Praise for the NHS

2 weeks ago, in Gloucester hospital, gowned up and ready for an operation on my right hand for

Dupuytren's Contracture (you can google that).

With my gown pulled down and cannulas inserted the pretty Anaethatist leaned over me and said

"You have lovely skin", then switched my lights out.

First-class service, no pain and four digestives plus buttered toast and a hot mug of tea afterwards.

why did he think you had lovely skin?
 
Thanks for your reply, but as I have posted before, there were no delays in the NHS response to my suspected skin cancer, sadly confirmed. But that is also down to being active in my care - speaking to the consultant's secretary, being flexible to come in at a moment's notice etc. Like so many faced with a potentially serious illness, I looked up the statistics on line and read widely; not altogether helpful as the outcome is multivariate. Most people who develop cancer to be +50 and often have multiple and dependent health issues (cardiac, obesity, T2 diabetes, etc), or respond adversely to the treatment and a consequentially slower recovery. Normal demographics also begin to play and this increases the apparent morbidity.

What was heart aching for me (I'm in my 50s) was seeing teens and young people at the cancer centre absolutely petrified with the prospect of treatment and an earlier death. But the advances in cancer care - especially in England - has had a dramatic and positive effect on morbidity in the last 10 years; Today's statistics are based on treatments of a decade ago, before immunotherapies were rolled out - often seen as the 'new penicillin'. Statistically for me, with my skin cancer, I have about a 10% chance of surviving beyond 5 years, based on the raw statistics. However, if I factor in my age, gender, lifestyle, general health, levels of activity, mental activity, active health monitoring etc...it's likely that I will have a normal life expectancy (ie about another 25 years!).

There's no reason to be complacent, however. The NHS needs constant transformation to meet the health demands of an ageing population and a recognition of the growing mental health problem; that will mean more money (and therefore fundamental questions on future funding and costs at point of delivery), and there needs to be a means by which healthy lifestyles are incentivised.

I have family in Australia (ACT and Sydney), and several suffer from a rare disease and they have fought for years to have funding for treatment that is available here. They have finally managed to get access to this treatment, but only after a high profile campaign.
The statistics I referred to were were form research carried out on 2019 using statistics for the years 2010-2014. That is the most recent data set on which one can assess five year survival rates. Personally, I would be very surprised if, when similar research is done on the subsequent five year period much will change.

The issues of age, obesity, diabetes etc are not exclusive to the NHS; many of the countries that score higher for cancer outcomes have similar challenges. Sure, the top performers like South Korea and Japan don’t have the same dietary and obesity issues. But Australia, France, Germany and the USA all significantly out perform the UK.

One thing that stands out to me; the countries that routinely score highly for healthcare outcomes allow I the presence of entrepreneurial business in healthcare delivery. Competition bring efficiency and investment. That is why, when my doctor refers me for a scan, I can chose where I go and get an appointment quickly.
 
The statistics I referred to were were form research carried out on 2019 using statistics for the years 2010-2014. That is the most recent data set on which one can assess five year survival rates. Personally, I would be very surprised if, when similar research is done on the subsequent five year period much will change.

The issues of age, obesity, diabetes etc are not exclusive to the NHS; many of the countries that score higher for cancer outcomes have similar challenges. Sure, the top performers like South Korea and Japan don’t have the same dietary and obesity issues. But Australia, France, Germany and the USA all significantly out perform the UK.

One thing that stands out to me; the countries that routinely score highly for healthcare outcomes allow I the presence of entrepreneurial business in healthcare delivery. Competition bring efficiency and investment. That is why, when my doctor refers me for a scan, I can chose where I go and get an appointment quickly.
As I mentioned in my post, I value the NHS but it must transform and I am not opposing innovative solutions. First example is rapid access to imaging - for me this has been either to commercial imaging companies or to units run by charities working alongside the NHS - in either case I have never needed to wait more than a couple of days. However if I was an in patient imaging was immediate.


Another example are renal dialysis units run by private companies for the NHS. Because there is an income stream from the NHS for very patient who goes through dialysis, the units can and do replace their equipment on a more regular basis than NHS-run units that have to adhere to sxlerotic procurement procedures.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
As I mentioned in my post, I value the NHS but it must transform and I am not opposing innovative solutions. First example is rapid access to imaging - for me this has been either to commercial imaging companies or to units run by charities working alongside the NHS - in either case I have never needed to wait more than a couple of days. However if I was an in patient imaging was immediate.


Another example are renal dialysis units run by private companies for the NHS. Because there is an income stream from the NHS for very patient who goes through dialysis, the units can and do replace their equipment on a more regular basis than NHS-run units that have to adhere to sxlerotic procurement procedures.
With regard to the imaging, there is a national shortage of radiologists (the specialist doctors who read and report on images)
So whilst there may be plenty radiographers (those who physically take the image, not doctors) it can take a while for an image to be reported on.
As most images are now digital, I can send a patient for a big xray, it will be done in Inverness, I will get email that it's been taken and be looking at it before the patient has made back to the car park to drive to see me again.

However a GP does not have access to the radiograph system and has to wait for the report.
 
With regard to the imaging, there is a national shortage of radiologists (the specialist doctors who read and report on images)
So whilst there may be plenty radiographers (those who physically take the image, not doctors) it can take a while for an image to be reported on.
As most images are now digital, I can send a patient for a big xray, it will be done in Inverness, I will get email that it's been taken and be looking at it before the patient has made back to the car park to drive to see me again.

However a GP does not have access to the radiograph system and has to wait for the report.
How long do they have to wait for an x-ray and how far away is Inverness?

If my doctor sends me for imaging (X-ray, CAT or MRI), I have a choice of where to go to. i will get probably get the scan the next day. The imaging will be shared electronically to the GP with the radiologists interpretation.

Not that the radiologists input is needed in a lot of cases.
 

endure

GCM
How long do they have to wait for an x-ray and how far away is Inverness?

If my doctor sends me for imaging (X-ray, CAT or MRI), I have a choice of where to go to. i will get probably get the scan the next day. The imaging will be shared electronically to the GP with the radiologists interpretation.

Not that the radiologists input is needed in a lot of cases.
If my GP thinks I need imaging he sends me to the BFO hospital which is a couple of miles away. If I go the same day it will be done that day
 
With regard to the imaging, there is a national shortage of radiologists (the specialist doctors who read and report on images)
So whilst there may be plenty radiographers (those who physically take the image, not doctors) it can take a while for an image to be reported on.
As most images are now digital, I can send a patient for a big xray, it will be done in Inverness, I will get email that it's been taken and be looking at it before the patient has made back to the car park to drive to see me again.

However a GP does not have access to the radiograph system and has to wait for the report.
Do most physicuans and surgeons possess sufficient knowledge to interpret diagnistic imaging? I would have thought that with the increase in medical litigation, most would feel compelled to wait for a radiologist report. Doubtless it is an issue that will vary deoendent on the presenting complaint. And do you think that fully integrated IT systems - accessible between secondary and primary care would help?
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
Do most physicuans and surgeons possess sufficient knowledge to interpret diagnistic imaging? I would have thought that with the increase in medical litigation, most would feel compelled to wait for a radiologist report. Doubtless it is an issue that will vary deoendent on the presenting complaint. And do you think that fully integrated IT systems - accessible between secondary and primary care would help?

I've seen enough facial fracturing missed on radiographes by doctors to say no to the first question.
But I qualify that with an it depends.
I am used to looking at facial radiographs so can usually spot abnormalities better than a doctor.
However an orthopaedic surgeon is expert at the radiographs they look at.

GPs are exactly that, they are more dependent on the reports, and often have no need to actually see the image itself.

We are working on Integration but it takes time and is complex. Up here we have a system SCII gateway where all lab results, tests, radiographs etc all the reports are available to primary and secondary care, provided you have a log in.

But that is accessing a central system rather than a true intergrated single record for each patient which can be accessed and information entered by all.
 
I've seen enough facial fracturing missed on radiographes by doctors to say no to the first question.
But I qualify that with an it depends.
I am used to looking at facial radiographs so can usually spot abnormalities better than a doctor.
However an orthopaedic surgeon is expert at the radiographs they look at.

GPs are exactly that, they are more dependent on the reports, and often have no need to actually see the image itself.

We are working on Integration but it takes time and is complex. Up here we have a system SCII gateway where all lab results, tests, radiographs etc all the reports are available to primary and secondary care, provided you have a log in.

But that is accessing a central system rather than a true intergrated single record for each patient which can be accessed and information entered by all.
While I have long advocated that having multiple info systems is a pathway to trouble, I wonder if we were to take a long range view and design a new cradle-grave system to commence with births from a specific future date. That date would act as a 'flag' for those benefiting from what could be a national EHR and eventually (and inevitably) the old system for the rest of us would cease to have operational relevance (though research institutions could take ownership of the data). Massive project, thus the sooner it begins the better. I think that such an approach would provide the time needed to perfect the data sets and devise structures and procedures for data entry or capture.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
And an integrated system would allow me to see what medical conditions and medication a patient is on.

For instance had a patient this week. referred from doctor as about to start a medication which can have oral side effects.
Patient completed medical questionnaire, stated no meds taken, I got receptionist to check, confirmed no meds.
Took patient into surgery, verbally questioned her, admitted to taking 4 meds, including an inhaler, but could notremember which ones.
Contacted GP to check medications, actually takes 9 different meds (though as takes some at more than one point in day actually takes some 12-14 tablets a day!) and 2 inhalers. One of those meds being a anti-coagulant, which give I was about to rip a tooth out was useful to know so I could have suture set and haemostatic agents to hand.

But basically if I could have seen her med records, I would have known beforehand, and not gone through all this rigmarole.
 
And an integrated system would allow me to see what medical conditions and medication a patient is on.

For instance had a patient this week. referred from doctor as about to start a medication which can have oral side effects.
Patient completed medical questionnaire, stated no meds taken, I got receptionist to check, confirmed no meds.
Took patient into surgery, verbally questioned her, admitted to taking 4 meds, including an inhaler, but could notremember which ones.
Contacted GP to check medications, actually takes 9 different meds (though as takes some at more than one point in day actually takes some 12-14 tablets a day!) and 2 inhalers. One of those meds being a anti-coagulant, which give I was about to rip a tooth out was useful to know so I could have suture set and haemostatic agents to hand.

But basically if I could have seen her med records, I would have known beforehand, and not gone through all this rigmarole.
Just for interest, if she had been taking Riveroxaban as her anti-coagulant, would you have needed to cancel surgery and have her desist for a couple of days?
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
Just for interest, if she had been taking Riveroxaban as her anti-coagulant, would you have needed to cancel surgery and have her desist for a couple of days?

Nope, we have quite good guidance on it, single anticoagulant with relatively simple extraction then no change to anticoagulant therapy. Anticoagulants and Antiplatelets - SDCEP
I regularly extract teeth on patients taking riveroxaban.
There are no tests for the novel anticoagulants compared to INR for warfarin
 
Nope, we have quite good guidance on it, single anticoagulant with relatively simple extraction then no change to anticoagulant therapy. Anticoagulants and Antiplatelets - SDCEP
I regularly extract teeth on patients taking riveroxaban.
There are no tests for the novel anticoagulants compared to INR for warfarin
I have taken Riveroxaban for around six years and always had to cease prior to surgery on a couple of occasions. However, on one domestic occassion I screwed up my meds and took a second tab within four hours of the first........and the flood gates opened. Never had a nose bleed like it. I was told that an antidote is on the horizon.
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
I have taken Riveroxaban for around six years and always had to cease prior to surgery on a couple of occasions. However, on one domestic occassion I screwed up my meds and took a second tab within four hours of the first........and the flood gates opened. Never had a nose bleed like it. I was told that an antidote is on the horizon.
If going to the dentist would do you no harm to highlight the above guidance.

I would prefer patient to be stable on their anticoagulants. A few years ago, I had an elderly patient on aspirin who was due a tooth out. Unknown to me GP suggested that stopped the aspirin. When he did he had a stroke
 

Dr Death

War Hero
"goodwill" ???

You're very highly paid over the course of a career to do a job - no-one's asking you to do it for free, although a vast number of doctors and medical staff world-wide do just that.

"under funded" ???

You get 134 bn! That's double the amount spent on education and ten times the amount spent on the police. If part of that money's mis-spent on outrageously expensive medication for a few people that no other country would consider, or on expensive treatment rather than cheap prevention, that isn't "under funding", it's incompetence.

"under staffed" ???

Well, one out of three's not bad. If the money was used properly, though, instead of wasted, and if, for example, free medical training for nurses and doctors was followed by a period of compulsory service in NHS hospitals, then there'd be no such problem.
Yes ..... so would a money tree.
Must be terrible having to listen to sick and dying people moan an complain. Why can't they all get Stockholm syndrome, or better still just die and the problem would be solved ...
Some of us feel once you become a consultant you have to do 10 yrs to the NHS.
But most, like me get so hacked off with NHS managers we go part private.

If the NHS only offer me 3 days a week work we go private
 
If going to the dentist would do you no harm to highlight the above guidance.

I would prefer patient to be stable on their anticoagulants. A few years ago, I had an elderly patient on aspirin who was due a tooth out. Unknown to me GP suggested that stopped the aspirin. When he did he had a stroke
Ah......unfortunately my dentistry days are long over. They began back in the mid 1950s with the much feared mechanical drill and began a terminal decline at 4am on a cold night in Belfast when a dental surgeon removed 13 of my teefuls following a bomb blast. Terminal gum problems resulted in the removal of the remainder within five years and I acquired my first set of plastic knashers the day before I went to uni as a mature student (so classified merely on 'years on the planet' rather than fully developed common sense).

As for the 'meds', I take them all faithfully to control my AF, Hypertension, Polymyalga etc........andI am still able to complete five milers. There again, Mrs Kinch is a 40 year career nurse, now retired and thus practices her Obergruppenfurherery on her one remaining patient to ensure no medication relapses. Such is life........pretty good really.
 
My best experiences with the NHS (the couple of times I used them), while living in London, were with my GP (Portugese lady) at this place:


And for dental:



They did most of the routine and some specialized stuff as well, but not everything, no more wait that 30 mins, even for walk-ins.

The longest was when I had to wait 6 hours for a doc to take a quick look at an x-ray of my jaw to see if it was broken or not at the Fulham hospital.
 
A lot of what you say is indeed relevant and accurate and should form part of a debate about how our health care could/should be improved.
Be careful who you praise / agree with.

I agreed with the same poster, disagreeing with a mod, and found myself unable to post anything until I contacted board admin. I suspect Dr Death, who joined Arrse at the same time and also made his first post in this thread, but disagreed with said poster, hasn't had to jump through the same hoops.
We have reached the stage when we can no longer exercise freedom of speech freely or criticise constructively in case it hurts someones feelings.
Are you talking about Arrse or more generally?
 
This is a classic philosophical dilemma
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No "dilemma".

It's called triage - prioritising medical care in order to save the most lives and prevent the most pain and suffering. Medical professionals do it routinely every day.

If the NHS is incapable of doing triage at its simplest, which it evidently is, then something's more than badly wrong.

In the specific example you've chosen the NHS has the choice of either extending one life for maybe five years or saving 5,500 lives, and doing so routinely, but it can't afford to do both or it would.

Where's the dilemma?
 

Fang_Farrier

LE
Kit Reviewer
Book Reviewer
No "dilemma".

It's called triage - prioritising medical care in order to save the most lives and prevent the most pain and suffering. Medical professionals do it routinely every day.

If the NHS is incapable of doing triage at its simplest, which it evidently is, then something's more than badly wrong.

In the specific example you've chosen the NHS has the choice of either extending one life for maybe five years or saving 5,500 lives, and doing so routinely, but it can't afford to do both or it would.

Where's the dilemma?

You are obviously unaware of how the NHS works.

At a national level there are committee and boars who decide where money should be spent, what treatment are funded due to being most cost effective. And generally they will fund the treatment options that give greatest benefit to the most people.

Then at a national level, a decision will be made what to spend any left over money on, which of the more obscure treatment will be funded.

At a local level each board will have a committee which decides upon whether to fund treatment for it's patients outwith national guidelines. Called different things in different places, last one I sat on was an UNPAC committee, Unplanned care.

Bids are made by GPs, patient's representatives etc, for whatever money is available. Again pros and cons of each treatment are examined and weighed up, and sometimes a Yes, and sometimes a No, occasionally a partially funded option is available.
 

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