NHS=Negligent Health Service

[1664kronenbourg]

That's assuming the average politician (especially current generation) will actually listen to anyone.

Only if you make an under the table 'donation' in the form of a large brown envelope stuffed with cash, take them on an all expenses paid golding holiday or weekend on a yacht.

 

[dlockers]

The time I was in recently, food was the only poor thing. It seemed to be outsourced and the result was watery tasteless fare. Given that patients require food which will aid their recovery it is a false economy. The care was excellent. One patient was moaning about it and other patients rounded on him asking him what was wrong. After a load of moans it turns out his problem was nothing to do with the NHS but welfare services when he came out of hospital.

The outsourced argument is a very poor one. The NHS should be focusing on delivering health services, not catering. The problem is they've outsourced with clearly, very poor requirements. Or conflicting requirements - like fresh food, but able to be stored for long periods of time.

 

[dlockers]

That's assuming the average politician (especially current generation) will actually listen to anyone.

Can't really blame several decades of decline on the current generation, can you?

 

[shorttricky]

Maybe you should have done the barest amount of reading of my post as what you said "I have said" is not even close to what I actually said.

Instead what I actually said is absolutely 100% in agreement with what you also agree with - if it is a physical or mental health reason then cosmetic surgery is ok by me - I've never ever said anything different so I'm a little confused as to why several posters have claimed I'm saying something I'm not.

Maybe, based on your response of "mail and express screaming" etc it's your own bias at play, deciding that I might read those because you've misread my comment as one that a frothing gammon might write and so triggered your disingenuous auto-reply, I don't know but hopefully you do.

Did you read your post?

i.e. no "cosmetic" stuff unless it's part of recovering from an injury or illness (for example burns, reconstructions etc) so it'd be no boob jobs to just make someone feel happy but it'd OK for breast cancer victims etc

I guess you could read this as either "no boobs jobs for mental health reasons", which you've now ruled out; or "no frivolous boob jobs" which literally never happens.

Focusing on either is exactly the sort of thing that the Mail/Express (other awful papers are available) love to throw around as proof of the NHS' failings, but it's either ignorant or just flat out wrong.

There are many problems in the NHS (waste of equipment and archaic/disparate ordering systems would be a great place to start), but cosmetic surgery is not one to focus on - if anything, they should probably offer more - it's much harder to get things like varicose veins or potentially mental health affecting scarring treated nowadays

 

[2Thumbs]

Back in 2010/11 my Grandmother had a tickling cough she couldn't get rid of, after multiple trips and calls to GP they claimed it to be down to her age. A number of months later she's rushed to hospital with symptoms of pneumonia and after tests it turns out she's riddled with lung cancer (never smoked, but did work in a factory setting in her youth which could have been a factor). She died 6 weeks later.

As a lesser example my Mum would complain about lots of symptoms of feeling unwell in various ways she realised wasn't right. As before calls and visits to GP say it's due to her age and being mid-menopause etc. She spent weeks researching and self-diagnosing herself as having an over-active thyroid, and spent a number of months after that fighting the NHS system to receive the tests and start medication for it.

I can only imagine the level of incompetence, willing or otherwise, within the service since the start of the pandemic to be far worse. What with the planned operations and treatments that had to be delayed and the amount of deaths this would have caused.

 

[kindai]

Or conflicting requirements - like fresh food, but able to be stored for long periods of time.

I know several people who supply to the NHS on a daily basis, many of the fruit, veg, herbs and spices are from the fields to the kitchens within 24 hours of being picked and washed, most of it is put on re-usable trays and doesnt even get packaged because its pointless.

Obviously mileage might vary based on the suppliers a trust uses but some of them have outstanding in house services.

 

[Minstadave]

The point is a clinicians experience isn't representative, when I've seen polls taken in the past of patents the picture is different to the one you are painting.

We will just have to beg to differ on this one. 6 years of med school and 13+ years as a doctor working in the NHS can't trump a some polls you once saw in the past and what your mate down the pub thinks. It's all the guidelines fault, no problems with resources in the NHS at all.

He was a pedestrian hit by a lorry, it's probably not useful to go over individual examples as I'd have to elaborate on them too much, but I think to suggest that in the general case clinicians have no sort of reasonable judgement of what analgesics are going to be effective in a given clinical scenario is a little ridiculous.

Clinicians can give whatever they want at the end of the day. I can't really speculate on why some are reluctant to use opiates, but they're clearly exercising their own judgement and not following the pain ladder - which is what you want isn't it? Don't follow the guidelines, making their own decisions?

It also doesn't match up with my experience of being prescribed morphine in hospital straight away, as opposed to giving naproxen and leaving me in severe pain for an hour to see if it works following a stepwise approach.

Using morphine in a hospital setting is very different to dishing out opiates as a GP. Also Naproxen and Morphine don't act instantly, it's normal to titrate analgesia over time, their effects aren't very predictable at an individual level.

I get the impression that if I had been under your care I would have had a torturous experience!

You absolute clown

The US has too liberal an approach to prescribing opioids but the UK one is far too conservative.

The US have massive issues with opiate dependency and opiate related deaths, I'm not sure where the UK stands in the big picture (actually it looks like the UK is one of the top opiate prescribing countries) but claiming we are too conservative based on your very limited experience seems bold. A quick google shows rising opiate related deaths in the UK:

https://fpm.ac.uk/opioids-aware-clinical-use-opioids/current-uk-data-opioid-misuse

https://www.priorygroup.com/blog/opioids-understanding-the-current-state-in-the-uk

https://www.manchester.ac.uk/discover/news/dramatic-escalation-in-opioid-use-over-a-decade-revealed/

 

[Energize]

We will just have to beg to differ on this one. 6 years of med school and 13+ years as a doctor working in the NHS can't trump a some polls you once saw in the past and what your mate down the pub thinks. It's all the guidelines fault, no problems with resources in the NHS at all.

This is bad faith here, you know I never said there were no problems with resources.

The US have massive issues with opiate dependency and opiate related deaths, I'm not sure where the UK stands in the big picture but claiming we are too conservative based on your very limited experience seems bold. A quick google shows rising opiate related deaths in the UK:

It's not based on anecdotal evidence, the statistical data is there, some of which you've just shown, albeit opiate deaths is not really a great measure of prescribing related incidents because this is primarily recreational use. When I worked at the council in the public health department we had constant serious incident reports for opioid deaths but they were almost all related to heroin overdose, it was rare for it to be morphine related or any other opioid really.

 

[Minstadave]

This is bad faith here, you know I never said there were no problems with resources.

This is what you said - "At the core of it, most complaints are not resource issues (kill the Tories etc.), they are ones of dogma, orthodoxy and protocol, doctors in the UK are so guideline driven" which is, simply, utter guff.

It's not based on anecdotal evidence, the statistical data is there, some of which you've just shown, albeit opiate deaths is not really a great measure of prescribing related incidents because this is primarily recreational use. When I worked at the council in the public health department we had constant serious incident reports for opioid deaths but they were almost all related to heroin overdose, it was rare for it to be morphine related or any other opioid really.

It's not just drug deaths, there is plenty of evidence to suggest a huge increase in prescription opiate use and not much suggesting UK opiate use is "far too conservative". But opinion trumps evidence in this day and age.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00479-X/fulltext



This bit is quite interesting:

"Despite the declines seen in the above three countries, opioid consumption rates increased in many other HICs over the same period. Although the opioid consumption rate has gradually declined in the UK since 2016, it had the highest MME rate in the world in 2019. The INCB assigned the UK a global ranking of 19 for the total average consumption of narcotic drugs (in DDDs for statistical purposes per million inhabitants per day) from 2017 to 2019. However, this estimated total for the UK did not include codeine, tramadol, buprenorphine, and tapentadol. In 2019, these opioids accounted for 53% of total MME opioid consumption in the UK [codeine, 32%; tramadol, 12%; buprenorphine (for analgesic use) 7%; tapentadol, 2%].

Previous research has noted high levels of opioid use in the UK, and discussed concern about an incipient opioid crisis. However, many factors blamed for the crisis in the US do not prevail in the UK context (in the UK centralised oversight is relatively strong, there is not a consumerist approach to health care delivery, and financial incentives to enhance customer satisfaction are relatively absent), suggesting that other mechanisms are in play."

 

[Energize]

This is what you said - "At the core of it, most complaints are not resource issues (kill the Tories etc.), they are ones of dogma, orthodoxy and protocol, doctors in the UK are so guideline driven" which is, simply, utter guff.

So you've leaped from "most complaints" (i.e. 51% or more) to "all complaints". Amazing.

It's not just drug deaths, there is plenty of evidence to suggest a huge increase in prescription opiate use and not much suggesting UK opiate use is "far too conservative". But opinion trumps evidence in this day and age.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00479-X/fulltext

It's not a case of opinion trumping evidence, it's a case of two reasonable people can interpret the evidence and come to different conclusions. You appear to be taking the unreasonable position that only your dogmatic view can be correct and discount experiences that don't align with it.

 

[Minstadave]

So you've leaped from "most complaints" (i.e. 51% or more) to "all complaints". Amazing.

Neither all or most complaints are related to dogma, orthodoxy etc...it's just not true. Even your main example of why you believe this doesn't fit with this opinion.

It's not a case of opinion trumping evidence, it's a case of two reasonable people can interpret the evidence and come to different conclusions. You appear to be taking the unreasonable position that only your dogmatic view can be correct and discount experiences that don't align with it.

No I take the view that if there is no evidence to support your view, it's probably wrong. If you still think you're right despite all evidence to the contrary then you're probably not a reasonable person (or more accurately a person unable to reason).

 

[Energize]

This bit is quite interesting:

"Despite the declines seen in the above three countries, opioid consumption rates increased in many other HICs over the same period. Although the opioid consumption rate has gradually declined in the UK since 2016, it had the highest MME rate in the world in 2019. The INCB assigned the UK a global ranking of 19 for the total average consumption of narcotic drugs (in DDDs for statistical purposes per million inhabitants per day) from 2017 to 2019. However, this estimated total for the UK did not include codeine, tramadol, buprenorphine, and tapentadol. In 2019, these opioids accounted for 53% of total MME opioid consumption in the UK [codeine, 32%; tramadol, 12%; buprenorphine (for analgesic use) 7%; tapentadol, 2%].

Previous research has noted high levels of opioid use in the UK, and discussed concern about an incipient opioid crisis. However, many factors blamed for the crisis in the US do not prevail in the UK context (in the UK centralised oversight is relatively strong, there is not a consumerist approach to health care delivery, and financial incentives to enhance customer satisfaction are relatively absent), suggesting that other mechanisms are in play."

I've just noticed you've edited your post.

So the UK was ranked 19th by the INCB when weak opioids were excluded, that's a pretty low position considering UK ranks 20th on world population and not many countries have good access to opioid drugs.

And the ONS data shows a flatline in the deaths from strong opioids over the last 10 years where these were the sole dug involved, this data seems to support my position more than yours.

I've just skimmed it but the applicability of this data to the question of outpatient prescribing of strong opioids is questionable as it doesn't seem to differentiate between inpatient and outpatient use, not even sure it differentiates between prescription and non prescription use at all?

Not sure how you are interpreting the data?

 

[heeeed]

I think one of the problems energise is that you look at opiate harms as only being from overdose. It’s an awful lot more than that

I think you’re wrong that the UK is too conservative in their use, but that the situation is improving and we aren’t quite as liberal, throw an opiate at the problem mentality of the past.

We still overall use far to much opiates. The issue with opiate use is not in the car crash scenario it’s the chronic pain sitatuation which is where the largest amount of opiates are used despite very poor evidence of efficacy but increasing awareness of their harms.

it’s the easiest thing in the world to just dish more out, so why do you suppose I spend hours of my life trying to help people come off it, or avoiding inappropriate initiation? It’s pretty rare to be thanked for doing this (although that does happen) it might lead to higher complaint levels against me. Yet I still do it and consider it the correct approach and best for my patients. Why do you think I do it? I truly believe that as a population level it should be reduced and it should be very carefully managed on an individual level and I see regularly huge harm from their use

 

[Minstadave]

I've just noticed you've edited your post.

So the UK was ranked 19th by the INCB when weak opioids were excluded, that's a pretty low position considering UK ranks 20th on world population and not many countries have good access to opioid drugs.

And the ONS data shows a flatline in the deaths from strong opioids over the last 10 years where these were the sole dug involved, this data seems to support my position more than yours.

I've just skimmed it but the applicability of this data to the question of outpatient prescribing of strong opioids is questionable as it doesn't seem to differentiate between inpatient and outpatient use, not even sure it differentiates between prescription and non prescription use at all?

Not sure how you are interpreting the data?

Your statement was the UK is "far too conservative" with opiate prescription. I've shown you data that we are leading the world in prescription opiate use from a pretty reputable source (the Lancet).

Shifting the goalposts to strong opiates only to suit your point after the fact is pretty poor form. Added to that the INCB report (whilst almost impossible to make sense of being hundreds of pages long and terribly presented) ignores tramadol and codeine, very commonly used prescription opiates in the UK so that would seem a big flaw in using that data to examine UK opiate prescriptions.

The Lancet paper compares the use of those opiates not in number of prescriptions but in morphine milligram equivalents so the data isn't skewed by large numbers of people on tiny doses of cocodomol for headaches, but actually shows large amounts of opiate consumption.

You yourself argued that opiod deaths aren't a great measure of opiate prescriptions so I'm not sure why you'd use this to try and justify your position that we aren't prescribing enough.

The data presented in the Lancet paper linked is all about prescription opiates, it's in the title. It may include some over the counter purchasing by the looks of it, it doesn't seem clear in the methodology. The data is sourced from pharmaceutical supply chain data.

Regarding outpatient vs inpatient use, this too is shifting the goalposts away from your very broad initial statement, but this seems to be your style.

To be honest we've strayed so far off the topic at this point that we may as well leave it. Internet bickering can only be dragged out for so long. I hope your Dad feels better, if he's still in pain ask another doctor to see him.

 

[Energize]

I think one of the problems energise is that you look at opiate harms as only being from overdose. It’s an awful lot more than that

I think you’re wrong that the UK is too conservative in their use, but that the situation is improving and we aren’t quite as liberal, throw an opiate at the problem mentality of the past.

We still overall use far to much opiates. The issue with opiate use is not in the car crash scenario it’s the chronic pain sitatuation which is where the largest amount of opiates are used despite very poor evidence of efficacy but increasing awareness of their harms.

it’s the easiest thing in the world to just dish more out, so why do you suppose I spend hours of my life trying to help people come off it, or avoiding inappropriate initiation? It’s pretty rare to be thanked for doing this (although that does happen) it might lead to higher complaint levels against me. Yet I still do it and consider it the correct approach and best for my patients. Why do you think I do it? I truly believe that as a population level it should be reduced and it should be very carefully managed on an individual level and I see regularly huge harm from their use

It's not true that I measure harms as only being from overdose, this was just the issue Minstadave brought up. I have a friend who was prescribed opioids for a long time after a car accident resulting in a fractured spine and spent a long time coming off them as they caused a physical dependence so I'm well aware of these issues, but this is not applicable to the more common acute or subacute pain scenario. People should not be disabled by subacute pain from car accidents.

Also people on high doses of opioids like my friend who was on 200mg morphine a day skew the data entirely as it makes it looks like for every one of them ten people are on low dose morphine a day.

Shifting the goalposts to strong opiates only to suit your point after the fact is pretty poor form. Added to that the INCB report (whilst almost impossible to make sense of being hundreds of pages long and terribly presented) ignores tramadol and codeine, very commonly used prescription opiates in the UK so that would seem a big flaw in using that data to examine UK opiate prescriptions.

Regarding outpatient vs inpatient use, this too is shifting the goalposts away from your very broad initial statement, but this seems to be your style.

To be honest we've strayed so far off the topic at this point that we may as well leave it. Internet bickering can only be dragged out for so long. I hope your Dad feels better, if he's still in pain ask another doctor to see him.

I thought it was pretty clear I was talking about outpatient strong opioid use as you can buy weak opioids in the UK without a prescription and the example of my dad was not an inpatient situation, but if I didn't make it clear enough I apologise.

Thanks for your well wishes for my dad, he has zomorph if he wants to take it as this was leftover medication, this is partly why I am concerned about inadequate analgesia, because patients then self medicate and can suffer serious harm as as result.

 

[FortuitousFluke]

Only if you make an under the table 'donation' in the form of a large brown envelope stuffed with cash, take them on an all expenses paid golding holiday or weekend on a yacht.

I have a costa coffee loyalty card with 6 out of 10 stamps, in a medium sized white envelope, and access to a large, partially submerged peddle boat in the shape of a swan. What will that get me?

 

[ahar]

I have a costa coffee loyalty card with 6 out of 10 stamps, in a medium sized white envelope, and access to a large, partially submerged peddle boat in the shape of a swan. What will that get me?

3 nearly out of date paracetamol, a cushion for your seat on your 4 hour A&E wait, a 10% discount on hospital parking (still no guarantee of a space though) and a less grumpy receptionist when you phone your GP.

 

[do_ron_ron]

The outsourced argument is a very poor one. The NHS should be focusing on delivering health services, not catering. The problem is they've outsourced with clearly, very poor requirements. Or conflicting requirements - like fresh food, but able to be stored for long periods of time.

Health = getting good food, especially in a hospital where you are sick. To try to say that food and health are not linked goes against every academic study. Probably another Tory backhander scam with outsourcing.

 

[do_ron_ron]

Back in 2010/11 my Grandmother had a tickling cough she couldn't get rid of, after multiple trips and calls to GP they claimed it to be down to her age. A number of months later she's rushed to hospital with symptoms of pneumonia and after tests it turns out she's riddled with lung cancer (never smoked, but did work in a factory setting in her youth which could have been a factor). She died 6 weeks later.

As a lesser example my Mum would complain about lots of symptoms of feeling unwell in various ways she realised wasn't right. As before calls and visits to GP say it's due to her age and being mid-menopause etc. She spent weeks researching and self-diagnosing herself as having an over-active thyroid, and spent a number of months after that fighting the NHS system to receive the tests and start medication for it.

I can only imagine the level of incompetence, willing or otherwise, within the service since the start of the pandemic to be far worse. What with the planned operations and treatments that had to be delayed and the amount of deaths this would have caused.

No you have unfortunately comes across human failings. Anything involving humans will have errors - human fallibility. The NHS is not the only service where failings occur as we have seen with the two horrific murders of children recently.

 

[Minstadave]

Health = getting good food, especially in a hospital where you are sick. To try to say that food and health are not linked goes against every academic study. Probably another Tory backhander scam with outsourcing.

Poor food in hospitals has been a problem for decades, its not really a Tory thing, just never a priority.