NHS has been underfunded for years. These issues are, in a way, not new. But it just kept getting worse and worse, COVID added burnout and a huge backlog of treatments and missed diagnoses.
It probably doesn't help that a lot of the medical staff were from the EU and just before COVID were PTFO.
I'm still waiting for those hospitals to be built by all the money saved by Brexit.
How do you know the problem is in fact underfunding? The UK seems to spend as much on healthcare as many other first world countries, but with worse results.
Well, let me rephrase. NHS has for a long time been unable to spend money it considered necessary for a sufficient level of ongoing and preventative care.
At the tail end it certainly seems plausible, stories about lack of funds for hiring doctors, and visible queues at A&E have long been a staple of healthcare. What caused that tail-end lack of funds, I'm not sure.
Increase in demand - much of which is attributed (by the NHS itself) for people having poor life-styles (meaning tending to obesity [0] and not maintaining physical and mental fitness), and the tendency for people to be kept alive longer existing with chronic conditions that a few decades ago would have naturally expired (dead!).
There's been an endemic problem for the last 30+ years where-by a large proportion of the population has a sense of entitlement to NHS care without at the same time bearing responsibility to keep themselves reasonably fit and healthy.
@ [0]: "Nearly two-thirds of adults in England are overweight or obese. In 2016/17, 617,000 admissions to NHS hospitals recorded obesity as a primary or secondary diagnosis"
> Nearly two-thirds of adults in England are overweight or obese.
That means the issue is systemic and one needs to look at things outside of individual control. Yes, often systemic issue can be overcome by individuals - by the top quartile kind of individuals with more luck, better genes, better education (including what they picked up at home while growing up), more money, more suitable lives than the majority, or with outliers in levels of personal discipline. But systems should work for the people that actually live, if you need to blame two thirds of the population(!) it's most likely your system that is wrong.
Yes you can look at most of the individuals that are part of those two thirds and find what seems to be personal choices - but you miss the environment and the pressures from it that lead people into making those choices.
For example, that a lot fewer people know how to cook today than several decades ago (example link: https://www.bonappetit.com/entertaining-style/trends-news/ar...), do yo want to blame each individual? To me this very much looks like a bigger societal issue. It's not like people make such choices after careful consideration, it "just happens" and they "slip" into those behaviors without much deliberation, based on their living situations.
You can both blame people and society. Modern living makes it easy to be fat, but plenty of us don’t succumb to the temptation of easy meals and overeating.
I’m not sure how you’d even change modern life to get around this, save maybe for incredibly large sin taxes on everything from soda to every restaurant. I’m sure we’ll just end up with a pill sometime soon. Semaglutide comes close.
I wonder if metformin does the same thing, but the patent fell off too soon, so there just wasn't much marketing for its benefits to decision-makers.
metformin for 26 weeks lead to a net 6.6kg weight loss in non-diabetic obese patients (I would've preferred BMI reduction as the outcome measure, and a placebo-control arm, but can't have it all):
The UK has an ageing population. A higher percentage of older people and fewer younger people. Saying that those old people should have died earlier would be disgusting so I'm sure that's not what you meant.
So to be clear there's an increase in demand because British people are living longer. That's a good thing and should result in increased funding.
It's exactly what I mean. There is absolutely no value in hanging on to the last possible moment due to ever increasing levels of interventions.
Living longer is not "a good thing" if that life is costing (not just in financial terms) society and the country so much more and the person can not sustain an independent quality of life.
In 1946-47, when the NHS, National Insurance (state pensions), and related programmes were created the average survival after retirement (60 for women, 65 for men) was 10 years or so (average mortality was 75 for men and little later for women).
So pension funding only needed to last on average 10 years and there was no comprehensive costly life-sustaining interventions to keep people alive that would otherwise have popped their clogs.
Now the average age of mortality in men is 85 and 89 for women, and these are rising. And as these are averages there are a lot of people lasting a lot longer - many spend years sitting in a chair effectively waiting for Death to show up.
So now the same pension funding has to provide for 20 or more years AND there are many costly and life-sustaining health interventions and "social care" that add cost and load on a dwindling number of tax payers.
I'm a farm-boy born n bred, as is my father, who is now 86. He's been amazingly fit his entire life but the last two years he's going rapidly downhill due to onset of mild dementia, but also due to not accepting doctors advice on treatments and medicines (this he's been doing for 40 years!) and subsequently hitting crisis where there have to be expensive emergency interventions.
As far as I am concerned he is abusing the NHS - like those who are obese or mistreating themselves in other ways - and if it were up to me I'd refuse to treat his emergencies if he is not prepared to look after himself by simply taking medicines that would prevent the emergencies.
Personally, I'll kill myself when I can no longer be useful.
Humans need to learn from how the rest of the planet's breathing life-forms treat life... and death, and lose the sentimentality. The planet already has twice as many humans on it as it can naturally sustain.
Meanwhile in the US there’s been a push to limit the copays for insulin, pushing the cost of all of those almost entirely preventable type 2 diabetics on to everyone else.
Lack of qualified staff willing to work at the current pay rates. There are shortages in plenty of sectors at the moment so medical personnel who have had enough are leaving or retiring early and they can’t be replaced because pay rises are not keeping up with inflation. I’m going to look for my source just now but I read that there are 100,000 vacancies in the care professions currently. Postal workers, train drivers, bus drivers, dockers and barristers(!) are all planning to strike in the next month or two because of inflation effectively causing large pay cuts.
There's a big problem where social care got moved from the department of health to local government a few years ago.
Then, shortly after, the government cut local government funding massively. It used to be funded by a mix of local taxes and funding from central government that was about 50/50. This was part of a strategy to insulate richer areas from the impact of cuts, while poorer ones (which relied more on central funding) took the hit.
This means there's a huge problem with elderly patients who need to be discharged into social care not having the support they would need to go home or a spot in an old people's home to go into.
Which, combined with covid still being around and the fact that even before covid government obsession with efficiency meant that there were a relatively low number of beds which already had a high occupancy rate.
So there was no spare supply to begin with, increasing demand due to a growing and aging population and covid, and lots of people who are stuck in hospital because they need support to leave which doesn't exist.
Both. Demand has increased faster than expected because of covid, and supply has been hampered by covid, but even in the counterfactual world that has not faced this pandemic the UK has not funded enough nursing places to meet the previously forecast demand (the ageing population told us demand was going to go up, but the government cut funding in 2017 that reduced nursing degree applications in England and Wales by 23%), and Brexit reduced the number of nurse applications from the EU.
In England social care (care homes) are funded by local authorities, not the NHS, and are overwhelmingly provided by private providers. We've had decades of under-funding of local authorities, and the Conservative government has made it very difficult for LAs to raise funds via taxation.
So, during a time where we have an ageing population we do not have nearly enough beds for these people to be cared for.
When people go into hospital, either as a planned (elective) admission or as an emergency, and they get treatment, and they're ready to leave hospital they have to have somewhere to go to. Lots of people will go back to their own home, but some people will be unable to do this because it's not safe to do so. These people need a care or nursing home. Because there aren't any available beds, and because there aren't any available suitable home care packages, these people stay in hospital on the wards.
Those beds are now not available to be used.
So, now you have a problem of flow of patients through hospitals. You can't discharge patients from the ward, which means that ward can't now accept patients from elsewhere (surgery, ED) in the hospital. This means that elective care reduces, and emergency care slows down. People wait in Ed for very long times. And because ED is full people can't get in to ED, so ambos queue outside ED for hours. This means many ambos are queued outside ED waiting to transfer a patient, and not available to travel to people. So now people in life-threatening emergency or with severe injury are waiting far too long for an ambo.
Fixing care homes and nursing homes would do a lot to fix patient flow, but it's not going to happen because we have a government that hates the NHS and hates LAs and hates taxation.
On top of all of this we have an incoherent approach to staffing. The English NHS is full of staff who've come to England to work. We need these people - they improve the quality of care and they increase the amount of care we can deliver. We should be making it easier for people to come here, but we don't, we put up a load of weird bureaucratic blocks. (Because we have a government that hates immigration.)
We need to train very many more staff (there is something like 100,000 staff shortage, at least 10,000 doctors and 50,000 nurses) but we've made it more expensive to train to become a nurse, or a doctor; we've cut pay for all staff (for junior doctors to achieve pay restoration they'd need something like a 25%-30% pay increase).
We need to retain the staff we already have, but there are a range of things that make working for an English NHS trust pretty terrible. It's not just pay, but poor pay doesn't help. There's a weird thing around pensions that means many doctors can either retire early or face a massive increase in their taxes. Lots of staff have trouble getting paid on time when they start work at a new organisation. People have to pay for car parking, and they're fined if they overstay even if that overstay was caused by saving the life of a very ill patient. (These can be over-turned but why should it happen at all?). Rest areas are generally awful and expensive. Hot food is generally not available 24 hours a day. Rotas are chaotic. Doctors can apply for leave a year in advance and then have that denied with very short notice. Some NHS trusts have toxic work cultures and problems with racism, sexism, and bullying. And these are just the things I can remember, the real list is very much longer.
About demand: there has been an increase in demand for healthcare. GPs are seeing more people than they were before pandemic, but there's a perception that it's quite hard to see a GP. (I don't have much trouble, but I have cancer and my GP is pretty good, but I recognise other people have difficulty with weird access restrictions). This trickles through to ED - a few people turn up to ED needlessly. Before pandemic we had clear evidence that it wasn't really enough to make much difference to the overall ED demand. The picture is less clear during pandemic - certainly people going to GP not ED if they need GP is a good thing because they get better care, but it's hard to know if it's making the ED problem much worse.
Its always the same answer. People stuffing their faces with garbage food and chilling on the couch all day. Apparently there was an explosion of obesity in UK during covid. These people clog up all the available supply leaving very little for the rest. Its the same story everywhere. Ppl whine about funding, shortages ect but no one cares about if we can do something about the demand.
Govt pushed covid vaccine on young healthy people saying its good for the community if we all get it and its our duty to society. So why isn't getting off the couch and going for a walk considered duty to society.
lol. i don't see how this being marketed as duty to society like covid vaccine. No denunciation or shaming of voluntarily obese as a strain on society. No "COVID is a disease of unvaccinated" by the presidents.
90% of health care costs are attributable to chronic disease in usa per cdc. [1]
Americans with five or more chronic conditions
make up 12 percent of the population but
account for 41 percent of total health care
spending.
Hypertension, high cholesterol, diabetes are top chronic conditions. Course of treatment for all those is "lifestyle changes" ( along with meds for managment). [2]
It probably doesn't help that a lot of the medical staff were from the EU and just before COVID were PTFO.
I'm still waiting for those hospitals to be built by all the money saved by Brexit.