Dr_Pangloss Posted February 9, 2018 Share Posted February 9, 2018 6 hours ago, BillyShears said: I do not agree with any kind of patient-blaming. The real reason the NHS is in the state it is in is due to mis-management, by massively overpaid managers. It will not change because some of these managers are often involved in government. I'm an A&E Nurse, we have loads of people who really don't need A&E, but they all feel that they need to be there. I agree RE the issue of poor management, but it's clear that there is an issue with people incorrectly using things like A&E and this has to be stopped by a concerted government effort to educate people about what A&E is for. 1 Link to comment Share on other sites More sharing options...
Xela Posted February 9, 2018 Share Posted February 9, 2018 9 hours ago, Demitri_C said: Absolutely and that is just a GP appointment. imagine a hospital that runs probably 20-30 outpatient clinics each day seeing anything from 30-40 patients and 5-10 dont turn up lets say 5 for each 30 clinic thats 150 a day. That isnt even including those who are booked for admissions or pre assessments. These are worse because patients are sent a letter and called 28hrs before their procedure to ensure they are coming yet people STILL dont turn up. This is wrong and they should be fined . I think this should be done more than what @Ingram85 proposed with onging issues as that will be more difficult to implement. What happens if they don't pay? Is the NHS going to take people to court for a £30 fine? What if they are on benefits? Are they not charged? Only workers who miss appointments to be charged? That would just create even more resentment. People who deliberately don't turn up for appointments are cocks but what can you do? Its impossible to manage. Link to comment Share on other sites More sharing options...
snowychap Posted February 9, 2018 Share Posted February 9, 2018 2 minutes ago, Xela said: People who deliberately don't turn up for appointments are cocks but what can you do? Its impossible to manage. They have trialled sending out different types of reminder messages at St Barts, I beelieve. The most successful one appeared to be the one that told them how much it cost the NHS if they were to miss the appointment (approx £160, I think). More details here: Quote Abstract Background Missed hospital appointments are a major cause of inefficiency worldwide. Healthcare providers are increasingly using Short Message Service reminders to reduce ‘Did Not Attend’ (DNA) rates. Systematic reviews show that sending such reminders is effective, but there is no evidence on whether their impact is affected by their content. Accordingly, we undertook two randomised controlled trials that tested the impact of rephrasing appointment reminders on DNA rates in the United Kingdom. Trial Methods Participants were outpatients with a valid mobile telephone number and an outpatient appointment between November 2013 and January 2014 (Trial One, 10,111 participants) or March and May 2014 (Trial Two, 9,848 participants). Appointments were randomly allocated to one of four reminder messages, which were issued five days in advance. Message assignment was then compared against appointment outcomes (appointment attendance, DNA, cancellation by patient). Results In Trial One, a message including the cost of a missed appointment to the health system produced a DNA rate of 8.4%, compared to 11.1% for the existing message (OR 0.74, 95% CI 0.61–0.89, P<0.01). Trial Two replicated this effect (DNA rate 8.2%), but also found that expressing the same concept in general terms was significantly less effective (DNA rate 9.9%, OR 1.22, 95% CI 1.00–1.48, P<0.05). Moving from the existing reminder to the more effective costs message would result in 5,800 fewer missed appointments per year in the National Health Service Trust in question, at no additional cost. The study’s main limitations are that it took place in a single location in England, and that it required accurate phone records, which were only obtained for 20% of eligible patients. We conclude that missed appointments can be reduced, for no additional cost, by introducing persuasive messages to appointment reminders. Future studies could examine the impact of varying reminder messages in other health systems. 2 Link to comment Share on other sites More sharing options...
Xela Posted February 9, 2018 Share Posted February 9, 2018 8 hours ago, HanoiVillan said: In practical terms (since patients will obviously lie to avoid being fined) what this actually means is running all kinds of extra tests to find out the way in which they are lying. Which is an enormous waste of time, money and patience. And at the end of it, you have a large group of people who now have a burning resentment towards the NHS, which doesn't exactly help its 'politically untouchable' status. This is just more detective work. What if my car broke down? What if my mother fell down the stairs that morning and I had to take her to hospital? What if my boss sends me on a business trip to Buffalo at short notice? What if I'm under enormous mental and financial pressure after my wife died, and I just forgot? Etc etc. When I was undergoing tests for my stomach problems a couple of years ago at my local NHS hospital (Good Hope) they advised I needed a colonoscopy. It would be about 10 weeks. No problem I thought, get it booked. Few days later I thought "**** it, i'll go private" and had it done at Little Aston the following week. When my NHS letter came advising me of my date of my colonoscopy I rang up the office straight away, informed them i'd gone private and cancelled it. The lady thanked me for my prompt response and said by letting them know early they could get someone else booked in earlier. Fine, job done. A couple of months later I got a shitty letter from the same office advising them I hadn't turned up for my appointment and telling me I was wasting their time and it could have been used for someone else. I was fuming and was very close to ringing them up and tearing into them, but I didn't. Under the 'fine' proposal I'd be billed for that and I would have a hard job proving I cancelled it unless I requested their phone records. 1 Link to comment Share on other sites More sharing options...
Xela Posted February 9, 2018 Share Posted February 9, 2018 While my political views may fall right of centre, I would gladly pay more tax/NI if it meant 'fixing' the NHS but I simply think it can't be done Increasing and ageing population, not enough hospitals, not enough incentives for young people to enter the field and other things like people misusing the system and health tourism. I think you could thrown trillions at it and it still wouldn't be right. Link to comment Share on other sites More sharing options...
HanoiVillan Posted February 9, 2018 Share Posted February 9, 2018 14 minutes ago, Xela said: When I was undergoing tests for my stomach problems a couple of years ago at my local NHS hospital (Good Hope) they advised I needed a colonoscopy. It would be about 10 weeks. No problem I thought, get it booked. Few days later I thought "**** it, i'll go private" and had it done at Little Aston the following week. When my NHS letter came advising me of my date of my colonoscopy I rang up the office straight away, informed them i'd gone private and cancelled it. The lady thanked me for my prompt response and said by letting them know early they could get someone else booked in earlier. Fine, job done. A couple of months later I got a shitty letter from the same office advising them I hadn't turned up for my appointment and telling me I was wasting their time and it could have been used for someone else. I was fuming and was very close to ringing them up and tearing into them, but I didn't. Under the 'fine' proposal I'd be billed for that and I would have a hard job proving I cancelled it unless I requested their phone records. Yes, I think this is an excellent example of how the system is so complex already that adding yet another layer of complexity will only lead to further problems, and, as I mentioned upthread, frustration and annoyance with the NHS, which damages its long-term prospects. People propose these sort of schemes on the one hand, and then moan about the number of managers and back-office staff the NHS employs on the other. Link to comment Share on other sites More sharing options...
bickster Posted February 9, 2018 Moderator Share Posted February 9, 2018 18 minutes ago, Dr_Pangloss said: I agree RE the issue of poor management, but it's clear that there is an issue with people incorrectly using things like A&E and this has to be stopped by a concerted government effort to educate people about what A&E is for. That's as much a symptom of the underfunding of the GP service as anything else. Most people who misuse A&E do so because they can't get an appointment with their own doctors 1 1 Link to comment Share on other sites More sharing options...
Dr_Pangloss Posted February 9, 2018 Share Posted February 9, 2018 (edited) 3 minutes ago, bickster said: That's as much a symptom of the underfunding of the GP service as anything else. Most people who misuse A&E do so because they can't get an appointment with their own doctors I don't disagree in terms of the underfunding point but there's also a lack of knowledge and common sense among some who go down to A&E, especially when other services, i.e. walk in centres or helplines can be used instead. Edited February 9, 2018 by Dr_Pangloss 1 Link to comment Share on other sites More sharing options...
chrisp65 Posted February 9, 2018 Share Posted February 9, 2018 38 minutes ago, Dr_Pangloss said: I agree RE the issue of poor management, but it's clear that there is an issue with people incorrectly using things like A&E and this has to be stopped by a concerted government effort to educate people about what A&E is for. Ooh! Ooh! I know this one. A&E is for when you can't get a GP appointment and the local minor injuries unit has closed. 3 Link to comment Share on other sites More sharing options...
Demitri_C Posted February 9, 2018 Share Posted February 9, 2018 43 minutes ago, Xela said: While my political views may fall right of centre, I would gladly pay more tax/NI if it meant 'fixing' the NHS but I simply think it can't be done Increasing and ageing population, not enough hospitals, not enough incentives for young people to enter the field and other things like people misusing the system and health tourism. I think you could thrown trillions at it and it still wouldn't be right. This is a common problem I am afraid xela letters are automatically sent by the shitty system. If you "self discharge" as you did (good job on letting them know by the way as alot of people cant be bothered) the system automatically sends a DNA letter. It's a big problem when they changed the system over. Staff highlighted this issue to management tht automated letters could cause problems but we were ignored and you get crap like this happen. I did the same with a ent appointment and because I know I was going to get the same letter as you I just binned it. What we tend to is inform patients they will receive this letter and just to ignore it. The person you spoke to should have told you this, as its common knowledge within most employees in the trusts. 2 Link to comment Share on other sites More sharing options...
NurembergVillan Posted February 9, 2018 Moderator Share Posted February 9, 2018 Just randomly decided to click on the "Online Users" list and saw a user I'd never heard of who was browsing the site. I clicked on their name and saw they'd never made a post but had been a member for a couple of weeks shy of 10 years. So, @hyperdoo - pop in say Hello! Don't be shy! Link to comment Share on other sites More sharing options...
Popular Post Paddywhack Posted February 9, 2018 Popular Post Share Posted February 9, 2018 1 minute ago, NurembergVillan said: Just randomly decided to click on the "Online Users" list and saw a user I'd never heard of who was browsing the site. I clicked on their name and saw they'd never made a post but had been a member for a couple of weeks shy of 10 years. So, @hyperdoo - pop in say Hello! Don't be shy! Still probably won poster of the day more than I have. 2 3 1 Link to comment Share on other sites More sharing options...
NurembergVillan Posted February 9, 2018 Moderator Share Posted February 9, 2018 2 minutes ago, Paddywhack said: Still probably won poster of the day more than I have. I noticed you almost won it on Wednesday though! To be honest, I feel like I should buy you a few pints and a curry or something at this stage... 1 Link to comment Share on other sites More sharing options...
Popular Post markavfc40 Posted February 10, 2018 Popular Post Share Posted February 10, 2018 (edited) 5 hours ago, Xela said: While my political views may fall right of centre, I would gladly pay more tax/NI if it meant 'fixing' the NHS but I simply think it can't be done Increasing and ageing population, not enough hospitals, not enough incentives for young people to enter the field and other things like people misusing the system and health tourism. I think you could thrown trillions at it and it still wouldn't be right. This is what the Tories want you to believe mate and their policies over the last 8 years have actively encouraged it. Increasingly ageing population. You are bang on. The answer is to provide good adult social care then so people can be looked after in their own homes or a nursing home. The Tories have decimated this provision. Not enough hospitals. Again you are correct. Build more hospitals then or at least maintain the level of the ones you inherited. The Tories have closed hospitals. Not enough incentives for young people to enter the field. Again you are bang on. It wasn't always like this though. Three years ago you would get a bursary, around £500 - £600 a month, whilst undertaking a nursing degree. Now you get f all. Oh and you also now have to pay 9k a year to undertake a three year degree that will initially get you a job paying 21k a year. Oh and the 3 year degree is also 80% placement based where you work 37 hours a week on a ward basically doing the work of a nursing assistant. Health tourism costs the NHS peanuts in relative terms. It is a great line that is thrown about though and always a great distraction to blame Johnny Foreigner for any woes usually not backed up by fact. In fact the facts would usually suggest the opposite. The NHS won't cost trillions to fix. It'll cost more than it does now though but it is a price worth paying surely as it is a fantastic concept and this countries finest achievement. We are talking a few pounds extra a month and most of us can afford that. Those of us who can't then the rest us can dig a little deeper to help. Edited February 10, 2018 by markavfc40 6 Link to comment Share on other sites More sharing options...
blandy Posted February 10, 2018 Moderator Share Posted February 10, 2018 14 hours ago, HanoiVillan said: Yes, I think this is an excellent example of how the system is so complex already that adding yet another layer of complexity will only lead to further problems, and, as I mentioned upthread, frustration and annoyance with the NHS, which damages its long-term prospects. People propose these sort of schemes on the one hand, and then moan about the number of managers and back-office staff the NHS employs on the other. It shows, to me that in the instance Xela described the NHS managed to screw up a very simple piece of admin. He told them he didn’t need an appointment, they failed to record that. I very much doubt the reasons are to do with an appointment system needing to be complex. More likely is either human error or an unnecessarily complex, not joined up system. From experience I suspect the latter. My knee is knackered I saw a physiotherapist (at work, non NHS). He said I needed an MRI scan so far so good . To get one I needed to see my GP. So I saw my GP, she agreed and said “you’ll get your appointment through the post in a week or so. A week later a letter came with a date and time. The date and time was for an appointment for an appointment- I had to phone a number at a time another week away to make the MRI scan appointment I did exactly that, got my actual appointment date and time. Next I got a letter telling me I’d not contacted the number at the appointed time to arrange the appointment and blah blah.... I had the scan, was told “you’ll get the results in the post in a couple of weeks, when you do, make an appointment with your GP”. So I did all that, and the GP said “you need to see the knee specialist, do you want an appointment?” Er, yes, of course....so some 6 months after the starting point I got to see the knee specialist. There’s a whole bunch of inefficiency in there, and none of it should be so complicated. it can’t be helping the NHS to work that way. The other thing that I noticed from all that was that the actual MRI scan place was efficient and effective (and outsourced). The GP health centre place was all new and clean and completely overrun, due to staff shortages to the point of being almost overwhelmed by the situation. it was shocking and alarming in equal measure. The staff that were there deserved medals. 1 Link to comment Share on other sites More sharing options...
Chindie Posted February 10, 2018 VT Supporter Share Posted February 10, 2018 (edited) The staff situation won't be getting any better any time soon. Edited February 10, 2018 by Chindie 1 Link to comment Share on other sites More sharing options...
markavfc40 Posted February 10, 2018 Share Posted February 10, 2018 46 minutes ago, blandy said: There’s a whole bunch of inefficiency in there, and none of it should be so complicated. it can’t be helping the NHS to work that way. The other thing that I noticed from all that was that the actual MRI scan place was efficient and effective (and outsourced). The GP health centre place was all new and clean and completely overrun, due to staff shortages to the point of being almost overwhelmed by the situation. it was shocking and alarming in equal measure. The staff that were there deserved medals. Isn't that all part of the plan though. Chaotic A and E, understaffed hospital wards, you wait two weeks to get a GP appointment and it is packed to the rafters and you get to see the GP 45 minutes after your appointment time. You then go to an outsourced appointment and it is the total opposite. It could all leave you with the impression that outsourcing/privatisation is the answer which is exactly the impression the Tories want you to get. The answer is better resources for the front line services. More GP's, more surgeries, walk in centres, more hospitals, more doctors, more nurses. Better adult social care provision. None of this has happened under the Tories. In fact the opposite is the case. It has been set up to fail and failing it is and if it wasn't for the fantastic staff the situation would have been far worse. It is now at breaking point though and we have a choice and either fight to save it or we allow the Tories to completely destroy it. It certainly won't survive another term of Tory rule. 1 Link to comment Share on other sites More sharing options...
Demitri_C Posted February 10, 2018 Share Posted February 10, 2018 11 hours ago, markavfc40 said: This is what the Tories want you to believe mate and their policies over the last 8 years have actively encouraged it. Increasingly ageing population. You are bang on. The answer is to provide good adult social care then so people can be looked after in their own homes or a nursing home. The Tories have decimated this provision. Not enough hospitals. Again you are correct. Build more hospitals then or at least maintain the level of the ones you inherited. The Tories have closed hospitals. Not enough incentives for young people to enter the field. Again you are bang on. It wasn't always like this though. Three years ago you would get a bursary, around £500 - £600 a month, whilst undertaking a nursing degree. Now you get f all. Oh and you also now have to pay 9k a year to undertake a three year degree that will initially get you a job paying 21k a year. Oh and the 3 year degree is also 80% placement based where you work 37 hours a week on a ward basically doing the work of a nursing assistant. Health tourism costs the NHS peanuts in relative terms. It is a great line that is thrown about though and always a great distraction to blame Johnny Foreigner for any woes usually not backed up by fact. In fact the facts would usually suggest the opposite. The NHS won't cost trillions to fix. It'll cost more than it does now though but it is a price worth paying surely as it is a fantastic concept and this countries finest achievement. We are talking a few pounds extra a month and most of us can afford that. Those of us who can't then the rest us can dig a little deeper to help. To do all of that you would need an incredible hike of money taxes will go up significantly I don't see any other way to find all of that. Getting rid of high level management of course needs to be done but if this hasn't happened now after all these years it won't happen now. NHS should NOT be profit based. When they did this it was the beginning of the crap. They went and recruited people with degrees and a background in saving money as opposed to consultants who have worked in the NHS their whole life. These nobodies have more power than consultants now. its incredible 1 Link to comment Share on other sites More sharing options...
Xann Posted February 10, 2018 Share Posted February 10, 2018 Quote You hang out in these elite social circles and doing good has always been important to you, but are you seeing as much concern for the poor as you’d like from the ultrarich? No. The rich aren’t doing enough. They don’t **** care. I came from the street, and I care about these kids who don’t have enough because I feel I’m one of ’em. These other people don’t know what it feels like to be poor, so they don’t care. What’s something you wish you didn’t know? Who killed Kennedy. What were your first impressions of the Beatles? That they were the worst musicians in the world. They were no-playing really bad people. Paul was the worst bass player I ever heard. And Ringo? Don’t even talk about it. Vulture.com - In Conversation Quincy Jones Wide ranging and interesting enough not to go in the musician thread. 2 Link to comment Share on other sites More sharing options...
Xann Posted February 10, 2018 Share Posted February 10, 2018 The NHS has been run into the ground by greedy pricks that want to get their fat fingers into a very lucrative pie. Profits shifted abroad of course by other greedy pricks. 2 1 Link to comment Share on other sites More sharing options...
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