffic .. the staff on the CT stations had nothing to do and were searching for clients.

Whilst I understand the machinery has a mean time between failures .. I'm sure it also has a redundancy life term. But of course a scan is only as good as the doctor reviewing it.
 

Mek

Member
B1D5DF21-19F0-490F-8A0B-90C5CB51E749.jpeg
 

Highland Mule

Member
Livestock Farmer
Ollie, do the CT and MRI carry tangible health risks in the same way as an X-ray does? I know that there's strong reasons for not doing unnecessary X-ray, but does that apply to the others as well?

Since Ollie declined to answer, I've done my own digging. A CT scan can give a decent radiation dose - of a level that you wouldn't want un-necessarily (well above the legal limit for radiation workers), but an MRI scan doesn't give any radiation dose.

The dose levels from CT would certainly give a strong reason why one shouldn't get one "just in case", and hence would explain the need to see a doctor before.
 
Since Ollie declined to answer, I've done my own digging. A CT scan can give a decent radiation dose - of a level that you wouldn't want un-necessarily (well above the legal limit for radiation workers), but an MRI scan doesn't give any radiation dose.

The dose levels from CT would certainly give a strong reason why one shouldn't get one "just in case", and hence would explain the need to see a doctor before.


I did not see the post, why would I decline to answer if I knew the question?

Whole-body CT scans aren't routinely done but certainly they do give you a dose so they would not want to be doing them repeatedly and there would be a tiny but quantifiable risk to having that dose, hence why a radiologist would need justification for doing one.

MRI scans as you say don't give a radioactive dose but they aren't keen to do people who are pregnant (lack of evidence I guess) and aren't keen on people with any kind of metallic implant- there is a kind of heating effect involved.

The biggest bone of contention is in the contrast agents used. There is a small outcry over them being used in the USA but that's probably just America for you.
 

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