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Post by xyon100 on Apr 28, 2016 8:12:56 GMT
Whilst I'm very pleased with the treatment I have received over the years for many and varied injuries I'm wondering if some of the newly introduced 'preventative' measures being introduced and the routing of everything through GPs are not going to impose further strain on the NHS and GPs in particular. I received an invite for a 'general health check' from my GP surgery ... everybody will get one. I don't smoke or drink, I don't carry excess weight and walk 6-8km every day, I'm healthy ....... but why not. See a nurse who finds a minor problem which needs checking for a week. See nurse after a week - problem still there, need to see a GP. See a GP who then notices the effects of one of my old injuries - you need to see physiotherapy. See physio - you need to see a specialist. Specialist wants X rays but these need to be ordered by GP See GP who orders X rays See radiographer. Physio sees Xrays and doesn't like what she sees - need to see specialist. Specialist - physio can't help, you need fairly major surgery and soon ..... but that needs a referral from the GP. See GP who looks at Xrays and checks me out. Referred to Hospital for surgery! Now this has all happened in the last 3 weeks the equivalent of 10 appointments (yes I'm persuasive!) seeing 7 different Health professional with more on the way! 3 weeks ago I was healthy with a few longstanding 'niggles' now I'm preparing for hospital food  Yea, and before you know it you can claim a blue badge, regular monthly payments and a free car. But don't get me started on that. Earlier I mentioned my experience of the Belgian healthcare system due to a rare nerve disorder that effected both my arms and hands. Once I got a diagnosis and did my own research, I realised there was no point being shuffled from specialist to specialist and no point being "monitored" simply so the specialist could keep records, particularly as each appointment cost ME money. So I stopped going.
Same with physiotherapy that again cost ME money for every visit. I very quickly realised that the treatment I was receiving could be done at home, the electrical gadget to exercise the muscles could be bought myself for about £100. Now it's only too obvious that if I was in the UK where every visit to the doctor/specialist/physiotherapist was free then I would have had little to no disincentive to stop using them even though no cure in sight, and no way would I have bought my own physiotherapy gadgets.
If I was in the UK, I may well be doing the merry-go-round that you describe, all at tax payers expense while increasing workload for hard working doctors. After all, it's all free and I have nothing better to do.
But speaking of blue badges and free cars....Somewhere in my hospital folder is at least one paper signed by a doctor that states that I am at least 70 percent disabled. That was not true when it was signed and certainly is not true now. The point is, not only could I still be doing exactly as you describe with regular free hospital/doctor/physio visits, I could also be on generous benefits to suck up yet more taxpayers money.
And the reality is I have slightly weakened arms and hands that don't stop me leading a perfectly normal life, yet I COULD be doing the rounds of doctors/hospitals/physio while having my rent paid, a regular income and a free car. The UK system actively encourages people to do just that.
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ben
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Post by ben on Apr 28, 2016 8:30:40 GMT
Also when ever I walk past my local doctors surgery there is always a massive sign in the window stating how many appointments have been wasted by people not attending and it is usually about 10%. That is people just not turning up, not people phoning up to cancel as they don't count those ones. So I do believe that anyone who does not turn up should be charged. I know sometimes something happens and you can not make an appointment but unless you hospitalised is it really that hard to phone to cancel.
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mv
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Post by mv on Apr 28, 2016 9:56:21 GMT
Once I got a diagnosis and did my own research, I realised there was no point being shuffled from specialist to specialist and no point being "monitored" simply so the specialist could keep records, particularly as each appointment cost ME money. So I stopped going.
Same with physiotherapy that again cost ME money for every visit. I very quickly realised that the treatment I was receiving could be done at home, the electrical gadget to exercise the muscles could be bought myself for about £100. Now it's only too obvious that if I was in the UK where every visit to the doctor/specialist/physiotherapist was free then I would have had little to no disincentive to stop using them even though no cure in sight, and no way would I have bought my own physiotherapy gadgets.
It is great to have intelligent, motivated patients that are able to help themselves. Unfortunately the public at large do themselves few favours when confronted with illness. Take away free input and they will just deteriorate. The more vulnerable they are at baseline, the worse the outcomes...
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Post by Deleted on Apr 28, 2016 10:04:43 GMT
I suspect the NHS is the nearest thing we have to a National religion, it has all the features including the founding myth. For example the BMA voted against the NHS when it was first suggested and the phrase "stuff their mouths with gold" was coined purely for them to get them to come on board.
The NHS also suffer from the Tragedy of the Commons. There is no guilt in going to the NHS for a cure for something you did to yourself, so, bursting sacs of gel you have had inserted into your body are picked up by the NHS, stuff yourselves with Heroin, step this way let's find you a cure, I sucked contaminants into my lungs for years despite the bleeding obvious now can you give me oxygen? etc etc.
The Privatisation myth, note that nearly all the hospitals and GP surgeries were built using private contractors, the drugs are nearly all made and distributed by private companies, the staff all take home money to be used privately, its a private/public business with the till open and some good/kind people working in it
Then there is the "most efficient" myth, when what is meant is the lowest cost per person in the rich world. If you want an efficient service you do repeat work, for instance there are many procedures which are pretty much the same time after time after time, in an efficient world you give that work to the numpty in the corner and make it like a factory. In NHS land you let many of the most skilled people do it and do other stuff so they stay interested.
Bed blocking...
So the NHS has to change to improve it without spending more money.
On the other subject, has the Gov or the BMA done a good job managing this change process. I give them both "null points", that a "junior doctor" troll? walks onto this site to help us is either good or good marketing... right now I suspect everyone is just struggling with change. I understand the NHS doesn't like change (too many relations moan about it) well time to "man-up" life is about change.
Ways out of a dispute, someone has to give a little, now all hold your noses and step forward.
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mv
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Post by mv on Apr 28, 2016 10:06:45 GMT
The NHS has probably had its day when it was created if you had something like cancer, a) they would not know it and b) you were basically sent hone to die, nowadays they can spend millions keeping one patient alive, obviously if we were that patient we would all like it to be paid for but ethics aside the reality is someone has to pay for it so there is two choices the funding is significantly increased to cover this (ie taxes) or people would have pay private insurance to cover this.
Unfortunately that equates to, there is enough resources for everyone to have comprehensive healthcare (in modern times this may be considered a human right) but we as a society choose that those that can afford it will have excellent care and those that cannot will not. I do completely agree with you that the limits of what we can do with medical science are increasingly rapidly and the costs follow. Public expectation is a significant driver in the escalating costs too. We are treating dementia patients from nursing homes with cancer on intensive care because that is what people demand these days...They've paid their taxes after all...
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Post by xyon100 on Apr 28, 2016 10:22:28 GMT
Once I got a diagnosis and did my own research, I realised there was no point being shuffled from specialist to specialist and no point being "monitored" simply so the specialist could keep records, particularly as each appointment cost ME money. So I stopped going.
Same with physiotherapy that again cost ME money for every visit. I very quickly realised that the treatment I was receiving could be done at home, the electrical gadget to exercise the muscles could be bought myself for about £100. Now it's only too obvious that if I was in the UK where every visit to the doctor/specialist/physiotherapist was free then I would have had little to no disincentive to stop using them even though no cure in sight, and no way would I have bought my own physiotherapy gadgets.
It is great to have intelligent, motivated patients that are able to help themselves. Unfortunately the public at large do themselves few favours when confronted with illness. Take away free input and they will just deteriorate. The more vulnerable they are at baseline, the worse the outcomes... I don't think what I did was particularly smart, it was just common sense. Had all my specialist/doctors/physio appointments have been free as they would have been in the UK, I would likely not have taken the course of action that I did. There is no getting around the fact that completely "free" healthcare creates demand. Would there be 10 percent wasted doctors appointments if a visit meant fronting £20, even if you do get £15 back eventually? I think not. If you are paying for something you know you really don't need, you tend to stop paying.
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mv
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Post by mv on Apr 28, 2016 10:27:03 GMT
I give them both "null points", that a "junior doctor" troll? walks onto this site to help us is either good or good marketing... right now I suspect everyone is just struggling with change. I understand the NHS doesn't like change (too many relations moan about it) well time to "man-up" life is about change. Bobo, I'm sorry if you think I might be trolling. I've had a profile here for a year and only posted re P2P previously. I've tried to respond to comments constructively and avoid being rude to people who disagree with me. I agree that the BMA has been inadequate in putting forward a coherent case for opposing the new contract in its current form. That's why I prefer to engage personally (even if it is just strangers on the internet who happen to share an interest in P2P if nothing else). None of my colleagues oppose change especially if it would improve patient safety. I just don't see how increasing the number of junior doctors at weekends will help when the following facts apply: 1. There are a finite number of doctors- the number is set to decrease despite government optimism to the contrary 2. Junior doctors already work regular weekends, evenings and nights. None of the (weak) published evidence for a "weekend effect" has pointed at deficiencies in JD provision as a potential cause 3. Mon-Fri is the busiest time as all the outpatients and elective work happens then. We are already stretched to breaking point then and most rota up and down the country have empty slots being cross-covered by the remaining JDs 4. The new contract will have the same number of permitted hours on average per week therefore to work more weekends you will have to work less weekdays when it is already busiest and overstretched. GMC guidance says that anyone who identifies themselves as a doctor on social media should not insist on remaining anonymous. As you have questioned my status as a "junior doctor" feel free to investigate. Best wishes, Matt Varrier GMC no. 6105234
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mv
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Post by mv on Apr 28, 2016 10:37:10 GMT
I don't think what I did was particularly smart, it was just common sense. You might not think that spending less money than you earn, having a reserve of accessible cash savings, contributing to a pension, using your S&S ISA allowance and investing any excess in a well diversified set of P2P investments is particularly smart either but you are still in a small minority people with the sense and the means to do so :-) Charging people who don't turn up to appointments makes a lot of sense and would reduce the number of missed appointments I'm sure. But it's not like charging for a missed restaurant or hairdressing appointment. You can't assume that the person missing their appointment has £20 in the world, or doesn't need it to feed their baby.
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ben
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Post by ben on Apr 28, 2016 12:06:29 GMT
I don't think what I did was particularly smart, it was just common sense. You might not think that spending less money than you earn, having a reserve of accessible cash savings, contributing to a pension, using your S&S ISA allowance and investing any excess in a well diversified set of P2P investments is particularly smart either but you are still in a small minority people with the sense and the means to do so :-) Charging people who don't turn up to appointments makes a lot of sense and would reduce the number of missed appointments I'm sure. But it's not like charging for a missed restaurant or hairdressing appointment. You can't assume t that the person missing their appointment has £20 in the world, or doesn't need it to feed their baby. The problem is the type of person that misses the appointments are generally they type that probably do not contribute to it as there attitude is entitlement. If I booked an appointment with anybody and could not make it for what ever reason unless I was physically unable to I wouldn't dream of at least not phoning and if I had forgotten for whatever reason I would be straight on the phone apologising, 10% of appointments being missed is just tt he odd person doing it once its people doing it regularly who do not care as they do not have to pay for it.
I guess as many on here I am a fairly high earner have a fairly high disposable income. I do not object to paying for things like the NHS I just object to supporting the people that abuse it, although I think we have pretty much gone of the original topic now.
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duck
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Post by duck on Apr 28, 2016 12:50:20 GMT
Yea, and before you know it you can claim a blue badge, regular monthly payments and a free car..... Absolutely, 15 years ago I was told I wouldn't in all likelihood work again and should have a blue badge. I said I would have the badge but could I have an 'extra sticky' one since they tend to blow off motorcycle windscreens  Same with physiotherapy that again cost ME money for every visit. I don't disagree with your sentiments, I've been paying a chiropractor for the last year which has improved matters no end, I don't mind paying to keep myself 'fit and well'. What was finally shown on the Xrays surprised me greatly, but without doing the rounds I wouldn't have been able to find out, now I know why my 'sort it myself' approach has failed. Until this time I've always managed to gather information from the relevant professional and then go away and sort it myself. It is great to have intelligent, motivated patients that are able to help themselves. Agreed, but therein also lies the problem. The availability encourages abuse of the system, something that can be seen in all A&E departments (my usual point of contact) .... but how that problem is to be solved is not an easy one. If I was in the UK, I may well be doing the merry-go-round that you describe, all at tax payers expense while increasing workload for hard working doctors believe me I felt guilty about taking up so many appointments but that was the point I was making, the system is wrong. I needed 1 GP appointment and 1 Xray and I would have been able to see what is wrong, its that obvious! Systems need to work and for me it certainly did ..... but at what cost in time and expense? So systems need to work efficiently and cost effectively. I would suggest the current system is not cost effective.
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Post by earthbound on Apr 28, 2016 14:11:49 GMT
The NHS has probably had its day when it was created if you had something like cancer, a) they would not know it and b) you were basically sent hone to die, nowadays they can spend millions keeping one patient alive, obviously if we were that patient we would all like it to be paid for but ethics aside the reality is someone has to pay for it so there is two choices the funding is significantly increased to cover this (ie taxes) or people would have pay private insurance to cover this.
hi ben There is of course another way, but it is fairly simplistic and would have the lefties up in arms, how about voluntary NHS contributions, (ps i am not talking about tax or NI contributions, i am talking "i love the NHS and want to give more" ) if everyone in the uk was offered the option either through their PAYE paypacket or their tax return to make a monthly/weekly/lump sum or whatever ... completely voluntary contribution towards the running of the NHS. OR How about the govt introduces a flat rate.. say £100 per year voluntary NHS only insurance policy which would cover the first £1000 of cost's if you needed hospital treatment, i am not a financial annalist so please only take the figures as bandied about amounts. I reckon there would be quite a few people who would find either or both of these options acceptable, i would have no problems at all donating say £10 per month, and if say only 10% of the uk population took up this option then i'm sure it would be a considerable amount. If anyone sat about at the moment with a calculator and nothing better to do, then maybe a figure would be nice. edit.. In fact ... CD, what about an NHS poll.
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Post by Deleted on Apr 28, 2016 14:23:04 GMT
I give them both "null points", that a "junior doctor" troll? walks onto this site to help us is either good or good marketing... right now I suspect everyone is just struggling with change. I understand the NHS doesn't like change (too many relations moan about it) well time to "man-up" life is about change. Bobo, I'm sorry if you think I might be trolling. I've had a profile here for a year and only posted re P2P previously. I've tried to respond to comments constructively and avoid being rude to people who disagree with me. I agree that the BMA has been inadequate in putting forward a coherent case for opposing the new contract in its current form. That's why I prefer to engage personally (even if it is just strangers on the internet who happen to share an interest in P2P if nothing else). None of my colleagues oppose change especially if it would improve patient safety. I just don't see how increasing the number of junior doctors at weekends will help when the following facts apply: 1. There are a finite number of doctors- the number is set to decrease despite government optimism to the contrary 2. Junior doctors already work regular weekends, evenings and nights. None of the (weak) published evidence for a "weekend effect" has pointed at deficiencies in JD provision as a potential cause 3. Mon-Fri is the busiest time as all the outpatients and elective work happens then. We are already stretched to breaking point then and most rota up and down the country have empty slots being cross-covered by the remaining JDs 4. The new contract will have the same number of permitted hours on average per week therefore to work more weekends you will have to work less weekdays when it is already busiest and overstretched. GMC guidance says that anyone who identifies themselves as a doctor on social media should not insist on remaining anonymous. As you have questioned my status as a "junior doctor" feel free to investigate. Best wishes, Matt Varrier GMC no. 6105234 Hi Matt No problem with you being a doctor, but the point is you are offering only one point of view I suspect you are missing my point, you are saying that there are not enough doctors, but you are not striking about there not being enough doctors, but about having to change working patterns, since you are already doing say Saturday mornings, there is no issue with you accepting the new contracts, because that is what they are asking you to do. I suspect, like everyone else, you don't like being told what to do and the BMA are pushing back to defend you from people who are telling you what to do, I understand that completely and fair does. But the various claims about "saving the NHS", etc are so much nonsense and do the BMA no favours. If say 6 day working was the norm the clients will move to coming days a week, if 7 then demand will cover all 7. I do see merit that having a contract that is unattractive is just that, but then striking about is just kinda crazy, you say that you have insufficient staff, but then the BMA reduces the capacity of the NHS by taking you out on strike. The logic is not there. The best negotiations I've ever sat in is when the both sides stop playing games and start working towards the same thing (and of course this takes both sides). If you want to expand the capacity of the NHS and make working hours more attractive then the BMA needs to formulate some clear to understand structural changes which are easy to prove (the good old scientific method) and then march/strike about those. The BMA is being seen as leading negatively, if it were leading positively it would have pushed Hunt out of the way by now. As I suggested earlier both sides need to hold their noses and step towards each other. No one wins a strike they just cause a loss of confidence in both sides while the customer suffers, eventually they have to meet again.
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adrianc
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Post by adrianc on Apr 28, 2016 14:43:55 GMT
Unfortunately that equates to, there is enough resources for everyone to have comprehensive healthcare (in modern times this may be considered a human right) I think you might find the US arguing against that. If you're meaning private health cover on top of the NHS, then I have absolutely no issue with that. So long as the NHS provides adequate, comprehensive cover for free, then if people want to pay out on top, in order to get quicker treatment or nicer rooms or treatments that the NHS doesn't provide - then that's absolutely fine by me. Same with education. Let's not forget that those are people who are paying larger amounts of tax, on the whole, but taking less out. And THAT is the root cause of the problem. Medical technology is advancing massively, rapidly. And those advances are often not cheap. Would <say> £100k be best spent in providing one person a few more months of seriously impaired life - or jobs for three more nurses - or keeping a rural GP surgery open - or or or or... The NHS could VERY easily absorb every single penny that could possibly be thrown at it, and still come back for more.
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adrianc
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Post by adrianc on Apr 28, 2016 14:46:07 GMT
There is of course another way, but it is fairly simplistic and would have the lefties up in arms, how about voluntary NHS contributions, (ps i am not talking about tax or NI contributions, i am talking "i love the NHS and want to give more" ) if everyone in the uk was offered the option either through their PAYE paypacket or their tax return to make a monthly/weekly/lump sum or whatever ... completely voluntary contribution towards the running of the NHS. It happens already, regularly. www.sath.nhs.uk/media/news_archive/2016-04-April/160425-Marathon.aspxand many, many, many similar appeals and events.
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Post by earthbound on Apr 28, 2016 14:53:15 GMT
There is of course another way, but it is fairly simplistic and would have the lefties up in arms, how about voluntary NHS contributions, (ps i am not talking about tax or NI contributions, i am talking "i love the NHS and want to give more" ) if everyone in the uk was offered the option either through their PAYE paypacket or their tax return to make a monthly/weekly/lump sum or whatever ... completely voluntary contribution towards the running of the NHS. It happens already, regularly. www.sath.nhs.uk/media/news_archive/2016-04-April/160425-Marathon.aspxand many, many, many similar appeals and events. You are quite right , what i was sort of suggesting is an extremely simplistic way to raise large amounts voluntarily with no hardships involved , no charity events, no bucket shaking, just a simple way to get voluntarily contributed money straight to the NHS.
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