NHS - Beware

[DRD]

I have seen a mixture of good and bad with the NHS. Friends of mine work in it. But this story should be shared. As should the reaction from a totally unconnected early 50s GP friend of mine that I forwarded the message to.

I have a late 40s friend with long term lupus which is an auto-immune disease. You would not know anything was amiss if you met her, she appears fit and healthy with low BMI. This condition predates and is nothing to do with the covid jabs.

I received this terrifying message from her husband today. Mercifully they are currently in South Africa so she received proper healthcare in the nick of time.

"So here's another anecdote for you. XXX injured her leg five weeks ago - a big gash. A&E for 4 and a half hours patched up and dismissed. No antibiotic no painkiller. A week later the gash had turned black the wound was worse and so her gp then gave her some weak antibiotics. Wound carried on weeping and wouldn't heal. A&E this time at [UK Hospital]. Four hour wait whereby they cleaned the wound but said no more could be done. Three weeks by this stage with XXX incapacitated and myself running around doing everything including renovating the house. Back to the gp who now administers a super strong antibiotic - ten days course. No joy - leg still swollen still not healed. We are now at five weeks with XXX still hardly able to walk as we get on the plane to SA. Off at Joburg XXX's leg has swollen to the size of a balloon. Rush to the doctor who instantly books her into [Joburg Hospital] same day. Her lymph nodes all the way up her leg had chocked up and she was five minutes away from getting gangrene. She was already suffering from cellulitis. Operated on the next day by a wound specialist ,IV for 48 hours straight. £3500 later she is finally healed although walking on crutches. Two doctors and the surgeon confirmed that if she hadn't arrived when she did she was in serious danger of losing her ****ing leg."

My UK GP mate's response:

"Daily occurrence unfortunately and it's likely to get worse"

 

[Tilt_Birmingham]

People only share the $hitty stories...

You love South Africa don't you always plugging it...

 

[DRD]

If you have experienced SA/ French/ Australian healthcare - as I have - you can compare and contrast.

 

[Doggard]

Unfortunately our nhs isn’t perfect, you will always here good and bad stories.
10 years ago my wife ended up in a+e, after a failed suicide attempt, jumping from a bridge. She was declared paralyzed from the waist down, 4 operations later, and 6 months in hospital, and she ended up being able to walk ( aided) with limited mobility. Both me and my wife are eternally grateful for everything they done, and the care she received, the nhs were truly amazing.
On the flip side, had she had the proper care and attention from the mental health specialists, she most probably wouldn’t have ended up in hospital.

 

[Fantazia2]

I would have to ask if her leg was that swollen why she was getting on a plane to start off with, was it discussed with a medical expert about flying I that condition?

 

[Wizcat]

I had a lump appear on my ear a month or two back. Phoned the doctors on a Thursday, they saw me the same day. Booked me in with a specialist Tuesday, After seeing the specialist she booked me in to have it excised on the Thursday.

One week from bringing it to their attention to having it removed and sent for biopsy. I was impressed. All NHS by the way, and over the Xmas period.
(Totally benign it turns out, but still)

 

[Wayne J]

I work withing the NHS, and have been a patient recently, and have had loved ones as a patient.

To be frank, it's a show, a lottery.

I got seen for a physical injury quickly, because I went direct to Theatres (where I work) and was able to get seen quickly - under 2hrs. The aftercare was appalling and resulted in a delay of 3 months to partial recovery.

I've also had tests for bowel and prostate cancer, which although fast tracked because I was staff, I still don't have answers for over 9 months on.
I also had a vasectomy start without anaesthetic - trust me in this, you do NOT want to experience the same.

A loved one had an excision of a cyst, but again the aftercare was awful and took over 4 months, when it should have been under 4 weeks. She is now too terrified to have life improving surgery because of that experience.

90% of all staff who work within the NHS go above and beyond their duties/pay grade to try and ensure that the patient gets the best treatment they can.


BUT, as long as the NHS is used as a political l issues will continue. The NHS isn't poorly funded, its poorly ran - with little to no accountability to the higher management/directors. I've seen Directors come in to Walsall - **** up - and then move to another position in another Trust. In the Private Sector they'd just be sacked for being incompetent.

The sooner the NHS is privatised the better - AS LONG AS PATIENT CARE REMAINS FREE

 

[Crewey]

NHS removed a tumour in my skull 20 years ago very very quickly after discovery, I have had multiple tumours start to regrow in the last few years so I require regular MRI.
There’s no way that would be affordable, I am very F’ing thankful I was born here

 

[Sam C]

The sooner the NHS is privatised the better - AS LONG AS PATIENT CARE REMAINS FREE

I'm always curious about this sentiment - privatisation is sold as some sort of magical fix that will make all the problems go away overnight but nobody seems to be able to explain how. If it's anything like the absolutely disaster/failed experiment of privatising the railways my opinion is always steer as far away from privatisation as is humanly possible. I'm not sure privatisation and 'free' ever go together, all it seems to do is serve to make people money when services are changed in this manner. It no longer becomes about providing a service, but making maximum profit for minimal expenditure. A step towards the American system like this would be my personal nightmare, unless it can somehow remain free.

Particularly what I hear is that especially for private healthcare currently, if they're unable/unequipped to deal with the patients issue they send them to the NHS anyway.

Can you enlighten me on this one Wayne? Seeing as you have your ear closer to the ground than most being in the NHS.

Personally my own use of the NHS has been good. I had an operation a couple of years ago that was identified on a follow up correctly after my initial contact with my local GP identified it incorrectly, but he sent me to see someone who did identify it properly. After this I was pretty quickly in short order booked in for the required op with 3 months roughly to wait.
Operation went well, however describing the aftercare as nonexistant would be an understatement. I was packed off with no dressing or follow up contact. What I found out afterwards was that the hospital should have contacted my local practice to schedule weekly visits to a nurse until the wound was fully healed.
And this is where I believe privatisation is utter c*ap - because the hospital I went to is primarly a PRIVATE HOSPITAL. They do however take a small number of NHS patients for operations which I took advantage of - so telling people privatisation is going to magically fix everything is total b*llocks, here the private hospital made the major mistake.
Once it was rectified - caught when I got an infection (due to said private hospital not properly scheduling any sort of follow up, even when they were supposed to hand it off to the NHS) and an NHS urgent care nurse caught it, then put me in contact with my local practice to schedule the weekly appointments, it was discovered that the private hospital should have done all this and didn't (we did contact them to explain all this, that's another story). After that, the care from the NHS was great and a course of antibiotics later I made a full recovery after months of resting up properly.
So because of that, I am one of those 'NHS all the way' people. The care I got from the NHS was brilliant, and while the private hospital conducted the operation, they were utterly useless with aftercare. I dread to think what a patient spending thousands on the same thing I had done for free would have thought!!!

 

[Colywobbles]

I have a very good friend and fellow Pinhead who works in the private sector as a consultant. The majority of his working life he was with the NHS but was poached away with the lure of less hours and a shed load of more money.

When told him of my diagnosis last year and the endless waiting and cancelled appointments I asked would I be better off going private.
His advice was to hassle my consultants secretary and ring on a weekly basis till they addressed my concerns. Which I did and it worked!
However he steered me away from private saying if it was a simple knee rebuild or hip replacement then yes but having a kidney removed due to a tumour is best dealt with at a general NHS hospital. He has seen 1st hand what happens when things go wrong with complex operations and patients are immediately shipped to the general by blue light to fix the problems.
NHS hospitals have all the facilities and specialists to cope with whatever when the unexpected happens.
This may not be for all private hospitals mind you but that was his advice and he works at a north east private hospital.

BTW I am getting regular MRIs and follow-ups and they have already picked up on a liver problem that’s being looked into less than a week after my latest blood test flagged a few problems.
I feel in good hands with the NHS albeit I realise they are under a lot of pressure and something has to give and the tide of longer waiting lists and cancelled appointments is now the norm sadly.

 

[JT.]

I'm always curious about this sentiment - privatisation is sold as some sort of magical fix that will make all the problems go away overnight but nobody seems to be able to explain how.

It's not correct, and that's backed up by overwhelming academic evidence. These anecdotal stories are worthless in terms of evidence of anything I'm afraid.

Large bureaucracies in the private sector are just as inefficient, and suffer from the exact same issues, as large bureaucracies in the public sector. Most of the issues we hear about in the NHS are simply characteristics of all large bureaucracies. Conversely, evidence of private sector 'success-stories' tend to be situations where they have cherry-picked provision of some small part of a service, separated it out from the bureaucracy, run that small thing well and profitably, whilst leaving any complex and unprofitable aspects of it behind for the NHS to pick up.

One key difference in the scenarios, though, is that public sector organisations have to be transparent, so you hear about the issues in the national press; whereas the private sector publish as little as possible, least of all about their screwups and problems.

 

[VeeMonroe]

I work withing the NHS, and have been a patient recently, and have had loved ones as a patient.

To be frank, it's a show, a lottery.

I got seen for a physical injury quickly, because I went direct to Theatres (where I work) and was able to get seen quickly - under 2hrs. The aftercare was appalling and resulted in a delay of 3 months to partial recovery.

Yes, after care seems to be a fail point.

I waited 7 hours to be seen with my broken shoulder, had a X-ray and CT done in that time, and had someone come down from orthopaedics - not wonderful, but not incompetent. However, I was sent home with no discharge instructions, no idea where the exact breakage was, and the wrong sling, which was so poorly fitted that I had to pay £100 for a private physio within two days because of the severe muscle pain in my back, chest and shoulders (i.e. the sling was causing more pain than the broken bone)!

When I returned for a follow-up appointment a fortnight later, I was given the correct sling, shown the X-ray, and provided with lots of helpful advice from a specialist nurse. However, she mentioned in passing the number of people who turn up for their follow-up with their arm twice the size and their shoulder broken worse than when they started.

Realistically, I should have got the advice and discharge information a fortnight *before* the follow-up, not during it! As it was, I’d made use of Google!

The sooner the NHS is privatised the better - AS LONG AS PATIENT CARE REMAINS FREE

Private healthcare, which we’ve made extensive use of in the past, as my husband has work health insurance, is definitely faster, and more experimental, but not necessarily better. I ended up with an A&E visit, a cancer scare, and nearly a year of continuous pain as a result of a botched private IVF cycle, which the clinic denied having anything to do with. If we’d been in the States, we’d have lawyered up.

 

[crsedgar]

re: privatisation concens

The taxpayer still funds the railways via large subsidies, you don't think this would happen with NHS.

Look at the private English water companies, quite a topical subject, not a success story and who will have to bail them out.

 

[Arv]

I waited 7 hours to be seen with my broken shoulder, had a X-ray and CT done in that time, and had someone come down from orthopaedics - not wonderful, but not incompetent. However, I was sent home with no discharge instructions, no idea where the exact breakage was, and the wrong sling, which was so poorly fitted that I had to pay £100 for a private physio within two days because of the severe muscle pain in my back, chest and shoulders (i.e. the sling was causing more pain than the broken bone)!

I've found you have to ask questions and lots of them to get the information you require from them. I had to tell them once my late father had sepsis as i'd seen the symptoms before - they didn't believe me of course and did the tests and low and behold.

 

[Wayne J]

I'm always curious about this sentiment - privatisation is sold as some sort of magical fix that will make all the problems go away overnight but nobody seems to be able to explain how.

Can you enlighten me on this one Wayne?

The biggest issues I see on a day to day basis are that:

There is no accountability for spend - it's seen as having an unlimited bottomless pot of money and it's easy to blame the government (whoever is currently in power) for underfunding. This simply isn't the case, money is poorly managed. WMH is 17mil overspent year to date, but still nothing changes.

There is no accountability for poor performance - the number of staff members I work around who are bordering on incompetent is unbelievable. In the private sector they would either be performance managed or sacked. It simply doesn't happen in the NHS due to a combination of the strength of the unions, and the fact that a significant number of managers have no management experience - they are promoted from a purely clinical background to senior roles based on length of service.

Consultants are like magpies - they are shown something new and shiny by a rep and they MUST have it, regardless of the costs. I've seen business cases presented which are clearly made up from falsified numbers - but the people in procurement let it ride. This is either due to incompetence i.e. not able to read the data, or negligence i.e. it's easier to let it pass than challenge it, or shudder the thought from 'inducements'.

The pay structure - the pay structure is very rigid, based on the categorisation of your job. If you remain in the same position, you get an increase in each of your first 8 years (a don't get sacked bonus) - on top of the annual pay increase which is what is being fought over in the media. The pension is also a significant factor, and substantial. It means that staff have no incentive to go above and beyond, as there are no way bonuses can be paid on performance, it also means that when staff are 2, 5 even 10,15 years out from retiring they are financially tied to the NHS as they couldn't get a better pension elsewhere. It leads to staff doing just enough not to get sacked in that period so that they can collect their pensions.

It is simply too large - trying to have a single entity manage just the hospitals from a single set of rules (ignoring the other parts of the NHS) is simply ridiculous. Especially as it is seen by the politicians as a vote winner. It needs breaking down in to smaller chunks, whether that be by region, speciality or even both.

The above would all be addressed by having it 'privatised'. The government would still fund a hospital with an annual budget, and set rigid targets on performance, but it is up to that hospital as to how to spend it efficiently. Bonuses would then be paid out at the end of the year based on said performance.
I've offered to work for 'free' without any salary or pension - just take 5% of any savings I can identify purely from purchasing, without even considering improved practices and procedures. I'd have more than enough money from that to buy every LE that comes out!

 

[DRD]

The fundamental problems here are accountability and choice.

If the NHS were broken into pieces then some people could choose hospital co A rather than hospital co B. Just like they choose other services. That could lead to a profound transformation in standards over time if managed properly.

Any monopoly provider is at serious risk of offering low standards - as high standards require effort/ discipline/ hardship. Look at delays getting HGV licences, passports, probate, planning permission, border force ......

Privatisation is not a silver bullet. I worked with companies involved with the outsourcing of school meals, council house maintenance etc etc. Some local authority union agreements were eye wateringly stupid. The then Labour government did not have the stomach/ political will/ ability to sort out grotesque inefficiencies.

So it transferred all the kit, the people, the buildings over to private sector contractors to run these services. The private sector had the will to take on unions and make unpopular decisions. It was not terrified of public sector strikes the way the various government bodies are

That led to immediate productivity improvements, the application of common sense....... BUT you now had a new monopoly provider financially incentivised to produce the lowest acceptable and cheapest services it could.

There is no easy fix to the NHS. It would take Thatcher in her prime/ Rudy Giuliani in his prime- politicians willing to be unpopular for extended periods of time. Starmer and Sunak ain't got anything like the bottle to take on a challenge of this scale.

 

[crsedgar]

Interesting read Wayne, good to hear from someone on the ground. I'm just not sure privatisation is quite a silver bullet but happy to be wrong.

From my experience private companies have plenty of incompetent people moved around, some into management without training. I suspect they are just as vulnerable to these inefficiencies as the public sector maybe just not as extreme.

 

[Wayne J]

It would take Thatcher in her prime/ Rudy Giuliani in his prime- politicians willing to be unpopular for extended periods of time.

And this is the real problem - politicians too interested in not upsetting the public so they get voted back in.

Removing, or at least distancing, politicians from the NHS would improve it significantly

 

[VeeMonroe]

I've found you have to ask questions and lots of them to get the information you require from them. I had to tell them once my late father had sepsis as i'd seen the symptoms before - they didn't believe me of course and did the tests and low and behold.

I do normally, but my will had been sapped by seven hours with no food and limited water sitting in a boiling hot, crowded waiting area with a broken shoulder/black eye/facial bruising/bleeding knee.

I’d already had the experience, the previous year, of sitting overnight for 12 hours in the same A&E with such severe internal abdominal bleeding that I couldn’t get comfortable in any position except bolt upright, and no one could be found to come down from gynaecology to take a look… and I was worried I was going to have that experience over again.

By the time someone came down from orthopaedics, I just wanted to get out of there, to be honest!

I’d known from hour four, when I had the x-ray, that my shoulder was broken and there was likely nothing they could do besides painkillers and a sling. I just needed someone to confirm that and issue me with the sling, but no one in A&E could do that without sign off from orthopaedics, and no one from orthopaedics turned up. A better organised system could have got rid of me at the four-hour mark by giving me a sling and a leaflet.

 

[Sam C]

The biggest issues I see on a day to day basis are that:

There is no accountability for spend - it's seen as having an unlimited bottomless pot of money and it's easy to blame the government (whoever is currently in power) for underfunding. This simply isn't the case, money is poorly managed. WMH is 17mil overspent year to date, but still nothing changes.

There is no accountability for poor performance - the number of staff members I work around who are bordering on incompetent is unbelievable. In the private sector they would either be performance managed or sacked. It simply doesn't happen in the NHS due to a combination of the strength of the unions, and the fact that a significant number of managers have no management experience - they are promoted from a purely clinical background to senior roles based on length of service.

Consultants are like magpies - they are shown something new and shiny by a rep and they MUST have it, regardless of the costs. I've seen business cases presented which are clearly made up from falsified numbers - but the people in procurement let it ride. This is either due to incompetence i.e. not able to read the data, or negligence i.e. it's easier to let it pass than challenge it, or shudder the thought from 'inducements'.

The pay structure - the pay structure is very rigid, based on the categorisation of your job. If you remain in the same position, you get an increase in each of your first 8 years (a don't get sacked bonus) - on top of the annual pay increase which is what is being fought over in the media. The pension is also a significant factor, and substantial. It means that staff have no incentive to go above and beyond, as there are no way bonuses can be paid on performance, it also means that when staff are 2, 5 even 10,15 years out from retiring they are financially tied to the NHS as they couldn't get a better pension elsewhere. It leads to staff doing just enough not to get sacked in that period so that they can collect their pensions.

It is simply too large - trying to have a single entity manage just the hospitals from a single set of rules (ignoring the other parts of the NHS) is simply ridiculous. Especially as it is seen by the politicians as a vote winner. It needs breaking down in to smaller chunks, whether that be by region, speciality or even both.

The above would all be addressed by having it 'privatised'. The government would still fund a hospital with an annual budget, and set rigid targets on performance, but it is up to that hospital as to how to spend it efficiently. Bonuses would then be paid out at the end of the year based on said performance.
I've offered to work for 'free' without any salary or pension - just take 5% of any savings I can identify purely from purchasing, without even considering improved practices and procedures. I'd have more than enough money from that to buy every LE that comes out!

Thanks Wayne that provides a lot of information I wasn't aware of, interesting read.

I suppose my only query is this part:

The above would all be addressed by having it 'privatised'. The government would still fund a hospital with an annual budget, and set rigid targets on performance, but it is up to that hospital as to how to spend it efficiently.

I don't know if you know much about how they privatised British Rail but this sounds extremely similar to what the Government have tried to do there, albiet without the funding part (The Government still pay and maintain the infrastructure, stations/tracks/signals etc whereas the companies are run by private entities trying to make a profit). What happens is they get in 'Franchisees' (Private firms) to attempt to run these services at profit, but the Government basically tells them what trains they have to run and when to an extent to provide the service. Basically imagine a company with little to no room to manouver outside the strict Government targets but still trying to make a profit. All these companies get picked on the lowest bidder as well, AKA who thinks they can run the service at maximum profit. It's why apart from a few, most rail operating companies fail within 3-4 years because under this model they simply cannot make any money and pull out. The Government then steps back in to run their trains as an operator of last resort, because a service must be provided (ironically in 1 case, the company the Government operated became the third best in customer satisfaction in the short time they took it on). I could see this happening if a similar model was adopted by the Government if the NHS were to go - they'd constantly be stepping in every time a private company failed because they simply can't meet the Governments targets/what was agreed when they took it on. You'd have even more chaos (see the state of British Rail).

Obviously healthcare is vastly different and it would work differently, but this does feel like a very similar model to what currently runs the railways and its a monumental failure. I'd need some serious convincing privatation has any benefit for anybody besides lining peoples pockets due to what has happened with the railways, sewage dumping etc etc - all public services sold off to 'privatisation' in the aim of improvement but have actually gotten worse. I take quite a lot of your points however.

I have a family member who is reasonably high up in the NHS and his perspective on the entire thing mainly is 'Leave the NHS alone.' - I don't remember the argument exactly it was after a few beers, but his main point was every time a new Government/Health Minister comes in they constantly attempt to 'fix' the NHS by instituting new cost saving policies, different ways of working etc etc. He admitted there are lots of places things can be done better, but for the most part the NHS works well when you just let people get on and do their jobs. Constant Government meddling putting the NHS in a state of flux and turmoil every time there is a change is what is doing it in because nothing ever has a chance to settle and 'work'.

 

[Arv]

"I do normally, but my will had been sapped by seven hours with no food and limited water sitting in a boiling hot, crowded waiting area with a broken shoulder/black eye/facial bruising/bleeding knee."

Bugger that for a game of soldier's I'd of told them I'm nipping out for provisions. Ask for your position in the queue, they don't like giving it out but shy bairns get nae sweets.

 

[Lebowskis Rug]

If you have experienced SA/ French/ Australian healthcare - as I have - you can compare and contrast.

My father experienced French health care first hand. Incompetence, misdiagnosis and **** care killed him.
My grandfather had diabetes undiagnosed for years in the french system, it was diagnosed on a visit to A&E in Milton Keynes after about 10 minutes.

Anyway bigging up the French system is out of their minds.

 

[johnwhitfield]

The argument that incompetent people get sacked in the private sector is pretty much laughable. Maybe it happens in small firms but I’m certain we can all think of clear examples where people are paid large salaries and are mediocre at best. Pretty much think of any call centre you’ve contacted, how efficient were they? Thames water are hardly bursting with talented go getting people. Look at the CEO of JohnLewis and the dreadful job she’s done. When was the last time your bank impressed you with their efficiency?

The public sector has its fair share of absolutely lazy ****ers but also loads of really hard working people. Replacing people when they move on is now amazingly hard due to constant pay cuts and worsening conditions. This in turn makes it harder to get rid of under performing people as it’s impossible to find good replacements.

Large firms inevitably are wasteful whether in the private or public sector. Who is keeping a strict eye on costs as it’s not their money?

I’ve never understood why the NHS pay way over the odds for basic medication. Given their purchase power shouldn’t they be getting the best prices?

The current system needs a revamp though. Getting to see a doctor is nearly impossible in our area. The local GPs are booked solid for the next 3-4 weeks minimum. The local walk in centres were closed down as a cost cutting exercise which only leaves A&E which you are then told not to visit.

An aging population is only going to make problems worse.

 

[David_Vi]

The above would all be addressed by having it 'privatised'. The government would still fund a hospital with an annual budget, and set rigid targets on performance, but it is up to that hospital as to how to spend it efficiently. Bonuses would then be paid out at the end of the year based on said performance

But what's the incentive for these private companies? They want profit.
You've only got to look at the railways and see how much of our money is sent abroad to different governments, how big the paycheck and bonuses are of the higher ups rather than be reinvested.