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Is the NHS really the best healthcare system in the world? watch

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    (Original post by nexttime)
    The staff have to use the same facilities every single frickin day so no need to tell me! Some organisations might give the staff discount... many hospitals do not.

    No. I unfortunately am not aware of any publicly available statistics, but supposedly 60-70% of complaints are about parking.
    That's separate from what I'm talking about, really - complaints about a specific kind of behaviour. I'm surprised discounts aren't pretty much mandatory for staff, though

    Of course there are legitimate cases and legitimate reasons to take time over what people say. Even in my example - the doctor who told people to get out was often pretty abrupt about it. The patients may feel aggrieved, and legitimately so. But there are limited resources and each doctor has very limited time - by being abrupt she saw people quickly and made beds free for newer sicker patients to come in. The patients felt less satisfied but they were more likely to receive prompt treatment, more likely to survive.

    We're talking about is the paternalistic vs patient-directed models of care. The former assumes the professional knows best and should decide everything. The latter asks what the consumer wants and provides whatever that may be. Obviously the optimum lies in between. We've seen a huge shift towards patient-centred care in the last 10-15 years. For example, most med schools now attach heavy priority to communication and empathy at the expense of academic prowess. You seem to be saying it should go further, putting greater emphasis on communication at the expense of medical know-how, whereas I personally would rather my doctor was very good at treating my disease.

    An example that might make you see my perspective a little more: are you a homeopathy user? The NHS now put significant money into providing homeopathy at a number of specific centres. This is a direct result of the shift to patient centred care. Doctors would never advocate money be spent on a treatment that categorically doesn't work when it could be used on cancer drugs or nurses etc. But a significant voice in the public wanted it, so the NHS managers listened and provided it. Agree with that? Disagree?

    It is superficial. In the literal sense. Its on the surface and its very visible. It is not necessarily related to what's underneath.

    If you attach high importance to that that's fine. Not everyone does. The private sector does indeed attach big importance to these very visible aspects for the exact reason you identified. Things that the public perceives well, like how nice food is and how polite people are, are highly controlled in the private sector and are the things that would change if we start taking a more consumerist approach to healthcare. Things like time to antibiotics, the surgical approach used, or the optimal distribution of resources to minimise mortality... not so much.
    No offence but you're really missing my point. This has nothing to do with taking longer to baby a patient, or fiddly customer service skills of the sort they probably drill into you at an expensive hotel or something. This is about basic manners which take no further time and which don't even require training, TBH.

    Everyone who has been in an environment with other people (these are the sort of things you learn as a kid in school, or if home schooled, will end up learning at university and not through being taught it in classes either) knows not to act in a certain way. It's not either/or. I already agreed with you (further down in the post you're quoting) that doctors should do what they think is best for the patient. But that's not impoliteness, although we seem to be blurring the boundaries here. Yes it probably gets a lot of complaints, but, like the parking thing, it's not what I'm talking about.

    "Politeness" as I am defining it doesn't mean deferring to the patient X times when they're insisting that they or little Jimmy has pneumonia when actually it's just a common cold and they should never have gone to A & E. It's basic respect. I would define politeness as not being rude.

    It boils down to this: there is no benefit to medical staff from being rude, and sometimes, because you have to listen to what a patient says as well as possibly examine them before treating them, if a patient feels intimidated into not "opening up" as much that could affect your treatment negatively, so it's not superficial. Or, if you don't listen to patients as much as you should (and not because they are insisting something that's clearly wrong) that could also affect your treatment. Yes, one might have to be more "direct" in certain situations, say if a parent is refusing to leave till little Jimmy gets to stay in hospital overnight and you don't have enough beds and have to see a lot more patients after them. You're going to have to insist they leave. Some people might perceive that as rudeness, but it's like assertiveness v aggressiveness - the former is called for sometimes. Aggressiveness/rudeness is not, unless someone is drunk and abusive or something, and in that case they probably need the security staff and not a doctor or nurse.

    But some doctors/nurses (perhaps while stressed, understandably) seem to display the sort of behaviour my aunt saw. You don't need to divert resources to training to know that throwing your toys out of the pram in front of people you're being paid to treat is not OK just because you're having a bad day. TBH, a 15 year old would know this. And it's not going to help you as well as the patient either, so this either/or situation you talk about doesn't exist. I would argue that that's not OK even if stressed. (FYI, that did seem to affect her treatment, if you have mental health problems you're not going to "open up" as much about the way you feel to someone who is acting in that way and she said she kind of had to gloss over her problems. In her situation!)

    You seem to think I'm suggesting loads of "politeness training" of the sort GP receptionists have apparently gotten in certain areas. In fact, I would argue that it's just common sense. You don't need to be focusing all your mental energy on "be nice to the patient" instead of "treat them" to know not to throw their papers across the desk at them. But, if you have a culture where basic civility everyone knows is seen as a luxury, maybe it's OK to treat patients as your emotional punching bags if you're having a bad day. I don't know.

    Does that not happen in the private sector? Isn't it just that we don't hear about it? Or that people just leave their job and work elsewhere?

    The rigid medical hierachy is pretty annoying though yes. Its way more pronounced in less developed countries though. Not sure about European/the US.
    To be honest, you do hear about it when it goes on. I lurk the IB forums, as well as other ones, and it definitely gets out. Like I said, I've worked in a decent range of industries too. I also refer you to all the threads the "meninists" make on here whenever women leave their jobs claiming bullying or harassment and the papers get hold of it

    Maybe it's because medicine is high stress (certain types of finance places have a lot of bullying too, apparently). I can imagine the hierarchy may be annoying too.

    (Original post by nexttime)
    That sounds pretty bad. Just to play devil's advocate: what would you have them do? Suspend him based on the word of one patient and their family?

    Another part of the problem is that doctors are a) in very short supply and b) very very expensive to train. Its not like a mechanic or Tesco sales assistant, where you can just pick up another one next week..

    And I'm sure you will defend this based on your experience, but my experience of complaining against private companies has not exactly been smooth sailing either. Some have been good, others awful. Natwest repeatedly ignored me and were threatening me with bailifs, yet the instant i mentioned taking it to the ombudsmen suddenly the problem evaporated.

    But yes, another way to move things towards patient-based care would be to make complains procedures even more robust. Perhaps for every complain there could be a hearing with the senior managers to explain yourself. Costly and time-consuming and again takes people away from patient care, but perhaps that is what we will see in the future based on current trajectories.
    What I found annoying after having read through the emails myself was that they didn't even state whether they'd spoken to him or not. I'm not sure if this is to do with the whole admission of liability thing, but they didn't need to admit "Dr X may have been under a lot of stress at the time" as an explanation to do this. It was simply a total deflection of fault, insinuating that the whole thing was my aunt's fault if anything. A non-apology of the kind politicians make.

    Don't you think at least saying something like "We have spoken to Dr X about the situation," Dr X having the balls to apologise for it (again, nobody acts like that and doesn't know it's completely not OK) and so forth would have improved the NHS-patient relationship a little? If people feel unsatisfied/unlistened to by the NHS, even if they never return to that particular hospital, they may end up not going to see the doctor when they should, or taking that out on the next one they see who doesn't deserve it, or making more complaints about things they don't need to (like the doctor not giving the diagnosis they want, which is clearly wrong).

    I have never had a problem TBH, and as you've probably guessed as someone without a degree, I earn a decent salary but am not necessarily at the "top of the totem pole" so don't have any particular clout or use fancy companies. I have complained to my bank (Barclays) numerous times before, as unfortunately they don't handle my account too well, as well as places like Tesco's, and certainly never had any problems there.

    Without knowing the nature of your complaint to Natwest, though (they asked you to repay a loan you never took out or something, I'm guessing?) it's hard to know why they would've been threatening bailiffs. And banks are a pretty extreme example TBH, reason being that sometimes they have power over you too and for good reason (because people can take out loans, overdrafts, etc - in some ways they're your customer too). But a "non apology" of the kind my aunt got is pretty much nonexistent in the private sector. Unless the parent of little Jimmy writes in complaining that the staff told him nicely to stop throwing their food on the floor.

    I'm curious as to why you think a hearing is required, provided the complaint is detailed enough when made through email/letter. Do you think most complainants are lying or exaggerating? The NHS can always ask any enquiries they have back without speaking to the person in person. That would allow them to do it in their own time and probably save resources too. Call me a cynic though, but I used to work as a secretary for a law firm and one of the things I picked up was that people always try to avoid having stuff in writing to avoid liability, I'm guessing the NHS might prefer one for that reason?

    I'd also like to point out that, on the whole "saving resources thing," where doctors/nurses are legitimately acting out of line (my whole "being rude/aggressive for no reason" definition earlier), if they didn't do this it would cut down on the resources needed.

    Both I guess.

    Well I've never had a complaint against me so I'm basing this on other's experience and what i've observed in this and my previous hospitals.

    There are different 'tiers' of complaint. First is to talk to the person you're bothered by. Next is the senior nurse in charge of the ward. Next is the formal complaints service. Next is to write to the CEO directly. Formal complaints are mostly dealt with by the senior nurse in charge of the ward and the head nurse of the hospital (i think that complaints form a good 80% of his job, for which his salary will be a good £75,000). There is lots of paperwork and every complaint must be responded to. A lot of replies will be generic as a lot of complaints are similar - perceived rudeness, not getting medication quick enough, not being hoisted into bed quick enough, and other than hiring more staff its difficult for the responder to say 'we will do x simple solution that costs no money and this problem will never happen again'. The only honest answer for 90% of complaints (that aren't about parking) is 'we'll look at our procedures to try to minimise the chance of it happening again'. That may look like its not being taken seriously, but look at the resources already committed: multiple band 6 and 7+ nurses spending huge chunks of the day, doctors having to write long and carefully worded e-mails, and then the main cost: having to document everything you do in the first place. As mentioned doctors and nurses spend literally hours doing this every day. That translates to a huge amount of money.

    Personal consequences for doctors - you will hear about it. You will likely have to respond to the person who made the complaint via e-mail (or your senior will on your behalf). You will have to discuss it at your next meeting with your supervisor.

    I think the incident will be treated with as much seriousness as it warrants. It can be escalated to the GMC. A serious issue will not depend on the staffing of your post, at least in theory.

    As a junior you shouldn't be getting that many complaints as any conflict that starts to escalate you are going to defer to a senior anyway. As a senior trainee... I've seen it argued that if you haven't had at least a couple of complaints against you then you are not doing your job properly. They argue that its our job to protect the NHS's resources against people demanding unnecessary tests, to protect junior our staff from rude and abusive patients and relatives, and perhaps you've just been lucky but on balance, no complaints = you're too much of a pushover. One perspective anyway.

    As above. If we want to divert resources to tackle this then so be it. A rigorous system for patients to highlight shortcomings is obviously important.

    If the situation really is so bad then I will also agree that we need to do something. Its just that in my experience there is so much faff and admin already dedicated to defensive practice its hard to believe that much more will be gained by committing more.
    On the no complaints thing, I would agree there (like I said above, I've been in enough hospitals and seen enough abusive patients etc. to know that some complaints are going to be unwarranted). The rest of what I would've said is mostly covered above too (perceived v actual rudeness, etc.).

    I was under the impression that a complaint didn't "go on a doctor's record", so to speak if the NHS managed to get the patient not to chase it up further (without outright dropping it), and that the NHS often pushed for this outcome, so as to not have too many complaints on someone's record? Please correct me if I'm wrong. (Don't ask me how I know this - got a few friends who work for it too :ninja:)

    I agree that understaffing definitely leads to complaints - not talking about rudeness here from stressed staff but, like you said, not getting medication fast enough and so on. Out of curiosity how long would you say the NHS has been "understaffed" for? What's causing this?

    Its from a lecture - supposedly there was a decent sized American study that retrospectively looked at the care of patients who were admitted to hospital and they reckoned that in 10% of cases there was a mistake sufficiently bad that you could be successfully sued for it. The actual rate of lawsuit was 1%. However, this 1% was true for both the group of patients who did have a significant mistake, and the group that did not.

    I've tried to google but there are so many hits about healthcare mistakes and cover-ups (mostly from the US I might add). Not sure I'm afraid.

    The rudeness bit was extension from my own experience of dealing with angry relatives, but maybe its wrong. Perhaps its just random, who knows.
    Oh, I see. Would the patient necessarily know if a mistake was all that "significant," though? Like you said earlier, sometimes every blunder seems huge in healthcare. Most patients wouldn't have the legal know how to know if they could successfully sue.

    Remember that you're seeing an anonymous writer writing specifically to entertain. And that of all of those writers this particular one has become popular largely because of how mean he is.

    Writing about how you're 99% sure this patient doesn't have an infection but if they do then they might sue and you're struggling with the stress of the job anyway so you're going to give them treatment just because its easier and you lost your passion for making an efficient NHS years ago anyway... is a lot less glamorous. There are a lot of defensive doctors out there.
    Good point. Are there not a sizeable proportion of seniors who are almost proud of their complaints, though? Again, it could just be that people make a big deal out of this, but especially in certain specialties (like surgery) I've heard that they're commonplace.

    As above. Of course, no one is arguing that you should be deliberately rude or that we should not be addressing concerns. We're talking about how to allocate limited resources - to prevent the things that patients complain about, or to prevent the things that kill them.

    Well exactly. At least some doctors will leave. The standard of the NHS will drop. There will be more doctors looking for private work. There may be more demand for private work. etc.
    Also as above

    Yeah, I was talking about direct v indirect causation.

    Yeah obviously pretty bad. But it appears he has been forced to change speciality as he was rubbish, which is a pretty significant action. You could have struck him off but as I say, that's a half a million pound decision. Retraining under supervision is the preferred option, which they seem to have gone with.
    What would actually have been the reason he made all those mistakes, though? Negligence maybe? That might have transferred over to another specialty though it doesn't say what he was retraining under. Are there even any other specialities where he might have doing "less serious" work?

    For the same reason it happens to whistleblowers outside of the NHS, I guess? http://www.fraud-magazine.com/articl...?id=4294968656

    Just look at what happened to Edward Snowden!
    Snowden is an extreme example as you know! :lol: Made my morning though lmao

    That's an American site. Yeah, a fair share of UK whistleblowers have to deal with unfair treatment too, but a lot of NHS examples seem pretty extreme. I find it hard to believe that cover-ups would go on to that extent in a private organisation and be tolerated, unless we're talking Enron or something. For example, this lady, who even had her mum's grave trashed and stuff

    http://www.theguardian.com/society/2...-whistleblower
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    (Original post by RiotGirll)
    No offence but you're really missing my point. ... You don't need to divert resources...
    Then we're talking about different things!

    There is clearly no benefit to being rude or causing offence without need or reason. No one's really going to argue that :p:

    The original point was that you thought complaints aren't taken seriously. If you do want them to be taken more seriously, and more effort put into prevention, that is going to require a re-allocation of resources and change of priorities, no? Just saying it shouldn't be that way isn't going to change anything.


    What I found annoying after having read through the emails myself was that they didn't even state whether they'd spoken to him or not. I'm not sure if this is to do with the whole admission of liability thing, but they didn't need to admit "Dr X may have been under a lot of stress at the time" as an explanation to do this. It was simply a total deflection of fault, insinuating that the whole thing was my aunt's fault if anything. A non-apology of the kind politicians make.
    I think it is the liability thing. Although med schools now teach that an apology categorically does not mean an admission of liability, a lot of older doctors and other staff do still believe it. Old habits die hard.

    Don't you think at least saying something like "We have spoken to Dr X about the situation," Dr X having the balls to apologise for it (again, nobody acts like that and doesn't know it's completely not OK) and so forth would have improved the NHS-patient relationship a little?
    Some of the more on the ball consultants do seem to personally respond to complaints. I am not sure if that's standard procedure.

    Without knowing the nature of your complaint to Natwest, though (they asked you to repay a loan you never took out or something, I'm guessing?) it's hard to know why they would've been threatening bailiffs. And banks are a pretty extreme example TBH, reason being that sometimes they have power over you too and for good reason (because people can take out loans, overdrafts, etc - in some ways they're your customer too). But a "non apology" of the kind my aunt got is pretty much nonexistent in the private sector. Unless the parent of little Jimmy writes in complaining that the staff told him nicely to stop throwing their food on the floor.
    I don't specifically recall an apology from Natwest.

    Doctors also have power over their patients. We are the only ones who can give treatment* . There is no competitor to go to (unless you've £££).

    I think they're pretty similar.

    *(and the only ones who can conserve it so its there for when you need it)

    I'm curious as to why you think a hearing is required, provided the complaint is detailed enough when made through email/letter. Do you think most complainants are lying or exaggerating? The NHS can always ask any enquiries they have back without speaking to the person in person. That would allow them to do it in their own time and probably save resources too. Call me a cynic though, but I used to work as a secretary for a law firm and one of the things I picked up was that people always try to avoid having stuff in writing to avoid liability, I'm guessing the NHS might prefer one for that reason?
    I meant a hearing for the doctor. Facing a huge panel like what happens for serious disciplinary offences. I was being slightly facetious.

    I was under the impression that a complaint didn't "go on a doctor's record", so to speak if the NHS managed to get the patient not to chase it up further (without outright dropping it), and that the NHS often pushed for this outcome, so as to not have too many complaints on someone's record? Please correct me if I'm wrong. (Don't ask me how I know this - got a few friends who work for it too :ninja:)
    I honestly don't know.

    Out of curiosity how long would you say the NHS has been "understaffed" for? What's causing this?
    Since its conception.

    The thing about healthcare is that it will absorb as much money as you throw at it. If you double funding to £200bn it'll disappear into computer systems, complex regulatory red tape and expensive cancer drugs in no time. Equally if it was £70bn the NHS would look pretty different but it'd do what it could with what it had.

    I think the main problem at the moment is that, for the first time in its history, the level of funding is going to decrease relative to the demand. We've grown used to a particular service and are unwilling to give it up. Rather than dropping things like expensive cancer drugs which generates big headlines, a few staff here and there (or even just failing to increase staff levels) is the easier target.

    A second huge problem that seems to be new is immigration laws. My hospital has 150 nursing vacancies that must be met in order to meet minimum safe staffing limits. In 6 months they managed to hire 8 from the UK, so they went to the Philippines and found 142. Every single one of them was blocked by immigration, and now we're going into the winter with no staff and no solutions left.

    Oh, I see. Would the patient necessarily know if a mistake was all that "significant," though? Like you said earlier, sometimes every blunder seems huge in healthcare. Most patients wouldn't have the legal know how to know if they could successfully sue.
    Well yeah exactly. Patients simply do not know what is important to them staying alive/avoiding serious harm.

    Good point. Are there not a sizeable proportion of seniors who are almost proud of their complaints, though? Again, it could just be that people make a big deal out of this, but especially in certain specialties (like surgery) I've heard that they're commonplace.
    I've not really come across that no. We were told about one complaint, which supposedly resulted from the phrase 'the elephant in the room here is your weight' which we did have a laugh at. I haven't been pry to many others at all though.

    What would actually have been the reason he made all those mistakes, though? Negligence maybe? That might have transferred over to another specialty though it doesn't say what he was retraining under. Are there even any other specialities where he might have doing "less serious" work?
    Maybe he was just bad at image recognition? I really don't know. Remorse and willingness to learn from mistakes are generally the two most important features of dealing with a serious incident, they say. Hopefully he showed both and that's why he's still around.

    Snowden is an extreme example as you know! :lol: Made my morning though lmao

    That's an American site. Yeah, a fair share of UK whistleblowers have to deal with unfair treatment too, but a lot of NHS examples seem pretty extreme. I find it hard to believe that cover-ups would go on to that extent in a private organisation and be tolerated, unless we're talking Enron or something. For example, this lady, who even had her mum's grave trashed and stuff
    Enron was the example I was going to use alongside Snowden :p:

    I honestly think that private companies have more incentive to, and are therefore better at, stamping down whistleblowers. Threatening with litigation would be the most above-board method, something which I really can't see the NHS being that hot on given its nature as a public business.
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    The NHS has always served me well, thought recently it feels as if it's impossible to get a doctor's appointment - particularly if you've working during the day.
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    If I was earning enough, I would be inclined to opt for private insurance but I feel as if that would be giving in to what the current government wants.
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    Also an NHS worker. I am very grateful for its existence and that our country provides mostly free healthcare. But there are problems in the system. We are overworked and understaffed probably due to the messed up budget.
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    kinda
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    The worst. It's a drain on the taxpayer. If you need a doctor then you pay for it.
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    (Original post by ubisoft)
    The worst. It's a drain on the taxpayer. If you need a doctor then you pay for it.
    But if you can't afford it?

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    (Original post by Rakas21)
    France, Germany and the Netherlands are all highly rated.

    Yeah. Personally I'd like to see a much leaner and focused NHS. Make working people take out outpatient insurance for the small stuff and have a complete review of NHS services so that we no longer waste resources providing transgender surgeries and hymen replacements.
    I have to point out that the services the NHS provides to transgender people are absolutely necessary. Untreated it causes severe mental health issues and prevents people functioning in society, part of the reason why the transgender population has a stupendously high attempted suicide rate. There it as of yet absolutely no alternative treatment that has shown anything like the benefits of supported transition in improving the quality of life of these people. Even now it's suffering from a chronic lack of funding mainly because there has been a massive increase (thankfully) in the number of young transgender people coming out and seeking help. To give you some idea, I had to wait 18 months for an initial consultment appointment, and that's yonks before you're going to get anywhere near treatment. It's one of the areas where we could most efficiently improve people's quality of life compared to the amount it'd cost, but it's not done because transphobia, lack of understanding and the scumbag wing of the tabloid press make it politically unviable.

    (Original post by Rakas21)
    It does indeed perform operations for cultural reasons, a giant waste of money. Yes, and statistically those people still suffer depression afterward.
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    (Original post by Saoirse:3)
    I have to point out that the services the NHS provides to transgender people are absolutely necessary. Untreated it causes severe mental health issues and prevents people functioning in society, part of the reason why the transgender population has a stupendously high attempted suicide rate. There it as of yet absolutely no alternative treatment that has shown anything like the benefits of supported transition in improving the quality of life of these people. Even now it's suffering from a chronic lack of funding mainly because there has been a massive increase (thankfully) in the number of young transgender people coming out and seeking help. To give you some idea, I had to wait 18 months for an initial consultment appointment, and that's yonks before you're going to get anywhere near treatment. It's one of the areas where we could most efficiently improve people's quality of life compared to the amount it'd cost, but it's not done because transphobia, lack of understanding and the scumbag wing of the tabloid press make it politically unviable.
    Ok and what's the reason for post op rates of suicide/self harm being so high?


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