NHS Problems....

[GeneralVeers]

Interesting read:
British PM May apologizes as overwhelmed hospitals cancel non-emergenc

All you proponents of socialist medicine in the U.S. should be aware of what you are asking people to accept in place of the current system. As bad as the flu outbreak has been in my area this year, at least we are able to adapt, and scale the system up to deal with it, and not disrupt the routine practice of medicine.

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[xaelia]

Interesting read:
British PM May apologizes as overwhelmed hospitals cancel non-emergenc

All you proponents of socialist medicine in the U.S. should be aware of what you are asking people to accept in place of the current system. As bad as the flu outbreak has been in my area this year, at least we are able to adapt, and scale the system up to deal with it, and not disrupt the routine practice of medicine.

Glad to hear your facility is seamlessly handling the increased volume; our inpatient census has been so high, the resultant ED congestion leads to going on divert. It has been unpleasant these past couple weeks in the ED.

The current problems with the A&E and the NHS, however, are not a symptom of "socialized" medicine – moreso "austerity". Nothing functions adequately if inadequately funded. Don't forget the vast majority of healthcare systems in other modernized countries are "socialized", and they aren't developing sensational newsworthy problems. To pick out the NHS struggles as emblematic of "socialized" medicine is akin to the Trump tweet begging for global warming because it's so cold on the East Coast these days.

 

[Vandalia]

Second. Two of our affiliated hospitals have completely closed down to flu cases. No new patients. If your facility has the ability to handle a large surge, then you are wasting taxpayer's money on excess capacity.

Also, if the "Brexit leave" campaign had kept their promise to add $500M/week to the NHS, this probably would not have been an issue.

https://www.usnews.com/news/top-new...al-health-service-wont-reap-promised-millions

EDIT: My niece's kid was just diagnosed with the flu. Apparently there is no Tamiflu within 75 miles of where they live. (Whether he actually needs/will benefit from it is a topic for another post...)

 

[KGflyboy]

The current problems with the A&E and the NHS, however, are not a symptom of "socialized" medicine – moreso "austerity". Nothing functions adequately if inadequately funded. Don't forget the vast majority of healthcare systems in other modernized countries are "socialized", and they aren't developing sensational newsworthy problems. To pick out the NHS struggles as emblematic of "socialized" medicine is akin to the Trump tweet begging for global warming because it's so cold on the East Coast these days.

Sure... The underlying cause may be a healthcare system operating in the red, but that doesn't change the fact that it's only possible for the government to cancel surgeries like this in socialized healthcare. This wouldn't really ever happen with self pay or private insurance healthcare systems. Regardless of the cause of these financial woes, socialized medicine is the only system that allows the government to suddenly just cancel thousands of procedures.

 

[Perrotfish]

it's only possible for the government to cancel surgeries like this in socialized healthcare. This wouldn't really ever happen with self pay or private insurance healthcare systems.

True, but that actually seems like an argument FOR socialized healthcare. When slightly underfunded NHS hospitals face a terrible flu season they can triage at the hospital level, saving their limited bed space by putting off elective surgeries. Meanwhile our slightly underfunded hospitals go on divert and evacuate ICU level flu patients halfway across the state to the nearest open bed, while continuing to fill beds with elective hip, spinal, and bariatric surgeries.

 

[DeadCactus]

Healthcare system A has to delay elective cases during a particularly rough flu season while spending less than 10% of its GDP on healthcare and not bankrupting its citizens.

Healthcare system B spends 20% of the GDP on a healthcare system and bankrupts many of its citizens, but hey they can keep getting elective procedures (many of dubious clinical value) at a time when healthy people should be avoiding healthcare settings like the flu (like what I did there?).

Well, I'm convinced.

 

[GeneralVeers]

There you go again.....

Glad to hear your facility is seamlessly handling the increased volume

I never said that it was seamless. The 45 patients I saw (plus the 50 my PA saw) on X-mas day is testament to that. We didn't have to cancel any urgent or elective outpatient procedures, and no patients were left sitting in ambulances for hours at a time.

The current problems with the A&E and the NHS, however, are not a symptom of "socialized" medicine – moreso "austerity". Nothing functions adequately if inadequately funded.

Austerity is any amount of funding less than infinity to socialists. Even in our own system, where I agree we spend too much, there are shortages, and rationing. In a "Free" system like the NHS, Britain could funnel the entire country's budget into healthcare, and still run into shortages and rationing. There is unlimited demand for healthcare, therefore even unlimited funding wouldn't fix all the problems.

 

[deleted480308]

True, but that actually seems like an argument FOR socialized healthcare. When slightly underfunded NHS hospitals face a terrible flu season they can triage at the hospital level, saving their limited bed space by putting off elective surgeries. Meanwhile our slightly underfunded hospitals go on divert and evacuate ICU level flu patients halfway across the state to the nearest open bed, while continuing to fill beds with elective hip, spinal, and bariatric surgeries.

Or you could do something crazy and allow hospitals to demand payment to hold a bed....then no occupied bed is “underfunded”

 

[Perrotfish]

I never said that it was seamless. The 45 patients I saw (plus the 50 my PA saw) on X-mas day is testament to that.

You made this thread about how the NHS provides substandard care, and then post that you had a PA seeing more than 4 ER patients per hour?

 

[GeneralVeers]

You made this thread about how the NHS provides substandard care, and then post that you had a PA seeing more than 4 ER patients per hour?

'
Yes. We are rock stars.

 

[Angry Birds]

Read The Righteous Mind to understand how the brain of GeneralVeers works.

 

[GeneralVeers]

Read The Righteous Mind to understand how the brain of GeneralVeers works.

Someone needs to represent the forces which oppose socialism. To equate me seeing 45 patients in a day, with the much more massive problems of the NHS is not a reasonable argument. Although it happens, it's hardly the norm.

 

[Perrotfish]

To equate me seeing 45 patients in a day, with the much more massive problems of the NHS is not a reasonable argument. Although it happens, it's hardly the norm.

The NHS postponing elective surgeries is not the norm either. Both are responses to the worst flu season in years. The NHS's approach of diverting more resources to deal with the flu problem, though, is designed to minimize harm at the cost of some inconvenience to the patients. The approach at your hospital, where a PA is seeing 4 pph without supervision (and you're not supervising if you're seeing your own 4 pph) is designed to maximize profit and minimize patient inconvenience, while putting patients at enormous risk.

If the NHS is having 'massive problems' you haven't mentioned any of them in this thread. You're actually making a very good case that our system is less rational than a healthcare system where physicians and public health experts direct resources, rather than insurance companies and hospital CFOs.

 

[UKEMdoc]

Its an interesting situation.

Loyalty to the NHS is the closest thing the British have to a state religion. At the moment it is in a mess - in real terms, per capita it's actually been getting budget cuts despite an ageing population, expensive new therapies, increased expectations etc.

The core of the NHS is General Practitioners - everyone has a GP who has complete responsibility for their care, referrals, well patient checks etc. Except for the ED there is no access to hospital specialities without a referral from your GP. There's a thriving private sector thats either insurance or self pay based for elective surgery/procedures as well as some outpatient specialities. They tend to go for the "low hanging fruit" so no high risk patients and very few private ICUs. I probably wouldn't want to be in a private hospital if I became seriously ill.

Traditionally everything was funded centrally but has now devolved to the point were there is an incredibly complex internal market between different organisations where different organisations bid to provide services.

Our big challenge is the same as everyone elses. People are getting older and living longer, but at the same time they're getting sicker and needing more treatment. We're nowhere near as bad as the US but are continually getting patients with terminal dementia arriving at the ED with families who say something needs to be done. While it's a doctors decision to make someone DNR/DNI it's much more difficult to refuse IV fluids/antibiotics. Theres a shortage of places in SNF and the ones we do have are pretty acopic and call an ambulance if a resident has "altered mental status" or a simple fall. We've got quite a significant welfare culture when it comes to using health resources as well.

Recently the government has been overtly antagonistic to the NHS, making unpopular changes to doctors contracts, publicly cutting budgets etc. My personal feeling(based on things said by the health secretary before he gained power) is that they want to deconstruct the health service and hand it over directly to private organisations.

Despite this we manage to do a hell of a lot of good work with not much money. If you want value for money then the British system is the way to go. If you want a knee replacement tomorrow, to get seen in 10 minutes in the ED, a private rooms or a 97 year intubated and dialysed then less so.

Unfortunately the problem with a single payer system is it only works if the single payer is willing to pay...

 

[UKEMdoc]

Parrotfish - where is this system that has resources directed by public health experts? Are you sure you weren't dreaming?

 

[UKEMdoc]

Another point - people posting on the internet about how many patients they saw in their last shift is like listening to fisherman after they've been in the bar for a few hours.

 

[BoardingDoc]

Theres a shortage of places in SNF and the ones we do have are pretty acopic and call an ambulance if a resident has "altered mental status" or a simple fall.

I enjoy how you used a word which has 2 meanings which in this context are direct antonyms of one another. That said, it's clear what you meant.

 

[carbonizedeyesockets]

'
Yes. We are dangerous.

Fixed it. You may have rose to the occasion when there was a surge in patients. But, in no way at all is that ideal, and frankly can be down-right dangerous. I see no point in bragging about seeing that sort of volume unless you are a PCP seeing patients in the office. The fact that you and a PA had to see so many patients during a surge in volume is a failure of the system in and of itself.

 

[deleted109597]

Fixed it. You may have rose to the occasion when there was a surge in patients. But, in no way at all is that ideal, and frankly can be down-right dangerous. I see no point in bragging about seeing that sort of volume unless you are a PCP seeing patients in the office. The fact that you and a PA had to see so many patients during a surge in volume is a failure of the system in and of itself.

The failure is in the fact that American Patient has become a twittering fool. 95% of my flu patients are there for Tamiflu and a work note. Sometimes I have to teach the parents of kids how to dose Tylenol. They're not all dying. We aren't that far ahead of 2015/2016 season pace (look it up on the CDC).
I could see 30 of those patients an hour and not break a sweat. What we need is for people to stop going to the doctor for every minor thing. I get it, you have the flu. It sucks. You still have a pretty good chance of being alive tomorrow. If you start being less alive, then come back.

 

[WilcoWorld]

The failure is in the fact that American Patient has become a twittering fool. 95% of my flu patients are there for Tamiflu and a work note. Sometimes I have to teach the parents of kids how to dose Tylenol. They're not all dying. We aren't that far ahead of 2015/2016 season pace (look it up on the CDC).
I could see 30 of those patients an hour and not break a sweat. What we need is for people to stop going to the doctor for every minor thing. I get it, you have the flu. It sucks. You still have a pretty good chance of being alive tomorrow. If you start being less alive, then come back.

10 years ago I knew an ED nurse who started every encounter with "What's your emergency?" I'm pretty sure she'd get reprimanded for that in my current workplace.

 

[GeneralVeers]

Fixed it. You may have rose to the occasion when there was a surge in patients. But, in no way at all is that ideal, and frankly can be down-right dangerous. I see no point in bragging about seeing that sort of volume unless you are a PCP seeing patients in the office. The fact that you and a PA had to see so many patients during a surge in volume is a failure of the system in and of itself.

I'm not going to argue it's not dangerous. I don't want to see 40 patients on a shift. fortunately it happens rarely, and it's the only time in the last 3 years I can recall doing so. We responded by hiring extra PAs and increasing their hours to cover the surge. We did it without disrupting the regular flow of hospital business.....which was my point. Ideal? Absolutely not.

I still see nothing in your argument to suggest that a vast re-organization of our healthcare under a command economy would be any better. You would simply trade one set of problems for another, while possibly exacerbating existing access shortages.

 

[Apollyon]

10 years ago I knew an ED nurse who started every encounter with "What's your emergency?" I'm pretty sure she'd get reprimanded for that in my current workplace.

You'd be correct. I was saying that, and I was told, directly, to stop.

 

[carbonizedeyesockets]

I'm not going to argue it's not dangerous. I don't want to see 40 patients on a shift. fortunately it happens rarely, and it's the only time in the last 3 years I can recall doing so. We responded by hiring extra PAs and increasing their hours to cover the surge. We did it without disrupting the regular flow of hospital business.....which was my point. Ideal? Absolutely not.

I still see nothing in your argument to suggest that a vast re-organization of our healthcare under a command economy would be any better. You would simply trade one set of problems for another, while possibly exacerbating existing access shortages.

However, surges can be unpredictable and the duration can be prolonged and it is imperative that the system respond to accommodate in the best way possible. And sometimes that does mean having to cancel elective procedure or other functions. I worked during a large MCI where the sudden influx of patients quickly became everyones problem. And while I think we responded superbly as a ED and as a hospital at the time of the incident, the hospital functions were affected for many days. Many elective procedures had to be rescheduled (mostly surgical, since ortho had many many operative cases), including radiologic ones since radiologists had hundred of CTs and Xrays to read since in a 4 hour period there were more xrays and cts than in a normal 24 hour period. If there is a massive influx of flu, even if largely man-flu, we all know that flu can be devastating and deadly for many and those cases will certainly be mixed in with the garbage. Even if the overwhelming majority if folks with adult-baby syndrome, there WILL be truly sick people to be dealt with who will require beds. And if its between grandpa getting his new hip (and the bed afterward) vs. the grandma with sepsis, it a no brainer. There's limited resources and rationing in a "socialized" system, for sure. But, lets not pretend that there isn't limited resources and rationing here. It occurs everyday.

As far as your unfortunate shift, you and your PA upped your speed etc. We agree it was not safe, but it what was "needed" to be done with the resources you had. But, with proper planning at a system/departmental level, there would be a mechanism for calling in additional physicians or PAs to help manage rare surges in volume so you and the PA don't have to work at such a precarious pace. (We're not talking about a gradual increase in volume where you hire additional physicians or PAs.)

What it sounds like, is that the NHS is responding to a surge. Their overall response may not be the best or most thought out, but cancelling elective procedures to free up beds for those needing to be hospitalized seem totally reasonable.

 

[GeneralVeers]

What it sounds like, is that the NHS is responding to a surge. Their overall response may not be the best or most thought out, but cancelling elective procedures to free up beds for those needing to be hospitalized seem totally reasonable.

Culturally Britons might be okay with this, but I can't imagine this EVER happening in the U.S. without tremendous uproar, not to mention lawsuits. Which again goes back to why this system won't work in our country.

 

[WildcatS11]

Culturally Britons might be okay with this, but I can't imagine this EVER happening in the U.S. without tremendous uproar, not to mention lawsuits. Which again goes back to why this system won't work in our country.

You think there would be lawsuits from postponing elective procedures? I’m not sure I follow.

 

[GeneralVeers]

You think there would be lawsuits from postponing elective procedures? I’m not sure I follow.

Yes. Pain and suffering. Lost wages. Disability. A savvy lawyer could come up with thousands of reasons.

 

[WildcatS11]

Yes. Pain and suffering. Lost wages. Disability. A savvy lawyer could come up with thousands of reasons.

Hm. I disagree. I dont believe here are grounds for litigation for changing the date of an ELECTIVE procedure/surgery.

 

[goodoldalky]

Hm. I disagree. I dont believe here are grounds for litigation for changing the date of an ELECTIVE procedure/surgery.

Lol.... you don’t need to have a good reason to sue somebody, this is America!

 

[VA Hopeful Dr]

However, surges can be unpredictable and the duration can be prolonged and it is imperative that the system respond to accommodate in the best way possible. And sometimes that does mean having to cancel elective procedure or other functions. I worked during a large MCI where the sudden influx of patients quickly became everyones problem. And while I think we responded superbly as a ED and as a hospital at the time of the incident, the hospital functions were affected for many days. Many elective procedures had to be rescheduled (mostly surgical, since ortho had many many operative cases), including radiologic ones since radiologists had hundred of CTs and Xrays to read since in a 4 hour period there were more xrays and cts than in a normal 24 hour period. If there is a massive influx of flu, even if largely man-flu, we all know that flu can be devastating and deadly for many and those cases will certainly be mixed in with the garbage. Even if the overwhelming majority if folks with adult-baby syndrome, there WILL be truly sick people to be dealt with who will require beds. And if its between grandpa getting his new hip (and the bed afterward) vs. the grandma with sepsis, it a no brainer. There's limited resources and rationing in a "socialized" system, for sure. But, lets not pretend that there isn't limited resources and rationing here. It occurs everyday.

As far as your unfortunate shift, you and your PA upped your speed etc. We agree it was not safe, but it what was "needed" to be done with the resources you had. But, with proper planning at a system/departmental level, there would be a mechanism for calling in additional physicians or PAs to help manage rare surges in volume so you and the PA don't have to work at such a precarious pace. (We're not talking about a gradual increase in volume where you hire additional physicians or PAs.)

What it sounds like, is that the NHS is responding to a surge. Their overall response may not be the best or most thought out, but cancelling elective procedures to free up beds for those needing to be hospitalized seem totally reasonable.

I think there's a fairly large difference between a lot of elective procedures getting cancelled because of a mass casualty event, and a lot of procedures getting cancelled because the flu season is a little bit worse than usual.

 

[d2305]

Britannia no longer rules the waves due to NHS.

 

[deleted109597]

Hm. I disagree. I dont believe here are grounds for litigation for changing the date of an ELECTIVE procedure/surgery.

Hahahahahaha
Sure there is. They had 2 more weeks of pain before their elective hip, GB, knee, whatever.
Or now they're hooked on pain meds.
Or truthfully, because it didn't happen right now like they want it to.

 

[Dr Mantis Toboggan]

Also that tumor now has a few months to grow and potentially metastasize...

I know a doc who did medical school in the UK and residency here, such delays were not uncommon. He told me they frequently occurred when the NHS ran out of money, in about Sept/Oct...

Hahahahahaha
Sure there is. They had 2 more weeks of pain before their elective hip, GB, knee, whatever.
Or now they're hooked on pain meds.
Or truthfully, because it didn't happen right now like they want it to.

 

[deleted480308]

It’s almost like blind trust that others will buy you things puts you at their mercy

 

[d2305]

Socialism

 

[UKEMdoc]

Traditional thinking is that the loss of British Empire was inevitable as demonstrated by the independence of India a year before inception of the NHS.

I really don’t think there’s much point discussing “socialised medicine” there’s such a divide between the US and the rest of the first world on the topic that it’s almost impossible to reach any common ground.

Regarding getting sued, how about a system where losers pay the fees, vexatious litigants are prevented from taking suits and payouts are determined by formulas based purely on actual measurable harm sustained?