What is the root cause of overcrowded hospitals?

linga

Member
Location
Ceredigion
One of the ways to improve the NHS is to start on time.
I recently had an appointment at 9.00am. ( the first of the day for them )
I duly turned up a little early but couldn’t book in until 9.00.
Then I had to wait until 9.20 before anything happened despite all the staff being there. If they weren’t going to start until 9.20 why give me an appointment for 9.00.
it wastes my time and immediately makes all further appointments late
 

fgc325j

Member
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.
The procedure for hip replacements has been shortened, my mother went in for her first hip op in October 1996 and the procedure then was to be bed bound for a week, then to start daily mobility, and 2 weeks after the op, she was allowed home, i.e 2 week stay in hospital. I had my first hip op in July 2008, had the op first thing on a Monday - home by 3.00pm the next Thursday, 4 days in the hospital.
 

Hindsight

Member
Location
Lincolnshire
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:


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........

Why does it surprise you. I am more surprised given the vagaries of the job that more folk do not die etc as result of mis diagnosis and resulting incorrect treatment. See it all the time from agronomists and farmers, why should doctors be different?
 

Goweresque

Member
Location
North Wilts
Why does it surprise you. I am more surprised given the vagaries of the job that more folk do not die etc as result of mis diagnosis and resulting incorrect treatment. See it all the time from agronomists and farmers, why should doctors be different?

These weren't cases where an understandable misdiagnosis took place and wrong treatment was given. Of course doctors can't know everything about a patient's illness, they are not clairvoyant. It was cases where obvious serious errors were made. Errors that should never have happened. Possibly in diagnosis, or delays in treating something, or the drugs administered, that sort of thing. From the article:

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.

We are talking your agronomist deciding your crop of wheat needs a dose of glyphosate in April, or your vet deciding to treat mastitis with an injection of vitamins. The sort of decisions if made by an agricultural professional adviser you'd be expecting compensation for your losses, it was that obviously the wrong course of action.
 

Muck Spreader

Member
Livestock Farmer
Location
Limousin
Why does it surprise you. I am more surprised given the vagaries of the job that more folk do not die etc as result of mis diagnosis and resulting incorrect treatment. See it all the time from agronomists and farmers, why should doctors be different?
Particularly when the NHS has to deal with around 1.5 million people a day with a chronically under resourced and understaffed organisation.
 

Lowland1

Member
Mixed Farmer
In 202
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?
Doesn’t matter how much money you give it will never be enough. It’s the fifth biggest employer in the world. A state run entity in a country that has divested itself of state run entities. The main problem is it’s untouchable no one dare to reform it.
 

JP1

Member
Livestock Farmer
Having recently spent five weeks in hospital it's fairly easy to see at least some of the causes.
1 we have an aging population, the baby boomers of the 1950s and 1960s are needing healthcare increasing demand.
2 its seems people now rush to the doctor for any minor complaint meaning GPs are very hard to get an appointment with if you actually need one.
3 point two means people go to A&E instead, which is what I did, I was actually seriously ill and was admitted immediately, many there should have seen a chemist, some time later I was rushed by ambulance from one hospital to another and was told by the paramedic that hospitals arent allowed to have patients in corridors as it looks bad so they are put back in ambulances after being assessed hence the queues.
4 due to less operations being done due to covid there is a huge effort to catch up this is leading to more people in wards, my section was designed to have had four beds in each bit but has now an extra bed, I presume many units are the same.
5 The cost of treatments are rising due to new drugs etc .

All the above mean despite ever increasing resources there never seems to be enough. One thing I did notice was the large number of trainee doctors there.
As an aside to your point, I wish you well and rust you're on your way for a speedy and full recovery
 

Montexy

Member
This is an example of how the NHS could save time and costs and if it helps a few of you that will be a bonus. Five years ago started getting up for a pee or two every night, wife said get it checked out so saw the GP. He sent me to nurse for blood test, results came through very high score for my age, another GP apt, finger up backside, can't feel anything but I'm sending you to hospital. Specialist looked for half and hour and finger up my backside said you need a scan then realised Dr should have had given a second blood test so had one at hospital, few days later before scan due rang to say all normal but we would like to give you blood test every year. We'll I did some research on google and found out you should be told to refrain for one week before a blood test for prostate from: sex, riding a bike, driving a tractor, running/jogging, any form of vigorous exercise as these will all give a false PSA score. Every time nurse rings for me to book my yearly test I ask, "should I refrain from anything before the test" and the answer is always no just come on in - we always get into a slightly heated conversation over it when I point out the false readings and unnecessary hospital referrals and work for the NHS my surgery create. Multiply this many times and the cost to the NHS must be eye-watering.
 

robs1

Member
This is an example of how the NHS could save time and costs and if it helps a few of you that will be a bonus. Five years ago started getting up for a pee or two every night, wife said get it checked out so saw the GP. He sent me to nurse for blood test, results came through very high score for my age, another GP apt, finger up backside, can't feel anything but I'm sending you to hospital. Specialist looked for half and hour and finger up my backside said you need a scan then realised Dr should have had given a second blood test so had one at hospital, few days later before scan due rang to say all normal but we would like to give you blood test every year. We'll I did some research on google and found out you should be told to refrain for one week before a blood test for prostate from: sex, riding a bike, driving a tractor, running/jogging, any form of vigorous exercise as these will all give a false PSA score. Every time nurse rings for me to book my yearly test I ask, "should I refrain from anything before the test" and the answer is always no just come on in - we always get into a slightly heated conversation over it when I point out the false readings and unnecessary hospital referrals and work for the NHS my surgery create. Multiply this many times and the cost to the NHS must be eye-watering.

Is it a false high or low reading ?
 

JCMaloney

Member
Location
LE9 2JG
The core problem is patient flow.

If they come in the front door then folk need to be leaving as quickly.

So you need to reduce the inflow, increase the outflow and bingo - no overcrowding.

However to do that you need all the other bits of the NHS to do their bit and reduce the "go to A&E" syndrome, the clue is in the name Accident & Emergency.

If you have walked in and can sit around for 7 or 8 hours you shouldn`t even be there.

This poster campaign summed it up well but never really got traction.
1654787509152.png
 

toquark

Member
The core problem is patient flow.

If they come in the front door then folk need to be leaving as quickly.

So you need to reduce the inflow, increase the outflow and bingo - no overcrowding.

However to do that you need all the other bits of the NHS to do their bit and reduce the "go to A&E" syndrome, the clue is in the name Accident & Emergency.

If you have walked in and can sit around for 7 or 8 hours you shouldn`t even be there.

This poster campaign summed it up well but never really got traction.
View attachment 1041631
Yeah fair enough if you could actually get a GP appointment. My wife was quoted a 10 day wait for an appointment to deal with a persistent chesty cough last winter. Presumably the GPs in our local practice were hoping she'd either go to A&E or die before they'd have to come and see her face to face for the appointment.

As it was she went to A&E as she was having trouble breathing, the triage doctor there told us that the majority of her patients that day could and should have been seen by a GP before making their way to hospital but that they had no other choice but to come and gum up the hospital.

The system is a shambles but government and media can't bring themselves to criticise it so soon after declaring all NHS staff heroes on a par with the soldiers on D-Day or whatever. Its a total joke.
 

DRC

Member
My bowling mate is a paramedic and he said at Shrewsbury yesterday, there were 18 ambulances queuing for several hrs in front of them
Not sure what the answer is
This is the picture I posted and is the one mentioned by the OP
Shrewsbury hospital at 5.30 pm on Tuesday evening .
My wife said corridors were full.
BF408844-ACD3-43DC-B209-FDE40129D676.jpeg
 
This is the picture I posted and is the one mentioned by the OP
Shrewsbury hospital at 5.30 pm on Tuesday evening .
My wife said corridors were full.View attachment 1041650

5pm is when ED begins to get busy. A queue of ambulances is not an automatic cause for alarm.

This is an example of how the NHS could save time and costs and if it helps a few of you that will be a bonus. Five years ago started getting up for a pee or two every night, wife said get it checked out so saw the GP. He sent me to nurse for blood test, results came through very high score for my age, another GP apt, finger up backside, can't feel anything but I'm sending you to hospital. Specialist looked for half and hour and finger up my backside said you need a scan then realised Dr should have had given a second blood test so had one at hospital, few days later before scan due rang to say all normal but we would like to give you blood test every year. We'll I did some research on google and found out you should be told to refrain for one week before a blood test for prostate from: sex, riding a bike, driving a tractor, running/jogging, any form of vigorous exercise as these will all give a false PSA score. Every time nurse rings for me to book my yearly test I ask, "should I refrain from anything before the test" and the answer is always no just come on in - we always get into a slightly heated conversation over it when I point out the false readings and unnecessary hospital referrals and work for the NHS my surgery create. Multiply this many times and the cost to the NHS must be eye-watering.


Screening tests such as these may be incentivised by the government and so the practices of service providers may appear to be operating in a way that makes utterly no sense to you but it will be financially advantageous to them. It's not all as black and white as the public thinks it is. The case in point is the repeated use of the term 'NHS' in this thread. There is no such single entity. If you tried to point the NHS out as an actual thing to me you would fail as it simply does not exist. The healthcare provided to the UK is split up across many different organisations and providers in a huge collage of geographical and organisational boundaries. Some of them will invariably be privately owned, so arguments that it should all be privatised could well be rather flawed. All these different providers are monitored (and punished or even rewarded) by the government which has setup a complex set of goalposts through which they would like care to be delivered. Some providers may be more successful at achieving these goals than others and as a customer in the system your mileage may vary as well.
 
The core problem is patient flow.

If they come in the front door then folk need to be leaving as quickly.

So you need to reduce the inflow, increase the outflow and bingo - no overcrowding.

However to do that you need all the other bits of the NHS to do their bit and reduce the "go to A&E" syndrome, the clue is in the name Accident & Emergency.

If you have walked in and can sit around for 7 or 8 hours you shouldn`t even be there.

This poster campaign summed it up well but never really got traction.
View attachment 1041631

It would be a lot less busy if we had the American system and an ambulance ride was £400 even if all you did was step into it and ride 4 miles in the back.

A and E is a catch all service that turns no one away so it's hardly surprising that it is busy. To be honest I see no difference between someone arriving at the minors section of A and E or the local MIU. There will still be that small percentage of people who actually aren't 'minor' at all but they would be just as well served by an MIU but I suppose there would be a lot less of a walk to major care. In my experience, if you enter MIU even on a busy day you will see someone within 40 minutes and I understand completely why people use MIU instead of seeing their GP. To be honest, a good portion of that caseload wouldn't warrant a visit to the GP or would have self remedied by then anyway.

I wonder if you couldn't reduce the caseload on non-minor A and E if people had access to functional mental health and social care as I recognise that in some parts of the country these services are oversubscribed or unavailable. So guess what their default option is.
 
The procedure for hip replacements has been shortened, my mother went in for her first hip op in October 1996 and the procedure then was to be bed bound for a week, then to start daily mobility, and 2 weeks after the op, she was allowed home, i.e 2 week stay in hospital. I had my first hip op in July 2008, had the op first thing on a Monday - home by 3.00pm the next Thursday, 4 days in the hospital.

This is evidence based medicine for you. Research has shown that people rehabilitate much more successfully and faster if they are admitted, go through whatever they need to do and then get sent home promptly. Witness the legions of OTs and physios in hospitals at all levels- they are all aiming to get people home. People do not exist solely to lie in bed in hospitals, they have lives to lead. Let me explain.

You don't want people in hospital. Firstly, hospital is a top place for someone to catch a bug despite the best will in the world. Secondly, if I took even the average TFF reader and told them to lie in a bed for two or three weeks whilst their every whim was pandered to they would lose muscle mass, become weaker and might even begin to enjoy being waited on hand and foot. People, particularly the elderly, get admitted and begin to actually lose their normal capabilities, until one day, actually, no I can't get out of bed on my own. I can't climb stairs, I can't even dress myself. And do you know what, since I don't actually have any family or anyone to talk to back home, I quite like being in here. Constantly new faces and staff who will listen to me mean I have someone to talk to now, cripes, I don't even have to make my own tea or buy biscuits anymore. Heck here comes a free lunch, oh and more tea, fantastic. Suddenly I don't want to go home now. In fact, I'd much rather stay here in this bed with my expensive air mattress and which adjusts all the ways under the sun, you'd never fit this in my bedroom at home. Move to a care home? Cripes no, I'd have to pay £2000 a week for that, hospital is free. Besides, I like it here.

The longer you keep people in such an environment where everything is done for them, the less they will be able to do. It's also quite hot and dry in the average hospital, and with the best will in the world, people won't be eating and drinking as they normally would- what does this do for their health? And thirdly, the other reason you don't want people in hospital is because many elderly people, if you put them in an unfamiliar environment, with no familiar faces, it will confuse the fudge out of them and cause them distress. They are away from their loved ones, they don't see their regular carers, they don't have they usual clothes, their usual shower, their usual loo. You can't personalise a building to cater for every particular occupant. Think of the workload involved in just monitoring, feeding and caring for 20 people who are actually medically well. Physical observations done like clockwork, fed three times a day and supper at night. Drinks on demand. Bedlinen changes, cleaning, house keeping, just the loo roll use. It bends the mind.

This is why, no, if you are an otherwise healthy person who has their hip replaced, the next morning those dragonzord physios will have you out of bed and walking to the loo using walking aids. Then they'll make you climb stairs. If you can do this, they'll probably get you discharged tomorrow. I've seen privately treated hip op patients in the door and out within 72 hours, with a follow service at home a little later to check dressings, etc. The same is true for women giving birth. If you've had a normal birth, they want you out and away as soon as possible once the wellbeing of mum and baby has been deemed satisfactory. Not because the workforce are cruel or to meet some target or they want your bed, it's just widely recognised that people 'do' better in their usual environment and doing what they usually do. In the case of obstetrics, this can be seen in the numbers of women who prefer midwife-led units or even opt for home births.

The old ways may not have been the best after all.
 

Vader

Member
Mixed Farmer
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.
 
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.

Doctor training will never be shortened. To get provisional registration you need to have had 5000 hours training, EU law says so.
 
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:


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........

What percentage of deaths are you prepared to accept from human error alone? I'm also dubious about asking clinicians to second-guess decisions made by others from the comfort of a desk and also considering a single case at a time in an environment where you are isolated from the actual every-day demands of professionals in their usual place of work.

I've had conversations with people from both the aviation and nuclear worlds when talking about failures when it comes to healthcare. Both these industries have a system of forward rather than backward accountability. These mean systems have been created that are incredibly safe and reliable and in fact healthcare has adopted a lot of the same internal practices now.

The difference is, of course, if a passenger plane crashes in a million bits tomorrow, no one is going to try suing the captain even if it was his fault.

You cite examples where systematic failures led to patient harm. But these are not a clear sign that every provider and ever member of staff so employed in the UK is dangerously incompetent or corrupt to the point of trying to hide failures. I genuinely believe that the people who turn up to work each day at going to do their absolute best for the people they care for, not deliberately go out and allow people to come to harm. I am sorry if others do not share this view.
 

SFI - What % were you taking out of production?

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    Votes: 79 42.2%
  • Up to 25%

    Votes: 65 34.8%
  • 25-50%

    Votes: 30 16.0%
  • 50-75%

    Votes: 3 1.6%
  • 75-100%

    Votes: 3 1.6%
  • 100% I’ve had enough of farming!

    Votes: 7 3.7%

Red Tractor drops launch of green farming scheme amid anger from farmers

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As reported in Independent


quote: “Red Tractor has confirmed it is dropping plans to launch its green farming assurance standard in April“

read the TFF thread here: https://thefarmingforum.co.uk/index.php?threads/gfc-was-to-go-ahead-now-not-going-ahead.405234/
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