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  1. #31
    Quote Originally Posted by lyonhibs View Post
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    This is liable to take this thread in another direction, but to say that the care provided by front line staff in the NHS is "an absolute shambles" is offensive nonsense.
    He didn't say that. In fact, I think the exact opposite point was being made.

    IMHO, the lack of any real debate on the NHS because of the incessant need to praise/not offend front-line NHS staff and pretend that they are all wonderful is part of the problem. Either directly or indirectly, I've experienced great care, including staff who have gone well above and beyond, and I've experienced absolutely horrendous care, including gross incompetence and neglect.

    Like any organisation, some folk are good at their jobs, some not so good at their jobs.


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  3. #32
    Coaching Staff lyonhibs's Avatar
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    Quote Originally Posted by Beefster View Post
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    He didn't say that. In fact, I think the exact opposite point was being made.

    IMHO, the lack of any real debate on the NHS because of the incessant need to praise/not offend front-line NHS staff and pretend that they are all wonderful is part of the problem. Either directly or indirectly, I've experienced great care, including staff who have gone well above and beyond, and I've experienced absolutely horrendous care, including gross incompetence and neglect.

    Like any organisation, some folk are good at their jobs, some not so good at their jobs.
    Agree entirely but, unless I'm missing some very refined nuance in the post I quoted, what was effectively said was "when you or your loved ones actually need care from the NHS (or social services), it's an absolute shambles" which is, to put it mildly, painting with excessively broad strokes IMO.

    Out of interest, what level/angle of debate on the NHS are you talking about? Whether it is a fundamentally good/worthwhile thing? Or whether it in it's current state/with the current governance in place it's all that it could/should be?

    No doubt that it's far from perfect, but - with, granted, more notable exceptions (that always make the front pages) than anyone would ideally like - frontline staff are the last ones who should be having their work capabilities called into question. Again IMO.
    Last edited by lyonhibs; 14-12-2016 at 01:15 PM.

  4. #33
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    Quote Originally Posted by lyonhibs View Post
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    Agree entirely but, unless I'm missing some very refined nuance in the post I quoted, what was effectively said was "when you or your loved ones actually need care from the NHS (or social services), it's an absolute shambles" which is, to put it mildly, painting with excessively broad strokes IMO.

    Out of interest, what level/angle of debate on the NHS are you talking about? Whether it is a fundamentally good/worthwhile thing? Or whether it in it's current state/with the current governance in place it's all that it could/should be?

    No doubt that it's far from perfect, but - with, granted, more notable exceptions (that always make the front pages) than anyone would ideally like - frontline staff are the last ones who should be having their work capabilities called into question. Again IMO.
    I agree it's a ridiculous broad brush but I also agree with the earlier post that alludes to the fact that it seems somewhat ingrained that just because you work for the NHS you are somehow automatically classed as 'hard working' or the like.

    You say frontline staff are the last ones who should have their capabilities questioned...considering how many people that must cover is that too not a ridiculously broad brush.

    As others have alluded to I have seen excellent and terrible care administered by the NHS and a dramatic difference in the attitude and aptitude of the front line staff...to me it's one of the NHS's biggest failings is its inconsistency when delivering it's service.

  5. #34
    Quote Originally Posted by lyonhibs View Post
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    Agree entirely but, unless I'm missing some very refined nuance in the post I quoted, what was effectively said was "when you or your loved ones actually need care from the NHS (or social services), it's an absolute shambles" which is, to put it mildly, painting with excessively broad strokes IMO.

    Out of interest, what level/angle of debate on the NHS are you talking about? Whether it is a fundamentally good/worthwhile thing? Or whether it in it's current state/with the current governance in place it's all that it could/should be?

    No doubt that it's far from perfect, but - with, granted, more notable exceptions (that always make the front pages) than anyone would ideally like - frontline staff are the last ones who should be having their work capabilities called into question. Again IMO.
    I think the NHS is fundamentally a 'good thing' so any debate that needs to be had is, IMHO, around how it is improved and adequately funded.

    Your last paragraph sort of reinforces my point about the difficulty of debating its failings though.

  6. #35
    The real question should be how much money is wasted employing 3rd parties who operate purely for profit? The amount of different care agencies attending to older people is a huge drain when 1 company could do the same work, employ fewer carers, and avoid needless travelling time between clients.

    I know for a fact that on a daily basis 5 agencies supply upwards of 8 different carers every day to come in for 15 & 30 minute visits to 1 sheltered housing block, rather than 1 agency visiting all of these needing care and support to dress take meds and shower etc. Some people are visited 4 times per day by the same carer, who then has to dash to the next client whist not being paid for the time between visits. Some carers are starting at 6.30 and working until 10pm and only being paid for about 8 hours work.

    If anyone can explain why things are done this way other than to generate profit for the agencies I'd be interested to hear.

  7. #36
    @hibs.net private member Mibbes Aye's Avatar
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    Quote Originally Posted by lyonhibs View Post
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    This is liable to take this thread in another direction, but to say that the care provided by front line staff in the NHS is "an absolute shambles" is offensive nonsense.
    I think you've seriously misinterpreted my post. Having said that I could have explained my point fully, so I'm not saying you are at fault.

    If you reread my post I am not calling the care provided by frontline staff "an absolute shambles". In fact I start my post agreeing with someone who is praising nurses! Beefster's right though, there is a narrative which doesn't allow for criticism and that is a very dangerous thing.

    In my post I talked about people coming into direct contact with healthcare and social care. I put the two together deliberately and also deliberately referred to our older relatives because the thrust of my point was healthcare and social care for older people. You can't separate the two in this regard, hence why the SNP and the other main parties have all explicitly committed to integration of the two for several years now.

    Why do I think it's an absolute shambles?

    The OP talked about the growth in staff over the last year. But when you look at the key measures of what an older person's experience is like, across the country, it's hard to see improvement and easy to see decline.

    Key measures like the time it takes from being referred for treatment to actually getting the treatment. Not just are health boards all over the country failing to meet the target, they're getting further away from it.

    Delayed discharges - when someone doesn't need to be in hospital for medical reasons but can't leave because they can't get the home care they need or a care home place. So they're stuck in a ward, blocking a bed and massively increasing their chances of becoming unwell from hospital-acquired infections. Just to put this in context for those unfamiliar with it - this has consistently been one of the biggest healthcare priorities of government,regardless of party. It's not got any better either and has trended worse over the last few years.

    Hospitals like the Royal Victoria and Liberton were scheduled for closure, described by the senior managers as 'outmoded' and 'outdated'. In fact the Royal Vic was closed, then had to be reopened to deal with the issues described above.

    NHS boards around the country, Scotland and UK, are incapable of balancing their budgets and can't say where they will find the savings this financial year to balance their budgets despite us being three-quarters of the way through it.

    Out of the hospitals and into the community, we have GP practices. GPs are the gatekeepers for access to healthcare and should have a major role in reducing hospital admissions for older people. Up and down the country, practices are folding, or closing their lists to new patients because they can't deal with demand.

    Care home provision stumbles from one crisis to another. While there are some excellent care homes, they are few and far between and the average quality grades in this area are well below other areas of social care. More worryingly, most care home provision is in the private sector, often owned by private equity funds. This goes back to the days when they were seen as steady profit-makers. Those days went a long time ago and the financial model is not fit for purpose, which is why one major owner, Southern Cross went out of business and others have been rumoured to be in desperate trouble. Bear in mind that these are the homes of the most vulnerable older people in our communities.

    For those who can continue to live at home but require care, things aren't less precarious. The majority of home care is delivered by the private sector, using public money. However, these firms cannot recruit and retain staff, meaning people can go months without the care they have been assessed as needing (family having to cover, presumably) and when the care is in place there are constant issues about reliability and consistency.

    The last two paragraphs describe care that is the responsibility of the integrated health and social care partnerships, which are meant to be the NHS board and the local council working in partnership. Both the boards and councils are having to deliver savings on an unprecedented scale, during a time when the evidence says that performance isn't good enough and there is no sign of additional money any time soon.

    Oh, and to make matters worse, the older population is growing exponentially. Over-75s pretty much doubling over the next twenty years, over-90s trebling. So the demand goes up, while the means to address it is static or reducing.

    And it's actually worse than those stats because our acute healthcare and advances in drugs mean we are able to keep people alive for longer, but in ill-health. So people are living on with an increasing range of long-term conditions or life-limiting conditions (think coronary heart disease, COPD, diabetes etc). These conditions need support from services, putting further strain on what's available.

    These are some (and nowhere near all) the reasons I described the situation as an absolute shambles. It's quite good timing that since I made my last post, this debate has blown up down in England!

    Still, as someone said earlier, I guess these are just broad brushstrokes.......
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  8. #37
    Quote Originally Posted by Mibbes Aye View Post
    This quote is hidden because you are ignoring this member. Show Quote
    I think you've seriously misinterpreted my post. Having said that I could have explained my point fully, so I'm not saying you are at fault.

    If you reread my post I am not calling the care provided by frontline staff "an absolute shambles". In fact I start my post agreeing with someone who is praising nurses! Beefster's right though, there is a narrative which doesn't allow for criticism and that is a very dangerous thing.

    In my post I talked about people coming into direct contact with healthcare and social care. I put the two together deliberately and also deliberately referred to our older relatives because the thrust of my point was healthcare and social care for older people. You can't separate the two in this regard, hence why the SNP and the other main parties have all explicitly committed to integration of the two for several years now.

    Why do I think it's an absolute shambles?

    The OP talked about the growth in staff over the last year. But when you look at the key measures of what an older person's experience is like, across the country, it's hard to see improvement and easy to see decline.

    Key measures like the time it takes from being referred for treatment to actually getting the treatment. Not just are health boards all over the country failing to meet the target, they're getting further away from it.

    Delayed discharges - when someone doesn't need to be in hospital for medical reasons but can't leave because they can't get the home care they need or a care home place. So they're stuck in a ward, blocking a bed and massively increasing their chances of becoming unwell from hospital-acquired infections. Just to put this in context for those unfamiliar with it - this has consistently been one of the biggest healthcare priorities of government,regardless of party. It's not got any better either and has trended worse over the last few years.

    Hospitals like the Royal Victoria and Liberton were scheduled for closure, described by the senior managers as 'outmoded' and 'outdated'. In fact the Royal Vic was closed, then had to be reopened to deal with the issues described above.

    NHS boards around the country, Scotland and UK, are incapable of balancing their budgets and can't say where they will find the savings this financial year to balance their budgets despite us being three-quarters of the way through it.

    Out of the hospitals and into the community, we have GP practices. GPs are the gatekeepers for access to healthcare and should have a major role in reducing hospital admissions for older people. Up and down the country, practices are folding, or closing their lists to new patients because they can't deal with demand.

    Care home provision stumbles from one crisis to another. While there are some excellent care homes, they are few and far between and the average quality grades in this area are well below other areas of social care. More worryingly, most care home provision is in the private sector, often owned by private equity funds. This goes back to the days when they were seen as steady profit-makers. Those days went a long time ago and the financial model is not fit for purpose, which is why one major owner, Southern Cross went out of business and others have been rumoured to be in desperate trouble. Bear in mind that these are the homes of the most vulnerable older people in our communities.

    For those who can continue to live at home but require care, things aren't less precarious. The majority of home care is delivered by the private sector, using public money. However, these firms cannot recruit and retain staff, meaning people can go months without the care they have been assessed as needing (family having to cover, presumably) and when the care is in place there are constant issues about reliability and consistency.

    The last two paragraphs describe care that is the responsibility of the integrated health and social care partnerships, which are meant to be the NHS board and the local council working in partnership. Both the boards and councils are having to deliver savings on an unprecedented scale, during a time when the evidence says that performance isn't good enough and there is no sign of additional money any time soon.

    Oh, and to make matters worse, the older population is growing exponentially. Over-75s pretty much doubling over the next twenty years, over-90s trebling. So the demand goes up, while the means to address it is static or reducing.

    And it's actually worse than those stats because our acute healthcare and advances in drugs mean we are able to keep people alive for longer, but in ill-health. So people are living on with an increasing range of long-term conditions or life-limiting conditions (think coronary heart disease, COPD, diabetes etc). These conditions need support from services, putting further strain on what's available.

    These are some (and nowhere near all) the reasons I described the situation as an absolute shambles. It's quite good timing that since I made my last post, this debate has blown up down in England!

    Still, as someone said earlier, I guess these are just broad brushstrokes.......
    Great post. Explained things far better than I could have.

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