What is the root cause of overcrowded hospitals?

[ollie989898]

Without going into too much detail, just google the German and Australian models of healthcare. They aren't actually any cheaper but the service they offer is far superior.

Even in Norway you have to pay a small fee to see a GP, not enough that it would put you off going if you're sick but enough to weed out the time wasters and chancers looking for paracetamol on prescription.

You can have Norway's healthcare when you pay Norway's taxes. I'm all in favour, are you?

 

[ollie989898]

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

It's impossible to train in a year. It takes a year to learn just what 'normal' health looks like.

 

[caveman]

NHS is too successful.
Keeps too many of its customers coming back for too long.

 

[Oldmacdonald]

Not sure if it's the same elsewhere - but my local A&E has a MIU attached, and the reception drafts walk-ins into MIU or A&E as they arrive.

 

[toquark]

You can have Norway's healthcare when you pay Norway's taxes. I'm all in favour, are you?

It’s not about tax rates really, I’d have nothing against tax and spend if you actually got a decent service but the NHS is the worst of both worlds. Expensive and ineffective. The model needs ripping up and starting again.

 

[essex man]

It's impossible to train in a year. It takes a year to learn just what 'normal' health looks like.

That's what the medical profession would have you believe.
Clearly possible to train someone to do a limited number of simple procedures in a year.

 

[essex man]

It’s not about tax rates really, I’d have nothing against tax and spend if you actually got a decent service but the NHS is the worst of both worlds. Expensive and ineffective. The model needs ripping up and starting again.

Exactly!
It's inefficient and outdated in structure and protected by vested interests ...mainly doctors and big pharma but also the public who enfeeble themselves with unhealthy living with the NHS as their saviour.

 

[robs1]

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.

Having recently been in for five weeks I couldnt agree more.
I saw people who loved being there, one guy was in for his third stint in a year, wouldnt eat, wouldnt get out of bed etc etc eventually they would get him better send him home and he would stop doing everything again and they would have to take him back. One of the NA gave me chapter and verse about him.
As you said its very easy to get institutionalized in hospital, after my OP which took 9 hours I was out of bed the next morning unaided apart from the drip stand I was able to.move ok, within two days I had sepsis and nearly didnt make it, after the first two days of the right drugs I was helped out of bed and my wife helped me walk a bit, I had lost two stone by the sixth day and aged 20 years, all my food was given via a picc line, by day ten I was walking a km a day yet other younger people having much smaller ops thought doing 100 mtrs was a struggle.
The physios get really fed up with those who lounge about as it has been proved that the more you do the better the outcome. You have to help yourself

 

[robs1]

It’s not about tax rates really, I’d have nothing against tax and spend if you actually got a decent service but the NHS is the worst of both worlds. Expensive and ineffective. The model needs ripping up and starting again.

Exactly!
It's inefficient and outdated in structure and protected by vested interests ...mainly doctors and big pharma but also the public who enfeeble themselves with unhealthy living with the NHS as their saviour.

I dont think doctors in hospitals have a vested interest in it, they work extremely hard and do a great job, I do think GPs need to change but so do the public too many go when they dont need to.
While I'm sure things could be done better you cant just rip it up and start again change has to happen gradually because people are using the services and you cant change just like that

 

[toquark]

I dont think doctors in hospitals have a vested interest in it, they work extremely hard and do a great job, I do think GPs need to change but so do the public too many go when they dont need to.
While I'm sure things could be done better you cant just rip it up and start again change has to happen gradually because people are using the services and you cant change just like that

I'm not suggesting an overnight revolution but a revolution whether it takes one year or ten must occur in the way healthcare is delivered in this country. The current model is completely outdated, over priced and ineffective, but worse than that, it has been elevated to the status of a proxy religion which renders any criticism of its performance heresy.

 

[robs1]

I'm not suggesting an overnight revolution but a revolution whether it takes one year or ten must occur in the way healthcare is delivered in this country. The current model is completely outdated, over priced and ineffective, but worse than that, it has been elevated to the status of a proxy religion which renders any criticism of its performance heresy.

The government needs to set up a commission that is non political that looks at the worlds best systems.
Sooner or later the country needs to accept a charge for seeing a doctor, I'm sure most would accept that if you didnt have to wait so long for an appointment

 

[essex man]

I'm not suggesting an overnight revolution but a revolution whether it takes one year or ten must occur in the way healthcare is delivered in this country. The current model is completely outdated, over priced and ineffective, but worse than that, it has been elevated to the status of a proxy religion which renders any criticism of its performance heresy.

It's definitely a religion with the self enfeebled masses as the worshippers, the doctors as the priests and the doctrines including "the NHS must stay exactly the same forever and be given more and more money"

 

[ollie989898]

Having recently been in for five weeks I couldnt agree more.
I saw people who loved being there, one guy was in for his third stint in a year, wouldnt eat, wouldnt get out of bed etc etc eventually they would get him better send him home and he would stop doing everything again and they would have to take him back. One of the NA gave me chapter and verse about him.
As you said its very easy to get institutionalized in hospital, after my OP which took 9 hours I was out of bed the next morning unaided apart from the drip stand I was able to.move ok, within two days I had sepsis and nearly didnt make it, after the first two days of the right drugs I was helped out of bed and my wife helped me walk a bit, I had lost two stone by the sixth day and aged 20 years, all my food was given via a picc line, by day ten I was walking a km a day yet other younger people having much smaller ops thought doing 100 mtrs was a struggle.
The physios get really fed up with those who lounge about as it has been proved that the more you do the better the outcome. You have to help yourself

Cripes, that sounds awful. I'm glad to hear you came through that.

 

[ollie989898]

The government needs to set up a commission that is non political that looks at the worlds best systems.
Sooner or later the country needs to accept a charge for seeing a doctor, I'm sure most would accept that if you didnt have to wait so long for an appointment

The health services of the UK and it's budget should be overseen by a cross party committee so that it cannot be used for political purposes.

 

[ollie989898]

That's what the medical profession would have you believe.
Clearly possible to train someone to do a limited number of simple procedures in a year.

Put simply, come and have a go if you think it is easy.

 

[ollie989898]

It’s not about tax rates really, I’d have nothing against tax and spend if you actually got a decent service but the NHS is the worst of both worlds. Expensive and ineffective. The model needs ripping up and starting again.

Won't happen, you would have months of chaos in the meantime until everyone knew where they were with it.

It's like changing the computer software used. Can't be done really.

 

[JCMaloney]

The health services of the UK and it's budget should be overseen by a cross party committee so that it cannot be used for political purposes.

And given a long-term budget and not be allowed to exceed it without consequence!!

We had a minor "accounting error"............ around £43 million was "lost".

Nobody got sacked, CEO retired (ill health), CFO walked off to a new job.

 

[ollie989898]

And given a long-term budget and not be allowed to exceed it without consequence!!

We had a minor "accounting error"............ around £43 million was "lost".

Nobody got sacked, CEO retired (ill health), CFO walked off to a new job.

I can only go on what I have been told regarding how how the money and management side of things works I'm afraid so I can't comment on any specifics at a local level. I recognise that some trusts struggle more than others but this could be due to a myriad of factors.

Of course the whole system is evolving and changing over time, so the idea that nothing can ever be changed ever is a bit false but this happens at trust/provider level and is entirely down to their own ingenuity and desire to try new things and long may that continue.

I am however sceptical of wholescale reorganisation when the same faces are sat in the same chairs only for them to reshuffle a bit every time the music stops. How can wholescale change occur when the same limited pool of personalities are doing it within the upper echelons of the oversight and management in government- the CCGs, PHE, CQC, DHSS- How many of the same suits are in play as they shuffle from one chair to the next? These people are paid a great deal of money and I would be interested to know their employment histories. They hold top civil servant positions but are faceless to the public and it ultimately matters not a jot to them as to how any particular NHS provider performs.

EDIT: I do believe we are not far away from nurses being trained to do many routine surgeries. The glass ceiling on their pay is frankly ridiculous and should be dropped. We should be training, retaining and encouraging nurses to train for ever more specialist roles because from what I have seen, the ANPs, ACPs, ENPs and the like are absolutely brilliant. Many of them (including the midwives) have done their masters anyway so already have 4 years of academia behind them. They are basically doing some of the work of doctors just without that title. Let them multiply and go to work.

 

[Oldmacdonald]

I'm never quite sure how NHS is organised.

Seems fairly simple up here, but sounds more complicted south of the border. Is a NHS trust the same thing as a regional health board here?

 

[ollie989898]

I'm never quite sure how NHS is organised.

Seems fairly simple up here, but sounds more complicted south of the border. Is a NHS trust the same thing as a regional health board here?

@JCMaloney will be able to explain this far better than myself. I have way too much running around my brain right now.