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wallace

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My mother inlaw is a tough old bird, developed stomach cancer at the beginning of covid. She managed to survive it even though the NHS was in meltdown. Then they thought shed broke her hip, turns out she'd fractured a few vertebrae. Over the years her frailty has increased to the point that she weighs 5stone, but she still does her own shopping most of the time.
She recently developed dioreah and went to see the quacks. a nurse gave her imodium, then a nurse practitioner gave her codein, then a Dr thought they should investigate 7wks later. CT showed a mass so she was admitted, Day1 nil by mouth, day2 endoscopy which was cancelled, day3 still nil by mouth, endoscopy attempted then aborted, day4 still not eaten, endoscopy carried out.
We visited and her endoscopy paperwork had been left in her room so I read it. Diagnosis- malignant tumor. What a way to find out you have cancer. A day later a student Dr came in and attempted to give her the results in very broken english, she's just sitting there smiling trying to put him at ease not understanding a word he's saying. I manage to extract that her case will be discussed at the next MDT meeting in a weeks time. Fortunately she can have a cup of tea now, after 5days so shes happy.
My heart is warmed by DrAl's story and the great treatment his wife has received but I have seen first hand far to many times how utterly atrocious the NHS has become, there are glimmers of hope every so often in a great nurse or Dr that cares.
 
I'm sorry to hear this, my condolences to you and your family. I hope things go as well as they can from here.

My family and I have experienced both very good service (literally saved my life last Christmas) and very bad service where the problem/issue was allowed to get worse through misdiagnosis, losing x-rays and confusing them with someone else's, and doctors who just have no desire to show any care. All separate incidents.
I officially complained once (the issue with my son's x-rays being confused for someone else's) and they responded with a blah blah pro forma response, putting the onus on me to escalate and take further action. Who has time for that :-(

Sadly, the NHS does not always perform as required, even to minimum standards. In my personal experience, the performance rate is around 40% great, 60% inadequate/dangerous.

We should be able to talk about this without getting emotional and zealous, like some people do. There is a huge amount of improvement needed, and in my opinion, it is not all about giving the system more money. (e.g. the sheer stupidity of 'agency staff' that cost the NHS multiples of staffers is beyond silly, and I say this as a person who has worked over two decades in organizations that are huge, one of which is as large as the NHS).

PS - I still believe in the NHS as a concept, but it needs a vast improvement.
 
The problems with the NHS are so vast that one could say that it’s beyond saving at this point.

If you want to be frank about it, a population increase of around 20% (ten million) in the U.K. in the last thirty years has put extreme pressure on all public systems to the point where nothing really works properly anymore, especially when there has been very little investment in these systems for the last thirty years.

In Wales in particular where these is a severe lack of staff they have tried to solve the problem with under qualified agency staff brought in from other areas, but as you said many of these individuals are indeed dangerous and should not be working in the profession at all. The secondary issue of this is that the agency companies are charging the NHS a colossal amount for the travel and board of these agency workers, but it’s the agency that’s pocketing the cash.

If I call the GP today, I will not have an appointment to be seen for at least two weeks, and that’s if you’re lucky. You can keep throwing endless amounts of money at the problem but it won’t go away until the fundamental issues with management are sorted and as I say, it may be beyond sorting.
 
Just to understand just how bad it is in the GP world and not helped by the new 2024 contract that was forced on them..

Screenshot 2024-06-21 at 13.21.11.png
And to expand on one topic
Screenshot 2024-06-21 at 13.23.08.png
 
Sorry to learn of your MILs woes. Heartfelt sympathy.

Re NHS If this were operated as a commercial business it would be dismantled and regionalised pronto, and political control and interference removed. The NHS is capable of consuming limitless money as it is not feasible to make everyone well all of the time. Not only do we have a larger population at present, but is also quite an old one with people living far longer than two generations ago. Drugs and technology are also a factor where the NHS cannot control the costs. People's expectations of healthcare are often unrealistic it seems and we also fail to recognise that prolonging life as a key goal has a cost to society. This does not even consider later life care needs.

Society has abandoned multi generational family care which is also a factor along with more sedentary lifestyles and the growth of obesity and associated health issues. We could voluntarily or be forced to adopt radically different approaches to processed food, sugar, alcohol, smoking, vapes, etc and this would all reduce the drag on health care.

We will end up with the NHS being changed through necessity soon. We can't have free healthcare for all at the point of need, when a growing part of the population is living off a pension and the funding comes from those still in work. It will end up as an inverted pyramid until those born in the pre 1960's (say) die off. We will be forced to have a system which is at least partially funded by insurance. Clinging to the old NHS system which was designed for a different society is a route to failure.
 
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AJB Temple said:
Sorry to learn of your MILs woes. Heartfelt sympathy.

Re NHS If this were operated as a commercial business it would be dismantled and regionalised pronto, and political control and interference removed. The NHS is capable of consuming limitless money as it is not feasible to make everyone well all of the time. Not only do we have a larger population at present, but is also quite an old one with people living far longer than two generations ago. Drugs and technology are also a factor where the NHS cannot control the costs. People's expectations of healthcare are often unrealistic it seems and we also fail to recognise that prolonging life as a key goal has a cost to society. This does not even consider later life care needs.

Society has abandoned multi generational family care which is also a factor along with more sedentary lifestyles and the growth of obesity and associated health issues. We could voluntarily or be forced to adopt radically different approaches to processed food, sugar, alcohol, smoking, vapes, etc and this would all reduce the drag on health care.

We will end up with the NHS being changed through necessity soon. We can't have free healthcare for all at the point of need, when a growing part of the population is living off a pension and the funding comes from those still in work. It will end up as an inverted pyramid until those born in the pre 1960's (say) die off. We will be forced to have a system which is at least partially funded by insurance. Clinging to the old NHS system which was designed for a different society is a route to failure.
Click to expand...
It's not all dooming and glooming; first and foremost a few weeks ago No.1 daughter in Carlisle had a very suspicious looking mole on her right shoulder, mentioned it to her doc at the surgery and was sent for a biopsy to the local hospital. She was phoned the result on (archaeological) site last Monday...'all clear, but keep an eye on it'. Last week on holiday in Canada, I lost a filling and chipped a molar, so as soon as we landed at Gatwick on Tuesday, whilst having a brew at Pret I phoned my NHS dentist and organised a temp filling which was done yesterday, so within 48hrs I had it fixed, with another appointment for July to have it replaced with something more permanent. Thirdly, the last time I needed to see my doc down at the surgery, I rolled up at 8am and saw him personally at 8.15am on the same day. Last and foremost, when I had Prostate Cancer a few years ago, the way that the NHS handled it was exemplary; from first diagnosis to to a full on Radical Prostatectomy op was around two months.

Yes, it's a bit dire, but from personal experience I've got no complaints - Rob
 
I agree actually Rob - I've had superb service too, though I have absolutely no idea what an NHS dentist is :unsure:

But lots of people do have troubles. Eg there was a lengthy piece on the radio yesterday about children with degenerative conditions needing to wait 2 or 3 years for surgery / transplants, partly because they were on the same lists as adults and too ages to prioritise, and partly because the work needed required too much theatre time (6 hours in one case) and such slots were few and far between. I get the impression (zero evidence) that a great deal depends on where we live as some areas seem much better than others.

If all was well in the NHS then we would not have junior doctors and consultants and nurses and paramedics taking industrial action so although the media is obsessed with making mountains out of pimples, there must be issues.
 
My DiL is a GP, her contracted hours are 3x12 hour days but she wfh at least 3hours on her days off chasing up treatment appointments at the hospitals.
As a partner she also has regular Saturday mornings meetings.
For three weeks recently, the contract cleaner was off sick, no replacement was put in place, guess who cleaned the toilets after her shift?
She fell and hurt her back on a home visit and my son had to carry her to her car to get her home. Then he took two days off work so that he could ferry her around in a wheelchair as she didn’t want to let colleagues and patients down.

Last year like all GP practices they got a 1.5% increase so what with staff pay rises and everything else that has been hit by inflation, the partners are now much much worse off.
It’s no wonder that there’s a GP shortage.
 
The NHS is great for emergencies.

Cancer usually gets high priority as well.

As for the rest? Pot luck. I was sent for a referral beginning of April. The message said "If you don't hear from the clinic by June 10 re an appointment then call the clinic". I didn't hear and so I called the clinic and was told that they were currently booking appointments for referrals that were made in August 2023. So assuming nothing changes, I should get an appointment in Feb 2025.
 
Rob I just had a letter saying my dentist cannot get any dentists to do NHS work so I can look elsewhere or subscribe to a private policy. I just had my spirometry from the referral in 2022:)

Did I mention she's been put in a day room because there were no beds on the ward, no facilities for someone with chronic squits. Visited today and the nurses had been on the Dr's case about getting some nutrients into her. They liquidised some shepherds pie, she said it was gorgeous:sick:.
Without getting political, I do believe there is enough money within the system its just miss managed
 
wallace said:
Did I mention she's been put in a day room because there were no beds on the ward
Click to expand...

A friend's mother has just spent a stint in the local hospital, there was a 94-year-old woman on the same ward who had been there for two years because there was nowhere else to look after her. There are very few care homes left here to look after these individuals so they're lumped onto the hospitals as they can't leave until a secure place is found for them if there is no next of kin or if they do not want to look after them.

Another friend needs a knee replacement surgery, they were told the soonest it could possibly happen on the NHS would be in five years, he's now parted with £15,000 and will have it done in two weeks privately. He can earn much more in those five years with a good knee rather than hobbling around on an arthritic one, so it makes sense from a business point of view as well as having a better quality of life.
 
I visited my Dad on a ward for the elderly recently. I would not expect to have to complain that it is unacceptable to have mains plug sockets hanging from their trunking by the cables. Nor that it is not OK to serve elderly people their dinner using the ladle you just picked up off the floor. But this is typical of my recent experience. When I was in hospital with a broken ankle, I was puzzled why I felt really dehydrated despite being on a drip. Until I looked over the side of the bed and saw a growing puddle - the tube coming from the drip stand was not the one going into my arm. I think the will of a lot of the staff is broken, it is not just money.

But for heaven's sake let us not let insurers into the process. It will cost us the earth paying for their BMW's and plush suits.
 
The Swiss system which is insured and Canton based was fantastic when I lived there and neighbours say it still is. Population is under 9m, incomes are high, and immigration is minimal and strictly controlled so that all helps. I've lived in Nederland and part time Germany too and both systems are less fractured than the UK though Germany struggling a bit currently. The choices Tony are: tax, insurance, PAYG. Tax has surely failed as the NHS is a greedy consumer feeding greedy consumers getting older, more moany and demanding. What is your solution?
 
Anything totally free at point of use is liable to abuse / overuse by a few. It also encorages the attitude that as it is "free", the user should be pathetically grateful for whatever service they do receive. It is not free; we all pay just not at point of use.

At the same time, I hate the idea of funding insurers, and worry abou t the cost, particularly to people with preexisting conditions.

I do also think we need to move back from preservation of life regardless of quality. In that ward Dad was in, there was a man who looked like a skeleton covered in skin, crying out in pain but unable to communicate their feelings. Why was that man being kept alive ? In nobody's interest, certainly not his.

The ones not in that state were stuck, waiting for social care or care home places to become available. They are called bed-blockers almost like it is their fault; though none of them wanted to be there.

So as you asked:

- Nominal charge at point of use.
- Rest from taxation.
- properly fund and provide social care, from an increase in inheritance tax, to level up the lottery between those who succumb to physical ill-health (and receive free treatment) and those that suffer dementia (stripped of all but their last 20K of assets)
- prioritise quality of life over longevity.

We also need recognition that good food and sleep are a key parts of wellbeing and recovery, both of which you are currently deprived of in hospital.

I have of course not fully costed my proposals ....
 
OK.
How do you scale the nominal charge - means tested? If so, it's just a tax
Inheritance tax discourages saving and encourages offshoring - smart people will avoid it
Who makes the quality of life decision and based on what? Bonanza for lawyers
"Rest from taxation" - who stops the costs consuming all income?
What stops skilled staff being poached to better paid / shorter hours overseas jobs

What if insurance was a non-profit co-operative (going back to basics). Still bad? What's wrong with car choices? Is it not just prejudicial?
 
I'm not sure how introducing insurers into the equation helps. Now you have to pay for their salaries and profits as well as the service. You will probably have to pay according to their assessment of the risk you present, so leaving some people locked out.

Not insurance but pension companies are much the same - I had briefly a private pension with a provider who always wanted to meet with me. It was a short while before I realised there might be a connection between the fact he always appeared in a much nicer car than I could afford, much better dressed - and that each time he charged £800 while the pension pot didn't seem to be growing. Parasites.
 
OK, I will drop this after this post as it will derail. My point was that insurance started off as co-operatives where everyone paid in and spread the risk among many and few would need the payout. All systems have an operational cost, and we most certainly have that now with the NHS. In a pure form the NHS could be a co-operative NFP insurance scheme. But in reality National Insurance just goes into the treasury tax pot alongside income tax, CT, IHT, VAT, numerous duties and to a degree even local taxes with no ring fencing.
 
AJB Temple said:
..... Tax has surely failed as the NHS is a greedy consumer feeding greedy consumers getting older, more moany and demanding.
Click to expand...
Adrian, I find your pejorative choice of words somewhat distasteful.
 
'twasnt the intent, but the reality is the beast has grown out of control and societal expectations have grown exponentially too. It's crazy. We (society) seem to expect medical professionals to be error free cure alls, not fallible people who make mistakes. Anyway, I shall not comment further.
 
The link between hospital overcrowding and the availability of care homes is clear.
Local authorities used to run these as not for profit facilities.
Have a look at the profits that the big care homes providers are making, they would make the water companies blush!
 
consumers getting older, more moany and demanding.

… little story.
The DiL had a patient who contacted her worrying about a hospital referral for tests as the appointment had not come through after a few weeks.
DiL agreed that it was unacceptable and would chase it up.
Just before that day’s shift ended (20.30) she got a reply that there was a vacancy the next morning.
She drove home and then rang the patient to tell her the good news, the response was “ do you know what time it is? Why are you ringing me this late. Tomorrow is no good , I have to go to work. Phone slammed down.
 
We had a couple of care homes ran by the council but they did their usual thing of stopping maintenance for a while conduct a condition survey say it needs £3m of work then close and demolish. A friend does alot of campaigning with his uke.
We have promised MIL that she will never go into a facility.
 
A Tale of Two Trusts

The population demographics for both of them are broadly the same - pro rata. One has a budget of £300m and serves a population of 200,000. The other has a budget of £700m and serves a population of 500,000. Both areas are very rural.
But the measurements (May 2024) show that they are poles apart.

Screenshot 2024-06-23 at 10.37.51.png

Screenshot 2024-06-23 at 10.38.46.png

So if one Trust can get things right, then why can't the other ? Management ?
 
I've spent way to long at various NHS places over the years and one thing that is obvious. Parking, or lack of it. I recently had to go to james cook and made sure I left 45mins to get parked. Still only got to appointment with 2min to spare. Everywhere there are people who got desperate and parked on a verge or somewhere not allowed. I saw a row of about 25 cars all with parking fines. Darlington only has 220 spaces which is silly. At durham the company that built the hospital get all parking revenue so presumably the parking fines.
Mother inlaw has been in for 16days and she still doesn't know what is happening to her, plus shes caught covid whilst in there. Poor bugger
 
Terry Pratchett summed up the unfairness of socioeconomic policies in his book Men at Arms

“The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money.

Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.

But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that'd still be keeping his feet dry in ten years' time, while the poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.

This was the Captain Samuel Vimes 'Boots' theory of socioeconomic unfairness.”
― Terry Pratchett, Men at Arms
 
A good while has passed and after spending 5weeks in the broom cupboard and no plan of action decided MIL was allowed home. They did contemplate a resection to clear the stricture on her small intestine but decided against it because of frailty. She saw her oncologist a week later who knew very little of her case even though the hospital said they were discussing things with his team for the past 4weeks. He said he would chase things up and on the journey home got a call to be readmitted the next day. Getting ready in the morning she went arse over tit and broke her hip. Funnily she had surgery the following day. So much for frailty. I read somewhere it costs £1k a day to keep someone admitted and god knows how much a hip replacement costs. She has probably cost £50k because of such indecision. The nurses have been exceptional except a number of foreign agency ones, One removed a canular adhesive patch too quickly and removed a flap of skin, then proceeded to stick tape over the top. This triggered an investigation by higher up staff.
 
Wow she's been through the mill Wallace, hope she recovers well.
A hip replacement privately at the Nuffield costs around £15.000 but usually some initial consultation fees before that.
 
I was in hospital for foot ulcers in the olden days when I had a foot. A nurse told me I was good to go home in the morning as soon as someone from the foot clinic had OKed it. The morning came and went. At about 2pm I asked one of the older nurses if she knew when they were coming, as they were supposed to see me in the morning. Oh, she said, I could have told you they wouldn't have seen you this morning, they see outpatients in the morning and inpatients in the afternoon.
Some while afterwards I was chatting to my consultant (with whom I still have a beer or three occasionally) and said I had an idea which could free up beds and save the hospital loads of money, repeating this story to him. As I went on he put his head in hands and said oh, Lord, I can see this going - yes, see inpatients first thing in the morning and free up the beds . Precisely, I said, and it would suit most outpatients better as well. a working person doesn't really want to make a round trip of maybe fifty miles for an appointment at say 11am, his day is screwed.
That is so logical once someone points it out, he said, I'll bring it up at the next board meeting - where unfortunately it will probably be ignored as I am not a manager, only a consultant. (No longer having feet to worry about about I don't know whether the system has changed.)
And we wonder why the NHS costs more and more ad infinitum.
 
Lons said:
Wow she's been through the mill Wallace, hope she recovers well.
A hip replacement privately at the Nuffield costs around £15.000 but usually some initial consultation fees before that.
Click to expand...
MIL said she watched them doing the surgery. :sick: They gave her an epidural. She wasn't happy because they took her false teeth and she couldnt comment whilst they were digging around. I'm thinking they must of just plated and screwed the damage instead of a full replacement.
I hope Im as tough as she is when I grow up.
 
My wife watched via a blacked computer screen while they did one of her hip replacements. She's a retired nurse and watched her uncle perform a complicated heart surgery procedure when she was still a student. I'd have to be completely knocked out, no chance of me being an interested spectator.
 
And don't forget to always mark up the other hip with 'Not this one'. Nearly happened to me when I had my second cataract op. The paperwork had the same eye down as the last time. Not good.
 
I had 'trigger finger' attended to via local anaesthetic. My surgeon was an ex-pupil and he let me sit up and watch; talked me through the stages. Not even near the same ball park as a hip replacement, but fascinating nonetheless.
 
They drew on a large arrow pointing down to my knee on my thigh, I said I hope they don’t think it’s this way up.

Pete
 
They put big arrows pointing to both my elbows, luckily I was having both operated on.
 
So after 8weeks of being in hospital and being constantly gas lit by every man and his dog we are at a point where they admit the truth. You know its important when family get asked to be in to discuss things with the surgeons and a few others, one carrying a laptop taking notes of everything being said.
I knew months ago but always wanted to stay positive, once they'd left the room I started blabbering. Always been a softie walter, cried at lassie.
She said she would never go in a hospice so she's coming home for her last couple of weeks.
 
Sorry to hear that Wallace. No words really adequate but I hope all goes smoothly so you and your family can just concentrate on making things as comfortable for her as possible.

Robert
 
Never an easy time. We had some excellent support from local care services and hospice charities that eased us through tough times with my father earlier this year. I hope that time you have left with your mother can be peaceful. Home is often the best place.
 
Sad news and you have my sympathies. Hospices are actually very kind and peaceful places in my limited experience and the loved ones can focus on the person rather than the practicalities of caring, but if she wants to be home then that is fair enough.
 
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