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  1. #1

    Nhs

    David Cameron stated "The NHS is safe in my hands and I don't want anyone to ever tell you otherwise".

    We didn't believe him then and not much has changed since then.

    http://www.bbc.co.uk/news/health-41673412


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  3. #2
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    The NHS is devolved.

    What England decides to do with its NHS is nothing to do with Scotland's.

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    @hibs.net private member Golden Fleece's Avatar
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    Quote Originally Posted by SouthsideHarp_Bhoy View Post
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    The NHS is devolved.

    What England decides to do with its NHS is nothing to do with Scotland's.
    It has nothing to do with devolution, the article is about the NHS in England.
    Health Secretary Jeremy Hunt has admitted the health service in England must improve its record on waiting times after a BBC analysis revealed key targets were being missed en masse.
    #Persevered
    Scotland can be a beacon, within these islands and beyond, for a socially just and sustainable society. Whilst there are many priorities which will require independence, there is also much that can and must be done now by the Scottish Parliament and the Scottish Government.

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    Coaching Staff Smartie's Avatar
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    It can still be interesting to cast an eye the other side of the border to see how things are done.

    Thank god health has been devolved, so we're able to just about keep our NHS going. Some of what goes on down South is appalling.

    If only we had full control of all of the levers to decide how the NHs should be adequately funded........

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    @hibs.net private member wpj's Avatar
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    I see this from the inside working in a hospital in England. We have has instances of zero beds available and over 200 visitors to A&E. Discharges then become rushed and all non urgent surgery cancelled, some of the discharged will be back at A&E within days. If there was an incident nearby that required major medical support we would need to set up a "field hospital" and empty out some of the post op patients earlier than they should be. That's not taking into account the staff shortages and experienced staff leaving and massive stress related sickness. It's really sad.

  7. #6
    Quote Originally Posted by SouthsideHarp_Bhoy View Post
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    The NHS is devolved.

    What England decides to do with its NHS is nothing to do with Scotland's.
    Except that Scotgov's block grant is determined by what England decides to spend on devolved areas.

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    Quote Originally Posted by Golden Fleece View Post
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    It has nothing to do with devolution, the article is about the NHS in England.
    Yeah fair enough, i just worry people conflate the two things too often.

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    Quote Originally Posted by JeMeSouviens View Post
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    Except that Scotgov's block grant is determined by what England decides to spend on devolved areas.
    True, but the NHSScotland budget is decided by the Scottish Government.

    And of course that block grant is currently based on a significant spending deficit, so it could be argued we are already spending more than we can afford.

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    This is much more than a political debate.

    Look at the demand figures...A&E up 20% in four years, Cancer cases up 25%.

    Not sure how you go about meeting those sorts of increased without a fundamental rethink of how the services are consumed and delivered.

    More money would always help but it seems that just leads to more money being needed and will not meet the challenge of an ageing population by itself.

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    @hibs.net private member Jack's Avatar
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    Quote Originally Posted by RyeSloan View Post
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    Not sure how you go about meeting those sorts of increased without a fundamental rethink of how the services are consumed and delivered.

    More money would always help but it seems that just leads to more money being needed and will not meet the challenge of an ageing population by itself.
    Do you have any thoughts/care to expand?
    Space to let

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    Quote Originally Posted by Jack View Post
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    Do you have any thoughts/care to expand?
    Not sure I do to be honest....seems to be a major issue for all developed countries healthcare systems no matter what method of funding / delivery they are using.

    It's certainly not just an NHS issue and certainly not just a chuck more money at it solution either. The clear fact is that the NHS simply can never have enough money.

    So as a start I would suggest that it needs to have much clearer defined boundaries of what it will and will not provide. But as we know as soon as you do that people start lobbying for it to be expanded (the easiest example is the provision of costly drugs and the infrequent campaign for some to be added despite originally being rules out on a cost/benefit approach)

    Honestly I don't have strong views as to the correct solution but I know that a centrally controlled behemoth that employe at least 1.5m people, suffers from extreme political meddling and has a highly unionised and polarised workforce would not be my starting point...

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    @hibs.net private member wpj's Avatar
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    Quote Originally Posted by RyeSloan View Post
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    This is much more than a political debate.

    Look at the demand figures...A&E up 20% in four years, Cancer cases up 25%.

    Not sure how you go about meeting those sorts of increased without a fundamental rethink of how the services are consumed and delivered.

    More money would always help but it seems that just leads to more money being needed and will not meet the challenge of an ageing population by itself.

    Another major issue is the lack of support out with the acute setting where patients could get better and receive their post acute care in the community. This would free up beds and ensure patients receive the appropriate aftercare however this would need massive investment which just isn't there. I know of patients who have been in a bed for over a year because there is no suitable alternative for them but they do not need a hospital bed while urgent cases have to wait for a bed.

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    Quote Originally Posted by wpj View Post
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    Another major issue is the lack of support out with the acute setting where patients could get better and receive their post acute care in the community. This would free up beds and ensure patients receive the appropriate aftercare however this would need massive investment which just isn't there. I know of patients who have been in a bed for over a year because there is no suitable alternative for them but they do not need a hospital bed while urgent cases have to wait for a bed.
    Speak to people in the NHS about this, they would love to close down the local hospitals, centralise care and move care to community setting. But they camt as people get all dewy eyed about their local hospital or their local A&E, and politicians being politicians, they exploit this to get elected. Only then do they realise that itnis an inefficiemt and expensibe way to deliver poorer care.

    Im fairly pragmatic about how the NHS works - too many people treat it as some sort of holy cow, that is an ens in itself. The end is delivering the best care in the fairest manner, and as soon as the NHS stops delivering that, we need something new imo. That day may well be approaching fast, given the astronomical demands and expectations we as a society have, that we expect to be delivered for free.

  15. #14
    Quote Originally Posted by Jack View Post
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    Do you have any thoughts/care to expand?
    I work with the elderly. The amount of times they are encouraged to go to hospital for what could be considered routine things is an appalling waste of resources. The left and right hand not speaking and sometime contradicting one another doesn't help. Bed blocking whilst social care packages are sorted is also an issue for those who require it and have lost their previous package due to the hospital stay.
    Offering everyone the right to choose,even the most basic stuff means lots of work is for led and lots of time wasted when carers travel between locations and back Gain throughout the day. Having agencies that covered areas of the town would be a start and would also afford the workers better working conditions. That's just for starters.

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    @hibs.net private member Golden Fleece's Avatar
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    Quote Originally Posted by SouthsideHarp_Bhoy View Post
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    Speak to people in the NHS about this, they would love to close down the local hospitals, centralise care and move care to community setting. But they camt as people get all dewy eyed about their local hospital or their local A&E, and politicians being politicians, they exploit this to get elected. Only then do they realise that itnis an inefficiemt and expensibe way to deliver poorer care.

    Im fairly pragmatic about how the NHS works - too many people treat it as some sort of holy cow, that is an ens in itself. The end is delivering the best care in the fairest manner, and as soon as the NHS stops delivering that, we need something new imo. That day may well be approaching fast, given the astronomical demands and expectations we as a society have, that we expect to be delivered for free.

    How far should someone have to go to get to their 'local' hospital? For me the nearest A&E is 40 minutes. More often they will assess your condition and if it isn't easily treated you have a further 30 minutes.
    #Persevered
    Scotland can be a beacon, within these islands and beyond, for a socially just and sustainable society. Whilst there are many priorities which will require independence, there is also much that can and must be done now by the Scottish Parliament and the Scottish Government.

  17. #16
    Quote Originally Posted by wpj View Post
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    Another major issue is the lack of support out with the acute setting where patients could get better and receive their post acute care in the community. This would free up beds and ensure patients receive the appropriate aftercare however this would need massive investment which just isn't there. I know of patients who have been in a bed for over a year because there is no suitable alternative for them but they do not need a hospital bed while urgent cases have to wait for a bed.
    Correct. Truly crazy isn't it.

  18. #17
    Quote Originally Posted by SouthsideHarp_Bhoy View Post
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    Speak to people in the NHS about this, they would love to close down the local hospitals, centralise care and move care to community setting. But they camt as people get all dewy eyed about their local hospital or their local A&E, and politicians being politicians, they exploit this to get elected. Only then do they realise that itnis an inefficiemt and expensibe way to deliver poorer care.

    Im fairly pragmatic about how the NHS works - too many people treat it as some sort of holy cow, that is an ens in itself. The end is delivering the best care in the fairest manner, and as soon as the NHS stops delivering that, we need something new imo. That day may well be approaching fast, given the astronomical demands and expectations we as a society have, that we expect to be delivered for free.
    The Leith treatment centre is a good example of taking the pressure of the main hospitals. Equivalents dotted around would be a good idea imo.

  19. #18
    It's a vicious cycle. People misuse A&E for non emergencies but the waiting time for GP appointments is such that people often feel they have no choice.

    A huge issue is housing. New developments are thrown up all over the place but little thought is given to the surrounding infastructure. My girlfriend grew up in a village of 500 people, it now has a population of nearly 4000 with plans in place for another 200 houses but whilst all that building has taken place there is still exactly the same number of GPs, Dentists and schools. No wonder services are creaking.
    I fell in love with football as I was later to fall in love with women,. Suddenly, uncritically giving no thought to the pain it could bring. - Nick Hornby

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    Quote Originally Posted by beensaidbefore View Post
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    The Leith treatment centre is a good example of taking the pressure of the main hospitals. Equivalents dotted around would be a good idea imo.
    Yeah thats the model theu are moving to. There is lots of evidence that being treated at big centres of excellence with considerable expertise gives patients much better outcomes and is much more efficient to deliver.

    They are trying to reform the NHS, but it is a difficult thing to do. Im aware of a project to roll out a new way of doing a fairly routine task within the NHS. Getting it done will be fundamental to the NHS in the future, but 80% of the costs are simply to train amd encourage staff to adopt the new practice.

    Multiply that up, and it aint easy.

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    Quote Originally Posted by Golden Fleece View Post
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    How far should someone have to go to get to their 'local' hospital? For me the nearest A&E is 40 minutes. More often they will assess your condition and if it isn't easily treated you have a further 30 minutes.
    I dont know, id imagine it depends what is wrong with you. For example if you have a stroke, as long as local paramedics / emergency treatment can get you the initial treatment you need to stabilise you, id suspect that time spent in am ambulance to get you to a big specialist centre with experts in their field would be time better spent than lying in a 'local' hospital bed ina generalist ward with less capable / experienced clinicians.

    People dont expect to get cancer treatment at their local hoapital, so why would other conditions be any different?

    Increasingly hospitals are being concentrated, but the oppoaition to it happening is enormous. I know of one MSP who has said privately her local hospital should be downgraded, but would be voted out if she ever supported it publically.

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    There’s also the workforce and how they are treated and how they behave to address.

    my wife works for the NHS, and by and large the people working for the NHS are fantastic, dedicated, hard working, passionate, and very good at what they do, for the betterment of all of us.

    however, I do also know of someone who was deemed unable to work due to some health issues, but because they were ‘nearing retirement’, were allowed to stay on full pay for over 2 years on sick leave, until they chose to retire. Other situations where people have refused to carry out some of their duties as they felt they were ‘someone else’s job’ (despite being repeatedly told it was their job and shown the job description), yet nothing done beyond that. One person contracted to work 8:30-16:30 who chose to go into work from 7:30-15:30 because it suited them, putting a lot of pressure and their duties onto other people, yet never challenged despite other people having to pick up the offender’s workload. Someone else been signed off for over a year for reasons universally recognised as frivolous (as happenings in the individuals personal life contradict the reason for being off).

    these are very much the few of NHS workers, however they must cause a huge drain by not being managed properly.

    the NHS is an amazing organisation which provides a fantastic service, and something that is the envy of many parts of the world, however it is creaking now due to the expectations and demands on it, hopefully there is a way to stabilise it and change it to support the modern needs.

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    Quote Originally Posted by SouthsideHarp_Bhoy View Post
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    I dont know, id imagine it depends what is wrong with you. For example if you have a stroke, as long as local paramedics / emergency treatment can get you the initial treatment you need to stabilise you, id suspect that time spent in am ambulance to get you to a big specialist centre with experts in their field would be time better spent than lying in a 'local' hospital bed ina generalist ward with less capable / experienced clinicians.

    People dont expect to get cancer treatment at their local hoapital, so why would other conditions be any different?

    Increasingly hospitals are being concentrated, but the oppoaition to it happening is enormous. I know of one MSP who has said privately her local hospital should be downgraded, but would be voted out if she ever supported it publically.

    I took ill on Friday evening last week, I didn't consider it bad enough to drive to A&E in Perth, spoke to a pharmacist on the Saturday morning but there was nothing they could offer other than advice I already knew. On getting an appointment on the Monday morning after suffering over the weekend the doctor said I should have used NHS24. As it is, the GP was able to take me next door to the community hospital where he could carry out a minor procedure to relieve the discomfort. I have nothing but praise for all involved.

    It wasn't life threatening so I didn't consider it something to go to A&E about, but that was the GP's advice to go through NHS24.

    I'm better thanks to the local services available in a rural practice, without have the need to travel 40 minutes, which would have been difficult in the circumstances, and put more pressure on overstretched A&E services.
    #Persevered
    Scotland can be a beacon, within these islands and beyond, for a socially just and sustainable society. Whilst there are many priorities which will require independence, there is also much that can and must be done now by the Scottish Parliament and the Scottish Government.

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    Quote Originally Posted by Golden Fleece View Post
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    I took ill on Friday evening last week, I didn't consider it bad enough to drive to A&E in Perth, spoke to a pharmacist on the Saturday morning but there was nothing they could offer other than advice I already knew. On getting an appointment on the Monday morning after suffering over the weekend the doctor said I should have used NHS24. As it is, the GP was able to take me next door to the community hospital where he could carry out a minor procedure to relieve the discomfort. I have nothing but praise for all involved.

    It wasn't life threatening so I didn't consider it something to go to A&E about, but that was the GP's advice to go through NHS24.

    I'm better thanks to the local services available in a rural practice, without have the need to travel 40 minutes, which would have been difficult in the circumstances, and put more pressure on overstretched A&E services.
    Glad all ended well for you.

    So youre saying the system of local and remote care worked, and you didnt require an A&E visit?

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    @hibs.net private member Golden Fleece's Avatar
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    Quote Originally Posted by SouthsideHarp_Bhoy View Post
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    Glad all ended well for you.

    So youre saying the system of local and remote care worked, and you didnt require an A&E visit?
    yes, our GP's are able to minor procedures assuming the equipment is on site in the Community Hospital. Fall and break a bone and they should be able to patch you up, however a bad cut and they would do a quick patch and you would need to go to A&E. It is a minor injuries unit so can do only basics.

    A visit to A&E would have been difficult for me under the circumstances. (what I was suffering from)
    #Persevered
    Scotland can be a beacon, within these islands and beyond, for a socially just and sustainable society. Whilst there are many priorities which will require independence, there is also much that can and must be done now by the Scottish Parliament and the Scottish Government.

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    Quote Originally Posted by Golden Fleece View Post
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    yes, our GP's are able to minor procedures assuming the equipment is on site in the Community Hospital. Fall and break a bone and they should be able to patch you up, however a bad cut and they would do a quick patch and you would need to go to A&E. It is a minor injuries unit so can do only basics.

    A visit to A&E would have been difficult for me under the circumstances. (what I was suffering from)
    From an A&E perspective this is a salutary tale. Maybe there has and I haven't seen it (not my area of daily reading I must admit) but I would have thought that there should have been a concerted effort made to understand why A&E units are facing such unprecedented increase in demand.

    The earlier article suggested a 20% increase in 4 years...since the population hasn't increased by such huge numbers something else must be driving that.

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    Quote Originally Posted by RyeSloan View Post
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    From an A&E perspective this is a salutary tale. Maybe there has and I haven't seen it (not my area of daily reading I must admit) but I would have thought that there should have been a concerted effort made to understand why A&E units are facing such unprecedented increase in demand.

    The earlier article suggested a 20% increase in 4 years...since the population hasn't increased by such huge numbers something else must be driving that.
    Too many people don't understand what A&E does, or should be doing.

    The clue is in the name 'Accident' and 'Emergency'.
    Space to let

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    Quote Originally Posted by Jack View Post
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    Too many people don't understand what A&E does, or should be doing.

    The clue is in the name 'Accident' and 'Emergency'.
    This would suggest that may be true but maybe not the main driver..

    https://www.kingsfund.org.uk/project...re-mythbusters

    My take from this is that as suspected it's damn complex and there is no single solution.

    So any politician promising to 'fix' the 'broken' NHS is, in most likelihood, talking absolute nonsense.

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    Quote Originally Posted by Jack View Post
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    Too many people don't understand what A&E does, or should be doing.

    The clue is in the name 'Accident' and 'Emergency'.
    which is why I opted to suffer over the weekend until I could see my GP.
    #Persevered
    Scotland can be a beacon, within these islands and beyond, for a socially just and sustainable society. Whilst there are many priorities which will require independence, there is also much that can and must be done now by the Scottish Parliament and the Scottish Government.

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    Quote Originally Posted by Golden Fleece View Post
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    I took ill on Friday evening last week, I didn't consider it bad enough to drive to A&E in Perth, spoke to a pharmacist on the Saturday morning but there was nothing they could offer other than advice I already knew. On getting an appointment on the Monday morning after suffering over the weekend the doctor said I should have used NHS24. As it is, the GP was able to take me next door to the community hospital where he could carry out a minor procedure to relieve the discomfort. I have nothing but praise for all involved.

    It wasn't life threatening so I didn't consider it something to go to A&E about, but that was the GP's advice to go through NHS24.

    I'm better thanks to the local services available in a rural practice, without have the need to travel 40 minutes, which would have been difficult in the circumstances, and put more pressure on overstretched A&E services.
    The trouble is, a lot of the time NHS24 often don't have a clue (probably because they can't examine you) and send you to A&E or a minor injury clinic who then moan at the patient for going there. Similarly, there is a lack of joined-up thinking between NHS promotional campaigns and what GPs, A&E departments think on the matter. For example, there is the poster featuring Alex Ferguson saying that you should get yourself checked out if you've had a cough for more than three weeks. I was told I wasting my GPs time when I went after I had a cough for over a month.

    A relative who is an A&E consultant down South reckons their equivalent of NHS24 is a waste of time and money.

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    Nhs direct was dissolved in 2014. It was staffed by health care professionals who were paid their equivelent banding whereas the replacement staff are not necesarily health care professionals therefore reluctant to make a decision and would rather call an ambulance than get it wrong. They are paid less too. Community care is the way forward but budgets won't cope. The demand on current resources is too great.

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