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NHS (personal experience rather than bigger picture)

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Re: NHS (personal experience rather than bigger picture)

Post by murf »

It is a problem with many heads (another is that new-fangled treatments/drgs often aren't cheap!)

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Re: NHS (personal experience rather than bigger picture)

Post by sted »

Groomyd wrote:I agree with both of us too :wink:
Group hug? :lol:

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Re: NHS (personal experience rather than bigger picture)

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Image

The hand that brough love and group hugs to FISO

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Re: NHS (personal experience rather than bigger picture)

Post by unc.si. »

My most recent NHS experience has been in the last 12 months when my Dad has had bowel cancer. The only bad part of the experience was the initial diagnosis at the GP surgery - took a 3rd opinion to persuade the GP that no, I really don't think it is 'just piles' and yes I would like to see a specialist (OK - they probably get a lot of people that just want to go for tests for the slightest twinge but you think they would take some account of the fact that my Dad's hardly a hypochondriac - the only other time he's been in a hospital was when he fractured his skull nearly 70 years ago when knocked off his bike by a truck).

Can't really fault the treatment, from surgery through to the 6 months of Chemo and the current follow up visits (all clear as of a few weeks back :D ).

The overall impression is that the system is just very stretched. A lot of waiting around, not quite enough staff, tired infrastructure. Couldn't fault any of the care though (initial GP contact excluded).

It's a world away from BUPA hospitals - appointments virtually on demand, chatting to the surgeon on the way down to theatre, handshakes with the anaesthetist and theatre nurse and nurses popping in to see how you are on a regular basis when you're back in your private room. Suspect that there's no real difference in the clinical care (both the surgeon and anaesthetist had been at Queens NHS hospital in surgery that morning), it's just a nicer environment and you don't have to wait.


One thing that strikes me is that in some cases 'efficiency' in the NHS doesn't necessarily always mean reduced costs, depending of course on how you are measuring efficiency.

I think that what most people would want from the NHS is reduced waiting times, faster appointments and less time actually spent in hospital recovering. If that happened, then I think that the general public would think that the NHS was more efficient. That would mean getting more people through the system though - more operations, more high cost care, therefore increase in cost. More efficient = more expensive?

Of course cost control measures need to be in place, but there's a difference (and maybe confusion) between clinical efficiency and cost efficiency. Clinical efficiency may increase costs, the effect of which is damped by cost efficiency, but overall costs will still increase (without a complete restructure of the system, which would take a long time, be hugely expensive and still may not work).

Is the corollary of this the reduction of clinical efficiency if cost control becomes the primary focus (which is currently the case). Is it possible to cut costs in absolute terms without damaging the overall service given? Probably not.

Anyway, that last bit is just a bit of a ramble off the top of my head and may well just be complete bollocks, so feel free to mock away :lol:

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Re: NHS (personal experience rather than bigger picture)

Post by unc.si. »

Tricky Tree wrote:Image

The hand that brough love and group hugs to FISO
Looks broken to me mate.

You want to get that seen to. There's a good BUPA hospital on Mansfield Road.

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Re: NHS (personal experience rather than bigger picture)

Post by Bunners »

sted wrote:
Groomyd wrote:I agree with both of us too :wink:
Group hug? :lol:
Ah I feel all warm inside.....hold on maybe im ill...off to the docs I go :wink:

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Re: NHS (personal experience rather than bigger picture)

Post by Tricky Tree »

unc.si. wrote:
Tricky Tree wrote:Image

The hand that brough love and group hugs to FISO
Looks broken to me mate.

You want to get that seen to. There's a good BUPA hospital on Mansfield Road.

Think only myself and Mrs Tree covered by your firm ;-)

In 11 days between accident and when they intend to pin and maybe plate, will it not start knitting back together?

he will ask for full anaesthetic anyway...

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Re: NHS (personal experience rather than bigger picture)

Post by Groomyd »

unc.si. wrote:
I think that what most people would want from the NHS is reduced waiting times, faster appointments and less time actually spent in hospital recovering. If that happened, then I think that the general public would think that the NHS was more efficient. That would mean getting more people through the system though - more operations, more high cost care, therefore increase in cost. More efficient = more expensive?
Yes and no

Under the Tories it was normal to wait 6 months and frequently longer for a referral - and this did keep down costs. For example such was the wait to see a physio that GPs rarely referred on the NHS - what good is physio to a patient when they won't get it for 6 months!!!!!

One of the huge changes the last government made was to state that we all have a right to be seen within 18 weeks - and that forced costs up.

The Tories are now trying to get rid of such "targets" and seem to have convinced the tabloid reading public that all targets are bad - while removing rights to be seen by a GP within 48 hours max, A&E within 4 hours and of course the 18 weeks for a referral (2 weeks for cancer).

However it is cheaper for patients to be discharged as quickly as possible - every night in hospital costs the tax payer a minimum of £300 no matter what tests and operations are being performed - that's just the base rate of a bed day.

Furthermore if a hospital has beds it can use them for elective care (as opposed to emergency care) and that makes the hospital money

BUPA of course is JUST elective care - no A&E full of urgent serious life saving emergencies - everything can be planned and anticipated and thats why it's more like a hotel - it works like one - imagine staying at a hotel when any minute a load of other guests could arrive at any minute barging in front of you and making all sorts of urgent demands .................. It's a totally different beast.

Can we save money and still have quality? Only if we stop eating shit, drinking too much, smoking and being fat sedentary bustards.

And that is a culture shift which outlasts any government

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Re: NHS (personal experience rather than bigger picture)

Post by Vid »

Just a thought to chuck out there, if fags were a quid a pack rather than seven(?) could it possibly enable the low/ no waged smokers to spend the "spare" 6 or 12 quid a day (for a couple) on better quality food for their kids and themselves rather than the cheap shit that they buy at Iceland or wherever?

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Re: NHS (personal experience rather than bigger picture)

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Vid wrote:Just a thought to chuck out there, if fags were a quid a pack rather than seven(?) could it possibly enable the low/ no waged smokers to spend the "spare" 6 or 12 quid a day (for a couple) on better quality food for their kids and themselves rather than the cheap shit that they buy at Iceland or wherever?
That's quite a health policy you've got there Vid :shock:

Smoking kills far more people than any other single activity - cheap fags = more smokers and more smoking

"Cheap shit" processed food costs more than decent homemade food

Walking is free

Being healthy is not a financial issue for the vast majority of people

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Re: NHS (personal experience rather than bigger picture)

Post by Vid »

Groomyd wrote:
Vid wrote:Just a thought to chuck out there, if fags were a quid a pack rather than seven(?) could it possibly enable the low/ no waged smokers to spend the "spare" 6 or 12 quid a day (for a couple) on better quality food for their kids and themselves rather than the cheap shit that they buy at Iceland or wherever?
That's quite a health policy you've got there Vid :shock:

Smoking kills far more people than any other single activity - cheap fags = more smokers and more smoking

"Cheap shit" processed food costs more than decent homemade food

Walking is free

Being healthy is not a financial issue for the vast majority of people
Not saying that it's a great idea, just that it could possibly help with the currently highlighted area that is a national health concern, obesity and various ailments that are connected. Honestly I have no idea of the demographics of who uses most of the NHS resources or if certain conditions are more prevalent to specific groups.

Personally I have needed the NHS twice in the last 4 or 5 years due to working injuries, for the extended family the one that has had most called on the NHS is the step-daughter, unemployed and grossly overweight.

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Re: NHS (personal experience rather than bigger picture)

Post by murf »

Only caught the end of it on the news but I think this is right.

Compared to other western countries, we have poor stats re deaths from most diseases but we did have the lowest death rate for one..... diabetes.

Seems odd....

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Re: NHS (personal experience rather than bigger picture)

Post by Groomyd »

murf wrote:Only caught the end of it on the news but I think this is right.

Compared to other western countries, we have poor stats re deaths from most diseases but we did have the lowest death rate for one..... diabetes.

Seems odd....
No we do very well and in terms of outcomes per £1 spent it's exceptional

Cancer survival rates are an area of weakness - largely due to late diagnosis/late presentation at GP level

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Re: NHS (personal experience rather than bigger picture)

Post by sleuth »

Good to see the NHS has their house in order. :?

http://www.thesun.co.uk/sol/homepage/ne ... tting.html" onclick="window.open(this.href);return false;

As the Sun rightly says.


SHAMELESS!

With breathtaking arrogance, NHS chief executive SIR David Nicholson tells MP,s he should continue to head the health service despite sharing blame for the Stafford hospital scandal that killed 1,200 patients.

Nicholson tried to duck the heat by playing politics, suggesting the NHS was in imminent danger from vital coalition reforms.

The best reform of all would be for the discredited and disgraced Nicholson to be BOOTED OUT so a decent leader can take over.

HEAR HEAR!

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Re: NHS (personal experience rather than bigger picture)

Post by Groomyd »

I agree Nicholson should be sacked

I also think that managers at the hospital should be jailed

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Re: NHS (personal experience rather than bigger picture)

Post by sleuth »

Groomyd wrote:I agree Nicholson should be sacked

I also think that managers at the hospital should be jailed

Yeah one of those Hospitals is mine where they couldn't even find me a bed (not coz one wasn't big enough) when i was ill for several days a couple of years ago.

Basildon eff shithole.

As i said too much immigration..

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Re: NHS (personal experience rather than bigger picture)

Post by murf »

sleuth wrote:Basildon eff shithole.

As i said too much immigration..
Yeah, bloody cockneys, all moving into Essex.....

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Re: NHS (personal experience rather than bigger picture)

Post by Groomyd »

Why did you need a hospital bed Dot?

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Re: NHS (personal experience rather than bigger picture)

Post by sleuth »

Because i was unwell- its not rocket science you know- trying to ascertain why people have to occasionally be in these places.


I reckon the average waiting time in A & E at Bazz is probably in the region of 3 hours plus.... unless your dying.
And a doctors appointment with your local GP is 3-4 days after booking by phone- you cant just wander in and expect to be seen.

It's all down to immigration and freeloaders over here..

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Re: NHS (personal experience rather than bigger picture)

Post by unc.si. »

Groomyd wrote:
BUPA of course is JUST elective care - no A&E full of urgent serious life saving emergencies - everything can be planned and anticipated and thats why it's more like a hotel - it works like one - imagine staying at a hotel when any minute a load of other guests could arrive at any minute barging in front of you and making all sorts of urgent demands .................. It's a totally different beast.
for the record I wasn't suggesting that I was comparing like for like - just highlighting the difference in environment but pointing out that the clinical care wasn't likely to be much different, in my experience anyway.

Slightly OT, but my sister used to work at the Maternity ward of LA County Hospital (that's where you go to give birth if you can't afford healthcare insurance or to pay full stop). Hundreds of babies born every night - in wards, corridors or anywhere they could stick a trolley, mothers handcuffed to beds in some instances with armed police in attendance. Chronically understaffed. She also did the odd shift at Cedars Sinai in Beverley Hills - a handful of births every night and about 8 staff to every patient. The UK may have a 2 tier system but the 'lower tier' is pretty damn good compared to the US, as others have pointed out.
Groomyd wrote: However it is cheaper for patients to be discharged as quickly as possible - every night in hospital costs the tax payer a minimum of £300 no matter what tests and operations are being performed - that's just the base rate of a bed day.

Furthermore if a hospital has beds it can use them for elective care (as opposed to emergency care) and that makes the hospital money
Not being obtuse, but how is that £300 derived? Surely that's just the fixed cost per bed and doesn't really have much relevance to decisions involving patients (it'll be £300, or whatever number, whether the bed is occupied or not).

My hypothesis is that if you discharge patients quickly, you get more patients treated overall (which is good), but that as I'm assuming that the initial cost of treatment is higher than costs when the patient is in a bed recovering then discharging early will increase costs overall. The fixed cost of £300 per bed doesn't change but you get more high cost surgical procedures etc. Don't know if that's right or not - like I say, just a hypothesis. Of course if the bottleneck is Theatre / Radiography / Consultant etc availability then that will change the balance.

Also depends on your statement about hospitals making money from elective care. Not quite sure I understand this in the context of the NHS overall - surely it's all cost to the NHS. OK, depending on how trusts are accounted for, the individual hospital may 'make money', but at the macro level of the NHS as a whole isn't it all just cost?

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Re: NHS (personal experience rather than bigger picture)

Post by Zimmerman »

Whilst I agree with pretty much everything else you've wrote in this thread, got to disagree here;
Groomyd wrote:
"Cheap shit" processed food costs more than decent homemade food
Sure I saw an advert the other day offering a ton of chicken and chips for less than a tenner. Can't remember the exact deal. But it was wnough to feed the family.

You can get a couple of chicken kievs for a quid :shock: Or 8 chicken breast steaks for £2 it's not hard to see why people go for this stuff (if you also factor in the convenience factor... Just whack it in the oven and away you go).

http://www.iceland.co.uk/our-food/froze ... n-and-duck" onclick="window.open(this.href);return false;

I'd say 80% of the stuff we eat is home made - I wouldn't say it's cheaper at all. No doubt there will be some stuff which can be cheaper, but not on the whole.

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Re: NHS (personal experience rather than bigger picture)

Post by Zimmerman »

Achiles74 wrote:We have a 2 tier service, BUPA is excellent, I'm lucky that at work I get private healthcare which also covers my entire family.
I well remember shoddy service at the NHS way back in the past.
If you can afford it, I would always reccomend getting private healthcare with BUPA, the difference you get is enormous.
That's some perk. I get private earth care but have to pay for family members (about £54 each I think).

Maybe I should get myself a job in mountain rescue.

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Re: NHS (personal experience rather than bigger picture)

Post by Zimmerman »

The examples given of the american system should put our system in to perspective.

Personally speaking, on the one hand, my mrs has had 2 or 3 really bad experiences in hospital (each time she's been in)! But on the other the amount of treatment and aftercare you get when having a baby is amazing (including prescriptions etc). Not sure sure if health visitors and midwives come out of the nhs pot too, but they do agreat service (despite undoubtedly being stretched).

Got a friend who lives in the states, he had a similar(ish) story to Jags. Whilst having a back operation, another consultant had to come in to theatre to take a look. That added on a few grand. Nice work if you can get it.

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Re: NHS (personal experience rather than bigger picture)

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Zimmerman wrote:I'd say 80% of the stuff we eat is home made.
I'm interested as to what that means. While lasagne from a supermarket, anything tinned, any takeaway etc is obviously not home made, where do you draw the line.

If you make a sauce you are presumably using cornflower.

Does frozen fish count as home made, and what if it comes already covered in breadcrumbs?

I suppose that cooking bacon can count as home made, but what about sausages, salami etc

We never eat takeaways, and virtually no processed crap from supermarkets, and our microwave is used primarily for defrosting. But to say we eat 80% home made may be pushing it. What about bread (which we get from what I'm convinced is the best bakery in the UK), or more importantly chocolate.

I'm intrigued by your diet.

I hope that this post isn't considered off topic as what we eat is vital for the future of the NHS.

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Re: NHS (personal experience rather than bigger picture)

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unc.si. wrote:

Not being obtuse, but how is that £300 derived? Surely that's just the fixed cost per bed and doesn't really have much relevance to decisions involving patients (it'll be £300, or whatever number, whether the bed is occupied or not).

OK, depending on how trusts are accounted for, the individual hospital may 'make money', but at the macro level of the NHS as a whole isn't it all just cost?
You might think that but it is not how it works

Firstly the NHS in England has an "internal market". Commissioners buy the services for their patients and providers provide those services. Everything has a tariff price.

So if you go to a hospital and have a blood test the hospital bills the commissioner x amount for it, same for a bed day, x-ray, MRI scan etc etc everything has a tariff.

So in answer to your first question - no - the £300 per bed day is a real variable cost even though in accountancy terms it's a fixed cost. If there is no one in the bed then there is no tariff earned on it.

Your second observation is again logical but also untrue in England (Scotland is totally different) All hospitals are to become Foundation Trusts and they are genuine stand alone businesses - they have to make money - they have to generate enough activity to break even and if they go bust then they will not be bailed out. The Toried are trying to create a genuine Market.

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Re: NHS (personal experience rather than bigger picture)

Post by Zimmerman »

That's a fair question striker... And now you've made me question my own statement :?

Ultimately what I was meaning was that we don't eat frozen meals... We do eat a small number of ready made meals from marks and spencers, but that might be once a week or the odd pasta meal for lunch.

Stuff like bread etc is bought (although we do have a bread maker).

If we eat a lasagne ('home made') we'll use shop bought pasta sheets and jarred sauces. So you could argue its not home made. But my comparison/thought was that buying the mince £2, buying the pasta £?, buying the sauces £2-£4, buying the cheese.... That's nigh on a tenner. I dare say a ready made one from tesco is probably half that price?

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Re: NHS (personal experience rather than bigger picture)

Post by Striker »

That all sounds logical, but on that definition shouldn't you be trying to get the percentage well above 80%? Admittedly it's easier for us retired old fogies, with no kids pestering us for crap, and more time on our hands to organise our eating more healthily.

But what excuse have the unemployed got? With time to spare one can eat healthily for much the same as crap costs.

Time is certainly a key factor when it comes to healthy eating.

P.S. In your lasagne example the cost is probably similar if you make you own sauce. In most sauces, cheese is the only expensive ingredient, so if you stick to cheese free or low cheese sauces, the only significant cost is time.

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Re: NHS (personal experience rather than bigger picture)

Post by Zimmerman »

Can they though?

A couple of cheap chicken breasts at tesco will cost you £4.

You can get 8 (although I'm guessing they are thin and you'd need at least two each) from Iceland for £2.

Spag Bol I would say is a cheap meal mince £2, pasta about 50p, sauce £1 or £2... So £3.50/£4.50 that's for two of us.

Still trumped by the 8 frozen chicken breasts for £2 :)

Granted my comparisons are limited, and we do tend to indulge ourselves.

I dare say we could eat jacket potatoes and cheese or an omelette or something and the net cost would be very cheap?

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Re: NHS (personal experience rather than bigger picture)

Post by Groomyd »

Ok Zim you have a point - but you can also buy enough mince, mushrooms, onions etc to make a huge spag Bol or chilli very cheaply and freeze the portions - that works out cheaply

You often see, as has been suggested on this thread, that a good diet is all about income and that poor people just can't afford to eat healthily - my point is that that is completely wrong and it's more about convenience and education

You may be able to do it slightly cheaper at Iceland but my point was that the real reason that people eat shite food is laziness and poor cooking skills

The difference between the meals I'm suggesting and the ones you are highlighting are less than the price of a pint - for a family to eat

Furthermore those chicken bits from Iceland may be battery framed super cheap and not as good for you as chicken that has had a better life - that's not the problem - the problem is the high fat and salt ready meals, pizzas, and fried chicken outlets

Buy the chicken from Iceland - but add some veg - or buy better food and add veg and fill up on bread, rice, pasta and spuds.

http://www.nhs.uk/LiveWell/Goodfood/Pag ... dhome.aspx" onclick="window.open(this.href);return false;
Last edited by Groomyd on 06 Mar 2013, 18:02, edited 1 time in total.

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Re: NHS (personal experience rather than bigger picture)

Post by Zimmerman »

Yep, fair point, and I agree. Takeaways aren't cheap (nor healthy).

I completely agree that it boils down to convenience/laziness in a lot of cases.

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