If you were in charge of the NHS what would you cut?
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Original post by holly432
it's an interview question and I'm curious to see others views 
I would cut your penis.
Your genetic lineage will end with you.
Antidepressants aren't very addictive.
Saving money by not lowering the blood pressure of hypertensives so they have strokes or heart attacks is an interesting viewpoint.
GPs don't get money for prescribing bp tabs, they get paid for getting the bp of hypertensives or people with heart disease, strokes or diabetes below certain levels. these levels have been decided by groups like the British Hypertension Society and most QAF stuff is evidence based with large numbers of specialists on the committees deciding the guidelines. The NNT (number needed to treat) for hypertension can be high but so can those of many diseases and the guidelines for treating hypertension appropriately used reflect this with all our patients now being diagnosed with ambulatory bp monitoring.
Some of you seem to have very little knowledge of general practice or respect for GPs which is sad as about half of all medical students enter general practice. It is an interesting and varied branch of medicine but most of you seem to have got your knowledge of general practice from the daily mail.
Saving money by not lowering the blood pressure of hypertensives so they have strokes or heart attacks is an interesting viewpoint.
GPs don't get money for prescribing bp tabs, they get paid for getting the bp of hypertensives or people with heart disease, strokes or diabetes below certain levels. these levels have been decided by groups like the British Hypertension Society and most QAF stuff is evidence based with large numbers of specialists on the committees deciding the guidelines. The NNT (number needed to treat) for hypertension can be high but so can those of many diseases and the guidelines for treating hypertension appropriately used reflect this with all our patients now being diagnosed with ambulatory bp monitoring.
Some of you seem to have very little knowledge of general practice or respect for GPs which is sad as about half of all medical students enter general practice. It is an interesting and varied branch of medicine but most of you seem to have got your knowledge of general practice from the daily mail.
Original post by Juichiro
I would cut your penis.
Your genetic lineage will end with you.
Your genetic lineage will end with you.
Given that OP's name is 'Holly' and (s)he has the symbol of venus next to her name, there might be a slight flaw in your plan
Original post by Asklepios
Given that OP's name is 'Holly' and (s)he has the symbol of venus next to her name, there might be a slight flaw in your plan
Epic fail. 
Original post by Democracy
Medicine is a caring profession - most medics don't tend to be socially awkward objectivists with psychopathic tendencies.
Shiggydiggy has it spot on, and lol at you for thinking anything about this country is "socialist".
Shiggydiggy has it spot on, and lol at you for thinking anything about this country is "socialist".
Lmao, you don't think we have socialist tendencies? So much for your condescending and 'knowledgeable' stance...
Being 'socially awkward' isn't necessarily bad. Just because the majority think that something is correct doesn't mean that morally, it is. The majority can be swayed by falsehoods and fallacies.
Also, objectivism isn't bad. If implemented correctly, it would solve every world problem we face today.
Finally, as in my previous post, I do not wish only for survival of the fittest, merely that people in this country seem to think it's a God-given right that they must have anything that is slightly deemed as typical of being a human being.
You are a prime example.
Original post by Dick Dastardly
A reply said, how would you cope with complication of staff shortage at hospitals, in reply to my comment about the massive wage bill for locum doctors, considering some hospital locum trainee doctors earn £2000 per day, a pensioner receives £110 per week basic pension, it has to be addressed what ever complication arise, from staff shortage.
Highway robbery of tax payers hard earned cash, most on low pay.
http://www.telegraph.co.uk/health/healthnews/9975925/The-highest-sums-paid-for-NHS-agency-doctors.html
Highway robbery of tax payers hard earned cash, most on low pay.
http://www.telegraph.co.uk/health/healthnews/9975925/The-highest-sums-paid-for-NHS-agency-doctors.html
OK, so more than half of that list are consultants, therefore don't come under your "trainee doctors" category.
The highest pay per hours worked would appear to be the A&E staff grade who got £2474 for a 9.5 hour shift. Yes, that is a LOT of money. But consider the following: -
•
It's not clear if that's what the doctor received, or what the hospital paid the locum agency (which is usually a lot more than the amount the doctor themselves will actually get)
•
This is very far from normal. Locum rates for staff grades/registrars are usually between £40-60/hr depending on specialty and the time of the shift (nights/weekends are paid more than weekdays)
•
In order for them to pay that much, they must have been really desperate for staff, at very short notice. Imagine how much more it would have cost if they'd had to close the A&E department because there was no registrar/staff grade overnight?
You say "it has to be addressed what ever complication arise, from staff shortage." First of all, I'm not even sure what you really mean by that. Staff shortages sometimes happen, even with the best planning in the world. And if the missing member of staff is a crucial one like an A&E/medical registrar, the effects on the hospital of not having one can be catastrophic. If they have to get someone in or close the hospital to admissions and/or risk excess patient deaths/harm, then sometimes you have to pay a lot for that. How else would you suggest managing the situation?
Yes, it's an awful lot of money, but relating it to pensioners' income is pointless because the two are just not comparable.
tayside frog said - Antidepressants aren't very addictive.
Why was I addicted to them if that is the case.
Money for BP drugs, same difference can be a money tree IMO.
tayside you ended with the following.
Some of you seem to have very little knowledge of general practice or respect for GPs which is sad as about half of all medical students enter general practice. It is an interesting and varied branch of medicine but most of you seem to have got your knowledge of general practice from the daily mail.
Perhaps lack of respect is from misdiagnosis and in some cases arrogance, doctor knows best, rather than listening to patients. Knowledge of Gp's for people of my age is extensive, if they were receiving minimum pay could stand up and shout. Some doctors I know, are the new UK millionaire's from tax payers purse, retire with lucrative pension, average Joe receives about £6k pa. There is often an element of brainwashing and scare mongering patients.
The Telegraph highlighted the offending trusts quoting amount paid.
Why was I addicted to them if that is the case.
Money for BP drugs, same difference can be a money tree IMO.
tayside you ended with the following.
Some of you seem to have very little knowledge of general practice or respect for GPs which is sad as about half of all medical students enter general practice. It is an interesting and varied branch of medicine but most of you seem to have got your knowledge of general practice from the daily mail.
Perhaps lack of respect is from misdiagnosis and in some cases arrogance, doctor knows best, rather than listening to patients. Knowledge of Gp's for people of my age is extensive, if they were receiving minimum pay could stand up and shout. Some doctors I know, are the new UK millionaire's from tax payers purse, retire with lucrative pension, average Joe receives about £6k pa. There is often an element of brainwashing and scare mongering patients.
The Telegraph highlighted the offending trusts quoting amount paid.
Helenia. I understand your post, but doctors can be compared to pensioners, one day they will become one, except on lucrative pay, don't forget public servants are payed for by the tax payer, which also includes some pensioners.
The NHS say they are short of money, how can they justify these high overheads to a chosen few. How do we justify the high life style of lots of doctors.
The NHS say they are short of money, how can they justify these high overheads to a chosen few. How do we justify the high life style of lots of doctors.
OK, got the message, you're not a prospective medical student just someone who's come on the medical forum to have an argument. Must admit I can't be bothered trawling all the fora just to pick fights.
Original post by Biblio
I'd make people pay to see GPs to clear up the backlog. ( A small fee - £2, so no time is wasted by those coming in for every little thing when no treatment is needed, it costs allot of money to have a GP see someone)
I'd use private contractors to run the ambulance service.
I'd cut wages across the board for higher up medical professionals, the NHS is almost the sole employer of doctors etc, so they have huge market power, this could be used to drastically cut higher paid professionals wages. Surgeons and anaesthetists would be cut first.
I'd introduce league tables for surgeons and anesthetists, allowing patients to choose who cares forthem ( for planned operations) then I would pay them per operation. Making operations voluntary of course.
I'd stop those paying over the 40% rate of tax from claiming for non emergency treatment. For example rich pensioners should pay for their own hip treatments, rich middle class families should miss a holiday if their kids need braces.
I'd stop paying orthodontists per each treatment they give out because they are dishing out braces willy nilly now.
I'd use private contractors to run the ambulance service.
I'd cut wages across the board for higher up medical professionals, the NHS is almost the sole employer of doctors etc, so they have huge market power, this could be used to drastically cut higher paid professionals wages. Surgeons and anaesthetists would be cut first.
I'd introduce league tables for surgeons and anesthetists, allowing patients to choose who cares forthem ( for planned operations) then I would pay them per operation. Making operations voluntary of course.
I'd stop those paying over the 40% rate of tax from claiming for non emergency treatment. For example rich pensioners should pay for their own hip treatments, rich middle class families should miss a holiday if their kids need braces.
I'd stop paying orthodontists per each treatment they give out because they are dishing out braces willy nilly now.
But wouldn't cutting wages for higher up doctors like consultants make them potentially consider practising abroad where they will get more, it's already kind of happening even at the current salary. :/
I would make some form of basic health education in school mandatory or something for parents too who worry unnecessarily about their kids, bringing them to GP appointments or A&E for minor things, kind of wastes doctors time. So by giving a bit of basic education on symptoms and the management of them and also showing which are red flag symptoms it might potentially cut some visits down. I understand that the NHS kind of does this like with the blood in the urine advert or if you have had a cough for 3 weeks then come see us, but some things are minor. I could but wrong though and there could be some ethics from stopping this, such as my dad who is the completely over the top from seeing medical professionals, when my sisters toe got badly infected he failed to take her to emergency and almost risked her foot being amputated. (I can't remember the exact story I was young) but my point is by being to far to that side you can risk your health i guess. But im not sure how to fully tackle this problem, just my thoughts
Other thing would be to give real education on diet and exercise and encourage people to do their own research and take their health into real consideration. Again I know the NHS kind of does this but I was reading a BMJ article where a doctor was telling his patients who had high cholesterol and diabetes about healthy eating only to later find that they order fairly high calorific meals for lunch containing lots of bad nutrients ect. He mentioned there are healthy options but the 'healthy options' failed to mention all the extra things like a salad layered we tonnes of cheese or salad cream, what's the point? Although in the NHS it is not easy to correct, it would be cheaper to serve chips and sausage than salmon and salad, but what I am trying to say is out of hospital, patients should know what is good, not knowing a salad is good but forgetting the extras make it bad for example. Im sure patients see other healthcare professionals ordering bad food and that's up to them but that might not set a good example either. Another thing brings me back to exercise, many patients needlessly run for miles on end or cycle in an attempt to correct health, but what they are doing is damaging their heart and risking heart attack/stroke/cardiac arrest which would inevitably land them back in hospital. On exercise, it is important to build up, start from the bottom and up your game as your body adapts and also finding a variety of exercises, running is debatable and said to be inefficient alone at aiding weight loss, it keeps your heart healthy but can also damage it and damage your joints. Im not saying running is bad but understanding that a mixture is required, from cardio to resistance training, muscles need some time too and that aids weight loss as well as your health.
Again I could be wrong but that's my thoughts on it
Other thing would be to give real education on diet and exercise and encourage people to do their own research and take their health into real consideration. Again I know the NHS kind of does this but I was reading a BMJ article where a doctor was telling his patients who had high cholesterol and diabetes about healthy eating only to later find that they order fairly high calorific meals for lunch containing lots of bad nutrients ect. He mentioned there are healthy options but the 'healthy options' failed to mention all the extra things like a salad layered we tonnes of cheese or salad cream, what's the point? Although in the NHS it is not easy to correct, it would be cheaper to serve chips and sausage than salmon and salad, but what I am trying to say is out of hospital, patients should know what is good, not knowing a salad is good but forgetting the extras make it bad for example. Im sure patients see other healthcare professionals ordering bad food and that's up to them but that might not set a good example either. Another thing brings me back to exercise, many patients needlessly run for miles on end or cycle in an attempt to correct health, but what they are doing is damaging their heart and risking heart attack/stroke/cardiac arrest which would inevitably land them back in hospital. On exercise, it is important to build up, start from the bottom and up your game as your body adapts and also finding a variety of exercises, running is debatable and said to be inefficient alone at aiding weight loss, it keeps your heart healthy but can also damage it and damage your joints. Im not saying running is bad but understanding that a mixture is required, from cardio to resistance training, muscles need some time too and that aids weight loss as well as your health.
Again I could be wrong but that's my thoughts on it
Original post by Democracy
Don't you think that the government's refusal to institute minimal unit pricing and plain packaging for cigarettes (in an effort to please an Australian lobbyist) is a more significant reason for the problems we're facing?
In other words - don't blame individuals, look at the system we live in and who runs it.
In other words - don't blame individuals, look at the system we live in and who runs it.
Maybe if the government continues to allow alcohol to be sold and tobacco which it will, then it should give a slight more from profit to the NHS to account for its losses or perhaps charge the tobacco/alcohol companies directly? Or Inflation just affect those two so people can buy as much
(this is beyond the scope of the NHS though, but maybe the health secretary can do something?)Original post by Dick Dastardly
Helenia. I understand your post, but doctors can be compared to pensioners, one day they will become one, except on lucrative pay, don't forget public servants are payed for by the tax payer, which also includes some pensioners.
The NHS say they are short of money, how can they justify these high overheads to a chosen few. How do we justify the high life style of lots of doctors.
The NHS say they are short of money, how can they justify these high overheads to a chosen few. How do we justify the high life style of lots of doctors.
Firstly, please learn to quote, it's not hard.
Secondly, I think you're viewing it as a moral situation rather than a practical one, which is what it is when your night registrar calls in sick at short notice/fails to turn up because they've been in a car accident (this has happened at one place I worked). You have to get somebody, and if nobody will do it for less money, what choice do you have? It's all very well saying that people shouldn't get paid that much, and maybe they shouldn't - and most of the time they don't, as I keep saying - but how would you propose to solve the problem otherwise?
I am well aware that the NHS is funded by taxpayers, and that the state pension is small, but that makes absolutely no difference to the need for a hospital to have suitable medical staffing available.
Original post by nexttime
Insulin and the flu vaccine? I don't see why you'd want people to not take their £100 insulin and instead come in in DKA costing thousands, or come in a few years later with wrecked kidneys needing hundreds of thousands spent on kidney transplants and/or dialysis.?
In my experience, there are plenty of people who mismanage their diabetes and end-up requiring the above interventions anyway. The argument as to what should be cut can be financially motivated as well as morally motivated, we have to save money somehow and that means tough choices being made at times....
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Original post by Asklepios
I would say that the idea of charging people for certain things is a bit of a slippery slope - how do we know where to draw the line between free to use and paid? I think charging for anything just defeats the point of the NHS. As a healthcare professional, what would you do if someone broke their arm but then refused to get a cast because he/she didn't want to pay?
People already have to pay for a lot of the things they need medically though. For example: glasses, dentures, hearing-aids, and also prosthetic limbs (which are fairly important if you happen to require one).
Therefore I don't think a notional charge is a bad thing, not the true cost, but a fixed-fee a bit like when you have "NHS" dental services.
As for the broken-arm scenario, you would just do as any doctor would do now, attempt to treat the patient in the best way possible with what was available. A splint perhaps? With lots of aftercare advice.
It is quite a (dare I say it) naive attitude to think that everyone who walks into A&E just accepts the treatment offered and behaves themselves. I am sure there are plenty of people who have refused plaster casts in the past and te docs have found a workaround. I once saw a guy with a suspected DVT in his leg tell the doctors to "**** off" and wander out of A&E because he wasn't willing to wait for a scan, or another patient who injured himself cutting off a plaster cast in his shed with a dremmel because he didn't want to wear it any more. Doctors are presented with unique and unusual problems in treatment every day, and have to come up with innovative solutions to match :-)
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(edited 10 years ago)
Original post by DeadGirlsDance
That's how I felt when I had someone puke in my direction and it just missed my shoes 
.
.You shouldn't have started undressing for him then.
Original post by Pittawithcheese
In my experience, there are plenty of people who mismanage their diabetes and end-up requiring the above interventions anyway. The argument as to what should be cut can be financially motivated as well as morally motivated, we have to save money somehow and that means tough choices being made at times....
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Posted from TSR Mobile
But if you charged for insulin, far more people would be at risk of mismanagement and complications - and these cost far more than insulin. It is a financial decision for diabetics to have free prescriptions, not a moral one.
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Original post by Helenia
But if you charged for insulin, far more people would be at risk of mismanagement and complications - and these cost far more than insulin. It is a financial decision for diabetics to have free prescriptions, not a moral one.
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True true. I think the overriding point being made in this discussion is that one cannot cut any services without: a) disadvantaging somebody or some group, or: b) creating some kind of financial time bomb elsewhere in the health service....
In the current climate though, I believe the emphasis has to be on cutting capital spending and worrying about the consequences later. We simply cannot afford to keep treating everyone for everything... sad as that is :-(
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Original post by Pittawithcheese
In my experience, there are plenty of people who mismanage their diabetes and end-up requiring the above interventions anyway. The argument as to what should be cut can be financially motivated as well as morally motivated, we have to save money somehow and that means tough choices being made at times....
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Posted from TSR Mobile
Chronic disease is already a ticking financial time bomb in regards to their potential complications from inadequate management. Putting an additional barrier like charges for insulin will certainly light that fuse.
You might earn some dollar from the insulin, but you'll lose an arm and a leg when you start paying for the subsequent increase in CKD, strokes, IHD etc. You said it yourself - people are already mismanaging without additional barriers being implemented.
You gotta spend money to make money.
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