Cross-party review into the NHS?

Administrator said:

Diabetes bankrupting the NHS sounds like something you'd read in the DM, for sure. However, perhaps people with non-insulin dependent type 2 diabetes could be given better access to testing equipment? That could help prevent complications, surely? That's just one of many areas that could be discussed (for example).

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Yes! should be discussed, must be discussed.

For me it's a yes. The reason that it's needed is because the NHS runs to a charter that was created in 1947. What is medically possible in 2016 is very, very different.

In 1948 the principles were:

• Comprehensive treatment, within available resources
• Universal access, based on need
• Services delivered free at the point of delivery

For me the question isn't "Should the NHS continue to exist?" With the above principles in place, the answer is "Of course!".

The question is "What does 'Comprehensive treatment, within available resources' mean in 2016"?

When it was set up in 1948, UK spending on health was 5% of GDP. At the end of 2015 it was roughly 9%. We spend more, but there are vastly more options now available.

Should every taxpayer pay for every person to have access to each and every treatment option, or should "Comprehensive treatment, within available resource" mean that you will get the treatment you need in an emergency; that which you need to maintain a relatively normal life thereafter; that should provide a preventative approach to longer term issues where it would save significant costs in the long run and anything that does not fulfill these criteria needs some other form of non-government funding?

I think, for the NHS to continue to exist it has to be the latter, but if it is to be the latter, what this means has to be very clearly communicated to the public, and that's something the NHS fails to do at this point in time.

There should be a review as a matter of urgency and among the recommendations I would like to see the following.

NICE to stop recommending that Type 2 diabetics be encouraged to eat a similar diet to the general population,

Clear diet sheets not written by Nanny McPhee showing which foods increase blood sugar levels.

Yes the state of the NHS needs to be discussed and acted upon, however a cross-party review would take years, diverting money away from the NHS.

In theory it needs discussing at 2 levels - clinical level and then political/monetary level - there's no point having a fully funded cash rich NHS if clinically it's flawed, and you can't provide the best appropriate clinical care if you haven't got the funding.

If the gov / NHS got their advice right about controlling T2 diabetes then it would cut the cost to the NHS .. simple

I voted yes because the advice given to the newly diagnosed is not suitable

No-brainer.............................YES.

Squire Fulwood said:

There should be a review as a matter of urgency and among the recommendations I would like to see the following.

NICE to stop recommending that Type 2 diabetics be encouraged to eat a similar diet to the general population,

Clear diet sheets not written by Nanny McPhee showing which foods increase blood sugar levels.

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i have looked at CG87 which is the guideline set for T2D then all it says about diet is:-
Dietary advice

• Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight. [2009]

Thats all. If NICE was to change this then which of the many diets would you want to see them champion?

I think that people in general [not just diabetics] should be expected to take more responsibility for their own health. That is, they should stop smoking, drink less, lose weight, exercise more. Help to do those things should be given to a certain extent but I'm sure we all know people who don't make any effort at all to improve their lifestyles and I'm not sure why those who do make an effort should be funding those who can't be bothered. Better advice is needed too. I'm type 2 diet controlled. When I showed my typical diet upon being diagnosed, I was told that it was fine and to just carry on! Clearly it wasn't fine because it wasn't controlling it. It included having cakes and puddings regularly!! Of my own volition I cut out all of those and brought my glucose levels right down. I also have friends who are 'diet controlled' and don't understand why it works for me but not for them but they all have a couple biscuits 'just a couple won't hurt' or a slice of cake 'it's only a small slice', they just make excuses and pretend that they are not in fact eating these things, when often they are eating them several times a day. If I can cut them out, so can they and if they won't, well, in my opinion they shouldn't get free treatment for their deliberately self inflicted problems.

I would be concerned if this was left to MPs as many of them have financial connections to Private Health Care and drug companies.
There are even MPs who think that health is governed by your astrological sign and others who think that Type2 is self inflicted and you should eat less and move more.
I think that without updated education for all involved in diabetes care then things will stay the same regardless of how much money is thrown at it.
There have always been G.P.s who have a good knowledge of diabetes, regardless of type but there are also some who opt out and leave it to their Practice Nurse to deal with Type2s . Practice nurses do not have the expertise to advise patients as their education on the subject is sadly lacking. We need DSNs for Type2s as well as Type1s but I doubt that will ever happen.
I would prefer to see a cross section of Clinicians with a special interest in their chosen field, including diabetes, to run the review and then they can put forward their recommendations to the Government.

Who pays for the NHS?

http://www.thecommissioningreview.com/article/blog-who-pays-nhs

I cannot understand why we even have to consider the NHS in this way, as surely it was always designed to be operated 'by the people for the people' - and the people vote in the government to carry out their wishes, even if it means all this extra money being required to enable that success on our behalf?
(I would NEVER have objected to contributing more during that time if asked to - so successive governments are totally at fault here, just as with pension contributions!)
I paid my NI contributions for all my working life for over 49 years, became diabetic 10 years into that period and type 1 after 12 years in when I was 27 - and therefore feel that I should NEVER have to fear for MY future medical treatment, when I am only T1 through NO choice of my own, unlike many other sick people who have been known to consciously contribute to their own sickness, by smoking despite for years being advised not to, drinking to excess despite being advised not to, take drugs despite being told not to, eat to much - or the wrong things, despite being warned about the dangers of obesity - and I rest my case!

Oldvatr said:

i have looked at CG87 which is the guideline set for T2D then all it says about diet is:-
Dietary advice

• Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight. [2009]

Thats all. If NICE was to change this then which of the many diets would you want to see them champion?

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I don't want them to champion any particular diet since the diet wars would kick off again but I would like to allow for dietitians to stop saying to eat carbohydrates with every meal and don't eat animal fat. I think this comes about because of the following.

"1.3.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]"

.......and no, I will not enter a debate about which diet is best since that usually causes ill feeling on this site.

I am 39 years old and have T1 since being 18 months old. One of the things that at times annoys me is the fact that I can get ALL prescriptions free, I would not have a problem paying for them if it is not for a diabetes related issue. Surely this could be a direction to go for most conditions as I am sure there are people out there who play on a condition. And I also think that education from an early age about health and diet for all should be brought into primary schools onwards. I have had to laugh over the past 15 years or so since gyms have become such a popular place that I hear people going on about counting carbs.... I have done this since being very young and my weight hasn't changed since I was 16 so the training that I received from a young age has paid off.

Squire Fulwood said:

.
"1.3.3Emphasise advice on healthy balanced eating that is applicable to the general population when providing advice to adults with type 2 diabetes. Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids. [2009]"
.

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Point taken I must have viewed an abstract, but on checking the full published report, I see you have correctly quoted from the Dec 2015 suite. So yes, I would think this needs changing to reflect the latest thinking. The words 'wholegrains' and 'saturates' may no longer be appropriate, but I would question if this forces a High Carb approach as you implied, I mean, there are peobably not many people acheiving a Zero Carb diet, so the term 'carbohydrate' is applicable in the guideline, unless the LC lobby wins out and gets NICE to mandate for LC alone, Hence my previous question., I mean the LCHF plate is similar to the 'Eatwell' plate, and both are balanced in their own way.

I agree with quite a lot of these comments I have been T1 for 40 years and the way that you are cared for these days it is all stuck in the past. I now have a number of Diabetic Complications that could have been avoided if the correct care was given. I personally find that communication is a big problem, you are just expected to know. I now know that I do not receive all the checks I am supposed to. It is all promised and then the follow up doesn't happen.

Oldvatr said:

Point taken I must have viewed an abstract, but on checking the full published report, I see you have correctly quoted from the Dec 2015 suite. So yes, I would think this needs changing to reflect the latest thinking. The words 'wholegrains' and 'saturates' may no longer be appropriate, but I would question if this forces a High Carb approach as you implied, I mean, there are peobably not many people acheiving a Zero Carb diet, so the term 'carbohydrate' is applicable in the guideline, unless the LC lobby wins out and gets NICE to mandate for LC alone, Hence my previous question., I mean the LCHF plate is similar to the 'Eatwell' plate, and both are balanced in their own way.

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I have not implied that it forces a high carb approach. It could equally well suggest a less than high carb approach. The result of the advice, however, could be at the root of why dietitians "Encourage" carbs with every meal. There is no need to mandate any level of carbs for a group of people who have to be careful not to raise their blood sugar levels too high. They will do what they have to do to keep some control.

The Eatwell plate may well be balanced but may not be applicable to diabetics. I am not familiar with the LCHF plate.

This thread is in danger of going off topic so having made my point in my first post I will not pursue this any further.

It would help those involved in our care treated us as individuals and not as numbers, that would help. What is the point of the Government pushing self patient care when we aren't listened. Then there's the contradictions from those involved in our care.

Squire Fulwood said:

I have not implied that it forces a high carb approach. It could equally well suggest a less than high carb approach. The result of the advice, however, could be at the root of why dietitians "Encourage" carbs with every meal. There is no need to mandate any level of carbs for a group of people who have to be careful not to raise their blood sugar levels too high. They will do what they have to do to keep some control.

The Eatwell plate may well be balanced but may not be applicable to diabetics. I am not familiar with the LCHF plate.

This thread is in danger of going off topic so having made my point in my first post I will not pursue this any further.

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Agreed.

holmroad said:

(I would NEVER have objected to contributing more during that time if asked to - so successive governments are totally at fault here, just as with pension contributions!)

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You may not have, but many have, and that's where the problem lies. And fundamentally, if we pay more tax specifically to fund the NHS as a population, doesn't that make a mockery of the statement that the NHS is free?

Personally I'm of the opinion that the free at the point of delivery needs to remain, but the critical bit is the "Comprehensive treatment, within available resources" statement. By all means provide free life-saving care; free long term condition treatment and free long term prevention, but anything that is not this and is elective should be covered by an individual having a top up insurance model.