The NHS

[Vince Green]

To be fair, my mother has had appointment letters that have arrived after the appointment had passed, so no shows on appointments can just be down to admin. errors

Edited July 3, 2017 by Vince Green

[Wb123]

It's not about agency staff.

It's the comparative - for example the U.K. is approximately 100,000 square miles and is 60% the size of the State of California, and yet our national health service employs more people than the indian military, or Royal Dutch shell, exon, Volkswagen, Toyota any bank or financial institution.

It can't be right that a little country like ours needs a health service with nearly 2 million people in it.

It might be different if as a nation we were all living to 130 years of age but we're not

Edit:

I also don't think it's just the cost of treatments - that wage bill is a massive recurring cost.

.

Everywhere else has multiple providers, this gives a nice flavour of how we compare on numbers per capita: http://ec.europa.eu/eurostat/statistics-explained/index.php/File:Practising_nurses_and_caring_professionals,_2014.png

 

Doctors per head of population if i remember rightly was at the low end of the spectrum for the western world, and also managment staff but i cant find the data with a quick look.

[BRYAN3]

I have three prescriptions.

I pre-pay now which saves me few bob.

I would gladly even pay the old price plus a little if they would allow me to have 56 or better still 84 days pills each time.

I can buy enough bum wipe to last a decade but have to burn fuel,get out and about and take up dispensery staff time two or three times more than nessesary.

There are so many ways savings could be made.

[norfolk dumpling]

Our family experiences of NHS has been mixed - some excellent ie A&E but some absolutely dire. Recently my son, who has an implant to control epilepsy had a day procedure operation to replace implant as battery was nearly out. For reasons I won't bore you (life is just to short to explain) the op was delayed and battery had expired. However in he goes for a GA op and nurse allocated to him a) was new to the ward b) was unfamiliar with the procedure and b) has a very loose grasp of our language and our sone has learning difficulties!! Anyhow op didn't go well and he now has damage to his vocal cords and his seizure rate increased. 7 weeks after the op we visit neurologist only to find out that the device hadn't been switched on. Lucky he hadn't died?

[Yellow Bear]

I have three prescriptions.

I pre-pay now which saves me few bob.

I would gladly even pay the old price plus a little if they would allow me to have 56 or better still 84 days pills each time.

I can buy enough bum wipe to last a decade but have to burn fuel,get out and about and take up dispensery staff time two or three times more than nessesary.

There are so many ways savings could be made.

The rub is the dispenser gets paid per item, doesn't matter if it is 1 pill or 1000 they get paid for the action.

We live in a fairly rural area where because of the distance to a town or large village the doctor's surgery is allowed to dispense and gets paid the same as a pharmacist . It is this money that keeps the surgery viable so I put up with having to get items 2 weekly. The next nearest surgery is about 5 miles away.

[Vince Green]

A lot more drugs like blood pressure tablets, statins etc can now be bought on line from companies like Superdrug and I believe Boots are now getting in on the act. Dr Fox is a big player online for prescription medicines.

 

The cost is often way below what you would pay via a prescription charge. And you can buy six months at a time. You have to tick a box to confirm that you are being prescribed these drugs by a GP and your case is reviewed by their doctor.

 

Its the future.

[JohnfromUK]

I have three prescriptions.

I pre-pay now which saves me few bob.

I would gladly even pay the old price plus a little if they would allow me to have 56 or better still 84 days pills each time.

I can buy enough bum wipe to last a decade but have to burn fuel,get out and about and take up dispensery staff time two or three times more than nessesary.

There are so many ways savings could be made.

I am just the same (3 prescriptions, used to prepay, but now over 60, so free) and have to drive (twice, once to drop of paperwork, then again 2 days later to collect) every 28 days

[AVB]

 

Hi avb

 

good question?

 

most certainly 30- 20 years ago patients would not have received this level of service, as knowledge and advances in management of conditions was nowhere near what it is now. 10-20 years ago our aetiology of wound conditions and care planning was extremely limited. Most management of pressure ulcers was chronic management and in my long experience at best a significant proportion of ulcers would never heal, the statistics for mortality (death) related to pressure ulcers was high. All the measures put in place have resulted in a significant lowering of mortality rates from septicaemia secondary to pressure wounds. I have seen many patients have wounds that had been managed for 10 years and with addition of the measures above have resulted in promoting wound healing and prevention of reccurence. Hard to believe but the nhs sometimes gets it right in some areas. Cost of pressure ulcers to nhs currently running around 1.5 - 2.2 billion per annum. Phew!

 

atb

7diaw

 

I appreciate that the treatment of the condition itself has improved which, to some degree, must be due to improvements in treatments (dressings, drugs etc.). I am just wondering whether the process that you describe itself improves the outcome. A lot of what you describe does not, to me at least, seem to relate to the a treatment of the actual condition itself. I am not saying it is wrong but rather whether it represents good value.

[Vince Green]

I appreciate that the treatment of the condition itself has improved which, to some degree, must be due to improvements in treatments (dressings, drugs etc.). I am just wondering whether the process that you describe itself improves the outcome. A lot of what you describe does not, to me at least, seem to relate to the a treatment of the actual condition itself. I am not saying it is wrong but rather whether it represents good value.

I totally agree with you. The trouble with box ticking is, as you say, its just an exercise in box ticking. If a person has a leg ulcer asking about their sleeping or the state of their bowels etc is probably costing more in time than any benefit to their treatment gained by knowing the answers.

 

Every time I go to see the hygienist at my dentist I get a long questionnaire to fill out. Some questions are relevant like what toothpaste I use but others but like how many units of alcohol I drink a week has no bearing on getting my teeth cleaned. And I get the same questionnaire every time I go

Edited July 3, 2017 by Vince Green

[Vince Green]

I am just the same (3 prescriptions, used to prepay, but now over 60, so free) and have to drive (twice, once to drop of paperwork, then again 2 days later to collect) every 28 days

Why every 28 days? you should query that, that's taking the micky.

 

Also, you can request prescription electronically now, Then have it sent directly to the chemist of your choice.

Edited July 3, 2017 by Vince Green

[JohnfromUK]

Why every 28 days? you should query that, that's taking the micky.

 

Also can't you request prescription electronically now? Then have it sent directly to the chemist of your choice?

They tell me that the prescription 'cycle' is 28 days and they are all neatly (and expensively) pre packed in 28 day 'blister packs' in fancy cardboard boxes. I did enquire about getting more, but they will only do that as an exception if (for example) I was going to be away for an extended period. Incidentally, the blister packs are hard to open. OK for me as I'm not arthritic - but I can see them being a real problem for those with arthritic hands.

 

No 'online' facility - I get a printed prescription for the next 28 days worth with the collection, keep that for approx 25 days, then take to the dispensary section of the doctors surgery. Two working days later I go again and collect. The two days is because apparently a doctor has to review all repeat prescriptions - which seems crazy, but may be a local rule at our surgery/practice. Note that these are long term very 'standard' blood pressure and statins - cheap, not prone to abuse, and not a 'dangerous' medication. It isn't a streamlined system. They also close at lunchtime for an hour (but are open later in the evening for prescription collection).

 

It isn't a big problem to me as I drive past at least once a week anyway, but it isn't an efficient system for anyone.

[7daysinaweek]

 

I appreciate that the treatment of the condition itself has improved which, to some degree, must be due to improvements in treatments (dressings, drugs etc.). I am just wondering whether the process that you describe itself improves the outcome. A lot of what you describe does not, to me at least, seem to relate to the a treatment of the actual condition itself. I am not saying it is wrong but rather whether it represents good value.

 

I can understand how some of the above measures may appear to ot relate directly to the treatment of the wound condition:

 

Direct absolute essential measures to help aid wound healing and prevent further deterioration of wound, represent good value as follows:

 

1) Clinical assessment by community nurse to grade the wound and set out treatment plan and which treatment should be used, assessment of pain

2) gp or nurse prescriber to prescribe the antibiotics

3 blood profile and swab of wound to assess any imbalance in systems of the body as these can have a detrimental effect on how a wound heals

4) pressure relieving aids to reduce pressure to the wound, air mattress

5) assessment of nutritional status and hydration

6)patient involvement and education in self care to aid the wound to heal

7)patient perception of their health status and mental capacity

8)good standard of record keeping in patient held casenote for monitoring and evaluating wound and patient condition

9) full holistic nursing assessment as stated, this underpins all your care planning, is national policy and once patient is accepted onto caseload a duty of care is owed by the provider service (nhs)

10)care package for carers to support with meal preparation, good nutrition, essential in wound healing if patient struggling at home (acopia) standing the patient at regular visits to relieve pressure

 

 

Other measures i have stated above are for that scenario

the following are outside the direct management of wound but are other measures which may be attributed to looking at the short to mid to long term outcomes for the patient which some of which may impact on recurrence of wound: Also for audit data and planing of services

 

1)care package for carers to support with meal preparation, good nutrition, essential in wound healing if patient struggling at home (acopia) standing the patient at regular visits to relieve pressure ( may or may not be required if patient has good concordance, family, carer support

2) reporting of grade 2 and above pressure ulcer, goes to form incidence and helps structure national policy on the prevention and management of pressure ulcers and costings

3) referral to social services as adult was assessed for having vulnrability, acopia, has capacity but refusal for hospital treatment. May have been referred prior as a vulnerable adult and can sometimes help the other aspects of social care to build up a picture.

Some patients with this one condition may require a little less input or increased dependent on the exact needs in this second second set of measures, however the ist set are essential for all. May seem like a lot of input but it is all about weighing risk benefits. A lot of resources put in initially may be costly, but they pale in comparison with lesser measures which can result in a non healing wound, decreased quality of life for the patient and possible mortality and hugely increased costs.

 

Hope this helps

atb

7diaw

[Vince Green]

They tell me that the prescription 'cycle' is 28 days and they are all neatly (and expensively) pre packed in 28 day 'blister packs' in fancy cardboard boxes. I did enquire about getting more, but they will only do that as an exception if (for example) I was going to be away for an extended period. Incidentally, the blister packs are hard to open. OK for me as I'm not arthritic - but I can see them being a real problem for those with arthritic hands.

 

No 'online' facility - I get a printed prescription for the next 28 days worth with the collection, keep that for approx 25 days, then take to the dispensary section of the doctors surgery. Two working days later I go again and collect. The two days is because apparently a doctor has to review all repeat prescriptions - which seems crazy, but may be a local rule at our surgery/practice. Note that these are long term very 'standard' blood pressure and statins - cheap, not prone to abuse, and not a 'dangerous' medication. It isn't a streamlined system. They also close at lunchtime for an hour (but are open later in the evening for prescription collection).

 

It isn't a big problem to me as I drive past at least once a week anyway, but it isn't an efficient system for anyone.

I thought all surgeries had to be online now. The surgery gets paid per prescription so they are making you get 13 a year. I would complain as its unnecessary and time wasting for you.

[Yellow Bear]

I thought all surgeries had to be online now. The surgery gets paid per prescription so they are making you get 13 a year. I would complain as its unnecessary and time wasting for you.

It may be time wasting but in rural areas it helps pay to keep the surgeries open

[JohnfromUK]

I thought all surgeries had to be online now. The surgery gets paid per prescription so they are making you get 13 a year. I would complain as its unnecessary and time wasting for you.

You can book appointments on line I believe, but not prescriptions. I would need to check, because it may have updated since I last asked about a year ago. To be honest, as it is a very rural practice, if the dispensary supports it, that may be a good thing to help support these rural practices. I can cope with the procedure as I pass regularly, but I raised it not so much as a problem to me, but as an example of the inefficiency that must push up (their) costs. For me (as an over 60), I don't pay.

[7daysinaweek]

I totally agree with you. The trouble with box ticking is, as you say, its just an exercise in box ticking. If a person has a leg ulcer asking about their sleeping or the state of their bowels etc is probably costing more in time than any benefit to their treatment gained by knowing the answers.

 

Every time I go to see the hygienist at my dentist I get a long questionnaire to fill out. Some questions are relevant like what toothpaste I use but others but like how many units of alcohol I drink a week has no bearing on getting my teeth cleaned. And I get the same questionnaire every time I go

 

In relation to leg ulcers both venous, arterial and mixed aetiology ulcers and pressure ulcers to other parts of the body. Lots of what we ask within the assessment are important and may have a direct impact on the outcomes for the wound healing. Smoking causes decrease in vascularisation of wound healing, alcohol increases serum glucose blood sugars increasing risk of incidence bacterial infection at wound bed which can result in extended wound healing, decreased quality of life and mortality, also affects wound vascularisation.Bowels: if patient taking osmotic laxative over the counter can have an increased incidence of dehydration, has direct affect upon wound vascularisation. Like a lot of things on the face the of it they may not appear important but they are. Asking these questions allows for treatments to be tailored.

 

atb

7diaw

[JDog]

In relation to leg ulcers both venous, arterial and mixed aetiology ulcers and pressure ulcers to other parts of the body. Lots of what we ask within the assessment are important and may have a direct impact on the outcomes for the wound healing. Smoking causes decrease in vascularisation of wound healing, alcohol increases serum glucose blood sugars increasing risk of incidence bacterial infection at wound bed which can result in extended wound healing, decreased quality of life and mortality, also affects wound vascularisation.Bowels: if patient taking osmotic laxative over the counter can have an increased incidence of dehydration, has direct affect upon wound vascularisation. Like a lot of things on the face the of it they may not appear important but they are. Asking these questions allows for treatments to be tailored.

 

atb

7diaw

QED

[pigeon controller]

QED

Own up how many have googled QED?

[JDog]

Own up how many have googled QED?

Sorry, quod erat demonstrandum, demonstrated perfectly by post 42.

Edited July 4, 2017 by JDog

[Jaymo]

And there was me thinking QED was them new dangled low voltage lighting systems.........

[hawkeye]

I personally think the NHS needs sorting out i had an appointment for hospital last November ( follow on from an Op i had 6 moths earlier ) anyway day before i was due to go i got letter cancelling appointment

and giving me another one in March this year, on the morning of the day i was going in got a letter to cancel appointment, and said they would be in touch with another one soon as sorted out, still waiting for the appointment..

[keg]

We've experienced the NHS both paid for ( 2 cycles of IVF @ Approx £3,500 a go) and free ( mum is in remission from lung and bowel cancer) At any point the NHS was great in both sectors.

 

The biggest issue is that it's being asked to do what it was never designed for ( IVF, MH issues that weren't even aoround when the NHS came into play, cosmetics surgery) All things that it now covers. Is having children a right Should smokers/obese/drink/drug users be given free treatment?

 

What should take priority? Heart, cancer diabetes, Kidney? All are important but who makes the decisions.

 

It's a minefield and has been said, whatever decision is made wil be wrong for someone.

 

My Sis in law is a nurse but baled out to NZ a few years ago, fed uup with waste and attitude.

 

Education and Health are the two biggest political footballs ever.

[Mice!]

7 days in a week, brilliant answers sir.

 

I never understand missed appointments I'm booked in for a blood test Thursday, I got a text msg yesterday as a reminder and will probably get another before then, so how do you miss?

 

I would like to see something done about this even if your on benefits if you've made an appointment you can just as easily un make it.

[Flashman]

I never understand missed appointments I'm booked in for a blood test Thursday, I got a text msg yesterday as a reminder and will probably get another before then, so how do you miss?

 

People don't value what's given to them for nothing.

 

In the end, the same people despise you for not giving them more - look at the Corbyn/Momentum-inspired chuntering at the moment.

[7daysinaweek]

7 days in a week, brilliant answers sir.

 

I never understand missed appointments I'm booked in for a blood test Thursday, I got a text msg yesterday as a reminder and will probably get another before then, so how do you miss?

 

I would like to see something done about this even if your on benefits if you've made an appointment you can just as easily un make it.

 

I really do not know the answer Mice, i have worked in the nhs for 25 years and no one has come up with a strategy that will ensure 100% compliance with appointments and cancellations and you never will. Yes, some missed appointments are down to unforeseen circumstances for the individual on the day or miscommunication by the nhs appointment service, it does happen! For repeat offenders you are dealing with a proportion of individuals within society who whose values do not encompass responsibility when it comes to care free at the point of need. Some feel that it is perfectly acceptable to repeatedly DNA (did not arrive) at appointments. I regularly see people turn up at clinic after they have dna for several previous appointments and then become angry why they cannot be seen saying they have been busy. Our building runs clinics 3 times per week mon, wed ad sunday until 8pm so if you work you can still be seen, people still dna and don't ring to cancel. Arrrrrggghhhhhh!

 

atb

7diaw

Edited July 4, 2017 by 7daysinaweek