What is the root cause of overcrowded hospitals?

[toquark]

I wonder if the uk problem is that it was the first. So well ahead of the game in the 60/70/80’s but now ahead of the game in declin.
much the same as motorbike manufacture, car manufacturers etc etc etc

I often think this, there's a certain degree of arrogance which pervades the British way of doing things. This was evident in the dying days of heavy industry and the big state owned businesses, and is certainly the case with the NHS. People just assume it will always be there then one day it won't be they left wondering why or blaming the Tories.

 

[essex man]

Took my daughter for private provided, NHS funded orthodontistry...eight people in chairs in one room, dental nurses doing the work fixing braces, one dentist roaming the room.
When the incentives are there people will innovate and increase productivity.
Doctor training clearly needs reform to enable earlier specialisation and cheaper, shorter training.
Doctors will/do not allow this, like all organized labour they love needless barriers to entry.
That's fine you expect that but you need to push back against it, recognise that they are not gods but selfish humans like the rest of us.

 

[Muck Spreader]

Took my daughter for private provided, NHS funded orthodontistry...eight people in chairs in one room, dental nurses doing the work fixing braces, one dentist roaming the room.
When the incentives are there people will innovate and increase productivity.
Doctor training clearly needs reform to enable earlier specialisation and cheaper, shorter training.
Doctors will/do not allow this, like all organized labour they love needless barriers to entry.
That's fine you expect that but you need to push back against it, recognise that they are not gods but selfish humans like the rest of us.

What a lot of rubbish.

 

[essex man]

What a lot of rubbish.

Because?

 

[capfits]

Because?

You speak with the voice of an expert on these things or your field?

Now let us just have a look at Medicine as a degree. You will no doubt know that the vast majority of entrants are sub 20, well over 60% are privately educated and while presenting as bright academically they are ehm not been in the real world.
So 2 and a half years of pretty pure academia and some skill development.
Then 2 and a half years of mixed on ward, GP surgery and academic learning with around 8 weeks holidays.
Get degree and then 2 years of placements within NHS.
Choose which part of medicine you may wish to follow
So Pathology, Endocrine,Surgery, Orthapedic all the way through to say maxillofacial.
Keep progressing and possibly at 10 years you may have the necessary qualifications to get on with it.
So in essence no 18 year old knows what they may wish to pursue medically.

Older second degree students ex nurses, pharmacists possibly, but it still ultimately needs the same skills etc and knowledge base to do the job effectively and safely.

 

[essex man]

You speak with the voice of an expert on these things or your field?

Now let us just have a look at Medicine as a degree. You will no doubt know that the vast majority of entrants are sub 20, well over 60% are privately educated and while presenting as bright academically they are ehm not been in the real world.
So 2 and a half years of pretty pure academia and some skill development.
Then 2 and a half years of mixed on ward, GP surgery and academic learning with around 8 weeks holidays.
Get degree and then 2 years of placements within NHS.
Choose which part of medicine you may wish to follow
So Pathology, Endocrine,Surgery, Orthapedic all the way through to say maxillofacial.
Keep progressing and possibly at 10 years you may have the necessary qualifications to get on with it.
So in essence no 18 year old knows what they may wish to pursue medically.

Older second degree students ex nurses, pharmacists possibly, but it still ultimately needs the same skills etc and knowledge base to do the job effectively and safely.

I don't care whether they know what they want to do or not at 18, does anyone know that?
They can be made to choose and get trained in a year to do whatever they are needed to do.
You think the current system works?
It sucks bright people out of schools to do a job that doesn't require intelligence, purely because of the misplaced idea that the job is difficult and the restrictions on entering

 

[capfits]

I don't care whether they know what they want to do or not at 18, does anyone know that?

We I did and I expect many other did to. Remember it is their choice and not yours, soz.

They can be made to choose and get trained in a year to do whatever they are needed to do.

Oh I see can be made to choose. How compulsion?slavery?
Square pegs round holes and all

You think the current system works?

Depends how you define works and who for arguably. But yes it does.

It sucks bright people out of schools to do a job that doesn't require intelligence, purely because of the misplaced idea that the job is difficult and the restrictions on entering.

Wowser there chum. Interesting take there.

In the meantime I look forward to regaling us with you experiences of Dougy Howser, doing a triple heart valve bypass on a close one, and shortly followed by the cast of Holby working wonders o a smashed pelvis.
Crack on

 

[Devil's advocate]

Doctors retireing so young

 

[Goweresque]

An older workforce that is reducing hours or retiring.
Media, "if you have this speak to doctor"
The pandemic and the fears that have surfaced in folk.
An ageing population.
Less fit population.
All mixed together

All these apply to all Western nations. Yet their healthcare systems seem to be coping just fine. The problem is the NHS, it doesn't work. There's absolutely no incentive for it to get any better at what it does, because there's no market feedback via either profits or customers walking away. Its gets its budget to spend every year, come what may.

Lets say someone comes up with a new procedure that will revolutionise hip replacements (say), make them cheaper and faster to do. In private industry that would be implemented as soon as possible, because it would increase profits. In the NHS it will get sat on by umpteen committees, half of whom don't want it because it would mean them working harder, or it might make their role redundant entirely. Either way, the 'needs' of the employees are more important than those of the patients, because it makes no difference to most of those sat round the table whether they implement this new procedure or not, they'll get paid regardless. And anyone who would be surplus to requirements afterwards will definitely vote against it.

Its not surprising really, the NHS is pretty much pure socialism. And we all know how well that works. I've often thought that as it took about 70 years for the internal economic contradictions within the socialist USSR to induce a final collapse (1918 to 1990), and as the NHS was formed in 1948 we should therefore be seeing the same result in it around 2020. Which seems to be about spot on.

 

[essex man]

We I did and I expect many other did to. Remember it is their choice and not yours, soz.

Oh I see can be made to choose. How compulsion?slavery?
How is it compulsion, you change the nature of the profession and make it attractive enough.
They complain about overwork, would do away with that problem with enough to go round.
Why should taxpayers foot the bill for people to do extended training for effectively a myriad of different jobs, til they decide which they like the look of the most.
They're just glorified mechanics at the end the day.

 

[teslacoils]

Keeping folk alive too long.
Promising things it can't deliver.

Is be interested what percentage of deaths in hospital are caused or exacerbated by illness caught in hospital.

 

[Muck Spreader]

Doctors retireing so young

Bizarrely, the BMA have to recommend GP's in their 50's retire early if their pension plans become full as it virtually can cost them money to keep working. This also limits how many days some GP's can work without landing some huge tax bills. Stupid situation that Mr Rishi is supposed to be addressing.

 

[Muck Spreader]

I don't care whether they know what they want to do or not at 18, does anyone know that?
They can be made to choose and get trained in a year to do whatever they are needed to do.
You think the current system works?
It sucks bright people out of schools to do a job that doesn't require intelligence, purely because of the misplaced idea that the job is difficult and the restrictions on entering

Taking twaddle. Ruddy sure I wouldn't want a mentally challenged 19 year old with a years experience doing bypass surgery one me, which is what you are implying. Not even sure I would want them cutting my toe nails.

 

[7610 super q]

UK population when the NHS was formed = 49 million.
UK population 2021 = 68 million. And more in the over 50 age bracket too.
It's not rocket science.

 

[BrianV]

Bed blocking is the cause of queues of ambulances parked outside of hospitals

UK population when the NHS was formed = 49 million.
UK population 2021 = 68 million. And more in the over 50 age bracket too.
It's not rocket science.

Interested to know how many hospital beds have been lost & closed down in that time scale?

Key messages​

• The total number of NHS hospital beds in England has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2019/20, while the number of patients treated has increased significantly.
• Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK has fewer acute beds relative to its population than many comparable health systems.
• Since 1987/88, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community.
• The number of hospital beds for general and acute care has fallen by 44 per cent since 1987/88; the bulk of this fall is due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital.

 

[Muck Spreader]

Bed blocking is the cause of queues of ambulances parked outside of hospitals

Interested to know how many hospital beds have been lost & closed down in that time scale?

Halved in last 30 years apparently. From 299,000 to 141,000.

 

[BrianV]

Halved in last 30 years apparently. From 299,000 to 141,000.

Whilst population numbers have exploded & people living longer, hardly rocket science why there's a problem is it!

 

[Lowland1]

When my father had a heart attack and ended up in hospital we found that as we had never done a power of attorney for health we couldn’t remove him from hospital until he was deemed safe to return home as such he was a prisoner of the NHS for five months unable to return home and mentally deteriorating until when he was finally allowed to return home he wasn’t fit to be allowed home. Emergency care is very good but that’s the easy bit as far as i am concerned the doctors were rubbish and the nurses not much better. I have two sister in laws who are doctors and a cousin who is a nurse practioner and my father in law and mother in law were doctors so i have a bit of an idea how it should work but it doesn’t. Want to sort out the NHS make people pay for it.

 

[Goweresque]

Is be interested what percentage of deaths in hospital are caused or exacerbated by illness caught in hospital.

I once read about a big study that was done in an NHS Trust area (Leicester) whereby they took all the records of people who had died unexpectedly in hospital, or within one month of a visit to one of the the Trust's hospitals, over a 1 year period. They then got a team of medical experts to scrutinise the paper trail of exactly what happened to each of those patients while in hospital, and gamed each case, ie they gave the information the patient presented with to the panel, let them make their own diagnosis and preferred treatment plan, then revealed what actually happened, and repeated the process right through the patient's treatment while in the hospital. They came to the shocking conclusion that about 25% of the patients who died had received seriously substandard care that increased the risk of harm to them, and half had received care that should have been better.

This is the article:

The inside story of a six-year-old boy's death. And the trainee doctor who took the blame. - BBC News

The inside story of a six-year-old boy's death. And the trainee doctor who took the blame.

www.bbc.co.uk

Its actually a BBC piece about a doctor who was convicted of manslaughter for making a serious error in the treatment of a child, but it covers the study almost as a throw-away. I've never seen anything mentioned about this study anywhere else since and its always stuck in my mind.

Quote
The Summary Hospital-Level Mortality Indicator (SHMI) uses adjusted data from individual trusts to flag up a higher-than-expected number of deaths. It acts as an early warning system highlighting a need for further investigation.

In 2013, Leicester GPs had started to become concerned about the University Hospitals of Leicester Trust’s SHMI. It had been higher than it should have been since the SHMI was introduced in 2010.

After deliberating with the Trust, they asked Dr Ron Hsu, then a public health consultant and now associate professor at the University of Leicester, to investigate further.

He met representatives from the local Clinical Commissioning Groups, the hospital and NHS England to devise and agree a plan.

Teams of doctors and nurses were tasked with going through the records of patients who had either unexpectedly died in hospital or died within 30 days of leaving between 1 April 2012 and 31 March 2013. It didn’t look at paediatrics.

They focused on a sample that would help them identify systematic clinical issues. This is where you learn the most, Dr Hsu says.

In large rooms set aside in the hospital, the teams pored over patients' notes looking at the kind of care they were receiving and identifying things they thought had gone wrong.

The bar was set high – a team of doctors or nurses had to be unanimous before they agreed a patient had received poor care, Dr Hsu says.

When Dr Hsu came to tally the results, he did not believe what he saw. “It was shocking. Based on what I read I was expecting around 10% of patients to have received unacceptable care,” he says.

But in fact nearly a quarter of patients in the report had received “unacceptable care” – serious errors had been made that would have increased the risk of harm.

In over half, there were “significant lessons to learn” – aspects of care that could be done better.

I am convinced that the NHS kills many thousands of people every year, possibly in the tens of thousands, through its negligence. Only occasionally do these scandals come to light, usually after years (sometime decades) of the victims families fighting tooth and nail against the NHS to get the truth into the open. Examples being the Mid Staffs hospital scandal, the Gosport Hospital scandal and the current Shropshire maternity care scandal. Most of the cases are buried along with the deceased.

But its the wonder of the world, don'tcha know........

 

[Oldmacdonald]

There's quite a lot of reasons given in the thread so far:

Too many people
No more cottage hospitals
Poor diet/exercise resulting in higher admission rate
aging population
et cet


But...do these not all just point to lack of funding for what we expect the NHS to do?