the NHS

[WashYourHands]

Wonderful idea now malfunctioning at profound levels, a monstrous labyrinth to navigate

After Version’s recent medicalisation thread and other posts getting at misappropriations of certain terminology, wondered if the focus can narrowed?

Seems as if enough pressure is being deliberately exerted to justify specific privatisation. Eyes, teeth are just two familiar examples (eg NHS dentist wait 12-14 months, private eye-watering £ route immediate)

A hospital cleaner spoke to me on Sunday that she’d gone pvt for a double hip operation for £13k. It took a few minutes to process her logic, boiled down to a) couldn’t wait any longer, b) her kids are independent so her health treatment options only led to a pvt option and c) she was morphine dependent for 4 years and “enough was enough, how long do I have left anyway?”

How has it come to this?

 

[you]

Privatisation has infected the NHS massively. I had shoulder reconstruction a few years ago and every stage after initial GP visit was private, including the rehabilitation and physiotherapy.

It's a foregone conclusion it feels. Years of underfunding, narrative of 'look it isn't working' as a justification for privatisation. Successive governments effectively creating the necrosis they wish to heal with inefficient private solutions.

Yes, the managerial strata swelled unnecessarily. Nonetheless, so many workers (people that really make the care what it is) are agency now. My concern about this degrees of separation in the private and public funding is responsibility. Like shell companies robbing with a teflon carapace. Direct responsibility and accountability will only become more blurred.

 

[version]

John Furse · The NHS Dismantled

www.lrb.co.uk

 

[Leo]

I've generally experienced a pretty decent level of quality care here in the states, but the healthcare industry -- hospitals, insurance companies -- is a viper's nest of evil fuckers always racing straight to the bottom in terms of how much they can charge and how little they can reimburse. In a free-market economy and capitalist society, coupled with the GOP/conservative mindset of opposing "handouts" as fundamentally un-American (except when it comes to corporate tax breaks, of course), it's basically everyone fend for themselves.

your system is most probably inefficient and possibly broken, but you're still kind of lucky to not have to worry about how a bout of illness can potentially bankrupt you for life.

 

[version]

your system is most probably inefficient and possibly broken, but you're still kind of lucky to not have to worry about how a bout of illness can potentially bankrupt you for life.

This is the thing though. There seems to be an active campaign to turn it into what you're describing in the US.

 

[catalog]

i dont think it would ever happen. the NHS is quintessentially English, big part of the identity. More so after Covid. No-one would ever wanna be the one to pull the plug, at least not officially. But as others have said, it's kind of happening anyway, with all the services being slowly outsourced and privatised.

 

[Leo]

May have told this story in the past: the wife had been living in NY for about 15 years and went back to visit the family in the Midlands for Xmas. She slipped on some ice, hurt her wrist when she fell, and went to the small local hospital. The administrative person at the front desk quickly connected her with a doctor, who did a through exam and set her wrist in a cast. Upon leaving, she was told she didn't owe anything for it. Since she's such a goodie two-shoes, she made a point of saying she hadn't lived in England for many years, but they insisted there was no charge.

She gets back to NY, has a followup visit with a top wrist doctor, and he said she was really lucky because her injury is often misdiagnosed and the wrist set incorrectly, but this doctor in the Midlands correctly diagnosed it and set it expertly. That kind of service and care would have cost tens of thousands of dollars here, and she got it for free.

 

[Mr. Tea]

This is the thing though. There seems to be an active campaign to turn it into what you're describing in the US.

The "healthcare providers" that are queueing up to get their teeth into the NHS are mostly/wholly American, from what I understand, so this seems the most likely course of events.

Lots of other countries have a mixed model, where there is some private insurance involved but a lot of it is paid for by government, and people below a certain income threshold pay a lot less or get treatment for free, or whatever. Which might not be too bad and could be preferable to the NHS limping on forever like this. But it seems we're going to bypass that setup and go straight for the diabolically bad American model.

 

[WashYourHands]

Privatisation has infected the NHS massively. I had shoulder reconstruction a few years ago and every stage after initial GP visit was private, including the rehabilitation and physiotherapy.

It's a foregone conclusion it feels. Years of underfunding, narrative of 'look it isn't working' as a justification for privatisation. Successive governments effectively creating the necrosis they wish to heal with inefficient private solutions.

Yes, the managerial strata swelled unnecessarily. Nonetheless, so many workers (people that really make the care what it is) are agency now. My concern about this degrees of separation in the private and public funding is responsibility. Like shell companies robbing with a teflon carapace. Direct responsibility and accountability will only become more blurred.

similar experience only in that certain pathways were allocated to a sort of ppi hybrid of nhs and private

day surgery hospital was a pvt unit (paid for by the nhs due to chronic overflow) but from pure incompetence ended up in A&E surgical assessment unit. surgeon who did me does one day a week nhs and 4 days pvt

another angle is the plethora of agency staff covering nights, add agent % fees tacked on, profiteering at barely quantifiable levels that simply aren’t sustainable. someone is clearly cashing in

John Furse · The NHS Dismantled

www.lrb.co.uk

ta! spot on analysis, completely nails it. part of the perverse frustration here is none of these pointers are being red flagged. charities seem to be constantly overstretched too by sheer volume of need, again from overflow. go to A&E, wait 14 hours to get seen is standard now. a mate had a cardiac incident recently and didn’t get his bloods done for 5 hours, turnaround should be 45-90mins, cunt could’ve gone into cardiac arrest at any moment in a corridor surrounded by randoms (equally surreal if you’re a consultant in respiratory disease, trained in communications and you still don’t get heard)

i dont think it would ever happen. the NHS is quintessentially English, big part of the identity. More so after Covid. No-one would ever wanna be the one to pull the plug, at least not officially. But as others have said, it's kind of happening anyway, with all the services being slowly outsourced and privatised.

mistake is seeing it as one big switch being flicked over to privatisation, rather than slow, purposeful/deliberate series of processes. enough small nibbles finish any meal eventually, incrementally. big piece of pie budget-wise

isn’t unique to England either - Scotland Wales and the north of Ireland all have serious systemic issues too - so you get entire health boards going into special measures (list of examples is epically grim). what do you do if you’re pregnant and your health board’s maternity sector is one of these wormholes? no dignity for people in crisis, add Covid and continuous underfunding brings all the corporate vampires out

 

[Leo]

we have medicare for those 65+ (and medicaid for those with little income or disabilities), but lots of retired people who can afford it still pay for a medicare+ program that sort of tops up the coverage to a higher level. our biggest issue is demographic: a huge bubble of aging boomers reaching retirement age and qualifying for medicare, which is funded by income taxes of the current workforce.

 

[WashYourHands]

Yeah an ex’s gran near you seemed to have it pretty good for a retiree. Home carer visited every day. Stairlifts placed. As a foreigner I couldn’t help but look on and see this 85+ year old girl as being treated with dignity, respect and patience. She was pretty independent and nothing really got in her way

Everyone else? You’re on your own jack, exactly what social care for the elderly has degenerated into here too

I get it, majority of humans have extreme horrific examples of next to zero medical services access and we’re lucky to have fuck all. It can appear as entitlement but more a case of asset stripping happening live in real time in front of you, drip drip of the full Grim Britannia equity portfolio

 

[boxedjoy]

just before Xmas I had a major health crisis and was recommended to go to hospital. They told me I would need to go to a superhospital that's twenty minutes down the road where the specialist is based and the surgery I potentially needed could be carried out. I was in complete agony, a pain I was later told is the only thing worse than childbirth by someone who experienced both (!), and they were sincerely suggesting that I get a taxi by myself. I arrived at the first hopsital at 5am, and I was only diagnosed and admitted to a ward at 8pm, and the surgery didn't take place for 48 hrs later. Everyone who I dealt with - doctors, nurses, support staff - couldn't have been nicer or more helpful but you can really see how the constraints on them have limited what they can provide and offer. My ward overlooked the helipad landing base and I knew as soon as I saw a helicopter landing my surgery would have been postponed another 24 hrs. It shouldn't be this bad.

Similarly, I've had experience indirectly with mental health service provisions. I phoned NHS 24, worried about a person who was self-harming, and told that unless they were a danger to their own life or someone else's that they wouldn't be a priority, and because their self-harm was not suicidal but just destructive they didn't qualify. Months later, this person now has a GP, psychiatrist and a care worker dealing with them, plus a charity group providing "bonus" services, but not one of them seems to know what's going on with the other. It surely can't be difficult to have one central database file where notes can be added, instead of forcing someone to explain three times a week how they've struggled to leave the house and scratched their arm up. It shouldn't be this bad.

 

[catalog]

I've not rwscir all boxedjoy but I just want to say o love you

 

[Leo]

I love it when @catalog is drunk.

 

[catalog]

I love it too Leo but I tell you whatg I'm feeling it now

 

[WashYourHands]

just before Xmas I had a major health crisis and was recommended to go to hospital. They told me I would need to go to a superhospital that's twenty minutes down the road where the specialist is based and the surgery I potentially needed could be carried out. I was in complete agony, a pain I was later told is the only thing worse than childbirth by someone who experienced both (!), and they were sincerely suggesting that I get a taxi by myself. I arrived at the first hopsital at 5am, and I was only diagnosed and admitted to a ward at 8pm, and the surgery didn't take place for 48 hrs later. Everyone who I dealt with - doctors, nurses, support staff - couldn't have been nicer or more helpful but you can really see how the constraints on them have limited what they can provide and offer. My ward overlooked the helipad landing base and I knew as soon as I saw a helicopter landing my surgery would have been postponed another 24 hrs. It shouldn't be this bad.

Similarly, I've had experience indirectly with mental health service provisions. I phoned NHS 24, worried about a person who was self-harming, and told that unless they were a danger to their own life or someone else's that they wouldn't be a priority, and because their self-harm was not suicidal but just destructive they didn't qualify. Months later, this person now has a GP, psychiatrist and a care worker dealing with them, plus a charity group providing "bonus" services, but not one of them seems to know what's going on with the other. It surely can't be difficult to have one central database file where notes can be added, instead of forcing someone to explain three times a week how they've struggled to leave the house and scratched their arm up. It shouldn't be this bad.

Fragmentation of services

One bugbear is how nursing training courses include next to no psychological training. A patient who presents (despise this term, total abstraction) in physiological crisis might be attended to on such a basis but any psychological crisis (which may well be escalating) can remain unchecked and unmonitored. Cue unsafe discharge and possible suicide

Someone harbouring suicidal, idealised plans might not what to open up if a care team’s lines of inquiry seem too brief and disjointed, or they’re palmed off with sertraline

I know Covid has compounded masses of problems, think we all see this but what will the picture be like in 5 or even 10 years? The frequency and regularity of enacting ‘special measures’ for health boards and/or entire departments shows where the fault lines exist - everyone seems in denial about the broader systemic pressures and no political representation seems capable of acknowledging or planning for further deterioration

Winter 2022/23 could be a catastrophic clusterfuck

 

[version]

Someone harbouring suicidal, idealised plans might not what to open up if a care team’s lines of inquiry seem too brief and disjointed, or they’re palmed off with sertraline

My brother's had a bunch of friends kill themselves and he said they often seemed more or less okay and didn't talk about it at all. They'd be at a party or whatever one night then the news would come through the next day.

 

[Leo]

a bunch of friends? wow, that's shocking and so sad, sorry to hear. one would be traumatic enough.

 

[version]

He's in a music scene with a lot of people with drug problems, mental health problems, abusive backgrounds and whatnot, so it happens much more regularly than it does elsewhere.

I think he's mentioned maybe four or five people in perhaps as many years and others he knows have attempted it.

 

[WashYourHands]

Horrific, hope your brother is staying sane