ozboy
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Mine's a Large One! (Snigger, snigger .......)
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Post by ozboy on Mar 19, 2020 18:12:21 GMT
Germany has 25,000 ventilators and 25,000 ICU beds. France has 5,000 and I think we are similar. Clearly we need more. www.nytimes.com/2020/03/17/opinion/coronavirus-europe-germany.htmlAlso, I do agree any private involvement should be paid for although I do think the private providers need to be careful not to be seen to be profiteering. However, other than staff (who largely obtain their status and permission to work from the state sector) I'd be surprised if they have many ICU beds. I have several times had someone in our family who has made use of private provision. The private "hospitals" I've been to our more like 5 star hotels geared up for low risk procedures. Some don't even have blood banks on site and there have been several cases of patients being transferred to NHS hospitals after something goes wrong. At those hospitals, typically the big shot surgeon and his consultant anaesthetist work through their list in the morning or afternoon and after that, they leave site and in my experience the entire hospital is then left to a junior doctor to manage. Going private for child birth is similarly not without risk. As I discovered when looking around there are very few private NICU units and I was not able to find a single "level 4" unit which is needed for very premature babies. Such level4s are not that uncommon in the NHS - most big hospitals have that. So to cut a long story short, even if you are fortunate enough to the have the funds in place or insurance, going private isn't always the best option (particularly outside London) and overall I'd be very surprised if there is much private ICU provision. And, if something goes wrong, it's relatively easy to sue The Public Medical Sector, most often with "great" results. Good Luck suing anyone for anything in The Private Medical Sector.
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registerme
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Post by registerme on Mar 19, 2020 18:15:10 GMT
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IFISAcava
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Post by IFISAcava on Mar 19, 2020 18:22:20 GMT
And you are missing one big thing. Ventilators and hospitals to be frank aren't really the issue. Staffing is the issue. The. Staff. Are. All. Sick. Or. Self-isolating.
I will happily volunteer to stand around and keep an eye on a room full of patients on ventilators, provided someone properly medically trained sticks the tube in and is reasonably nearby if something goes wrong.
A bit naive, maybe, but my point is that in a crisis we don't necessarily have to have people with years of training to do routine tasks. I'm not advocating doing anything invasive, but I bet there's a lot of "admin" that could be taken off doctors' and nurses' hands.
There's nothing routine about a patient on a ventilator - intensive care does what it says on the tin. Intensive = loads of medical and nursing time. Anyway, I don't want to be flippant, things are going to be really bad in hospitals for quite a while now - not just because of treating COVID itself, but because the measures taken to combat COVID have decimated NHS staffing. Routine stuff, admin, etc is already of out of the window, the peak isn't anywhere even near to beginning, and already services are struggling and having to make difficult, and risky, decisions. It's all hands to whatever deck is in crisis on any given day.
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IFISAcava
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Post by IFISAcava on Mar 19, 2020 18:23:53 GMT
You are conflating the two! And you are missing one big thing. Ventilators and hospitals to be frank aren't really the issue. Staffing is the issue. The. Staff. Are. All. Sick. Or. Self-isolating. Without adequate PPE, nobody could blame them. I quite agree, although getting it hasn't been easy for months and we had a supply from the no-deal Brexit planning. But also testing - if there were enough tests to actually test staff and families, you wouldn't have them all self-isolating.
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Mike
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Post by Mike on Mar 19, 2020 18:37:57 GMT
Germany has 25,000 ventilators and 25,000 ICU beds. France has 5,000 and I think we are similar. Clearly we need more. www.nytimes.com/2020/03/17/opinion/coronavirus-europe-germany.htmlAlso, I do agree any private involvement should be paid for although I do think the private providers need to be careful not to be seen to be profiteering. However, other than staff (who largely obtain their status and permission to work from the state sector) I'd be surprised if they have many ICU beds. I have several times had someone in our family who has made use of private provision. The private "hospitals" I've been to our more like 5 star hotels geared up for low risk procedures. Some don't even have blood banks on site and there have been several cases of patients being transferred to NHS hospitals after something goes wrong. At those hospitals, typically the big shot surgeon and his consultant anaesthetist work through their list in the morning or afternoon and after that, they leave site and in my experience the entire hospital is then left to a junior doctor to manage. Going private for child birth is similarly not without risk. As I discovered when looking around there are very few private NICU units and I was not able to find a single "level 4" unit which is needed for very premature babies. Such level4s are not that uncommon in the NHS - most big hospitals have that. So to cut a long story short, even if you are fortunate enough to the have the funds in place or insurance, going private isn't always the best option (particularly outside London) and overall I'd be very surprised if there is much private ICU provision. Yes. As others have said, it could be the same staff - but it is not be same gear or department or support staff. Private hospitals will blue light you to NHS in an emergency. NHS will not need to waste time driving across London because there's a 20second lift to ITU (which gets overridden to make things extra fast). Private medical care is geared to do simple things well - and nothing else. If your simple thing goes wrong, you're in the wrong place for something to go wrong.
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daveb
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Post by daveb on Mar 19, 2020 18:41:54 GMT
A few points. People are right to say the bottleneck is staff not ventilators. With all routine surgery cancelled there are enough theatre ventilators. There aren't a lot of trained staff. PPE for staff and testing so those with a non-corona cold don't have to isolate would help more than getting industry to make ventilators. Most consultants don't do much private work now, especially those in acute specialties which are taking the brunt here. Surgeons do some especially in the south east.
If you want to criticise the government, then do so for their management of the NHS for the last 10 years which has left us with 100,000 vacancies, not for managing this crisis (because I don't think anyone really knows what to do for the best)
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cb25
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Post by cb25 on Mar 19, 2020 18:42:57 GMT
I will happily volunteer to stand around and keep an eye on a room full of patients on ventilators, provided someone properly medically trained sticks the tube in and is reasonably nearby if something goes wrong.
A bit naive, maybe, but my point is that in a crisis we don't necessarily have to have people with years of training to do routine tasks. I'm not advocating doing anything invasive, but I bet there's a lot of "admin" that could be taken off doctors' and nurses' hands.
There's nothing routine about a patient on a ventilator - intensive care does what it says on the tin. Intensive = loads of medical and nursing time. Anyway, I don't want to be flippant, things are going to be really bad in hospitals for quite a while now - not just because of treating COVID itself, but because the measures taken to combat COVID have decimated NHS staffing. Routine stuff, admin, etc is already of out of the window, the peak isn't anywhere even near to beginning, and already services are struggling and having to make difficult, and risky, decisions. It's all hands to whatever deck is in crisis on any given day. There were a bunch of letters from medical professionals in The Times today (no link as I don't have a subscription, read the print copy). Seemed to be mixed views - some saying no big problems doing ventilation manually, others saying it can be dangerous to patients. What I found interesting was that there wasn't a uniform view from the professionals.
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Mike
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Post by Mike on Mar 19, 2020 18:47:47 GMT
From an NHS doctor point of view, there are a lot of resources that are simply waiting for work now routine procedures have been cancelled.
Mrs Xell has been doing almost nothing all day - her least busy day in over a year. She's not in ITU (although has been repurposed as an ITU on-call for tonight) but there is a lot of spare capacity at Guys & Thomas' in London that has been created; so far it's not needed.
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IFISAcava
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Post by IFISAcava on Mar 19, 2020 18:49:06 GMT
There's nothing routine about a patient on a ventilator - intensive care does what it says on the tin. Intensive = loads of medical and nursing time. Anyway, I don't want to be flippant, things are going to be really bad in hospitals for quite a while now - not just because of treating COVID itself, but because the measures taken to combat COVID have decimated NHS staffing. Routine stuff, admin, etc is already of out of the window, the peak isn't anywhere even near to beginning, and already services are struggling and having to make difficult, and risky, decisions. It's all hands to whatever deck is in crisis on any given day. There were a bunch of letters from medical professionals in The Times today (no link as I don't have a subscription, read the print copy). Seemed to be mixed views - some saying no big problems doing ventilation manually, others saying it can be dangerous to patients. What I found interesting was that there wasn't a uniform view from the professionals.Welcome to medicine! There is always a range of opinions, and as long a doctor's opinion is shared by a responsible body of medical professionals who work in the same field (Bolam) and it has a logical basis (Bolitho) then there isn't a right or wrong. Some do, however, shout their opinions louder than others.
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IFISAcava
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Post by IFISAcava on Mar 19, 2020 18:49:48 GMT
From an NHS doctor point of view, there are a lot of resources that are simply waiting for work now routine procedures have been cancelled. Mrs Xell has been doing almost nothing all day - her least busy day in over a year. She's not in ITU (although has been repurposed as an ITU on-call for tonight) but there is a lot of spare capacity at Guys & Thomas' in London that has been created; so far it's not needed. just give it a day or two
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Mike
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Post by Mike on Mar 19, 2020 19:14:56 GMT
From an NHS doctor point of view, there are a lot of resources that are simply waiting for work now routine procedures have been cancelled. Mrs Xell has been doing almost nothing all day - her least busy day in over a year. She's not in ITU (although has been repurposed as an ITU on-call for tonight) but there is a lot of spare capacity at Guys & Thomas' in London that has been created; so far it's not needed. just give it a day or two She's been told to expect to work from home!
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Greenwood2
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Post by Greenwood2 on Mar 19, 2020 19:15:50 GMT
Went back to Sainsburys this afternoon, it was relatively quiet, but it looked as if it had been looted, no meat, no milk, no eggs, no flour, no butter, no potatoes, no onions and very limited fresh fruit and vegetables. They did have fresh from the bakery still warm hot cross buns on offer though! So cruel. Mrs Dolt & I are on a "low day" today (the 5:2 diet).  I would give that up at the minute it might become normal so I would plump up in advance. 
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Greenwood2
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Post by Greenwood2 on Mar 19, 2020 19:17:57 GMT
From an NHS doctor point of view, there are a lot of resources that are simply waiting for work now routine procedures have been cancelled. Mrs Xell has been doing almost nothing all day - her least busy day in over a year. She's not in ITU (although has been repurposed as an ITU on-call for tonight) but there is a lot of spare capacity at Guys & Thomas' in London that has been created; so far it's not needed. just give it a day or two Spare capacity is a good thing even if only for a short time.
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Post by martin44 on Mar 19, 2020 21:56:51 GMT
A few points. People are right to say the bottleneck is staff not ventilators. With all routine surgery cancelled there are enough theatre ventilators. There aren't a lot of trained staff. PPE for staff and testing so those with a non-corona cold don't have to isolate would help more than getting industry to make ventilators. Most consultants don't do much private work now, especially those in acute specialties which are taking the brunt here. Surgeons do some especially in the south east.
If you want to criticise the government, then do so for their management of the NHS for the last 10 years which has left us with 100,000 vacancies, not for managing this crisis (because I don't think anyone really knows what to do for the best)
my bold. fortunately for the UK, we are some weeks behind the main epicentres and have therefor gained not only a little time but i'm guessing loads of data from China, Italy and south Korea on how the virus spreads, incubates and affects the population, and i think we are in a good position to manage going forward, Boris and his sidekicks "seem" to know what they are doing, whether its for the best remains to be seen, but if EVERYONE follows the social distancing and hygiene recommendations then i reckon we could fare better than most.
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mv
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Post by mv on Mar 19, 2020 22:03:36 GMT
A few points. People are right to say the bottleneck is staff not ventilators. With all routine surgery cancelled there are enough theatre ventilators. There aren't a lot of trained staff. PPE for staff and testing so those with a non-corona cold don't have to isolate would help more than getting industry to make ventilators. Most consultants don't do much private work now, especially those in acute specialties which are taking the brunt here. Surgeons do some especially in the south east.
If you want to criticise the government, then do so for their management of the NHS for the last 10 years which has left us with 100,000 vacancies, not for managing this crisis (because I don't think anyone really knows what to do for the best)
Enough theatre ventilators today. Maybe not by the end of the weekend. We have been asked to increase critical care capacity from 20 beds to 200. As you say, ventilators are not the rate limiting step :-(
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