NHS - safe in Labours hands?

Long time since I've posted here, although I can see some of the usual suspects in evidence. By now the way people go from "things could have gone better in A&E" to "the whole system's rotten and Labour have wasted all our money" shouldn't surprise me, but it never fails to depress me.

I am part of the 'propaganda machine' having been a press officer at the Department of Health and within the NHS for fifteen years. Sure people still have hard times in A&E depts. The point is that there are fewer and fewer such anecdotes.

Ten years ago it was scandal if someone 'waited' (although I want to come back to that word) for 72 hours. There were corridors full of elderly people on trolleys. As an area of specific investment and policy drive, A&E was pretty neglected, especially compared to high-volume elective specialties.

Now it's a scandal if someone waits more than four hours. And it's usually people who have something not-terribly-serious wrong with them. (Incidentally there is a correlation between these things and it's called triage.) Certain sections of the public (not necessarily anyone here) expect their experience of public service institutions to be like that of private service institutions and we have a helluva long way to go to get there. But the idea that A&E has not seriously improved over the last five years; in terms of waiting times, the environment and the quality of treatment; would be treated as a joke by anyone who has worked in or around one.

The thing that has driven most of this improvement (and this is where the really lazy thinkers step up to take a shot) is the four hour waiting target. IF you wait more than four hours in A&E, the offending hospital is marked down for it and can lose star ratings and investment as a result. It has totally changed the way people who manage and work in A&E think of themselves and how they run their departments, and it has also in many places (although perhaps not the one Steve's wife went to) changed the triage system so that the first person you see, quickly, is a consultant who does whatever needs to be done to you and sends you on your way. It's called 'see and treat' and despite opposition from some consultants seems to be working well. There were many targets that should have been thought through more carefully, but this one really has driven imporvements.

Just coming back to this idea of 'waiting'...part of the role of an A&E dept is the role of diagnosis and diagnoses often mean tests which take time; time that the patient either spends in A&E or in an assessment ward. Is that the same as a 'wait'? While many in the media and public life have used these cases to knock the NHS, is it fair to criticise those who work in A&E on this basis?

The "where's all the money gone?" debate was something I was deliberately asked to look at while at the Department and a complicated job it was too. The initial debate and subsequent cliche-mongering was sparked by what looked like a very large increase in spending was not being matched by increases in the number of patients seen. Fair enough, but what became clear was that the money was being spent on what many of the tabloids and the same cliche mongers had raved about previously - recruiting more staff (which so many other things depended on) and paying them more (so they didn't leave the NHS at the earliest opportunity).

Tim J

I've just read your post and to be honest I think you say (as an experienced NHS person) ABSOLUTELY NOTHING > Please do not take this personally, and this is not a usual suspect Fritzism either, innit.

When labour came into government there were 3 hospitals in Edinburgh providing a 24 hour A&E service - now there is only 1.

In Scotland waiting times are currently on the rise - using Scottish Executive figures then last year the average wait for an outpatient appointment was 56 days, this year it's 62 days (in 1995 it was 41 days). The inpatient & day case wait has gone from 42 days last year to 47 days this year (in 1995 it was 32 days).

For this particular hospital the A&E figures make for very depressing reading:

For trolley patients - in 2000 the percentage seen withing 2 hours was 85.7%, in 2004 it was 58.0%.

For walking wounded - in 2000 the percentage seen within 2.5 hours was 83.9%, in 2004 it was 61.9%

Lets see you "spin" those numbers then...

Perhaps if labour spent more money on real doctors and less on fucking spin doctors we'd have less of a problem?

Well said that Mon, innit


Fritz Von I wonder if 2Jags has had his dental treatment yet ?

The NHS in Scotland is run independently from England's, along differing policy lines. I think it's fair to say that in both Scotland and Wales, while similar NHS spending increases have happened over the past five years, new policies and ways of woprking haven't happened because they were seen as too controversial. And in both areas the quality of service and the promptness of treatment has not kept up with England, where controversial choices were made.

The irony is that politicians sometimes shy away from making difficult decisions because they don't fit in with tabloid cliches what the NHS should be like. Then the same people who were exhibiting those cliches complain that things haven't got better.

In England pretty well every single hospital seems over 90% of all A&E patients within four hours. My hospital sees 98% within four hours and I know from spending a lot of time with staff and patients in A&E that the service is good. This isn't spin - it adds up to satisfied patients.

I don't know what's happened with A&E in Edinburgh, but A&E departments need to be of sufficient size and attached to the right medical specialties (ITU, paeds, etc) to retain their status as training departments as recognised by the Royal Colleges. That was one of the fundamental reasons why ten years ago many English A&E departments were closed and merged. While this might not be what's happned in Edinburgh, it's no good having an A&E full of junior doctor jobs if you can't fill those jobs and if seriously ill patients always have to be (riskily) transferred somewhere else anyway.

Fritzy - I apologise if there are too many syllables in this for you.

Steve - if you want to have a go at me, fine, but if you really think the cause of your wife's long wait was 'fucking spin doctors' you're wrong.

Tim

I've just found out that the A&E department my wife attended is scheduled for closure. Even the local labour MP (Robin Cook) and MSP are campaigning against it, but unfortunately it will almost certainly happen. That means the nearest A&E will be 22 miles away and servicing a vast area (geographically and in terms of population).

A colleague had to go to A&E in Glasgow at the weekend and was seen in 4 hours and out in 6. Glasgow currently has 4 A&E departments however our Labour government is planning to reduce that to 2 in the near future.

That was a lovely patrionising protectionist & classic party line NHS speech Mr Jones, and I trust you get well rewarded for it? The essence of your second 'attempt' has absolutely no more meat on it than your first, in that you say ABSOLUTELY NOTHING ONCE AGAIN. You imply that all 'English' hospitals have A & E, units where I know, you know, and most of the country ´knows that that is absolutely not the case. I do not read tabloids (barring P-Eye) so do not have your up to date cliche's to defend with 'let's face it' streiotypical hogwash, that's been around for decades. The bottom line is, there are more people today requiring treatment, less hospitals, less money (IN REAL TERMS) invested in Staff, equipment, future research, and more to the point serious quality training of all levels from nurse-auxiliery to Consultant-Surgeon, and you and the 'Trusts' around you well know it, and take the wages to protect this 'False image'. Your attitude of treating the public as fools is classic (I mean you 'managers' generally, not you personally) and it's about time the never ending Blame Game stopped to a serious halt, and some looking around at other quality systems worldwide, instead of just those that can produce more profit for fat cat easy treatments in the sector.


Fritz Von And yes thank you I do actually know a little of what I speak, and I'm no more medically qualified than you are ! There again, Maybe I am ? innit. I trust you're privately insured John ?

OK it's time to get forensic. Digging what little sense I can get out of your prose Fritz:

"...less money (IN REAL TERMS) invested in Staff, equipment, future research, and more to the point serious quality training of all levels from nurse-auxiliery to Consultant-Surgeon.."

In almost every year of its existence except (I think) one, the NHS has received real terms increases in spending. Recent figures are as follows:

1992/93 5.9%
1993/94 0.6%
1994/95 3.8%
1995/96 2.1%
1996/97 1.6%
1997/98 2.1%
1998/99 2.6%
1999/00 7.0%
2000/01 8.5%
2001/02 6.0%
2003/03 7.4%
2003/04 7.3%

To reiterate - these are not cash increases, they are real terms increases.

(sources: Webster's 'Political History of the NHS' to 1996/97; National Council of Voluntary Organisations report 'Outlook for Public Finances after the 2005 Election' for subsequent dates.)

You can see Labour 'sticking to Conservative spending plans' during the first two years of their first term, and then the really big increases kicking in from 2000 after the pledge to match European levels of spending on health as a proportion of GDP. Incidentally the increases are projected to move back to a more 'normal' rate of small real terms increase after 2007/08.

2. "...it's about time the never ending Blame Game stopped to a serious halt, and some looking around at other quality systems worldwide, instead of just those that can produce more profit for fat cat easy treatments in the sector."

During 2000, just before the really big increases in spending, the Govt did take a pretty serious look at other methods of funding healthcare in this country, including comparisons with European countries, the US and others. On the basis of equity and (which surprised many) efficiency, the NHS was actually the best of the lot.

3. "You imply that all 'English' hospitals have A & E, units where I know, you know, and most of the country ´knows that that is absolutely not the case"

Where did I suggest all English hospitals have A&E units? I didn't. That was the whole gist of one of my points; not all hospitals have the specialties to support an A&E unit.

"That was a lovely patrionising protectionist & classic party line NHS speech Mr Jones"

I worked for the NHS under the Conservatives as well as Labour. I'm not 'political', but I do believe in defending the service against prejudice and misinformation.

Tim J

quote:

Originally posted by Tim Jones:
I worked for the NHS under the Conservatives as well as Labour. I'm not 'political', but I do believe in defending the service against prejudice and misinformation.

Please point out the prejudice and misinformation in my postings if you can. I've mentioned two real stories from the NHS in Scotland both of which happened this week. When you said those were unusual or unrepresentative I backed that up with NHS Scotlands own published figures.

Clearly you either have no awareness of the state of the NHS in Scotland or, if you are, are so used to spin that you think (like Jack McConnell clearly does) that if you tell us often enough and loud enough that the extra funding is being well spent and bringing about real improvements that we will be stupid enough to believe it.

On other threads many people, including me, have said we don't object to paying extra taxes to fund the NHS if that money would be well used. We do object to paying more for a worse service which, in Scotland at least, definitely appears to be the case.

Just so you understand my prose Tim, how about some figures ! not Websters Stats, you duck & dive (no suprise) avoid answering anything who are you trying to kid here, really ?


7.4 % Of WHAT Is WHAT ?

It's all very well throwing & bandying figures about that mean nothing, and you still are trying to imply that A & E units are to be found all over the place, which simply is NOT TRUE. TIME IS THE FACTOR, COMPARE A & E UNITS IN ENGLAND 8 YEARS AGO TO A & E UNITS IN ENGLAND TODAY, is that so very hard ? So besides rhetoric about finacial this & that, and paying endless interest back to PFI firms (at Council/LOcal Health care expense - Which you won't even admit), you treat the PUBLIC like fools again, by Quoting Websters, as if it's the bloody BIBLE, and so that's allright then. Training HOSPITALS ARE CLOSING, as are UNI-related connections. Bye Bye, I'm not wasting any more time with this, I'd get more joy out of talking to a second hand car salesman, innit.


Fritz Von You people make me larf, really; if it wasn't so important and sad, yer could bluff yer way out of a firing squad I reckon, no sweat John !

Steve - I didn't accuse you personally of anything, and as I said I am not familiar with events in Scotland. The general point is that bad things happen in A&E and people get (often rightly) pissed off about them and (rightly) complain. The majority of people who have a good experience don't. In England, that majority is getting bigger and bigger as A&E here gets better. Now the problem is the public know they can usually get treated in A&E much more quickly than seeing a GP; so attendances are going through the roof.

Fritz - Real terms increases in spending means the percentage increase in one year's spending compared to the previous year. There's no simpler way of putting it. You complained that this was what the NHS didn't get. You are just wrong on the basis of independent evidence. Now you're complaining about the evidence. What can I say. Try Google. Read some books. At least check whether what you're saying is factually right.

Hospitals do close, but that's not because the Government spends less on the NHS; it's because there is a clinical pressure towards bigger hospitals, which (the argument goes) are clinically safer. They can attract better staff because they see more patients, they have more sub-specialisation and better service integration. It's been going on for two decades.

If the evidence doesn't match your preconceptions it's no good getting personal with me, or simply labelling everything I say as 'spin'. What I say is based on independent evidence and my own non-political experience of dealing with these issues for fifteen years or more. What you say is based on nothing more (so far) than cliches and misinformation. If spin is defined as distortion, who is really 'spinning' here?

Tim

You are obviously very good at your job Tim, no sarcasm or personal attack intended, I know when a brick wall can't be talked to anymore, I've had enough experience I can tell you mate.


Fritz Von Why is Putney windy then ? Have you ever used the NHS yourself ? Just a thought if it's so bloody well funded


What a suprise that the NHS's new flagship Mega-Hospital (To be built one day)in LOndon culminating three old classics, is having 'Property Speculation Probs' bung a coiple more £Billion on taxpayers bill, no Doctors or medical pro's ever asked, managers maybe ! Public definately not, who's gonna clean it, THE ARMY MAYBE ?

I'll just briefly mention, as ever, that judging the NHS should be rather more than judging the performance of hospital A+E departments. 90% of all activity in the NHS takes place in primary care for starters. The NHS also delivers alll sorts of boring low technology services which never get any publicity but are enormously essential.

The fundamental 'problem' I have with this thread (and several similar ones before) is that we seem to be taling about this fiendishly complex organisation as if it simply boiled down to a few services, and a few anecdotes. I'm not going to defend the NHS (or the poor experiences others have had) but I just think it needs a bit of perspective.

Parts of the NHS are probably 'better', parts are 'worse'. What is obvious is that the NHS, is changing at great pace, so historical comparisons are pretty unhelpful.


Bruce

Tim, a little sophistry with those figures I'd suggest? The real-terms increase presumably relates to inflation figures. I'm fairly sure that 'medical inflation' (within the industry and due to technological change, drug avaialability etc) is much higher than 'shopping basket inflation'. I cannot give you figures though.

quote:

Originally posted by Bruce Woodhouse:
Parts of the NHS are probably 'better', parts are 'worse'. What is obvious is that the NHS, is changing at great pace, so historical comparisons are pretty unhelpful.

Figures, personal experience and public opinion together must count for something.

Anyway from all the information available it would appear that under a Labour/Liberal government in Scotland the NHS is close to being totally fucked. While figures in England are reporting significant progress on waiting times (in A&E 97% of patients being seen in under 4 hours) the situation in Scotland is entirely different. A report on the state of the Scottish NHS was held back until after the election and, according to leaks, it doesn't make for pleasant reading with the summary being the professor writing the report asking the government WTF they've been doing for the last 8 years.

Despite a slowly declining population, the NHS actually seeing less patients and more cash being spent we're in a situation where waiting numbers are still climbing, hospitals are being downgraded or closed, staff numbers are still in decline (unlike the rest of the UK) and even the targets being set for Scotland v the rest of the UK are different. For example the English target for the maximum time from first GP visit to hospital treatment is 18 weeks. In Scotland the target is 18 weeks to the first outpatient clinic appointment, then another 18 weeks to hospital treatment - i.e. double the English target.

Doubters about the benefits of devolution are having their case made strongly by the Scottish Exec at present as it would appear they're incapable of organising a piss up in a brewery. The usual PFI disasters (the new Edinburgh Royal being a great example) aren't helping either.

Nearly everyone I've spoken to on this subject has commented that the standard of care they're received has been great when they've eventually received it, but that the wait and the general organisation and management of their care has been poor. The lone dissenting voice so far was one of my members of staff who, after a heart problem about 9 months ago, was fitted with some sort of electrical device which checks his heart rate and fires electric shocks to regulate it if there is a problem. Unfortunately it would appear that the device was incorrectly calibrated and, instead of saving his life, at the weekend it nearly killed him, delivering a shock to his heart no less than 37 times before it could be turned off. Fortunately he's survived the experience and is now back home, however I can't imagine the experience is going to be great for this heart long term and he'll be off work for at least another month - a month for which I'll be picking up the bill.

I've been to A&E twice recently. On both occasions got seen in less than 30 minutes. For sure, it's a very different experience than going private but the essentials were done faultlessly. The second visit was pretty serious, and the staff really went the extra mile to ensure that the condition was treated, and that suitable reassurance was provided. The doctor in question looked barely out of sixth form, but was by far the most courteous and empathic health care professional I have yet to meet. I hope that this is a symptom of the investment in new doctors, and we'll see more of it in the future.

quote:

Tim, a little sophistry with those figures I'd suggest? The real-terms increase presumably relates to inflation figures. I'm fairly sure that 'medical inflation' (within the industry and due to technological change, drug avaialability etc) is much higher than 'shopping basket inflation'. I cannot give you figures though.

I take your point - that's just GDP deflated. But (a) there is a whole other debate about "medical inflation" and whether there is some serious long term naughtiness on the part of suppliers (cartels in generic supply, etc)and (b) it's not easy to find anyone who agrees consistently on what other deflator model to use.

It's certainly difficult to argue with the point that Labour has spent a huge amount more money since 2000. Whether it's on the right things or not is more interesting. Certainly my Trust and many others have very, very big deficits to contend with at the moment. The suspicion is that those grew up as people just grabbed non-recurrent money to throw at cutting elective waits.

I also agree about the complexity of it, etc. For instance, there is a huge, looming issue about maternity admissions. But the leap from "I had a bad time to A&E" to "the NHS is terrible", which is the way these things tend to go, just depresses me because I think a lot of it is wrong, at least as applied to England. From Steve's emails it sounds as if things are going wrong in Scotland. Perhaps if Scotland and Wales had adopted the same "money has to go hand in hand with reform" mantra as we did, they would be in a better situation now.

Tim J

quote:

Originally posted by Tim Jones:
From Steve's emails it sounds as if things are going wrong in Scotland.

I've been doing some further research and it's impossible to conclude anything other than that the SNHS is in a desperate state, the situation has been getting worse since labour came into power in 1997, and that the extra cash that's been invested has been wasted (that from the Scottish Parliament audit committee no less).

Steve, It would have been interesting to hear what spin had been put on the same story if it'd happened in London last week, and not conveniently in Scotland, innit ?

Fritz Von Bangin agains't brick walls as per usual

quote:

On both occasions got seen in less than 30 minutes

What does 'got seen' mean? In general I mean. ISTM that your treatment in A&E should be at the end of part one within 30 minutes, so you're on your way, you have an appointment for follow up, you're being admitted, or they're waiting for test results. Any way you're not in a waiting area feeling sicker than when you came in.

Paul

Great news, though £ 73 Million squid is peanuts, innit, lucky it only takes weeks to train them these days I can speak English, Honnist Guv !

quote:

Originally posted by Berlin Fritz:
Steve, It would have been interesting to hear what spin had been put on the same story if it'd happened in London last week, and not conveniently in Scotland, innit ?

Fritz Von Bangin agains't brick walls as per usual

'Conveniently'? Huh? This is the end of the slippery slope you're on with this 'spin' mentality Fritz. The world isn't the way you want it to be in order to justify your unsupportable opinions, so you prefer to imagine the alternative. Try banging your head harder.

I'm sorry that there isn't a London A&E horror story for you this week. I'm sure one will be along sooner or later, but perhaps (just perhaps) the A&E service might actually be getting better. Are you prepared to consider that possibility?

Tim

Attempting to preach to self-policing unconvertable complacency is self-defeating in the extreme. I am naturally very pleased that no horror stories have been 'Published' of late regarding England/London A & E units (wherever they may be found ?) Ambulance drivers themselves often don't know the latest data (a point not too unconnected with this fiasco your painting as rosy). The overall aspect of the NHS (and it's funding is the issue here) and continuous spinning to avoid the core reality. I'm not sure if the fact that the're are far fewer A & E units in London now than 8 years ago is at all relevent, buggers up targets and green - yellow pointers dunnit ? When certain scandals 'Shock horror no suprises here then' arise everybody scarpers and the usual scapegoats come to court, frightening if you ask me, and yes, you're right you should stay privately insured, let's face it why shouldn't you, you're hardly a Public servant are you ? British folk generally are thankfull for their system and are very coy/afraid almost to critisise it, as they'll immediately get labelled as anti-nurses or doctors etc, as you well know, and a factor not too strange in other fields either, though as a private patient/customer one complains (cos I've paid for this innit) as in the real world with everything else.



Fritz Von Say hello to Mr Campbell for me I didn't know that old Socialst. often called traitor, anti- warmonger, stirrer upperer, Tony Benn was one of the few, now dare's a ting, just a pity there's not more around with the same guts innit.

Good, bad or ugly?

I know where I'd rather be ! My Mum told me last night that she has to now wait 6 weeks to see a diabetis specialist at a hospital near her, she's already had two letters 'threatening her' about not attending appointments (letters she's never recieved, why should she ignore them ?) I've heard similar stories oif late (even on this forum), and it's likely that the pre-sorted blood tests tec, will be null and void if (very likely) this next meet is cancelled at the last minute, subsequently having to start all over again.


Fritz Von Germany has 80 odd Health Services (To which one do you refer John?)

Interesting reading this thread give my curremt need for medical treatment.

I have had knee problems, so I go to the doctor (my GP) who says I need physio, so refers me to get physio, says it will take 6 months to get treatment. Great that's six months no cycling, running plus non specific physio I would most likely end up seeing...

Thankfully my kind employers sees fit to generously pay for my medical insurance (which, please note, I have to pay more tax on) meaning that I get seen by a specialist (took two weeks because I was away on holiday inbetween booking and the appointment), that's yesterday, will get an MRI scan to check his diagonisis, today, and will be seeing a physio very soon, who will be somebody who specialises in knees and is maybe just 5 minutes from work. An almost completely different experience.

It seems odd that the press like to use the term a two tier system in reference to moving the NHS to partly privately funded when the system as it is now is about as two tier as you can get.

I would like to add that my GP did all he could and gave me some good advice but ultimately he was let down by a system that could be so more efficient with giving patients more then the NHS only or private only route.

Matthew