NHS Reform

[Clown Job]

I don’t understand what the problem with the NHS could be

Its very confusing 

 

[coprolite]

31 minutes ago, Clown Job said:

I don’t understand what the problem with the NHS could be

Its very confusing 

 

Which line's fat people? 

[Cyclizine]

10 hours ago, parsforlife said:

Ambulance service is already National 

It's a special health board, along with things like the SNBTS, NES, NHS24 etc. The health service priorities are set centrally, but you need some sort of local accountability and organisation.

[Salt n Vinegar]

8 hours ago, Clown Job said:

I don’t understand what the problem with the NHS could be

Its very confusing 

 

(On the assumption that these stats are accurate) ... it would be interesting to hear a Tory response to the picture presented. 

On might almost think that the Tory approach to the NHS was worse for waiting lists. What am I missing? 

[BFTD]

15 minutes ago, Salt n Vinegar said:

(On the assumption that these stats are accurate) ... it would be interesting to hear a Tory response to the picture presented. 

On might almost think that the Tory approach to the NHS was worse for waiting lists. What am I missing? 

They're having to deal with the fallout from a decade+ of Labour waste in the aftermath of an unprecedented pandemic that's affected the entire world, not just the UK, etc.

They are absolutely NOT allowing the NHS to fall apart until public opinion turns against it. Oh no.

[coprolite]

Is "insourcing" a thing in Scotland yet? I've used inverted comnas because it used to mean something different. 

This is contracting out of NHS services to private companies, who engage (but don't usually employ) NHS staff to do the work using NHS facilities. 

Apparently this works partly because the government refused to change consultants terms to make it worth their while doing overtime. 

Unlike wage budgets and agency wage budgets, there's no restrictions on how much the trusts can spend on this type of service, which is usually fairly routine work on scanning etc. 

There's been no policy announcement of course, just a restriction on the ability of the trusts to do things themselves with no equivalent restriction on private provision. 

[Cyclizine]

12 minutes ago, coprolite said:

Is "insourcing" a thing in Scotland yet? I've used inverted comnas because it used to mean something different. 

This is contracting out of NHS services to private companies, who engage (but don't usually employ) NHS staff to do the work using NHS facilities. 

Apparently this works partly because the government refused to change consultants terms to make it worth their while doing overtime. 

Unlike wage budgets and agency wage budgets, there's no restrictions on how much the trusts can spend on this type of service, which is usually fairly routine work on scanning etc. 

There's been no policy announcement of course, just a restriction on the ability of the trusts to do things themselves with no equivalent restriction on private provision. 

I'm not really aware of any insourcing in my area (theatres and critical care). We certainly lease private facilities for NHS work and use outsourced teams to treat NHS patients in these facilities (although we also use NHS staff), but also make extensive agency staff in NHS facilities. Big shortage of theatre staff: nurses, ODPs etc and many do agency work in the short and long term. In one area, we outsource theatre staffing to one agency, but provide the surgeons and anaesthetists. In another, an agency fully staffs the theatre.

[coprolite]

4 minutes ago, Cyclizine said:

I'm not really aware of any insourcing in my area (theatres and critical care). We certainly lease private facilities for NHS work and use outsourced teams to treat NHS patients in these facilities (although we also use NHS staff), but also make extensive agency staff in NHS facilities. Big shortage of theatre staff: nurses, ODPs etc and many do agency work in the short and long term. In one area, we outsource theatre staffing to one agency, but provide the surgeons and anaesthetists. In another, an agency fully staffs the theatre.

Leasing private facilities is interesting. Suggests that the problems in Scotland include lack of  physical capacity whereas they have that going unused in England. 

What's your take on why people work for agencies rather than the NHS directly? 

[Cyclizine]

3 minutes ago, coprolite said:

Leasing private facilities is interesting. Suggests that the problems in Scotland include lack of  physical capacity whereas they have that going unused in England. 

What's your take on why people work for agencies rather than the NHS directly? 

They're using private facilities in England too, I have colleagues down there. There is such a backlog and cases are building up, hospitals are full of acute patients, so it is difficult to admit patients for planned surgery. Easier to do low complexity stuff in a private hospital without worrying about if you've got a bed for them. This paradigm was (and still is) NHS Scotland's long term plan: elective care centres dedicated to routine care, with dedicated staff, so they shouldn't be impacted by emergency work. The problem is there's not enough staff and they're often moved from elective work to emergency work.

In terms of agency work, money is one advantage: whilst an ODP might earn ~£16/hr working for NHS, they could easily double this and more, working agency, with the flexibility this entails. Obviously there are disadvantages: sick pay, holiday pay, no job security etc, but for many the remuneration compensates. We're seeing similar with junior doctors. Why work for £15-25/hr in "training" when little training is provided and the job is primarily service provision when you can work as a locum and legitimately just do service provision, but be paid at a rate commensurate to the responsibility.

[Inanimate Carbon Rod]

21 hours ago, Dundee Hibernian said:

Recently read an article/thread from a consultant physician who reported that one-third of people in NHS beds are stuck there as local authorities have been short funded to the extent that they cannot provide care at home for the individuals, mainly old people, who are stuck in these beds.

That 33% require care in hospital, taking staff away from A&E and clinics. The article was from a north England physician, but the trend exists in Scotland. Forth Valley Health Board opened a Contingency Ward in a Community Hospital yesterday (Falkirk) in an out patients' unit to move elderly patients out of acute wards to await non existent care packages.

In short, a lack of fund provision for care staff is forseen as a greater issue than more finance being provided directly to the NHS. In any case, a large chunk of cash going to the NHS isn't utilised for patient care, but goes to 'preferred suppliers'

Further, and this wasn't part of the article, the 'early intervention' GP part of the system isn't as accessible or responsive as it was pre-Covid, leading to people possibly getting sicker faster, or trying to access hospitals to cut out the middle man. More people land in hospital because the GP system has become fractured.

GP system has become fractured because of a number of factors, these include but are not exhaustive, they are trying to do the work of the chronically under resourced mental health sector, trying to keep people out of hospitals, old folks homes not having enough trained staff so that things which an experienced nurse could deal with becomes a house call, not enough staff (this comes from the lack of training spaces/recruitment of doctors, loss of foreign doctors due to the UKs right wing policies and the absolutely prohibitive pension changes brought in which mean working out of hours shifts is financially not suitable for a full time GP) and the fact that patients abuse the service for things that they shouldnt be booking doctors appointments for. Recent examples ive heard include filling out a drivers licence form and wanting the doctor to provide after care for a botched trip to the dentist in turkey. See also the thousands of parents who demand emergency appointments everytime their ‘wean’ has a sniffle. 
 

Absolutely agree re the lack of care provision, it is the number 1 reason for the NHS not having beds now. 

20 hours ago, parsforlife said:

One organisation,  you know like the fire service and police have gone to,  dropping the unnecessary divisions.

Lets not use the national police force as an example here, it has the potential to work, but its certainly not meeting that potential right now. 

[Dundee Hibernian]

5 minutes ago, Inanimate Carbon Rod said:

GP system has become fractured because of a number of factors, these include but are not exhaustive, they are trying to do the work of the chronically under resourced mental health sector, trying to keep people out of hospitals, old folks homes not having enough trained staff so that things which an experienced nurse could deal with becomes a house call, not enough staff (this comes from the lack of training spaces/recruitment of doctors, loss of foreign doctors due to the UKs right wing policies and the absolutely prohibitive pension changes brought in which mean working out of hours shifts is financially not suitable for a full time GP) and the fact that patients abuse the service for things that they shouldnt be booking doctors appointments for. Recent examples ive heard include filling out a drivers licence form and wanting the doctor to provide after care for a botched trip to the dentist in turkey. See also the thousands of parents who demand emergency appointments everytime their ‘wean’ has a sniffle. 
 

Absolutely agree re the lack of care provision, it is the number 1 reason for the NHS not having beds now. 

Lets not use the national police force as an example here, it has the potential to work, but its certainly not meeting that potential right now. 

Totally in accord with you, and may I add the effect extensive house building programmes have had on GPs' catchment areas? Too many local authorities consent to large scale new build sites in order to accrue increased council tax revenues without a thought to pressures being placed on local services, including health centres and surgeries. 

[Inanimate Carbon Rod]

5 minutes ago, Dundee Hibernian said:

Totally in accord with you, and may I add the effect extensive house building programmes have had on GPs' catchment areas? Too many local authorities consent to large scale new build sites in order to accrue increased council tax revenues without a thought to pressures being placed on local services, including health centres and surgeries. 

Yep, they’ve failed to match demand. They havent raised the number of places at medical school to match either. There are some fixes which could be put in place to make things a bit better which they just dont do. 

[Dink]

1 hour ago, Inanimate Carbon Rod said:

Yep, they’ve failed to match demand. They havent raised the number of places at medical school to match either. There are some fixes which could be put in place to make things a bit better which they just dont do. 

To be fair the intake to medical schools has increased quite a lot over the last few years, with an increase of another 300 planned over the next three years. There have also been significant moves to encourage medical students to go into GP training with specific GP tracks being introduced at Glasgow and Aberdeen along with ScotGEM at St Andrews and Dundee (and a wee bit of UHI). In addition there have been moves to increase the proportion of Scot Doms in the intake, as they are more likely to stay and work in the Scottish NHS.

The bigger issues that need addressed at the moment are the stress on placements, encouraging foundation year doctors (and from then on) to take up rural placements and encouraging more Scot Doms to apply for medicine. Officials in SG, NES and universities are working on all of these but they will be more difficult to fix than than increasing the intake targets (which effectively boils down to being prepared to throw money at it).

[Inanimate Carbon Rod]

3 minutes ago, Dink said:

To be fair the intake to medical schools has increased quite a lot over the last few years, with an increase of another 300 planned over the next three years. There have also been significant moves to encourage medical students to go into GP training with specific GP tracks being introduced at Glasgow and Aberdeen along with ScotGEM at St Andrews and Dundee (and a wee bit of UHI). In addition there have been moves to increase the proportion of Scot Doms in the intake, as they are more likely to stay and work in the Scottish NHS.

The bigger issues that need addressed at the moment are the stress on placements, encouraging foundation year doctors (and from then on) to take up rural placements and encouraging more Scot Doms to apply for medicine. Officials in SG, NES and universities are working on all of these but they will be more difficult to fix than than increasing the intake targets (which effectively boils down to being prepared to throw money at it).

Was lead to believe that this was a bit of figure fudging by counting these spaces as per the pharmacist to gp route which sees them qualify solely as a GP with zero hospital experience/specialism experience? But if im wrong on that fair enough. 

Agree re rural placements being a massive issue, so many practices being lost to health board. The pension changes have been a disaster, my wife would happily do out of hours work, but doing so absolutely fucks her on tax/pension meaning in some circumstances it would actually cost them money. 

[Dink]

I don't think that there's any fudging in the numbers. If a pharmacist wanted to become a GP then they have two possibilities (as far as I'm aware) the 4 years at uni HCP Med route at Edinburgh, which is for existing health care professionals and which has an annual intake of around 30 students per year, or the ScotGEM route, which is a 4 year graduate entry course with an intake of 70 students. That's around 100 out of a total annual intake of over 1,100 (if I could be bothered checking my work PC I'd have the actual numbers).

[scottsdad]

My dad has been referred for an urgent scope down the throat. 

Urgent. Highest priority. 

He has been told it could be 4 weeks. 

[Theroadlesstravelled]

Let’s fund the NHS instead.

https://www.bbc.com/news/uk-wales-64168805

[Crazy Days]

13 hours ago, Inanimate Carbon Rod said:

Recent examples ive heard include filling out a drivers licence form and wanting the doctor to provide after care for a botched trip to the dentist in turkey.

A wee while ago I needed my ears syringed. Local health centre contacted and said they can do it but must get authorisation from a doctor first. Made appointment with doctor who took a quick look and filled in the form.  A total waste of an appointment. Yes there might have been an underlying issue but surely that would have been picked up by staff carrying out the syringing.

We need to adapt a more common sense approach to doctor's appointments.

[Cyclizine]

11 hours ago, Dink said:

To be fair the intake to medical schools has increased quite a lot over the last few years, with an increase of another 300 planned over the next three years. There have also been significant moves to encourage medical students to go into GP training with specific GP tracks being introduced at Glasgow and Aberdeen along with ScotGEM at St Andrews and Dundee (and a wee bit of UHI). In addition there have been moves to increase the proportion of Scot Doms in the intake, as they are more likely to stay and work in the Scottish NHS.

The bigger issues that need addressed at the moment are the stress on placements, encouraging foundation year doctors (and from then on) to take up rural placements and encouraging more Scot Doms to apply for medicine. Officials in SG, NES and universities are working on all of these but they will be more difficult to fix than than increasing the intake targets (which effectively boils down to being prepared to throw money at it).

Medical school intakes are increasing, but if you're increasing the number of medical students, you need to increase the number of postgraduate training posts. There's a huge bottleneck and a huge amount of attrition. We lose a lot of trainees to the Antipodes, but also to locum posts where pay is better and the training (that which exists) is similar. More students means medical schools need more capacity, we are really struggling, we just don't have the ability to place and appropriately supervise all these students, particularly in general practice, as there are limited spaces.

[Dawson Park Boy]

1 hour ago, Crazy Days said:

A wee while ago I needed my ears syringed. Local health centre contacted and said they can do it but must get authorisation from a doctor first. Made appointment with doctor who took a quick look and filled in the form.  A total waste of an appointment. Yes there might have been an underlying issue but surely that would have been picked up by staff carrying out the syringing.

We need to adapt a more common sense approach to doctor's appointments.

You can get that done privately at the high street hearing shops.

Not very expensive.

I thought the NHS had stopped doing that, quite correctly too.