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by anonporridge 1201 days ago
My understanding after reading this article is that the problem has nothing to do with ambulances or medics. https://www.nytimes.com/2022/12/20/world/europe/uk-ambulance...

First order problem, the hospitals have no beds. This means that ambulances end up waiting for hours and medics twiddling their thumbs at the ER until the staff can finally take the patient. Medics can't just abandon the patient because there legally needs to be a proper handoff. So your emergency can't be responded to quickly because we can't trivially spin up thousands of new medic units to spend all their time waiting in line at the hospital.

Second order problem, the hospitals have no beds because of a lack of long term care services. From the article...

> There is an acute lack of beds in the accident and emergency department, or A&E, as emergency rooms are called in Britain, which are overcrowded because of an inability to find room for patients elsewhere in hospitals. That is because patients ready to be discharged from the hospital often have nowhere to go as a result of dwindling social services — which have been hobbled by a lack of government funding and severe staffing shortages.

Now the question is why aren't there enough non hospital care services? Could be many reasons, but I'd speculate that it's a combination of a) an increasing population of old, sick people who need care in a society whose demographics are beginning to turn upside down, and b) because Brexit means it's drastically harder to import poor, foreign workers willing to do the shitty job of elder care for low wages. If this prognosis is correct, it starts to beg the question of whether Britain's world renowned health care system was only possible because it could extract excess, cheap labor from poor countries to take care of their old people, when Britain's own young people were never going to do that work for the wages offered.

4 comments

> when Britain's own young people were never going to do that work for the wages offered

Too true. I’m from Canada where we worry nurses will go south of the border, but was recently in London at an NHS hospital and was talking about this with a nurse. Pay for nurses in Canada is on par with a Jr Developer here. (Still low for the hours and effort required!) By comparison, nurses in the UK make about as much as an intern or admin assistant. After all, single payer means there isn’t much pressure to raise wages from other sectors, you’ve a monopoly on nursing so you can set the wages at whatever level keeps staffing adequate, which isn’t the same thing as paying a living wage…

They also do not keep the wages at a level that keeps staffing near adequate.
My understanding is, to a large extent "beds" really means "physical bed and sufficient staff to support the patient in it" and the ingredient most missing is the latter.

Doctors tend to be ridiculously overworked in the UK. This is much worse recently - first doctors were off sick / isolating due to Covid. That means less doctors to do the same jobs having to work harder. That drives more doctors to either leave or take long term sick leave - goto 1.

b) is not exclusive to Britain. A very large portion of the US benefits from poorer countries to the south with high birth rates and porous borders. Probably applies to almost all large developed countries.
In the EU it's the east European countries. Without Bulgarian and Romanian workers the Austrian elderly care system might already have collapsed. There were even highly pucliciced exceptions during strict lockdowns
Nurses in the US earn at least 3x their UK counterparts though.

Same for doctors, dentists, etc. too.

Yea, but we are starting to see upcoming issues with nurses in the US where some places just don't have enough. Granted, this is more because hospitals are trying to keep their number of nurses as low as possible. The hospital my wife works at, they suppress the number of nurses when they in fact need more and just hire travel nurses on demand. Then they complain that travel nurses cost too much. I don't think pay is the only factor here. Nurses get paid great by hospitals, but also still get treated like shit. My wife doesn't even get bathroom breaks during her 12 shift and most of the time no lunch break because there is never a nurse available to cover for a 30 minute lunch or a 5 minute bathroom break.
The care home vaccine mandates were far more impactful than Brexit. There were mass resignations when the government forced care home workers (and only them) to take the COVID shots.