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  #51  
Old 02-08-2018, 06:01 AM
Quartz Quartz is offline
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Originally Posted by Magiver View Post
I wouldn't have survived the average waiting times of the NHS.
You wouldn't have had to wait. They would have operated ASAP putting you into an immediate slot that was kept open for emergencies or delayed the operation of someone whose need wasn't urgent.

I know I'm repeating what others have said, but Americans seem to be blind to this.
  #52  
Old 02-08-2018, 07:08 AM
PatrickLondon PatrickLondon is offline
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You wouldn't have had to wait. They would have operated ASAP putting you into an immediate slot that was kept open for emergencies or delayed the operation of someone whose need wasn't urgent.

I know I'm repeating what others have said, but Americans seem to be blind to this.

I have no basis on which to comment on your final observation above, but it is indeed not just a matter of "take a number and wait your turn", or at least, not exclusively. It's about doctors deciding clinical priorities in the light of medical need and patients' personal circumstances. That must happen in any system in emergency rooms, or indeed where large numbers of people want to go to the "top" hospital, which has to decide who to take as a patient and when.

I do discern a difference of view about the function of government involvement in this. To us the NHS is not "the government" - it's the doctors and nurses at your GP practice, or that you may come into contact with at hospital or other community health services.

Quite apart from the fact that government in the US seems to involve itself in the system through a dizzyingly complicated set of legislation and a tendency to micro-manage clinical practice by legislation to a degree that we don't - I for one just don't see this as "the government taking your money and allocating your healthcare".

For one thing, if you want to do it yourself in the UK, there's nothing to stop you; but for another, it's about all of us deciding collectively (as we have the opportunity to do at every general election, not that anyone seriously proposes doing away with the NHS because they know what ther chances in an election would be) that it makes sense, morally and practically, for all of us to pay in, not so much for what we individually need as to ensure that all of us are covered - for the best that the doctors can do, according to their clinical judgment, with the money they've been allocated. The government stumps up the budgets - but the clinicians decide on the care you get.

Put it another way, I'd go further and say tax is the membership fee to a civilised society.
  #53  
Old 02-08-2018, 07:27 AM
thecontantorbiter thecontantorbiter is offline
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Originally Posted by Novelty Bobble View Post
I severely doubt that is how or why it happened (if it happened)

The biggest problem is that because it is seen as untouchable it is very hard to introduce any major improvements either in treatment or funding models and there is no doubt that something rather radical will be needed at some point in the near future.
...I couldn't agree more.

From my experience, practically all of the funding issues could be solved by introducing improvements - NOT throwing more money at it.

The service works, but many jobs are outsourced to expensive and inefficient agencies, CCS is an example of this. Carillion is another. The NHS still uses Oracle whilst simultaneously using open source. Petty debates rages over how to train staff. Meanwhile, there is little insight into how one can most efficiently organise units and wards (statistical research in this is woefully limited), meaning patients are often unnecessarily kept in (for any number of days) due to poor information exchange.

I'm not purposefully bashing the NHS. I believe the USA has it own set of problems when it comes to healthcare. It's just frustrating to see to see this system being managed poorly.
  #54  
Old 02-08-2018, 07:45 AM
Nava Nava is offline
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Originally Posted by thecontantorbiter View Post
The service works, but many jobs are outsourced to expensive and inefficient agencies, CCS is an example of this. Carillion is another. The NHS still uses Oracle whilst simultaneously using open source. Petty debates rages over how to train staff. Meanwhile, there is little insight into how one can most efficiently organise units and wards (statistical research in this is woefully limited), meaning patients are often unnecessarily kept in (for any number of days) due to poor information exchange.
Change a few words and I see this kind of thing as a frequent consequence of any kind of "less government!" or "lean management" campaigns. "Let's subcontract stuff out, that will be more efficient" - except when it's not. Subcontracting something on short contracts makes sense when it's infrequent and short-term; it doesn't make sense when talking about something permanent. At the very least, this kind of situation requires longer contracts with enough overlap and oversight to ensure decent handover between contractors (hey, I'm an optimist by choice).

I see companies where the computers were set up by one consulting firm, manuals written by another, and maintenance is now performed by a third one which has no idea where the documentation (if any) is and who'd kiss any user who says "well, when I look at the manual..." "*perks up and tries to avoid sounding too interested* do you have that as a local copy or do you read it from a remote location?" "uh?" "is this manual something you have printed out, a file in your computer, do you read it from a webpage...? I need to make sure you have the latest version." "Oh. Oh, I get them from [shared disk]."
IT person, switching off his microphone and turning to his coworkers: "GUYS I FOUND THE MANUALS!!!!!"

That's bad when it happens at a company making bricks. It's double triple quadruple bad when it involves the tax system (hi, current government of Navarre! please stop breaking your own website!), healthcare, or schools.
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Last edited by Nava; 02-08-2018 at 07:48 AM.
  #55  
Old 02-08-2018, 08:21 AM
thecontantorbiter thecontantorbiter is offline
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(hey, I'm an optimist by choice).
...I wish I shared that
  #56  
Old 02-08-2018, 06:19 PM
up_the_junction up_the_junction is offline
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Originally Posted by thecontantorbiter View Post

From my experience, practically all of the funding issues could be solved by introducing improvements - NOT throwing more money at it. ..
What is your experience because mine tells me no gov has "thrown money at the NHS" in my lifetime. Indeed, to do so would be irrational. Sounds like a painfully obv straw man.

Fwiw, I am relieved as hell the first and most of the second Blair gov invested considerably in modernising infrastructure and shortening waiting lists. Is that "throwing money"?
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  #57  
Old 02-08-2018, 10:18 PM
Nava Nava is offline
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Originally Posted by thecontantorbiter View Post
...I wish I shared that
It's a five-step, one day at a time kind of thing.

Step 1: have a lot of relatives who always jump into the worst conclussion they can find.
Step 2: realize they're a bunch of bitter fucks. In fact, there is a direct correlation between amount of negativity and amount of bitterness.
Step 3: realize that the happy people you know always give every person and situation a chance or two but not more than two.
Step 4: join the second group.
Step 5: when you find yourself jumping to negative conclussions, remind yourself that you're NOT going to be like your Evil Relatives, period. Give whomever just did something completely idiotic a chance; remind yourself that statistically speaking, he's more likely to be stupid than evil. That doesn't mean you shouldn't watch out for further stupidity, only that you shouldn't let stupidity screw your day.

/hijack.
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Last edited by Nava; 02-08-2018 at 10:19 PM.
  #58  
Old 02-09-2018, 03:22 AM
Quartz Quartz is offline
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Originally Posted by up_the_junction View Post
What is your experience because mine tells me no gov has "thrown money at the NHS" in my lifetime.
All governments have thrown money at the NHS ab initio. It was how they got buy-in from the GPs in the first place. Spending really took off with the Labour government of 1997. See the first two graphics in this BBC article. Note that the graph is adjusted for inflation.
  #59  
Old 02-09-2018, 03:39 AM
Novelty Bobble Novelty Bobble is offline
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Originally Posted by up_the_junction View Post
What is your experience because mine tells me no gov has "thrown money at the NHS" in my lifetime. Indeed, to do so would be irrational. Sounds like a painfully obv straw man.

Fwiw, I am relieved as hell the first and most of the second Blair gov invested considerably in modernising infrastructure and shortening waiting lists. Is that "throwing money"?
To a great extent....yes, throwing money at it is seen as the ultimate solution to all of the problems and it ends up not actually solving a lot of core inefficiencies.
Thing is, NHS funding has increased under every government since inception. No government has cut funding in real terms.......ever. So the system gets more and more money and outcomes do improve so the obvious solution continues to be yet more money. It is an easy and lazy political point.
There is an ideological barrier on all sides to considering other options. No-one would think that the German, Austrian, Netherlands, French etc. systems are in danger of sliding into USA-style healthcare delivery and yet when even a small move towards those european models is proposed all hell breaks loose.

People fixate on things like waiting times in A&E without stopping to consider how such targets end up actually driving problematic behaviours. It is perfectly possible to have long reported A&E waiting times and a great health service and also to have short reported times and a crap service.

My professional career has been in healthcare, pharmaceuticals and associated areas and I've seen first-hand how the NHS operates and the obscene inefficiencies in it. The staff are great, they work their collective nuts off but in many cases they do it within a process that is badly organised and that soaks up cash that could be properly allocated for more resources where it is needed.

As good as the NHS is (and it is!) it is harmful to see it as a fixed system that cannot operate in a fundamentally different way. More money is needed. It is being provided and will continue to be provided but if that is seen as the only possible solution to every problem then nothing will actually get much better.
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  #60  
Old 02-09-2018, 04:10 AM
Grim Render Grim Render is offline
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Originally Posted by Novelty Bobble View Post
To a great extent....yes, throwing money at it is seen as the ultimate solution to all of the problems and it ends up not actually solving a lot of core inefficiencies.
Thing is, NHS funding has increased under every government since inception. No government has cut funding in real terms.......ever. So the system gets more and more money and outcomes do improve so the obvious solution continues to be yet more money. It is an easy and lazy political point.
Well, no. I think every healthcare system in every developed nation constantly gets more costly. All populations grow older, and medical innovation keeps coming up with new ideas and devices.

The thing is, their costs do not increase at the same rate. The American system was pretty even with the various north-western European ones in 1980. Its just increased faster than the others since then.

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Originally Posted by Novelty Bobble View Post
There is an ideological barrier on all sides to considering other options. No-one would think that the German, Austrian, Netherlands, French etc. systems are in danger of sliding into USA-style healthcare delivery and yet when even a small move towards those european models is proposed all hell breaks loose.
I think that is because the model that Germany and the Nederland's uses is far more expensive than the UKs model. Hybrid systems like France and Austria are also more expensive. (There is also the cautionary tale of the US system looming over any changes in that direction). The UKs model is in fact the cheapest one out there, and gives the best results per pound spent.

As a strategy, "Lets move to a more expensive model" lacks appeal.

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Originally Posted by Novelty Bobble View Post
As good as the NHS is (and it is!) it is harmful to see it as a fixed system that cannot operate in a fundamentally different way. More money is needed. It is being provided and will continue to be provided but if that is seen as the only possible solution to every problem then nothing will actually get much better.
Like I said earlier, comparing the NHS to properly-funded Beveridge model systems may be helpful. It does appear that lack of funds is actually a major issue with the system.

Last edited by Grim Render; 02-09-2018 at 04:12 AM.
  #61  
Old 02-09-2018, 05:12 AM
PatrickLondon PatrickLondon is offline
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It's gone in phases, not quite of "boom and bust", but certainly periods of financial caution followed by periods of catch-up (which may or may not have been wisely spent). Currently we've had the same sort of persistent multi-year squeeze (don't look at the totals, look at the rate of increase per head, which I've seen quoted as down to 0.7% in recent years) as, in part, brought down the Major government in 1997.
  #62  
Old 02-09-2018, 05:20 AM
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If we were designing UHC from scratch today; what would be the best way to fund and manage it?
  #63  
Old 02-09-2018, 06:56 AM
PatrickLondon PatrickLondon is offline
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Define "best".. ! What are the priorities?
  #64  
Old 02-09-2018, 07:17 AM
Novelty Bobble Novelty Bobble is offline
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Originally Posted by Grim Render View Post
As a strategy, "Lets move to a more expensive model" lacks appeal.
That's not a strategy I'd suggest. It is possible to pick and choose best practice from across the various UHC systems in order to bring about better outcomes without sacrificing the concept of it being essentially free at the point of delivery.

In any case an equally bad strategy is to say "keep it exactly as it is and just put more money into it" seeing as many of the inescapable factors that will impact the NHS mean that remaining exactly the same is not an option. The best advice I can give to such organisations is that if you know what is coming down the road you should make the change before you are forced to.

And just so there is no doubt, I'm a massive fan of the NHS, my posting record on support for the NHS and disdain for the hideous mess that is the USA system is clear and unequivocal. I just don't think that the NHS will improve or even maintain its current performance without some degree of radical thinking and a blind political groupthink that refuses to even consider alternatives alongside increased funding is not helpful.
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  #65  
Old 02-09-2018, 07:33 AM
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Oh, I don't think even the most ardent fans of the NHS think it's perfect or that it can't be improved in ways other than funding. The problem is that occasionally the government thinks those ways involve privatisation for reasons that usually turn out to be related to whomever has been donating vast sums of money to the party in power at the time rather than for actual constructive reasons.
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  #66  
Old 02-09-2018, 08:22 AM
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Oh, I don't think even the most ardent fans of the NHS think it's perfect or that it can't be improved in ways other than funding. The problem is that occasionally the government thinks those ways involve privatisation for reasons that usually turn out to be related to whomever has been donating vast sums of money to the party in power at the time rather than for actual constructive reasons.
I think an additional reason for privatisation (besides just plain evil) that it can be very hard to predict consequences of privatisation. We can predict "healthy competition" and "market forces" and so things becoming more efficient, but the downsides seem harder to predict and often very specific.
  #67  
Old 02-09-2018, 10:54 AM
JackieLikesVariety JackieLikesVariety is offline
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I'm a massive fan of the NHS, my posting record on support for the NHS and disdain for the hideous mess that is the USA system is clear and unequivocal.
QFT

at least they HAVE a national health service

Last edited by JackieLikesVariety; 02-09-2018 at 10:55 AM.
  #68  
Old 02-09-2018, 03:51 PM
PatrickLondon PatrickLondon is offline
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As I recall, someone's always proposing reforms and reorganisations of the NHS. The Thatcher/Major government brought in the internal market because that was supposed to increase efficiency, the extra funding under the Blair government was tied to all sorts of changes (NICE, the National Service Frameworks for the main health priority areas), then the top leadership of the NHS itself asked for ways to work better without expecting increases to keep pace with demand, then the Cameron government reorganised the finances and administration nominally to put local GPs in charge, now they have these Service Transformation Plans. But they all have downsides - the moment anyone suggests it might be a better idea to concentrate services here and close down others there, people fight like mad to keep a service at their local hospital (and MPs who are all for more efficiency in the NHS are inclined to turn up on the barricades when it's a hospital in their constituency that's up for closing or downgrading).

Efficiency and effectiveness are always going to be contestable terms, and all the shiny policy documents in the world don't convince people when they suspect the underlying priority is actually simply to cut expenditure and/or to open more of the service up to cherry-picking by commercial contractors, simply for the sake of it.
  #69  
Old 02-09-2018, 05:16 PM
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The current thinking is that emergency services are best concentrated in large hospitals with all the bells and whistles, while the smaller units are left to concentrate on so-called 'cold' surgery and minor operations. There is a lot of good sense in this idea - a car accident victim with multiple injuries which may include orthopaedic, neurological and cardiological damage, need the facilities that only a large hospital can provide. Not only the fancy machines - PET/CT, MRI, Ultrasound, CT, X-ray, DXA et al, but the skills of the consultants who specialise in those conditions and the dedicated nursing teams in high dependency units.

On the other hand, there are outcries when the local A&E says that it will no longer accept paediatric cases and they will have to go 20 miles to the specialist unit; or that they will not accept stroke victims and their relatives are faced with a two bus - 90-minute journey to visit them.

There is no model that will satisfy everyone; the best we can hope for is that if we, or our nearest and dearest, are unfortunate enough to need the service it will be there for us. What we are eternally grateful for is that it will do its best regardless of our financial circumstances.

Last edited by bob++; 02-09-2018 at 05:18 PM.
  #70  
Old 02-09-2018, 05:27 PM
up_the_junction up_the_junction is offline
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As I recall, someone's always proposing reforms and reorganisations of the NHS.
It's what the model demands, surely. It's free at the point of delivery which puts enormous pressure on the service, and that - in turn - invites innovation and a constant search for efficiencies.

Problems start when the model stagnates. I don't think reforms demonstrate weakness at all, if that was indeed the inference.
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  #71  
Old 02-09-2018, 07:02 PM
up_the_junction up_the_junction is offline
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Desperately sad news today for Rob Delaney, an American comedian and sitcom person who lives in London - his son died aged 2. Part of Delaney's statement:
Quote:
If you'd like to help other families in the UK with very sick children, please make a donation to Rainbow Trust (https://rainbowtrust.org.uk) or Noah's Ark (https://www.noahsarkhospice.org.uk) in Henry's name or in the name of someone you love. Our family would be in much worse shape right now if it weren't for them. I would also urge you to take concrete and sustained action to support the NHS, however you can. Do not take it for granted.
http://www.bbc.co.uk/news/world-us-canada-43012424
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  #72  
Old 02-09-2018, 07:29 PM
Fiendish Astronaut Fiendish Astronaut is offline
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I have a fairly blood condition. The NHS doctors who I have to see on a regular basis are brilliant. I feel so lucky. When I went on holiday recently they gave me a plan for how to manage my medicine around my trip, sent me a letter to accompany my medicine to show the airline/security, and booked me in with a nurse for a last minute pre-trip check up. No paperwork and I don't even pay prescription charges because my condition is considered serious enough to get me an exception. It saved my life at least once when I had a blood clot and was bleeding internally. I can't say enough about it.

It's annoying to book GP appointments. I can do it online these days and my surgery is a very modern facility but it's so busy you usually have to wait days before finding an empty slot. I guess it's possible to get late notice emergency slots.

The one thing I find is that the nurses are impossibly friendly.
  #73  
Old 02-10-2018, 02:09 AM
up_the_junction up_the_junction is offline
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It's annoying to book GP appointments. I can do it online these days and my surgery is a very modern facility but it's so busy you usually have to wait days before finding an empty slot. I guess it's possible to get late notice emergency slots.
Might be worth phoning them to understand the whole system. I like to see a particular GP at my Practice and they have a system where you can book as you describe, or just rock up between 10-11.15 and wait. Max wait for me has been about 50 mins.
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  #74  
Old 02-10-2018, 02:45 AM
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My GP practice has both phone app and online booking systems but I get the impression they've set it up for future non-urgent appointments, usually for the junior salaried GPs. Phoning gets a much quicker appointment, and once when I was already there for something else and had to book another appointment, the receptionist took a look and seemed oddly apologetic about the fact that there was a slot if I didn't mind waiting 20 minutes.

I have raised the discrepancies in the different booking systems with them, but I suppose they'd be worried about losing control if they gave online/automated access to the entire system. Or the range of triage options if you were to have an automated decision tree would just be too complicated.
  #75  
Old 02-10-2018, 02:49 AM
PatrickLondon PatrickLondon is offline
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The one thing I find is that the nurses are impossibly friendly.
Things have changed no end since the days of the dragon lady matron. And sometimes it does feel some of the staff have almost been to a slightly creepy "Stepford Wives" school of bedside manner. But for most of the things I have to see them about it's sufficiently non-threatening (touch wood) that a bit of mateyness isn't inappropriate.
  #76  
Old 02-10-2018, 06:18 AM
Filbert Filbert is offline
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On the other hand, there are outcries when the local A&E says that it will no longer accept paediatric cases and they will have to go 20 miles to the specialist unit; or that they will not accept stroke victims and their relatives are faced with a two bus - 90-minute journey to visit them.
In rural areas, it can be much further than 90 minutes; having recently moved to Cornwall from Bristol, I've discovered that for quite a few medical facilities, the closest option hasn't changed. It's a regular topic of complaint here that the nearest long-term paediatric unit here is Bristol, which is over 3 hours drive at best for people in the Western edge of the county. Ditto for several other specialist care unit, but it's the kids' facilities that cause the most problems.

I mean, I can certainly see both sides; for the parents with kids there, especially if they have other children, that's really too far to commute daily, so especially if they have other kids, that must be adding a lot of stress to an already very stressful situation (do you uproot the whole family? alternate parents?); but then there's very unlikely to be enough patients to justify something big enough to actually provide the same level of treatment in a county like this.

I'm glad it's not my decision.
  #77  
Old 02-10-2018, 10:01 AM
Magiver Magiver is offline
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You wouldn't have had to wait. They would have operated ASAP putting you into an immediate slot that was kept open for emergencies or delayed the operation of someone whose need wasn't urgent.

I know I'm repeating what others have said, but Americans seem to be blind to this.
You missed my point entirely. I was misdiagnosed by a specialist. The need for surgery was not established. I was able to bypass the misdiagnosis without delay. I called my family doctor with my concerns and she set up additional tests the same day.

There are many choke points in any medical system. There are potential waiting times for each of these:
- a family doctor
- a specialist
- diagnostic procedures
- surgical teams
- post surgical treatment

Each one of these exist as part of a linear process and because of that process they carry their own waiting period. Those waiting periods are cumulative.

I was able to bypass that process with a phone call. I went from family doctor, to diagnostic tests, to specialist, to more diagnostic tests, back to the specialist (twice), back to my doctor, additional tests, a different specialist, and surgery within days of each event.

Any waiting period in any of those events would have cost me my leg. I posted the average wait time of just one of those processes. I used data directly from the NHS. Here's their data site showing where you can look up diagnostic imaging delays. The average wait time for an MRI is 23 days. Not hours, DAYS.


From the Guardian: Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

I've loosely followed the NHS system over the years and it's not the quality of care that's the problem, it's the delay times involved. Time is an important commodity in treatment and NHS has made progress over the last decade in reducing delays.
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Last edited by Magiver; 02-10-2018 at 10:02 AM.
  #78  
Old 02-10-2018, 10:25 AM
Magiver Magiver is offline
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My GP practice has both phone app and online booking systems but I get the impression they've set it up for future non-urgent appointments, usually for the junior salaried GPs. Phoning gets a much quicker appointment, and once when I was already there for something else and had to book another appointment, the receptionist took a look and seemed oddly apologetic about the fact that there was a slot if I didn't mind waiting 20 minutes.

I have raised the discrepancies in the different booking systems with them, but I suppose they'd be worried about losing control if they gave online/automated access to the entire system. Or the range of triage options if you were to have an automated decision tree would just be too complicated.
Do they have sub levels of medical personal available for entry level consultations? I used to go to a facility operated by 2 doctors and 2 nurses. Now there is a single doctor with, 2 Nurse Practitioners, and a Physicians Assistant. The NP's and PA's can handle most of the workload of a doctor.
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  #79  
Old 02-10-2018, 10:32 AM
Quartz Quartz is offline
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You missed my point entirely. I was misdiagnosed by a specialist.
No, I didn't miss your point. Specialists are human the world over. And humans make mistakes.

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I called my family doctor with my concerns
And you can do that under the NHS. It's called getting a second opinion and is entirely standard. And if you don't like the NHS you can buy private medical insurance.

Quote:
There are many choke points in any medical system. There are potential waiting times for each of these:
- a family doctor
- a specialist
- diagnostic procedures
- surgical teams
- post surgical treatment
And you get those in private health care too. There are only so many doctors. There are only so many specialists. There are only so many surgical teams. And so on.

No system is perfect. Why do you think doctors and hospitals in America have such huge insurance premiums? Hospital medical errors are the third leading cause of death in the US. 700 people a day. Cite. So to demand perfection is wrong. Could the NHS be better? Yes. Is the NHS good enough? Yes. Is the NHS better for most people than the American healthcare system? Absolutely.
  #80  
Old 02-10-2018, 12:02 PM
Novelty Bobble Novelty Bobble is offline
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You missed my point entirely
All of this is your experience as a private healthcare user. Everything you say is available to a similar private healthcare user in the UK. I don't see the relevance of your point. In fact, I'm not sure what your point is.
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  #81  
Old 02-10-2018, 12:03 PM
Filbert Filbert is offline
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Originally Posted by Magiver View Post

Any waiting period in any of those events would have cost me my leg. I posted the average wait time of just one of those processes. I used data directly from the NHS. Here's their data site showing where you can look up diagnostic imaging delays. The average wait time for an MRI is 23 days. Not hours, DAYS.
As people have said, taking an 'average wait time' for something like an MRI is an utter irrelevance. You're including yourself on the list with someone who's had a bit of a dodgy toe for the last 6 months, and thinks it's about time they should maybe get it checked out.

I had a microdiscectomy on the NHS; I was referred to a surgeon within 2 days once it was clear the problem was serious (until then, a 'wait and see' approach was recommended, as all spinal surgery carries a risk of paralysis). There were some delays, but mainly in the very early stages, when it didn't seem like anything bad, and at the end, when the ball was firmly in my court regarding asking for further treatment, but, y'know, paralysis risk, not that inviting, so I left it til it was really bad.

So, I saw the guy, he looked at my scan results, gave me a quick exam, and said (and I swear he got a kick out of this) "I'm going to highly recommend you have surgery. The current waiting list is approximately 10 weeks.

You're the worst case on it, would you rather stay and have it this evening or come back in the morning?"

Even if you do wind up being told you have to wait for some diagnosis or treatment element, you have the option to pay for it privately if you'd like, and you can even have the rest of the treatment on the NHS. My Mum did that; knee problems, not very serious, so she had a wait, but she had a physical job and was freaking out a bit, so paid for diagnosis privately, then got referred back to the NHS for physio.
  #82  
Old 02-10-2018, 01:14 PM
PatrickLondon PatrickLondon is offline
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Originally Posted by Magiver View Post
Do they have sub levels of medical personal available for entry level consultations? I used to go to a facility operated by 2 doctors and 2 nurses. Now there is a single doctor with, 2 Nurse Practitioners, and a Physicians Assistant. The NP's and PA's can handle most of the workload of a doctor.
My particular GP practice has about 12300 people registered with them. The system works by paying an annual fee for all of them rather than per item of service for those who actually use them.

That pays for 10 doctors (not all of them full-time) plus a couple in post-medical school training, half a dozen nurse practitioners (who have assorted special interests, like maternity/family planning, smoking cessation, diabetes and so on) and a couple of phlebotomists who also double up on other jobs.

Yes, I would often be routed to an NP for routine checks and minor matters.
  #83  
Old 02-10-2018, 03:40 PM
Magiver Magiver is offline
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Originally Posted by Novelty Bobble View Post
All of this is your experience as a private healthcare user. Everything you say is available to a similar private healthcare user in the UK. I don't see the relevance of your point. In fact, I'm not sure what your point is.
the point is that I went through 10 medical events consisting of doctors/specialists/diagnostics/surgery at my bidding without waiting for something that was never considered an emergency (until it became one). Any delay waiting in any of that combination would have cost me my leg. This is in comparison to the NHS system of long waits that would have delayed that process. What you've posted in comparison is the ability to pay twice for the same medical care because the tax based service failed to meet your medical needs. Are you carrying a separate insurance policy?
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Last edited by Magiver; 02-10-2018 at 03:41 PM.
  #84  
Old 02-10-2018, 04:13 PM
up_the_junction up_the_junction is offline
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the point is that I went through 10 medical events consisting of doctors/specialists/diagnostics/surgery at my bidding without waiting for something that was never considered an emergency (until it became one). Any delay waiting in any of that combination would have cost me my leg.
Isn't your argument based on 'average' waiting times?

If so, it's a pointless argument - there is no 'average' if your case is urgent.

No one deals in 'averegs' in real world healthcare, it's a statistical convenience is all.
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  #85  
Old 02-10-2018, 05:38 PM
Wesley Clark Wesley Clark is offline
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Is the NHS postcode lottery in any way tied to the wealth of the neighborhood being served? Do the richer neighborhoods get better care or is it the same quality as the poor neighborhoods?

The life expectancy gap between rich and poor in the UK is almost 10 years, which is roughly what it is in the US. I'd assume with a system like the NHS, the gap would be smaller.

But I assume a big part of that gap is just lifestyle choices (poor people on average probably lead more dangerous, unhealthy lives)
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Last edited by Wesley Clark; 02-10-2018 at 05:39 PM.
  #86  
Old 02-10-2018, 06:09 PM
Magiver Magiver is offline
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I remember my partner who is from the UK was dissatisfied with her doctor. So she changed doctors and surgeries. I remember that because the original doctor later lost his licence.
Its such an everyday thing, I am surprised at the non-UK people who seem to think the ability to pick your own doctor is something extraordinary.
If you're responding to me I've been discussion the time delays involved in the process.

Quote:
Originally Posted by Grim Render View Post
For about 44 000 Americans each year, more than they have.
If you're poor you get government care.
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  #87  
Old 02-10-2018, 06:16 PM
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Is the NHS postcode lottery in any way tied to the wealth of the neighborhood being served?
No.

Quote:
Do the richer neighborhoods get better care or is it the same quality as the poor neighborhoods?
Not NHS care; richer people will be more likely to have private health insurance.
  #88  
Old 02-10-2018, 06:20 PM
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the point is that I went through 10 medical events consisting of doctors/specialists/diagnostics/surgery at my bidding without waiting for something that was never considered an emergency (until it became one).
Please stop for a moment and start listening and thinking and fighting your own ignorance. Every single Briton in this thread is telling you that you are wrong about the NHS.

Edit: if you need urgent treatment, you get urgent treatment.

Last edited by Quartz; 02-10-2018 at 06:22 PM.
  #89  
Old 02-10-2018, 07:06 PM
Magiver Magiver is offline
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Please stop for a moment and start listening and thinking and fighting your own ignorance. Every single Briton in this thread is telling you that you are wrong about the NHS.

Edit: if you need urgent treatment, you get urgent treatment.
Please stop for a moment and listen to what I'm telling you. I posted your own statistics directly from NHS. The delays in your system are a denial of timely healthcare. Of course urgent treatment goes first. That's a given. Unless you know for a fact it's an emergency then the "go to the head of the line" card never gets dealt.

If people are buying private insurance to compensate for the insurance they already paid for with taxes then that validates the problem with NHS documented delays.

Really, why are arguing this? You're choices are tax funded delays in care or paying more and reducing those delays.
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  #90  
Old 02-10-2018, 07:20 PM
Banquet Bear Banquet Bear is online now
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Originally Posted by Magiver View Post
If you're poor you get government care.
...and "government care" would mean "no leg" right? Chop that leg right off.

"Government care" isn't the same care that you got was it? That you paid money to get to the front of the queue ahead of people who have might have more pressing medical need is an important part of your narrative that you seem to be ignoring.

Quote:
The delays in your system are a denial of timely healthcare.
"Timely healthcare" is a subjective measure. How are you determining what is and isn't "timely?" Can a person on "government healthcare" in the United States get "timely healthcare?" Would you care to post some statistics so we can compare?

Quote:
If people are buying private insurance to compensate for the insurance they already paid for with taxes then that validates the problem with NHS documented delays.
People might be buying private insurance simply because they want a private room. Travel insurance exists. That doesn't validate any problems with international travel. If you want to know why people are buying private insurance I would suggest you go talk to the people and ask them why rather than simply guessing.

Quote:
Really, why are arguing this? You're choices are tax funded delays in care or paying more and reducing those delays.
The system means that everybody gets treated, and if you need urgent treatment you get it urgently, without having to worry about how much it is all going to cost. The system has the advantage that if you pay a little bit extra you can get non-urgent care just a little bit faster, and rather than having to share a room you get to lie there on your lonesome.

In your system: does the poor guy with the same medical conditions as you who doesn't have health insurance and can barely pay his rent every week...does that guy still have his leg?
  #91  
Old 02-10-2018, 11:32 PM
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Sometimes people buy private insurance because they have fallen into the fallacy that "more expensive means better". Spanish private medical insurance comes in two flavors:
1) Some private hospitals have "associates". If you become an "associate" in the NPO which owns the hospital and you're ever a patient in that hospital, you have priority for the fancy rooms. Congratulations. The chocolates from the hospital store are still the same. The people I know who subscribe one of these schemes do it because they believe in the mission of the NPO, not because of the fancy room.
2) Payment schemes for off-system clinics or locations. I had to subscribe one of these because I sometimes travel to locations which are off-system; I specifically chose a policy which includes travel outside the EU (in the last six months I've been to the US twice). Most of the people who have these are very surprised the first time they need serious care, because what do those off-system clinics do? Why, refer them to the general system! "Why am I paying extra so I can be sent to the same hospital as everybody else?" Because you're stupid.
  #92  
Old 02-11-2018, 12:49 AM
Gary Kumquat Gary Kumquat is offline
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Originally Posted by Magiver View Post
If people are buying private insurance to compensate for the insurance they already paid for with taxes then that validates the problem with NHS documented delays.
Let me ask a question. Why do you think the people in this thread who've actually used the NHS are so overwhelmingly in favour of the system, and are reporting their experience of it working well for them?

If the issue was as neat as your particular dogma would like, you'd be happily sitting back watching us trot out story after story of the time we'd spend 8 hours waiting in a corridor on a trolley only to be told it'd be 8 weeks before we could get urgent surgery. You may note the absence of such stories, hence why you're now having to argue that average waiting times aren't actually an average, or that if anyone decides they'd like to speed the process up by going privately clearly there's a problem.

What's rather galling is that we're even going out of our way to stress the system can be improved, and that there are definitely particular regions where the quality of care is worse than others. No-one is pretending it's a perfect system, which frankly would be impossible considering the size of the operation.

But could you please drop this weird line of argument that in a private system you were misdiagnosed, so clearly in a UHC system you'd have died, because it's just a very poor position based on a complete non sequitur.
  #93  
Old 02-11-2018, 01:12 AM
up_the_junction up_the_junction is offline
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Originally Posted by Magiver View Post

Really, why are arguing this? You're choices are tax funded delays in care or paying more and reducing those delays.
That isn't the choice. The choice is what precentage of general taxation is channeled to healthcare and what, for example, goes to fund two pointless aircraft carriers at 3 billion each.
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  #94  
Old 02-11-2018, 01:27 AM
Magiver Magiver is offline
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If the issue was as neat as your particular dogma would like, you'd be happily sitting back watching us trot out story after story of the time we'd spend 8 hours waiting in a corridor on a trolley only to be told it'd be 8 weeks before we could get urgent surgery.
It's not my dogma and I didn't make up the numbers. I posted the official NHS numbers about delays in the system.

just a quick look on the net produced this:
Complaints about cancelled NHS appointments soar in one year
New figures show the number of patients complaining about cancelled appointments has risen by one fifth in a year.
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  #95  
Old 02-11-2018, 01:55 AM
Banquet Bear Banquet Bear is online now
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Originally Posted by Magiver View Post
It's not my dogma and I didn't make up the numbers. I posted the official NHS numbers about delays in the system.
...and what about the delays for people with no money in your system?

Quote:
just a quick look on the net produced this:
Complaints about cancelled NHS appointments soar in one year
New figures show the number of patients complaining about cancelled appointments has risen by one fifth in a year.
Its 2018. Why are you posting a cite from 2015 that uses figure from 2014/2015? You are aware that there will be 2016 figures and 2017 figures? Why aren't you posting those?

And why do you think they are complaining? Do you think that maybe it has something to do with the UK austerity programme? The Royal Society of Medicine suggest that it is likely the austerity cuts have caused up to 30,000 deaths in England and Wales in 2015. I would suggest to you that massively underfunding a previously successful healthcare system is likely to cause a few complaints. The system still works. But if you don't fund it properly it isn't going to work as well. That's an issue that people in the UK are dealing with now. But that doesn't point to a failure in the system, but to a failure of the people who oversee the system.

So maybe don't rely on "quick searches on the net." You've got no experience with universal healthcare systems. You have no real basis for comparison. You are welcome to express your view: but the OP explicitly asked for no comparisons to the US, you should really make an effort to comply with their wishes.
  #96  
Old 02-11-2018, 03:09 AM
Novelty Bobble Novelty Bobble is offline
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Originally Posted by Magiver View Post
What you've posted in comparison is the ability to pay twice for the same medical care because the tax based service failed to meet your medical needs. Are you carrying a separate insurance policy?
You seem to purposefully refuse to understand this.

You may be labouring under the misapprehension that you, as a USA taxpayer, are not paying into the government healthcare system. You are, and you already pay more per capita than we in the UK and your government systems don't even cover everyone.

So you are already paying twice and paying much more than a similar UK privately-insured citizen so the comparison is valid.

But more important is the comparison of the experience of a non-tax paying, non-insured person in the states v the same person in the UK. What is the relative experience of each of them?
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  #97  
Old 02-11-2018, 04:15 AM
thecontantorbiter thecontantorbiter is offline
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Originally Posted by Novelty Bobble View Post

My professional career has been in healthcare, pharmaceuticals and associated areas and I've seen first-hand how the NHS operates and the obscene inefficiencies in it. The staff are great, they work their collective nuts off but in many cases they do it within a process that is badly organised and that soaks up cash that could be properly allocated for more resources where it is needed.

As good as the NHS is (and it is!) it is harmful to see it as a fixed system that cannot operate in a fundamentally different way. More money is needed. It is being provided and will continue to be provided but if that is seen as the only possible solution to every problem then nothing will actually get much better.
I think that's what I meant by 'throwing' money at it. Similarly to you, I work in the NHS, and have seen how money is squandered, unnecessarily. More money is needed, but it's needed to help adapt the NHS into a more efficient place.
  #98  
Old 02-11-2018, 06:58 AM
Novelty Bobble Novelty Bobble is offline
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I think that's what I meant by 'throwing' money at it. Similarly to you, I work in the NHS, and have seen how money is squandered, unnecessarily. More money is needed, but it's needed to help adapt the NHS into a more efficient place.
Agreed, and there are pockets of dedicated NHS people who see this and know this but are hamstrung by the collective culture.
That culture being equal parts brilliant (hard-working, empathetic, dedicated) and obstructive (unwilling to change, ideologically fixed). It is a very difficult nut to crack.
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  #99  
Old 02-11-2018, 07:24 AM
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Much of UK industry was hampered by the anti-management attitudes of the 1970/80s. Some, like the Rail companies, still are. In the NHS, the divide is not so much workers vs management but medical vs bureaucracy. Speak to a nurse or a doctor and they will tell you that the problems of the NHS are that there are too many bureaucrats. Speak to a manager and they will tell you that the Consultants and the unions frustrate any reforms that they try to implement. The ancillary staff like radiologists, dental, ophthalmic fall somewhere in between, but I know very well that running, even a medium-sized hospital (budget 160m in 2010) is a very difficult trick to pull off well.
  #100  
Old 02-11-2018, 08:57 AM
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I was just reading through all of these posts and I've got to say that those of you from the U.K. are so very eloquent when debating, it is very admirable and fascinates me when I see your input and perspective on issues.

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