LSE analysis of NHS says patient outcomes are very poor, "holy cow" status stops improvement

Fretwired

Evilmags said:

BUPA is non profit. Most nurses in private hospitals are foreign and as far as I know the NHS does not have ownership of physicians. 

Ah private medicine. If you have something seriously wrong you're screwed. Call an ambulance and get into the NHS system. The outcomes are better. Private medicine in the UK is poor. I know this from personal experience and an old school friend who is a senior surgeon at Southampton General Hospital. Seriously ill .. go NHS.

ToneControl

Fretwired said:

Evilmags said:

BUPA is non profit. Most nurses in private hospitals are foreign and as far as I know the NHS does not have ownership of physicians. 

Ah private medicine. If you have something seriously wrong you're screwed. Call an ambulance and get into the NHS system. The outcomes are better. Private medicine in the UK is poor. I know this from personal experience and an old school friend who is a senior surgeon at Southampton General Hospital. Seriously ill .. go NHS.

I use private under my insurance, but choose one that is physically connected to a proper NHS hospital  - I'm amazed people want operations at little hospitals out in the suburbs, away from A&E and intensive care facilities

Snap

darthed1981 said:

The reality is, we as a country have an ageing population, and this affects everything, not just the NHS.  It will be a continued economic challenge to look after the elderly without putting a huge extra tax burden on working people.

Actually, that isn't the real challenge it faces. The big problem we have is chronic disease caused by bad lifestyle. Incidence of diabetes up massively for example. The reason? We are a nation of fatties. Over half the population is fat. That means people get ill at a younger age and need health service resources sooner. Drug and treatment advances mean people with chronic disease live longer, thus increasing the amount of cost to the NHS both in the short and long term.

Until the public gets a grip on it's waistline, this will continue. Everything else is minor in comparison, really.

Yes I know I go on and on about fatness, but its the scourge of the NHS. No other single factor plays such a big part in so many burdens on resource.

You can, and I have, traced this link in emerging and growing economies in different parts of the world. As societies adopt more western lifestyle habits, the weight of the nation goes up, disease increases and health service burden rises. Where the average weight is lower, life is longer, heatlhier and less expensive in health service terms.

Thing is, we don't know how to tackle it, and people are sensitive to talking about it.

You want a better NHS? Put the burger/cake/pasty/beer down

Boromedic

Saw this and it made me think of this thread:

http://www.pulsetoday.co.uk/views/dr-renee-hoenderkamp/we-need-a-tough-conversation-about-unnecessary-gp-appointments/20034878.article

Out of the mouth of someone dealing with the problems first hand.

Lots of facts quoted in the thread here but where is the evidence. Where is the salary comparison of Bachelor degree level qualified staff working nights and weekends? Nurses vs others. Can't find one online, from personal experience I have friends who work in procurement who are only CIPS qualified (diploma level below Bachelors), working 9-5 jobs with all weekends and bank holidays off, earning £50000 + bonuses and other benefits such as company car deductions etc.. I know who I would pay more, but then you're not rewarded for how moral your job is are you?

Also the cost per month per person of the NHS comparison with BUPA, where was this from? Having seen their awful nursing home care first hand (more than one home too), I'm not sure I'd be overly confident in their standards of care. They've sold this arm off now I believe as its basically been bad press for them for a long time.

NHS facts and figures when compared to other nations healthcare can be skewed but I found this Conservative backed 2020 study very interesting. It lists the potential for any skewed outcomes and makes stark reading to be honest. It also states that in comparison the NHS is still underfunded compared to the best systems in northern Europe, although increased funding within its current inefficiencies is not necessarily the way forward.

https://www.google.co.uk/url?sa=t&source=web&rct=j&url=http://www.uk2020.org.uk/wp-content/uploads/2016/10/UK2020-Final-eBook-RGB.pdf&ved=0ahUKEwjrsbuoj6TVAhUJXBoKHWn4DzkQFghHMAc&usg=AFQjCNHgPVslYgk6EMdPTztQ9BZ8c26trA

Having worked in the system I've always remarked to patients that when the shit hits the fan with emergencies the NHS is up there with the best. Once you leave that system and need further treatment, rehab, or chronic condition management it often falls down.

Personally from experience just as an example. I would never use an NHS physio again as the majority I've seen aren't great, I paid privately to get myself sorted perhaps stuff like this is where savings can be made. The last thing we need though is a US style system that creates a tiered healthcare process that prevents people in need getting adequate treatment. Having worked in a system like this its genuinely heartbreaking at times. I don't have the answers to the problems beyond saying that some people need to start taking more responsibility for themselves and some of the stuff already stated in this thread would be a good start. As long as any privatisation or insurance scheme is closely monitored and run as not for profit like the French system perhaps.

EricTheWeary

BUPA does make profit, it doesn't have shareholders so profit is reinvested in it's services or extending it's portfolio - it isn't a charity. 
I don't know it's total staff make up ( I know two people who do some work for BUPA and they are both British FWIW)) but it is reliant upon the NHS/ other countries for qualified staff so if you scale up what it does ( to replace more/all of the NHS)  I'm not sure that's sustainable ( ie no newly qualified UK staff coming through ). 
BUPA doesn't have the burdens that the NHS has. A and E for starters but it won't treat pre existing or chronic conditions or provide many cancer treatments ( all this is clear from the BUPA site). Examples of some of these costs run to £thousands per week for decades for some people and those costs have to be incorporated into NHS budgets alongside the ingrowing toenails.
With any medical treatment there is, at some level, a conversation about cost. Having had discussions around treatment for chrohns and colitis for the last seven years the experience there is in private health care the balance of that conversation is significantly different than in a public system and not to the patient's benefit. I find that worrying. 
We already a significant mixed economy in health in the UK as well as private health insurance there are examples like long term nursing care and non emergency ambulance services. Whilst I'm sure the organisations running those would like to expand they still benefit from an NHS system that provides a throughput of staff and expertise and an NHS which manages the really difficult stuff.

Evilmags

The NHS steals a lot more doctors from countries that need then than BUPA...

Fretwired

EricTheWeary said:

BUPA does make profit, it doesn't have shareholders so profit is reinvested in it's services or extending it's portfolio - it isn't a charity. 
I don't know it's total staff make up ( I know two people who do some work for BUPA and they are both British FWIW)) but it is reliant upon the NHS/ other countries for qualified staff so if you scale up what it does ( to replace more/all of the NHS)  I'm not sure that's sustainable ( ie no newly qualified UK staff coming through ). 
BUPA doesn't have the burdens that the NHS has. A and E for starters but it won't treat pre existing or chronic conditions or provide many cancer treatments ( all this is clear from the BUPA site). Examples of some of these costs run to £thousands per week for decades for some people and those costs have to be incorporated into NHS budgets alongside the ingrowing toenails.
With any medical treatment there is, at some level, a conversation about cost. Having had discussions around treatment for chrohns and colitis for the last seven years the experience there is in private health care the balance of that conversation is significantly different than in a public system and not to the patient's benefit. I find that worrying. 
We already a significant mixed economy in health in the UK as well as private health insurance there are examples like long term nursing care and non emergency ambulance services. Whilst I'm sure the organisations running those would like to expand they still benefit from an NHS system that provides a throughput of staff and expertise and an NHS which manages the really difficult stuff.

BUPA often doesn't have the skills or experience and won't pay to get access to it. I know of at least six people were were rushed out of BUPA hospitals into NHS hospitals which were better equipped and staffed. My mother had a horrible time with BUPA. For routine stuff they are fine - for anything serious I wouldn't take the risk.

Boromedic

Seen this first hand Fret, patient with massive airway problems due to botched surgery. BUPA hospital called for an ambulance and if it wasn't for their fast response and quick thinking NHS Paramedics the patient would've died. That's despite having experienced and qualified staff working there.

darthed1981

Snap said:

darthed1981 said:

The reality is, we as a country have an ageing population, and this affects everything, not just the NHS.  It will be a continued economic challenge to look after the elderly without putting a huge extra tax burden on working people.

Actually, that isn't the real challenge it faces. The big problem we have is chronic disease caused by bad lifestyle. Incidence of diabetes up massively for example. The reason? We are a nation of fatties. Over half the population is fat. That means people get ill at a younger age and need health service resources sooner. Drug and treatment advances mean people with chronic disease live longer, thus increasing the amount of cost to the NHS both in the short and long term.

Until the public gets a grip on it's waistline, this will continue. Everything else is minor in comparison, really.

Yes I know I go on and on about fatness, but its the scourge of the NHS. No other single factor plays such a big part in so many burdens on resource.

You can, and I have, traced this link in emerging and growing economies in different parts of the world. As societies adopt more western lifestyle habits, the weight of the nation goes up, disease increases and health service burden rises. Where the average weight is lower, life is longer, heatlhier and less expensive in health service terms.

Thing is, we don't know how to tackle it, and people are sensitive to talking about it.

You want a better NHS? Put the burger/cake/pasty/beer down

Except, it isn't...

You are correct it is an issue, but it's one small aspect of the extra costs, also costing massive amounts are: -

Drinking
Smoking
Sports Injuries (ironically)
Terrible Driving
Idiocy

Oh - and lots of old people who these days we try to care for, not let die.

The western weight problem is caused at least partly by the choices of our economic system, not least laissez-faire regulation of food production which can easily put 1000 calories in the palm of your hand.  1000 calories full of corn starch as natural food production is too expensive

Most food studies point to increased % risks from obesity and excess weight, but with just a few nudges, a bit of education and a bit of regulation, the problem can be made to go away....

Evilmags

Drinking and smoking are both heavily taxed.. being a bloater is not. Plus the effect the really fat ones have on planes when you are forced to sit next to them. Their is nothing worse than 5 hours on one arse cheek while rolls of flab invade your seat. 

Boromedic

One oft quoted fact about smoking is that for every £3 a smoker puts into the NHS, they only will ever use around one third of that no matter how much of a burden their condition makes them. There may be some truth in that but I can't find the info, that may have increased now due to the increased taxation of a pack of cigs.

crunchman

Evilmags said:

Drinking and smoking are both heavily taxed.. being a bloater is not. Plus the effect the really fat ones have on planes when you are forced to sit next to them. Their is nothing worse than 5 hours on one arse cheek while rolls of flab invade your seat. 

It's not just "being a bloater".  I know quite a lot of thin people you never do any exercise. I know they are at lower risk than large people who do no exercise, but most people in this country (me included) do not do enough physical activity.  I'm better than a lot.  I cycle to work but it's only 2 miles and only takes 10 to 12 minutes.  I know people who drive round and round the block because they don't want to walk 100 metres from the car to their destination.

Evilmags

crunchman said:

Evilmags said:

Drinking and smoking are both heavily taxed.. being a bloater is not. Plus the effect the really fat ones have on planes when you are forced to sit next to them. Their is nothing worse than 5 hours on one arse cheek while rolls of flab invade your seat. 

It's not just "being a bloater".  I know quite a lot of thin people you never do any exercise. I know they are at lower risk than large people who do no exercise, but most people in this country (me included) do not do enough physical activity.  I'm better than a lot.  I cycle to work but it's only 2 miles and only takes 10 to 12 minutes.  I know people who drive round and round the block because they don't want to walk 100 metres from the car to their destination.

When you get to my age if you still like skiing, fucking, drinking, weed then exercise becomes a nessesity or you fall apart. 

chillidoggy

If BUPA was the sole provider of healthcare in the country, we'd all be fucked when it came to something serious, or we'd have to at a lot more. Still, there wouldn't be any chancers rocking up from Nigeria to have their dialysis.

Boromedic

I think the introduction of mandatory health care cards or ID cards which highlight your entitlements would help. Must be presented by everyone at each healthcare appointment or procedure. No card no appointment, that would sort out the drain from healthcare tourists and also UK expats who don't keep up with their NI payments, and still expect the NHS to fund their knee replacement that would cost thousands in Spain.

Not sure how long it would take to recoup the cost of the implementation but if it was in conjunction with National IDs then it would be cheaper.

crunchman

Boromedic said:

I think the introduction of mandatory health care cards or ID cards which highlight your entitlements would help. Must be presented by everyone at each healthcare appointment or procedure. No card no appointment, that would sort out the drain from healthcare tourists and also UK expats who don't keep up with their NI payments, and still expect the NHS to fund their knee replacement that would cost thousands in Spain.

Not sure how long it would take to recoup the cost of the implementation but if it was in conjunction with National IDs then it would be cheaper.

Not practical.  I couldn't get my 5 year old to carry a card with her all the time.

Even disregarding issues like that, it would cost a fortune to implement.  If it's mandatory like that then you couldn't expect people to pay for it.  It's bad enough the amount you have to pay for things like driving licenses and passports, but you don't have to have them.

Also, what happens if someone gets mugged.  They get injured in the mugging, but their card is in the wallet which gets stolen.  You can't not treat them.  Cards could get lost for all kinds of other reasons.  Can you imagine the frenzy the tabloids would whip up when someone died as a result of being refused treatment because they didn't have a card on them.

Even if it was a good policy, it would be electoral suicide, so thankfully there is no chance of it happening.

Boromedic

Of course its practical, I've lived in countries that have them and no one is refused treatment if you don't have a card on you. The idea is you're logged on a system that can identify you to see that you're entitled to free care. As its a form of photo ID then they can see its you so it limits fraud, thats the difference. Right now anyone can walk into A and E give your date of birth and basic details and get treated free of charge. A system that identifies you as you wouldn't allow that to happen, currently if you go to A&E now and claim to be living in the UK by just giving an address they will treat you free of charge. If you were mugged or lost your card you would give your details and they can confirm who you are. It could also be used for other things.

Is your 5 year old going to go to the Dr's without a guardian btw? How ridiculous does that sound at the very least a relative or teacher or school nurse would attend with them. No one would expect a child to carry an ID ffs.

For the record I used to be against them also but having seen the benefits of it then I'm absolutely in favour now. Even with the costs and renewal fees associated with them.

darthed1981

Evilmags said:

Drinking and smoking are both heavily taxed.. being a bloater is not. Plus the effect the really fat ones have on planes when you are forced to sit next to them. Their is nothing worse than 5 hours on one arse cheek while rolls of flab invade your seat. 

Sounds traumatic bro!

Boromedic

P.s. Even with no ID card, anyone requiring emergency treatment would never be turned away at the door. Its simply a way of recouping costs. Ergo no one would die as in the example you posted

Chalky

Boromedic said:

P.s. Even with no ID card, anyone requiring emergency treatment would never be turned away at the door. Its simply a way of recouping costs. Ergo no one would die as in the example you posted

You have to remember that the diehards on here just refuse to believe that the health systems of other countries function or are in any way more effective than the NHS.  Its a bit like arguing with Jehovah's Witnesses....