If you were in charge of the NHS what would you cut?
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Original post by Quiddi
well not really lots of people live with others of their same ethnicity so you have areas where urdu is the language spoken on the street and you can get acess to the council etc with translaters so what incentive is there to improve your english there are many who cant speak or just speak very broken/little
Original post by taysidefrog
"I think you'd find A&E would be clogged up as ill people (I've noticed my additional languages disappear when I'm ill or in pain) struggle to explain where the pain is, and what happened. They won't just meekly go away! The UK doesn't just provide translation services out of kindness, we provide them because it makes life easier for us."
I didn't say translators shouldn't be provided, just that tax payers shouldn't provide them. If you are unwell in a foreign country and you have chosen to live in that country for over a year then if you require a translator you pay for it, not other people pay for it. It isn't a health expense it's a "can't be bothered to learn the language" expense. The NHS should be free at the point of use in the languages of the UK (or sign language/ Braille)
I didn't say translators shouldn't be provided, just that tax payers shouldn't provide them. If you are unwell in a foreign country and you have chosen to live in that country for over a year then if you require a translator you pay for it, not other people pay for it. It isn't a health expense it's a "can't be bothered to learn the language" expense. The NHS should be free at the point of use in the languages of the UK (or sign language/ Braille)
And again, do you think this person, with possibly anything from appendicitis to gallstones, will just go away? They probably can't afford an interpreter, so they will just keep trying to explain.
Are you going to tell staff that if they can't understand within so many minutes, they should call security to get sick people escorted out?
I have my doubts about how costs surrounding those with multiple comorbidities is calculated. I think more research into what is appropriate in the geriatric population may in fact yield cost savings.
More uniform IT would improve efficiency and reduce training time needed. Indeed, a formal national database collating data from all patients in the country like the one used in Denmark would almost certainly produce savings in the long run.
Investment in and increased awareness of warden-run accommodation seems like it would be a good compromise for those who cannot cope at home but are unwilling to consider care homes.
And fancifully: ban smoking and alcohol.
Cut it in half??!! Do that and literally about 80% of your staff are gone overnight. Some of the smartest and hardest working people in the country are not in demand elsewhere!? Please.
In most instances, translators cost next to nothing. For common languages like Polish, usually a nurse speaks it. For anything else at all, all you need to do is phone a helpline which connects you to someone who speaks the appropriate language. A simple 5 minute conversation costs pittance. Its not like there is an army of multi-lingual translators hiding in the basement of every hospital.
More uniform IT would improve efficiency and reduce training time needed. Indeed, a formal national database collating data from all patients in the country like the one used in Denmark would almost certainly produce savings in the long run.
Investment in and increased awareness of warden-run accommodation seems like it would be a good compromise for those who cannot cope at home but are unwilling to consider care homes.
And fancifully: ban smoking and alcohol.
Original post by Biblio
Surgeons, Gps etc should not be earning 100k + a year cut it in half, they have to work for the NHS, there is no demand for their labour elsewhere
Cut it in half??!! Do that and literally about 80% of your staff are gone overnight. Some of the smartest and hardest working people in the country are not in demand elsewhere!? Please.
Original post by taysidefrog
I didn't say translators shouldn't be provided, just that tax payers shouldn't provide them. If you are unwell in a foreign country and you have chosen to live in that country for over a year then if you require a translator you pay for it, not other people pay for it. It isn't a health expense it's a "can't be bothered to learn the language" expense. The NHS should be free at the point of use in the languages of the UK (or sign language/ Braille)
I didn't say translators shouldn't be provided, just that tax payers shouldn't provide them. If you are unwell in a foreign country and you have chosen to live in that country for over a year then if you require a translator you pay for it, not other people pay for it. It isn't a health expense it's a "can't be bothered to learn the language" expense. The NHS should be free at the point of use in the languages of the UK (or sign language/ Braille)
In most instances, translators cost next to nothing. For common languages like Polish, usually a nurse speaks it. For anything else at all, all you need to do is phone a helpline which connects you to someone who speaks the appropriate language. A simple 5 minute conversation costs pittance. Its not like there is an army of multi-lingual translators hiding in the basement of every hospital.
(edited 10 years ago)
Original post by holly432
it's an interview question and I'm curious to see others views 
I would recover costs from patients who need interventions as a result of botched private operations. If they can afford to go private in the first place, then they (or the private surgeon, or their insurer) can afford to reimburse the NHS for its costs.
Original post by Beska
Homeopathy - nil evidence for, lots of evidence against and in the world of increasingly evidence-based practice I think it's only right that evidence is used to identify areas of the NHS where savings can be made. Homeopathy costs the NHS £4-12m a year (so not a lot) but every little helps in times of austerity, and the continued running of purely homeopathic hospitals is madness considering there are A+E closures, ward closures, etc. around the country. It's madness that the NHS is paying millions of pounds for water.
This is a controversial, though.
This is a controversial, though.
I know how you feel - I even started a thread on the subject a year or so ago. The question I asked was whether it was ethical for doctors to provide a treatment which they know cannot conceivably work (because the 'medicine' is simply water). However, it appears to be the case that many patients stop presenting (ie, stop wasting the NHS' time and money) after being offered homeopathic treatment, and so arguably it saves money. Since it cannot be the 'medicine', it must be placebo effect and/or the holistic approach which typically accompanies homeopathy. I dunno, I cannot make my mind up on this one (the science is not in doubt, of course), but atm I'm inclined to axe it from the NHS because I think it is unethical to lie to patients about the efficacy of the 'medicine'.
Original post by Beska
I agree with the ambulance charge though, but more of a fine. Similar to wasting police time - but could it cause a situation where somebody is not sure if they are serious enough to call an ambulance? Is a lay person OK to make that call? What if they think they just have the flu but instead are lying there with pyelonephritis +/- sepsis?
Good points. My father had a good friend who died aged ~30 like that (in Germany, not the UK). It seems she thought she had flu or something, and took to her bed, but she had pneumonia. And she didn't have previous health problems - she was a martial arts enthusiast, so presumably quite fit.
Original post by Quiddi
thats illogical you are just appealing to authority
It's perfectly logical. Put the textbook down, you've misunderstood it.
Edit: Oops just read Quiddi's other comments, I got trolled
(edited 10 years ago)
Original post by Pastaferian
However, it appears to be the case that many patients stop presenting (ie, stop wasting the NHS' time and money) after being offered homeopathic treatment, and so arguably it saves money.
How many of those patients would then go private for their water though?
We could use placebos in every area of medicine to great effect. We could make all pills big and red just to maximize placebo. We could run sham surgery, shine lights in their eyes claiming its therapeutic, whatever we want, and i'm sure the patients would thank us for it. Its about integrity and honesty at the end of the day though, over short-term gain. Running homeopathic hospitals is completely against that.
(edited 10 years ago)
Original post by arson_fire
I`m not suggesting it should be banned - just not done at public expense. The NHS has limited resources and when people are dying while waiting for life saving heart operations (152 in Wales died after waiting more than 6 months: http://www.bbc.co.uk/news/uk-wales-23994943) I think its unfair to divert resources to what is basically elective cosmetic surgery.
The right to have a child is there so governments can`t ban you from having kids (i.e. China). It is NOT there so you can have your lifestyle choices paid for by everyone else
The right to have a child is there so governments can`t ban you from having kids (i.e. China). It is NOT there so you can have your lifestyle choices paid for by everyone else
I think it's absolutely sensible to consider spending carefully when there are such limited resources, as you say. But there is more to medicine than just curing diseases. It's also about reducing distress and disability which is where infertility comes into it.
Keep in mind that not being able to have a child isn't just something that you shrug off and go 'oh well, I guess that's that'. It's a lifelong impairment and most people build their adult lives around having children, raising a family and being a parent. Being able to overcome that with medical treatment is pretty amazing and the ultimate benefits are permanent and can redefine someone's entire life. On top of that, the effect of being infertile can be pretty horrible, especially when society constantly reinforces the idea of a woman being defined as a mother. I've seen some pretty terrible cases of depression as a result of infertility. On the otherhand, I've seen a number of patients completely turn their lifestyles around in terms of their own physical health in order to meet the criteria of elligbility, so it can be a massive incentive for people. So overall, looking at the cost/benefits, it's actually pretty damn worthwhile to be spending resources on it.
The real debate is how many attempts at IVF should be funded as the likelihood of failure increases which each cycle (as far as I am aware). So the cost/benefit ratio begins to change.
Original post by pane123
If you want to stand out from the crowd, you could suggest the NHS stops treating anyone with a terminal illness.
If you want to stand out from the crowd, you could suggest the NHS stops treating anyone with a terminal illness.
I would be fascinated to hear someone defend this suggestion.
(edited 10 years ago)
Original post by nexttime
How many of those patients would then go private for their water though?
We could use placebos in every area of medicine to great effect. We could make all pills big and red just to maximize placebo. We could run sham surgery, shine lights in their eyes claiming its therapeutic, whatever we want, and i'm sure the patients would thank us for it. Its about integrity and honesty at the end of the day though, over short-term gain. Running homeopathic hospitals is completely against that.
We could use placebos in every area of medicine to great effect. We could make all pills big and red just to maximize placebo. We could run sham surgery, shine lights in their eyes claiming its therapeutic, whatever we want, and i'm sure the patients would thank us for it. Its about integrity and honesty at the end of the day though, over short-term gain. Running homeopathic hospitals is completely against that.
Yes, I can see those points. Which is why I said I had problems with the ethical side of providing this treatment, and am inclined to agree with you. But I have problems with the ethics of withholding treatment as well - still not completely decided on this one.
Original post by arson_fire
I`m not disagreeing that its an unpleasant situation to be in, but IVF is not a medical necessity - nobody has to have it to stay healthy. I can`t agree that the taxpayer should pay for it.
If I changed what you wrote to "The effects on being ugly or flat chested can be pretty horrible, especially when society constantly reinforces the idea of a woman being defined by her looks.", would you say that cosmetic plastic surgery should be freely available on the NHS?
If I changed what you wrote to "The effects on being ugly or flat chested can be pretty horrible, especially when society constantly reinforces the idea of a woman being defined by her looks.", would you say that cosmetic plastic surgery should be freely available on the NHS?
I see what you mean by it not being a medical necessity. But at the same time, I would hope that we live in a developed enough society that we can provide care beyond that of bare bone necessity, even in the face of economic uncertainty. We know that the notion of 'being healthy' is more than just an absence of symptoms and medicine itself has progressed beyond that paradigm.
With regards to your example about cosmetic surgery - I think yes, there are very specific circumstances in which it can be appropriate and it should be made available publically, based upon the cost/benefit ratio.
Simple, stop trainee locum doctors earning £2000 per day at NHS hospitals.
Stop GP's handing out pills they earn extra income from.
Stop GP's handing out pills they earn extra income from.
Original post by Dick Dastardly
Simple, stop trainee locum doctors earning £2000 per day at NHS hospitals.
Stop GP's handing out pills they earn extra income from.
Stop GP's handing out pills they earn extra income from.
I agree with the locum thing - I think there are some serious logistical failings when it comes to temporary staff.
But the prescription, extra income thing - what are you referring to specifically? The QoF system?
Original post by Dick Dastardly
Simple, stop trainee locum doctors earning £2000 per day at NHS hospitals.
So who do you suggest comes in to provide urgent last-minute cover when none of the permanent staff are available?
(And most locums earn nowhere near that much, that was a single/small handful of cases found by the Daily Fail a while ago).
Original post by nexttime
In most instances, translators cost next to nothing. For common languages like Polish, usually a nurse speaks it. For anything else at all, all you need to do is phone a helpline which connects you to someone who speaks the appropriate language. A simple 5 minute conversation costs pittance. Its not like there is an army of multi-lingual translators hiding in the basement of every hospital.
In most instances, translators cost next to nothing. For common languages like Polish, usually a nurse speaks it. For anything else at all, all you need to do is phone a helpline which connects you to someone who speaks the appropriate language. A simple 5 minute conversation costs pittance. Its not like there is an army of multi-lingual translators hiding in the basement of every hospital.
Languageline costs $3.95 per minute (no idea why they price in dollars) http://www.languageline.co.uk/solutions/interpretation/personal-interpreter/. Hospitals in areas with large immigrant populations spend a LOT of money on interpreters. I don't think it's going to save the NHS but it would certainly be a useful saving.
Original post by arson_fire
I`d shut A&E at the weekends to all but life-threatening conditions
Already happening in some places.
My local NHS trust sent round a pamphlet saying that our two local A&Es now only handle life-threatening conditions or broken bones. That's all the time, not just weekends.
Everything else has to go to a GP (most in the area don't offer a 24 hour, callout or weekend service) or a Minor Injuries Unit. My nearest MIU is over 7 miles away in the next town, isn't on a bus route and is open 8-4, Mon-Fri. The nearest one that opens at a weekend is 20 miles away and that's not 24 hour opening either.
"Minor injuries" only stay minor if they're treated correctly and promptly. A cut that needs cleaning and stitching on Day 1, might look a bit nastier if left to become infected until Day 3. You could damage an eye on a Friday night and not get help until the following Monday. Can you imagine nursing an injured child through a weekend with no medical help?
Restricting access to A&E might solve the immediate problem, but it could lead to people suffering more damage by going untreated for a couple of days or overnight, thus costing even more NHS time and money. Until there are enough easily-accessed, 24 hour MIUs, restricting access to A&Es simply won't have the desired effect. People will keep turning up there because they simply have nowhere else to go.
(edited 10 years ago)
Original post by Beska
Mostly devil's advocate:
Few issues with the above:
- £2 might be little money to someone, but to someone else it might be an absolute fortune and it's then you start to enter dangerous territory. Will people choose to feed their family or go to the doctor? More likely the former, and in the longer term you're going to 1) end up with a population that has poorer health and 2) increase the incidence of poor health in the lower social classes.
- Cutting wages - bad idea. Pay peanuts get monkeys, and medical professionals (just like any other professional) will go to the highest bidder - including abroad.. Look at EDs right now, I bet someone along the line said "don't worry about it, where else are the doctors going to work!" and see where we are now - a less desirable speciality and an entire department that is crumbling. Cutting wages is probably the worst (so last) thing the NHS should do to save money.
- As for charging for treatment, that is completely contrary to what the NHS is, what the law states, what the NHS constitution says, etc. so would need an immeasurable change in culture, law, services, etc.
- All that means is that the drunk will be back tuesday morning with septic shock, or the person with tummy ache will be back monday with a ruptured appendix and generalised peritonitis. You can't triage like that - all it does it cause problems down the line.
I agree with the ambulance charge though, but more of a fine. Similar to wasting police time - but could it cause a situation where somebody is not sure if they are serious enough to call an ambulance? Is a lay person OK to make that call? What if they think they just have the flu but instead are lying there with pyelonephritis +/- sepsis?
Few issues with the above:
- £2 might be little money to someone, but to someone else it might be an absolute fortune and it's then you start to enter dangerous territory. Will people choose to feed their family or go to the doctor? More likely the former, and in the longer term you're going to 1) end up with a population that has poorer health and 2) increase the incidence of poor health in the lower social classes.
- Cutting wages - bad idea. Pay peanuts get monkeys, and medical professionals (just like any other professional) will go to the highest bidder - including abroad.. Look at EDs right now, I bet someone along the line said "don't worry about it, where else are the doctors going to work!" and see where we are now - a less desirable speciality and an entire department that is crumbling. Cutting wages is probably the worst (so last) thing the NHS should do to save money.
- As for charging for treatment, that is completely contrary to what the NHS is, what the law states, what the NHS constitution says, etc. so would need an immeasurable change in culture, law, services, etc.
- All that means is that the drunk will be back tuesday morning with septic shock, or the person with tummy ache will be back monday with a ruptured appendix and generalised peritonitis. You can't triage like that - all it does it cause problems down the line.
I agree with the ambulance charge though, but more of a fine. Similar to wasting police time - but could it cause a situation where somebody is not sure if they are serious enough to call an ambulance? Is a lay person OK to make that call? What if they think they just have the flu but instead are lying there with pyelonephritis +/- sepsis?
I don't think it should be a fee but a deposit of say £5. You'll only end up out of pocket if you miss your appointment.
I agree with not spending money on PFI hospitals, they're cheaper for that government in the short term because of the way the finances work but in the long term they cost the tax payer far more and the design has to be acceptable to the PFI funder who is often trying to do things on the cheap.
We use Language line and consultations are at least 10 minutes. My patients from overseas tend to fall into 2 groups, those who come with some English and rapidly improve and rarely bother with translators and those who speak minimal English when they arrive and don't make much effort to improve and are still wanting a translator 4 years later. Saying "oh they've just got poor English because they are ill" doesn't fit with life as I see it. I see no reason for tax payers to support people who don't want to learn English. A&E maybe sees a different subsection of patients. If they want to save money on English lessons then they can spend it on translators instead.
Not sure where I get money from prescribing tablets. That sounds like an idea from someone who has never spent any time in a GP surgery and if you're wanting to be a medical student would look very ignorant. A huge amount of money is spent on having pharmacists advising GPs as to how to get their prescribing budgets down and use cheaper alternatives. Yes we're encouraged to use statins to get the cholesterol level of people with heart disease and diabetes down, but that is evidence based and you'd be mad to say that we should save money by not prescribing statins to people who have had a heart attack. QAF doesn't pay us to give statins to the worried well.
We use Language line and consultations are at least 10 minutes. My patients from overseas tend to fall into 2 groups, those who come with some English and rapidly improve and rarely bother with translators and those who speak minimal English when they arrive and don't make much effort to improve and are still wanting a translator 4 years later. Saying "oh they've just got poor English because they are ill" doesn't fit with life as I see it. I see no reason for tax payers to support people who don't want to learn English. A&E maybe sees a different subsection of patients. If they want to save money on English lessons then they can spend it on translators instead.
Not sure where I get money from prescribing tablets. That sounds like an idea from someone who has never spent any time in a GP surgery and if you're wanting to be a medical student would look very ignorant. A huge amount of money is spent on having pharmacists advising GPs as to how to get their prescribing budgets down and use cheaper alternatives. Yes we're encouraged to use statins to get the cholesterol level of people with heart disease and diabetes down, but that is evidence based and you'd be mad to say that we should save money by not prescribing statins to people who have had a heart attack. QAF doesn't pay us to give statins to the worried well.
I would cut the following:
Gastric bypass surgery;
Cosmetic surgery (as distinct from plastic surgery);
Breastfeeding support workers (because the evidence shows they don't work);
Methadone prescriptions after a certain period of time has elapsed;
I would also introduce nominal charges for:
Dressings and other consumables;
Prescriptions upon discharge;
Insulin (cumulatively the most expensive prescription medicine in the whole NHS).
The flu vaccine
The idea being that if you go to hospital with a broken arm, the treatment and investigations are paid for, but you pay a small amount for the plaster-cast and other items that you take home.
:-)
Posted from TSR Mobile
Gastric bypass surgery;
Cosmetic surgery (as distinct from plastic surgery);
Breastfeeding support workers (because the evidence shows they don't work);
Methadone prescriptions after a certain period of time has elapsed;
I would also introduce nominal charges for:
Dressings and other consumables;
Prescriptions upon discharge;
Insulin (cumulatively the most expensive prescription medicine in the whole NHS).
The flu vaccine
The idea being that if you go to hospital with a broken arm, the treatment and investigations are paid for, but you pay a small amount for the plaster-cast and other items that you take home.
:-)
Posted from TSR Mobile
Free service to anyone who hurts themselves whilst over triple the drink drive limit and needs A&E.
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