British hospitals at breaking point

(Barbara Deane) #21

My animals are extremely well fed because I care about them.
I am not so sure who cares in Uk and who does not but the NHS
needs to care more…desperately.

(Trevor Hunton) #22

It may well not have been a bed of roses in the seventies, but it does depend a lot on the area in which you lived. My experience was if you wanted to see a doctor, you simply went and saw one. All the old folks you now refer to as bed blockers were shipped off to convalescent home’s, my wife used to work in one. According to all the various articles I’ve ever read on the state of the NHS, general problem is people living longer, new surgical procedures which have never been adequately budgeted for, new drugs also not adequately budgeted for and lack of investment in social care. private investment in various hospital building schemes hasn’t helped.
My experience with the more expensive French system is I can see a doctor whenever I like, get a blood test in the morning, get the results same day, have a scan next week if I want one. Fourteen day hospital stay I had was in a private room with an ensuite. They cured my cancer, and now its annual check up and scan for the foreseeable future. Friend of mine back in the UK had a growth on his kidney, had to wait all day because there was no bed available, finally had kidney removed, two days in hospital, sent home with a bag of painkillers. My father was in hospital for six weeks, simply laying there in a bed because the care agency employed by the social services, couldn’t put him together a care package due to lack of staff.
Norwich has a nice new hospital designed by an idiot full of people walking around, assessing patients to see if they can get them out of the hospital.
Best experience though was when we went over to visit my father and he collapsed on the floor, we couldn’t lift him. Called the ambulance service, went through the is it really an emergency bit, followed by an hour wait, then a visit from a sort of paramedic assessor and his driver. Assessed as needing hospitalisation. Waited another hour for an ambulance which was driven by far the fattest ambulance driver I’ve ever seen, then off to hospital. Eighteen billion a year more on the French healthcare system equates to around 280€ a year per UK citizen, 77 pence a day. Just imagine it, hospitals everywhere, clinics everywhere, hospital cars coming out of your ear’s, specialist cancer hospital in every region, IRM scanners everywhere and a heath service that treats everyone the same regardless of age and where according to my consultant there is no such thing as a bed blocker.

(Barbara Deane) #23

Trevor you have painted the picture of contrast.
I really feel sorry for my friends who live in UK.

(Mandy Davies) #24

I think one of the biggest problems for hospitals in the UK is the lack of GP services available. People who have to wait weeks for a GP appointment will go to A&E instead of waiting and who can blame them if they are worried about a health problem. I know people who have been told by Doctor’s receptionists and even by the staff on 111 (the NHS non-emergency number) that they should go to A&E if the wait is too long.

Also, there are so many procedures being done at hospitals that could be done at GP surgeries. For example, an elderly neighbour of my Mum was told to go to hospital to get her ears syringed because the Doctor’s surgery didn’t have the equipment to do it. She had to wait months for an appointment and then travel more than 20 miles just to have her ears syringed.

I’m sure there would be far less strain on hospitals if there were more GP surgeries together with better services available.

The French system is not perfect either. Living in a very rural area means GPs are few and far between. The nearest village with a GP had 4 of them until recently and now has only 1. When our GP left a few years ago none of the other 3 were taking on new patients so our new GP is more than 10kms away. The situation is even worse for patients of the other 2 GPs who retired in the last few months. They face a trip of 20kms or more as even ours is unable to take new patients any more. Getting an appointment now is very difficult. About a 6 week wait. I can go to the surgery and wait on 3 mornings a week but the last time I did that there were 8 people in front of me at 8:30am and I had to wait 3 hours. I’m told they start queuing about 7:30am!! It’s all a bit frustrating.

(Jane Williamson) #25

Mat, your daughter is a lot more patient than myself.
I was waiting for a doctor to release me in Macon and when nothing had happened by lunchtime, I went home.
No way would I wait for two days.

(Trevor Hunton) #26

Yes I agree, in some areas in France recruitment of new GPs is proving problematic. According to my doctor its because a lot of younger doctors now prefer to work in a health centre rather than operate alone all hours of the day and night. Working within a group surgery means less hours and more flexibility in working days. According to an American cancer specialist I took an interest in in my early days of diagnosis, prevention and early detection are far far more important than anything else. Chap stated that with lung cancer for example, annual scan and early detection meant 80% survival rate, straightforward uncomplicated operation, quick recovery and thousands of dollars saved per patient. Grain of rice, detection when its the size of a grain of rice usually means far more likely to survive, far less likely to need months or even years of expensive treatment saving the health system hundreds of millions every year.
I smoked, stopped the second I knew what the lump was, have never smoked since. Amazes me every time I go to see my consultant at the cancer hospital, the amount of people puffing away outside the main entrance. Annual check ups for the whole population would save the NHS hundreds of millions.

(Paul Flinders) #27

According to OECD figures the difference is more than 280€ per person per year - in 2013 it was about £570 though I’m not quite sure what they count, see below. It doesn’t really matter - given that millions have less than £100 in savings if they actually had to fork out an extra 280€ then they would struggle.

Again, from the OECD in 2013 France spent 10.9% of GDP on healthcare compared with the UK’s 8.5% - in figures this is £148 billion vs £196 billion so rather more than 18 billion difference. In any case 18 billion € extra for the NHS would be a stretch for the government at present (see threads passim regarding the deficit and PSBR).

I imagine the budget will find a modest sum, given the current political and economic pressures.

The caveat to the above is that the published NHS budget for 2013 was about £116 billion and I’m not clear why the OECD figure is different - probably because it includes private healthcare spending.

In the '70’s yes, you probably just did - at least to see the GP - but demand was way less - the generation that needed healthcare in the 70’s (then, as now, predominantly the elderly) were those who had come through the war and grown up without an NHS, it is not surprising that they “didn’t want to trouble the doctor”. We live in a different world today (an observation by the way, not a judgement).

OK, well - a couple of things here.

a) it is now recognised that “syringing” ears is largely a waste of time and has unpleasant side effects if not done correctly; vertigo if the water is the wrong temperature and perforated eardrum to name two.

b) in those rare cases where removal of a foreign body or impacted wax is needed it should be done with a vacuum device under direct vision - this is specialist equipment that the GP probably does not have

c) given that it has questionable clinical benefit, real risks and needs specialist equipment chances are that the GP won’t be being paid to offer it as a service

and, finally

d) as it is is a non-urgent procedure of dubious benefit (etc.) the hospital ENT department probably had no incentive to offer an early appointment.

I have no doubt you will now tell me that the hospital did it with a big syringe and warm water :slight_smile:

Otherwise some very sound reasons for healthcare today being a different landscape to healthcare in the 70’s have been mentioned (heck it is a different landscape to healthcare at the turn of the 21st century). People are, indeed living longer which is an indicator of how successful the NHS has been but it means they get more, more expensive treatment for whatever they do have. As I said above people’s expectations have changed - we live in an instant gratification society and people expect the NHS to deliver that. GP’s are under pressure because they live in something of a boom and bust world (roughly there is a crisis, lots of money gets put in which fixes the crisis, then because there is no crisis general practice gets ignored, resources get diverted elsewhere and eventually there is a crisis, repeat as necessary).

As an example of how treatments change let’s briefly take lung cancer, since it has been mentoned. To be fair if you have operable lung cancer things are not vastly different in that surgery is still the mainstay of treatment. Except in the 1970’s that would probably be the whole lung out whereas today it would be part of the lung if possible with corresponding reduction in hospital stay and morbidity afterwards. Consequently we operate on older and less fit patients so we do more ops at more cost but do manage to do that with less mortality due to the procedure than we did back then.

But suppose the cancer has spread? In the 70’s you would be given the devastating news that your expected survival was 3-6 months and told to put your things in order. You might have been given the drug Cisplatin which was introduced in 1979 but that was really a very unpleasant treatment and not that effective.

Now, I’d like to say that survival is massively better and, well, it is a bit but we have many more treatments now. We have new chemotherapy drugs eg Etoposide (introduced early 1980’s), Carboplatin (introduced mid 80’s), Gemcitabine (mid 90’s), Docetaxel (mid 90’s), Pemetrexed(early 2000’s), targeted treatments (Erlotinib, Gefitinib, Osimertinib, Afatinib, Crizotinib), mostly introduced in the last 10 years and immune therapies (Nivolumab, Pembrolizumab, Ipilimumab), mostly introduced in the last couple of years. Some of these need you to have the “right sort” of cancer but a typical patient might now be offered two, three or more lines of treatment - and when each month’s treatment is many 1000’s of £’s the bill quickly adds up.

And that is just one cancer site, there are 100’s of different types of cancer and the changes in modern medicine do not just apply to cancer.

It really is a different world to the 1970’s.

(Trevor Hunton) #28

Of course its a different world to the 1970’s which was exactly my point, healthcare expenditure has not kept up with new procedure’s, longer life span’s ( absolutely nothing to do with the NHS) expensive treatments for various illness’s, diabetes and obesity. Its a proven fact in the third world that people live longer when they have safe drinking water, better sanitary facilities and access to inexpensive decent foodstuffs. I didn’t pluck eighteen billion out of the ether, its a figure quoted recently in a newspaper article. Its totally unrealistic to think that the UK could offer free healthcare and social care to the same standard as both France and Germany, the population wouldn’t pay for it, couldn’t afford to pay for. With cancer its not so much the expensive drug’s, its more understanding of the way cancer spreads, the amount of flesh to remove, how it travels around your body. Certain cancers respond well to treatments, certain cancers do not. Most important thing is early detection. Cancer treatments are expensive, mine has cost over eighty grand, whereas earlier detection would have reduced that amount by well over seventy five thousand. The main thing I’ve noticed over here with my experience and back in the UK with my fathers experience is, the hospital he was in was full of old people, whereas over here that doesn’t seem to be the case.
The French national debt is around the same level as the UK’s, social charges in France are higher than the UK, healthcare is part funded by insurance, student’s receive bourses of up to 460€ a month, 150€ a month help towards rent’s, most leave university with no debt. New parents of average means receive a lump sum towards baby stuff, then 350€ a month for three years, followed by free preschool from the age of three to six years old. Quite a few mother’s receive 600€ a month towards a creche, creche business is booming over here. There’s absolutely shed loads of social housing, plenty of government funded course’s, kids holiday voucher’s, free school busses for low income families, free further education for kids from low income families, excellent road and rail networks. Nation wide high speed train network. Its not exactly utopia but after all these years of doing quite well, why hasn’t the UK got all this?

(Barbara Deane) #29

Yes early detection of cancer.
I knew that I had cancer but the doctors said no.
Even a private doctor just off Kings road Chelsea who
giggled at the reception desk with her young employee…
about my suggestion of cancer.
I wasted months and in those months my cancer grew.
It is about knowing how much tissue and what you can cut
away together with nearby lymph nodes cut out in order that
no cancerous cells travel off to other organs.
Here in France the opportunity to be tested for cancer is offered
appointments to see a doctor are instant…sometimes even made for
the same day.
The French are slow …they never seem to rush and the paperwork
seems never ending but with the vital matters they move!
Yes the british people could learn a lot more from the French.
Take adequate rest, keep warm, work hard but know when to stop,
Forget about keeping up with the Jones and just enjoy the love of those
who are close to you.

(Mandy Davies) #30

Hi Paul

Very interesting information on ear syringing. Yes it was done with a big syringe of warm water and a kidney dish to catch everything. How can a GP not have such things in their surgery? When my husband went to the GP here in France with a hearing problem she discovered lots of wax and syringed his ear there and then. Took about 3 minutes!! Hearing problem solved.

(Paul Flinders) #31

Hard wax build up - which can impair hearing - responds to softeners and will then come out of its own accord, syringing should not be necessary and should not be considered a risk-free procedure even if it is. Microsuction is safer but not everyone has the kit. Were the risks explained to you in either setting?

As to the particular reason an individual GP doesn’t offer the procedure it is hard to say.

Interesting comment about hospitals full of old people - hardly unexpected as old people are the main consumers of healthcare. If this is not the case in France I would wonder why but would not leap to any conclusions that it is a good thing (or a bad thing come to that, just different).

Also interesting that Trevor is able to put a figure on his surgery. I wonder whether people would be less negative about the NHS if they actually saw how much it would otherwise cost them - in particular I wonder what a £25 fee for a GP visit would do to demand (even if fully reimbursed).

(Barbara Deane) #32

My doctor did it for me in his surgery…water splashing
but it took no time,

(Paul Flinders) #33

Did your doctor (whether in the UK or France) explain the complications - failure to remove wax(29%), infection(17%), perforation (15%), trauma to the ear canal(11%) or discuss alternatives such as softeners?

If not then I do not think that you were in a position to give valid consent to the procedure.

(Barbara Deane) #34

I used softners…did not work.

(Paul Flinders) #35

I used softners…did not work.

Fair enough - I still hope that the risks were explained to you.

(Barbara Deane) #36

what risks…? I could hardly hear.
Life itself is a risk…Especially if you are in the NHS

Are you a doctor?

(Chris Kite) #37

All I was told was that it might make my tinnitus worse in the short term. Had the same syringe treatment several times. Couldn’t hear a thing and softeners didn’t work, so no alternative really.

(Mandy Davies) #38

He had already done the softening thing with a solution from the pharmacy. Hadn’t worked. It was either syringing or stay deaf. He’s had his ears syringed many times over the years and never had any problems. Infections, ear canal trauma! Really!!?? Obviously not doing it right, it’s just a bit of warm water under minimal pressure. Don’t we do that every day in the shower?!

(Véronique Langlands) #39

He sprays the water from the shower-head into his ear-canal? That’s probably why his ears are so bunged up.

(Mandy Davies) #40

Ha ha. What I meant to say was that we all get warm water in our ears every time we shower or wash our hair. I suspect it’s not the water that’s the problem but the wielding of the syringe.

Incidentally, after his ear was syringed the Doctor said to do exactly that and spray water into his ear with the shower to help keep it wax free. So, should we do what she says or not? No idea anymore.