Junior Doctors Strikes

[malachi]

Health care is a business people forget this and they receive a lot of money from parties which do not want people health.

Which goes back to my point about money is made from sick people, not healthy people.

Doesn't matter if it's the US, UK or India. The underlying business mode is all the same.

And if people are sick because of bad lifestyle choices then they deserve to be financially bled dry.

 

[Semple]

UK national debt = £2.9tn

Annual interest payment on national debt = £105bn

Annual cost of NHS = £205bn

Any ideas on how to improve the NHS without spending a shed load more money as the country is a bit broke?

The problem is the NHS in an absolute behemoth with around 600 million patient contacts a year - which sounds a lot considering the UK only has a population of 70million and obviously not everyone of those will use the NHS each year.

I bet out of that 205bn budget no-one could account for where every penny goes. It's just too much money to track and on millions and millions of different expenses.

 

[fez]

I bet out of that 205bn budget no-one could account for where every penny goes. It's just too much money to track and on millions and millions of different expenses.

If you ask my partner where a chunk of it goes she will tell you its spent on expensive medications. Its spent on people getting their prescriptions paid for them despite the prescription being for paracetamol. Its people who get expensive medications that they don't actually take for years on end but didn't care or bother to discuss this with their GP.

She spent years in the community going to peoples houses and finding that they had tens of thousands of pounds worth of out of date drugs they didn't take because "I didn't like how they made me feel". Well did you talk to your GP? No, you just didn't take them and your condition wasn't actually being treated and has got worse.

Shes been doing deprescribing as well which is a huge amount of work and a faff because so many people are on a heady cocktail of drugs that are often competing and counteracting each other with little thought as to whether they are all needed.

 

[edGfaCTor]

UK national debt = £2.9tn

Annual interest payment on national debt = £105bn

Annual cost of NHS = £205bn

Any ideas on how to improve the NHS without spending a shed load more money as the country is a bit broke?

What do people define as fix it?

NHS has outgrown it's purpose and national health is always going to be at a loss it's not a system which is about making profit if you want that system head over to US and take a look at how they treat people.

Pharmaceutical and food industry are the big contributors which is a massive conflict of interest both these do not want people healthy unless you move away from them not much can change.

The other issues is no long term planning Northampton for example has announced more work being done when the place needs a rebuild (Kettering & Northampton claimed it would cost 1 billion to do a rebuild they have been awarded 400m)

 

[Semple]

If you ask my partner where a chunk of it goes she will tell you its spent on expensive medications. Its spent on people getting their prescriptions paid for them despite the prescription being for paracetamol. Its people who get expensive medications that they don't actually take for years on end but didn't care or bother to discuss this with their GP.

She spent years in the community going to peoples houses and finding that they had tens of thousands of pounds worth of out of date drugs they didn't take because "I didn't like how they made me feel". Well did you talk to your GP? No, you just didn't take them and your condition wasn't actually being treated and has got worse.

Shes been doing deprescribing as well which is a huge amount of work and a faff because so many people are on a heady cocktail of drugs that are often competing and counteracting each other with little thought as to whether they are all needed.

Yeah I can definitely imagine that having some first hand experience, but the other way around. When we had our newborn, she was really struggling with the baby formula she was on, so the doctor prescribed a special formula (hydrolysed) had like 6 tins prescribed, she didn't take to it at all (smelled horrible so can't imagine what it tasted like - also quite well known to be disgusting). Ended up having to bin the lot. We then had luck with a different brand and as we got to the point of weaning and she didn't need it anymore the rest had to be binned - even unopened containers the pharmacy said they couldn't do anything with it once it was dispensed. Felt really guilty binning several KGs of baby formula when you knew in places like Gaza this amount could have fed several hundred babies for a few days.

 

[Minstadave]

Doctors work for a monopoly employer - A monopolist abusing its position, not good, should not be a monopoly then, right?

I'd settle for it just not being abusive and engaging in cartel like behaviour that would be illegal in the private sector.

Currently the NHS as a whole appears to just hates it's staff, they are the biggest cost so anything it can do to best down wages is the main focus.

 

[fez]

Yeah I can definitely imagine that having some first hand experience, but the other way around. When we had our newborn, she was really struggling with the baby formula she was on, so the doctor prescribed a special formula (hydrolysed) had like 6 tins prescribed, she didn't take to it at all (smelled horrible so can't imagine what it tasted like - also quite well known to be disgusting). Ended up having to bin the lot. We then had luck with a different brand and as we got to the point of weaning and she didn't need it anymore the rest had to be binned - even unopened containers the pharmacy said they couldn't do anything with it once it was dispensed. Felt really guilty binning several KGs of baby formula when you knew in places like Gaza this amount could have fed several hundred babies for a few days.

Oh theres not much you can do there. Shes talking about people who have been picking up their prescription for years sometimes and never using it. People who get free prescriptions so why would they buy paracetamol?

I'd settle for it just not being abusive and engaging in cartel like behaviour that would be illegal in the private sector.

Currently the NHS as a whole appears to just hates it's staff, they are the biggest cost so anything it can do to best down wages is the main focus.

Thats because many of the other huge costs are non negotiable. I can assure you they are trying to cut costs everywhere but staffing is a monstrous cost and one that can, in theory be cut. You can't stop giving people cancer drugs. You can reducing staffing levels.

I mean, the first thing I would do to help the NHS is give their staff good enough IT equipment to do theirs jobs effectively. My partner is very senior and is on a 4 year old laptop that is awful, she has crappy monitors and is probably about 40% efficient vs if she had another £500 of IT equipment. They lose way more than that in productivity from her in a week I would suggest.

 

[danielanthony]

I'd settle for it just not being abusive and engaging in cartel like behaviour that would be illegal in the private sector.

Currently the NHS as a whole appears to just hates it's staff, they are the biggest cost so anything it can do to best down wages is the main focus.

Any attempt to introduce competition into the health market which challenges the NHS's monopoly position is resisted by many, doctors included.

70% of the NHS budget is spent on staff, what would you like this percentage to be and what would you cut to fund it?

FYI, 7% of NHS spending is on medicines.

Source: Gemini

 

[Hagar]

I think all anyone can do is risk assess their trips in the car, their rides into town for shopping, their nights out for risky behaviour, drinking and drugs, getting a taxi home etc.
Fill your medicine cabinets don't forget slings plasters and other bandages. Carry a torch if out at night and stay in well lit areas if at all possible.

Or just stay home.

 

[fez]

Any attempt to introduce competition into the health market which challenges the NHS's monopoly position is resisted by many, doctors included.

70% of the NHS budget is spent on staff, what would you like this percentage to be and what would you cut to fund it?

FYI, 7% of NHS spending is on medicines.

Source: Gemini

I wouldn't trust AI for anything like this without actual sources include. But yes, a huge chunk is on staff. The NHS is a very manual service and a hell of a lot of that cannot be cut without serous service degredation and deaths. What I have seen is that medicines spending is ~10% which is still around 16-17bn/year which is a huge sum. There will definitely be plenty of fat to be cut there but its not necessarily easy to cut. Deprescribing is complex and when humans are involved, a ******* nightmare. Gladys doesn't like the new tablets, they are light pink instead of blue and she only has to take one of them instead of 2.

 

[Nabinium]

Gladys doesn't like the new tablets, they are light pink instead of blue and she only has to take one of them instead of 2.

Wow, do people actually say this? Though I'm not sure if I should be surprised or not.

 

[Hagar]

I wouldn't trust AI for anything like this without actual sources include. But yes, a huge chunk is on staff. The NHS is a very manual service and a hell of a lot of that cannot be cut without serous service degredation and deaths. What I have seen is that medicines spending is ~10% which is still around 16-17bn/year which is a huge sum. There will definitely be plenty of fat to be cut there but its not necessarily easy to cut. Deprescribing is complex and when humans are involved, a ******* nightmare. Gladys doesn't like the new tablets, they are light pink instead of blue and she only has to take one of them instead of 2.

Drugs bill is rising now due to agreement with pharma, approx 10% I believe with less discounts to be had.

 

[b0rn2sk8]

I expect the majory of that spend on drugs is on stuff which is wholly routine e.g. insulin, pain killers, statins, blood pressure and anti depressants. Those 5 things alone are prescribed to millions of people.

 

[fez]

Wow, do people actually say this? Though I'm not sure if I should be surprised or not.

People and especially the elderly fixate on things. The talk about their health with friends. People read facebook and buy into conspiracy theories about why things are being done and its rarely good. We have a friend who is diabetic and doesn't take his medication as he should. Why? Because hes spent too much time online with people telling him that he doesn't need it and that he can do things differently (which he doesn't do because its a lot of work to manage diabetes through diet etc).

People get nervous about medicines for all sorts of reasons especially if they have had a hard time of things. Then you have to worry about things like the placebo effect and the reverse of that so you could give people the same medication in 2 different pills and they would swear that one gives them horrible indigestion and the other is fine.

 

[RedMogg]

I expect the majory of that spend on drugs is on stuff which is wholly routine e.g. insulin, pain killers, statins, blood pressure and anti depressants. Those 5 things alone are prescribed to millions of people.

I need Veyvondi (recombinant clotting factor) to treat my Von Willebrands Disease, during a bleeding episode.

It costs nearly a quid per unit and I need 2600 units per dose. I typically need two, sometimes up to four treatments for a significant bleed.

That's over £20k per course of treatment. I average about two bleeds in a month.

£480k a year is the cost to the NHS (kind of, not really) just to manage the bleeding disorder I was born with.

Or the NHS could "invest" £1.6M in gene therapy to cure the disease - the same approx cost of 4 years of factor treatment...

Whilst I take no pride in being such a huge "financial burden" to the NHS, I don't feel guilty either, considering what I went through in the 80's & early 90's (Contaminated Blood Scandal, including unethical testing, intentional infection with Hep-C and exposure to other nasties like HIV & CJD, then 40 years of cover-up and gaslighting).

 

[jpaul]

People read facebook and buy into conspiracy theories about why things are being done and its rarely good. We have a friend who is diabetic and doesn't take his medication as he should.

you obviously haven't spoken to people who have been subjected to short supply of their diabetes drugs and had to change because of short supply due to diversion of capacity into 'slimming' drugs.
(southhampton area)

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Thought the small drugs bill, beyond some degree of underpaying, was seen as a negative for what nhs pays for personnel versus a higher drugs investment(like in eu) which would repair people more efficiently.




government celebrating the online reservation popularity, as people naturally do more stuff online (nothing to see here) - is it more efficient though and is there more triageing work going on behind the scenes.,

 

[heeeed]

government celebrating the online reservation popularity, as people naturally do more stuff online (nothing to see here) - is it more efficient though and is there more triageing work going on behind the scenes.,

It’s definitely less efficient as requests for nonsense that is very easy to ask and has no impact on them goes up. If they have to have a conversation to triage with reception some of those disappear immediately as they simply can’t be bothered.

I also don’t believe for a moment those statistics mean what they think or want to suggest it does. I think 98% compliant with contract is what it really means.

For an actual appointment with a GP it’s nuts to not have some form of triage so you can’t just offer an appointment to be booked with no questions as it’s a precious commodity and if it’s a waste of time you can’t get that time back

I’ve heard of some places having reduced significantly actual appointments to deal with the triage

 

[chrcoluk]

The NHS gatekeeps access to specialist services more than most healthcare systems. There is probably some efficiency to be found in these areas but it'd be a significant upheaval for the NHS and likely lead to problems in the short term. The basic problem remains: the UK needs more GPs.

Adding more GPs doesnt solve the excessive triage issue due to resource pressures on secondary care, I am really concerned here is people are sounding like people who cant admit they have an addiction, to fix something is first to acknowledge there is a problem.

There was a very public example of the issues when the recent announcement of new treatment for obesity, the NHS not only did it set very extreme criteria for who could get the treatment, even with the extreme criteria, it is not able to treat everyone eligible.

The BBC managed to get a HCP to say publicly, if the NHS treated everyone it would go bankrupt.

There is now a review announced for mental health care as well. Whether this will lead to even more triage and claims of over diagnosis or a fix so more people actually get treatment remains to be seen. Although this is only happening as a means to reduce the benefits bill rather than tackle unacceptable treatment levels.

Have we all forgotten about the people who have died because of GPs telling young people with cancer to take paracetamol and wait it out, not even a precaution scan was taken. There is enough whistleblowers on all the strains of the system, consultants admitting they denying referrals that need treatment because they have to pick and choose who to treat.

But at least you acknowledge the NHS does more triaging and improvements could be made.

 

[chrcoluk]

It’s definitely less efficient as requests for nonsense that is very easy to ask and has no impact on them goes up. If they have to have a conversation to triage with reception some of those disappear immediately as they simply can’t be bothered.

I also don’t believe for a moment those statistics mean what they think or want to suggest it does. I think 98% compliant with contract is what it really means.

For an actual appointment with a GP it’s nuts to not have some form of triage so you can’t just offer an appointment to be booked with no questions as it’s a precious commodity and if it’s a waste of time you can’t get that time back

I’ve heard of some places having reduced significantly actual appointments to deal with the triage

I will do 180 on that and say its nuts to need to triage to offer GP appointments, there should be enough resources to give everyone an appointment.
Healthcare should always be caution and safety first, dont take any chances, instead its more like wait until things get really serious (by NHS definition not patients, doctors can interpret serious very differently to a patient) then we "might" look at it. If you want us to absolutely look at it then go A&E.

I am not talking about someone ringing up who has had a runny nose or a cough for a day, I am talking about people with serious issues been told tough luck nothing we will do without an attempt to do anything. Bed bound, unable to mobilise enough for a normal life, cant care for themselves, needing prescription killers round the clock, that sort of thing.

Those who disappear you also cant make assumptions, they may instead be going private, a&e or just ringing back another day with another attempt. GPs have admitted to the BBC, the turn patients away strategy is been used as a form of managing demand.

 

[chrcoluk]

GPs do triage but they also manage a vast amount of complex health problems, increasingly so, every year.

I'm amazed at some of the things my wife manages as a GP, secondary care is constantly pushing more and more work on to GPs.

Thank about the highlighted bit, and what I am saying, if you think about it hard enough, they are the same thing.