Whos failing?

[Deleted member 45091]

Just a quick thread, recently seen a topic about a certain percent of diabetics type one and 2 that are not meeting the normal basic targets to keep there condition under control and this percent was high. Id like to know who is actually failing. I cant seem to grasp that that it all our fault when things go wrong. Went to see my diatitien yesterday she couldnt tell me one thing that i didnt already know..Once again i pushed for a cgm, straight away so many hundreds of pounds for the meter then an average of £50 a week to run it, that does seem expensive. Think these days they have got to justify the spending to the benefits, my point was if i havent tried it how do you know it wouldnt improve things. Also what is the point in new technology if it not available its like a tease, then i sort of pointed out if more pumps etc cgm and other new technologys are available to people surely in the long run the more people had them the cheaper they would become. Cut a long story short just up your insulin couple units at a time that tpe of thing. Dont get me wrong the medical staff do talk nice and polite etc but think there missing the point totally. Also one thing i would like to point out when i was in hospital for a day due to high sugars a saw a girl in there prob in her 20's she looked like she was having a hard time with her diabetes. Over hearing the conversation and again to cut along story short she was having all sorts of diabetes problems i felt sorry for her, but the doctors was discussing all sorts of things to help her. But have you got to be hospitalized every five minutes with organs failing just to get abit of support from the doctors, my opinion was the minute you become a burden on the NHS they move things faster all about the cost again...My final point again id like to point out i do not have any hard feelings for the nurses specialists etc, but how is it ive come to learn more from a charity diabetic forum than i do fully qualified professionals. So i suggest people that have diabetes and experiences should be working alongside these so called professianals then maybe these shocking statistics of diabetes targets might start to decline

 

[Yorksman]

Once again i pushed for a cgm, straight away so many hundreds of pounds for the meter then an average of £50 a week to run it, that does seem expensive. Think these days they have got to justify the spending to the benefits, my point was if i havent tried it how do you know it wouldnt improve things.

As far as I can tell, there is a problem with the way GP surgeries are set up thesedays. You may recall reports of GPs earning well in excess of £100k in those surgeries where they have opted into the target driven systems. My own local practice listed the doctors and the 'salaried doctors', presumably as if the others were 'with profits' doctors. Two of the best GPs have left for 'salaried posts elsewhere' and what was XXXX Day Surgery has now become Dr YYYY and Partners. You can hardly get to even see the receptionist let alone the GP. Repeat prescription requests are to be posted in a special box outside, they won't take them inside and when you attend an appointment, there is an automated computerised system with touch sensitive screens. Where there used to be 4 permanent receptionists, there is now one plus a part timer.

My brother has been very badly served by his practice and ended up in hosital overnight. The consultant told him that he would write to the GP but added, 'tell him from me that we know he has received my letter and also tell him from me that if he denies it, I know he is lying'. My brother asked what this was all about and the consultant told him that many GPs in the Taunton area simply deny recieving correspondence from the hospital. When my brother did enquire of the GP, he was simply met with shrugged shoulders and a 'sorry, don't know anything about it'.

My friend was bitten by a dog on a sunday night and went to the local casualty dept and got a jab, as the bite drew blood. Later he got a letter from his GP admonishing him for going to the hospital and saying that he should have telephoned the surgery for an appointment the following day.

I have little doubt about it. These instances are all about money. The more money the surgery can save against a budget, the higher the bonuses for the GPs concerned. They can use the popular misconception that the NHS is strapped for cash and hide behind a media driven image of austerity and talks of cuts.

The fact is, spending keeps going up:

2008 £102.1 bn
2009 £109.7 bn
2010 £118.1 bn
2011 £121.0 bn
(PESA 2012 figs, Central Govt. Public Spending Details, http://www.ukpublicspending.co.uk)

Projected:
2013 £125.9 bn
2014 £129.9 bn
2015 £133.2 bn

http://www.ukpublicspending.co.uk/year_ ... 10#ukgs302

IN simple terms, the more you do without, the more your GP earns, if the practice is set up as a partnership. We do still have some salaried GPs, but there is a trend against it.

 

[Yorksman]

This article is a little old but may shed some light on the matter.

Real cost of Salaried GP vs Partner
http://www.ramsaybrown.co.uk/Realcostof ... artner.htm

It concludes that the earnings of a 'with profits partner' is likely to fall behind that of a salaried GP:

"From the analysis of the above, it is surprising to see that a GP principal will earn less and accordingly, cost less than a equivalent salaried partner working the same sessions. The expectation is that GPs’ profits will fall in the next few years, which may not have an effect on the level of salaried GPs pay."

My own take is that they are responding by cutting back on the amount they spend on patient care to redress this loss of income.

 

[Scardoc]

"The more money the surgery can save against a budget, the higher the bonuses for the GPs concerned."

Welcome to Great Britain 2013! In case anyone has forgotten this country is broke, over a trillion in debt and still facing an enormous deficit. IF bonuses are paid for making savings against a budget then you can see why. However, I do know that surgeries receive bonuses for meeting certain criteria such as having x number of diabetic patients within a certain range etc. These bonuses are, in my opinion, fully justified as it should mean better results and fewer complications. We are all too quick to blame doctors etc because of the bad experiences and until we start reading in the press all the success stories (which will be never as it doesn't sell) it will continue.

There are failings out there, of course there are, and the people who get the sh*t end of the stick don't deserve it. I've said it before on this site, not to be controversial or stir up an argument, and I will happily say it again: from my experience and thinking about all the diabetics I know, more of them are failing themselves than are being failed by NHS etc.

We need to look at the entire picture. I personally am seeing my service at the hospital getting worse and after five years of having no complaints a few are creeping in. From speaking to the staff it's clear that the number of diabetic patients is increasing rapidly and putting a huge amount of strain on them.

Surgeries do have nice touch screens so you can book yourself in, why not? If it saves time for the staff then great because they've never been busier. Saying the NHS is not strapped for cash is meaningless. What do the government do? Draw a line and say "no, that's as much as we're spending on the NHS" and expect the country to go ok and stop being ill? No, they have to look for other ways to reduce spend......like giving surgeries incentives to have healthier patients who will cost less in the long run.

 

[mo1905]

@Scardoc, totally agree. It's not a failing NHS, it's a skint one ! The budget may well be going up each year but not as much as the amount of patients it treats. No nurse/doctor or specialist wants ti provide sub standard treatment. Sometimes however, there just isn't the money to give everyone the time and/or equipment that may best suit their needs. I'm not saying I agree with it, just that it's an unfortunate truth. We all learn a great deal of information on the internet/forums etc but that's hardly surprising ! How many hours do we spend trawling through it ? No healthcare professional has enough time to spend giving this huge amount o information 1 to 1. I hear many horror stories on here about poor treatment and advice but a lot of that is just the nature of forums and people in general I think. People love a rant when things go wrong but much smaller percentage will take the time to write about excellent service. I know this is not the case for everyone, but it's the majority. I still think many other countries are envious of our NHS. That's why quite a few come here to try it out lol !


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[Yorksman]

No, they have to look for other ways to reduce spend......like giving surgeries incentives to have healthier patients who will cost less in the long run.

Well that method fails spectacularly:
2008 £102.1 bn
2009 £109.7 bn
.....
2014 £129.9 bn
2015 £133.2 bn

It's just a line which doesn't stand up to any scrutiny at all.

Cost control is of course a serious issue and it is a problem for any system of health delivery, not just the NHS. Even insurance funded schemes entirely in the private sector suffer from it. The question is, how does one control costs? The evolutionary approach, whereby finances are squeezed in order to ensure a survival of the fitest doesn't work. The 'dead wood' doing 'non jobs' to use the 1980s terminology proved remarkably resilient and even thrived. They were simply better able to adapt to changing circumstances than their medically trained colleagues who tended to not pay too much attention to the way things were run and who wanted to concentrate on their vocation.

Freeing up the financial constraints and pouring in cash, up from £36 bn to £102 bn between 1997 and 2008, into a new target driven model didn't work either. It simply resulted in empire building, an endorsement of Parkinson's Law which states that work expands to fill the time, [and money], available. Hence out of 1,700,000 staff, only about 535,000 are anything to do with medicine, and that includes the ambulance drivers. What are the other 1,165,000 people doing? Switching the nature of the targets to targets based on delivery of service simply results in more manipulation. For example 3 hospitals with maternity services in Huddersfield and 3 hospitals with maternity services in Halifax results in a rationalisation whereby only one hospital in Huddersfield and only one hospital in Halifax end up with maternity services. But, why stop there? Merge Huddersfield and Halifax and why have two when one will do? Lets not bother having maternity services in Huddersfield and have them all in Halifax. When they tell you about 'patient choice' and improvement in service, you can be sure it is all about cutting back on the spend. But, as we see, the staff numbers and costs keep rising. Result is an increase in the number of births in ambulances during the rush hour traffic jams on the Elland by pass. The decision to attempt to stop heart surgery in another hosital has nothing to do with quality of service, it is just a high cost which takes up a disproportionate amount of budget. What excuse can we possibly come up with to free ourselves from this inconvenient burden and shift the problem onto someone else?

Seriously, I have been told that no one wants to go into heart surgery as it is too difficult. Yeah right, all those students who do 7 years at uni before they even start to train in surgery turn their backs on brain surgery, heart surgery and neurosurgery because they all have burning ambitions to do piles and peptic ulcers.

"like giving surgeries incentives to have healthier patients who will cost less in the long run" is a polictical line. It's just spin and has nothing to do with the reality. It is the sort of thing a health minister says because he doesn't know how to save costs but has to be seen to be doing something. It's up there with those other sad excuses of having to fight this war to save civilisation or having to impose austerity to ensure prosperity. I would like to know why the NHS is the 4th largest emplyer in the world with a non medical to medical staff ratio of 2:1. It is in the proliferation of the non medical staff and in the poor quality of the decisions of the management where the money is wasted.

 

[Yorksman]

No nurse/doctor or specialist wants ti provide sub standard treatment. Sometimes however, there just isn't the money to give everyone the time and/or equipment that may best suit their needs.

If only that were true but, when you are dealing with people you have to deal with all types. I have a lot of inside information because I pick up on the notes posted, things like "if this patient is still alive in the morning" and make enquiries. But, for those that do not get the insider info, one only has to read the papers or listen to the news. You get just as many unthinking or uncaring, prejudiced or opinionated, heartless, callous or or those with an axe to grind in the medical profession as anywhere else. Out of that £120 bn budget, the NHS is facing £15.7 bn in medical negligence claims.

 

[mo1905]

@Yorksman, I understand a lot of what you're saying. I can only comment on myself and families treatment, always been great. As for the negligence claims, that is a sad reflection of Britain today. I'm not so sure there is more poor treatment nowadays, it's just easier to complain. Just look at all the TV ads, injurylawyers direct etc. However, I do agree that in any profession there are good and bad. In my eperience though, the majority of people working in healthcare do so because they truly want to. Certainly not for the money !


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[catherinecherub]

I think you have to read about the history of the NHS up to the present day to decide. We can moan all we like but read what it was like for people before it's inception. If you were mentally ill then you would reside in an asylum for the rest of your life. (Being promiscuous was considered a mental illness as was a baby out of wedlock if the family thought so and I have met people who were incarcerated in their teens and stayed there for life). If you were old and could not take care of yourself then you were sent to the workhouse. If you couldn't afford care then you relied on charity.
"Whether knowing what we know now Britain would follow the sam path towards a universal health care system is anyone's guess".
http://www.nhshistory.net/shorthistory.htm

I had a bad experience during a recent stay in hospital and the care left a lot to be desired but that does not mean that everyone in the NHS is out to get you.

We also need to know that more people are being born every day than are dying so the number of people relying on the NHS is going up. We read in some places that the NHS crisis is because of the ageing population. We have a right to get old and rely on the NHS as does everyone else.

 

[Yorksman]

My previous GP helped save my life. He took the time to investigate, explain and refer me to the right people. My current GP is too casual for my liking and always talks about money, even the cost of asprin. I know a lot of people who work in the NHS, in admin, in pathology, as doctors and as nurses. Even an old schoolmate, with a degree in electrical engineering, who worked all his life as a porter. I am always fascinated to hear what they have to say and sometimes, horrified. But I do agree with you that even before solitictors were allowed to advertise, for it has not always been they case that they could, so well before the compensation culture, people had the wrong leg amputated or kidney removed. When I went in for an operation to have a lump in my eye removed, I had it done under a local anaesthetic becaue I wanted to ensure that it was the lump that they removed and not the eye.

 

[Yorksman]

If you were mentally ill then you would reside in an asylum for the rest of your life. (Being promiscuous was considered a mental illness as was a baby out of wedlock if the family thought so and I have met people who were incarcerated in their teens and stayed there for life). If you were old and could not take care of yourself then you were sent to the workhouse.

Well the workhouse system was over a hundred years ago but some of the practices you describe were still going on in Sweden in the 1970s. One poor girl was sterlised compulsarily because her parents and grandparents had lived on benefits and the state thought it best for her not to be given the opportunity to reproduce.

People with those sorts of attitudes still exist in the NHS though. One of our more colourful GPs*, the late Henderson-Smith was a regular contributor to BBC Radio 4's PM programme. He was interviewed by them when he admitted to dispatching several of his more elderly patients not because he was asked to, but because he thought it was in their best interests.

In the 1970s he was interviewed by Radio 4 about his view that when people died they should be turned into fertiliser because, 'they have taken out all their lives and should now put something back'. So was this truly a kindly old man concerned about alleviating the suffering of the elderly or did he simply think that they were a waste on precious NHS resources?

* or in local parlance, a nutter

 

[Yorksman]

We read in some places that the NHS crisis is because of the ageing population. We have a right to get old and rely on the NHS as does everyone else.

When my wife started working in the NHS, she could retire at the age of 60. It then went upto 65 and then 66 and is currently, 67.

It is incumbent on everyone to live longer just so they can live long enough to get their pension!

 

[hanadr]

The NHS doesn't push heavily in preventive medicine.thus they concentrate on treatment, rather than on prevention of problems.
I think this is down to the top level policy makers. They assign budgets over a small period of time, so the benefits of good control are never found out.
Aain, Healthcare professionals know much less than they should about the mechanisms of diabetes. they treat according to flow charts and tick boxes. this too is down to policy makers.
Very little NHS effort goes into prevention and lifestyle matters.
I blame policy makers for all this. Also the public has settled in to a "visit doctor, get prescription "philosophy of healthcare.
Individual healthcare professionals, REALLY try hard for their paients, but they are not supported.
Hana

 

[catherinecherub]

Workhouses were renamed Public Assistance Institutions in 1930 when the running of them was transferred to the Local Councils. They still existed for the same purpose and continued to operate as before until the start of the NHS in 1948. Some closed but some were used as Old People's Homes.

I personally think the NHS is too big an organisation to run smoothly and it will always have problems. Unless we are all brought up with the same moral compass then things will go wrong and what is considered acceptable for some people will not be by others. It's a bit like trying to define normal. I always think that normal is what is socially acceptable to you, your family and friends. If you treat others like you would like to be treated, then that is the best that you can do for anyone else.

 

[Robinredbreast]

DannyH you have raised a few good points there. There are failings in the NHS, I only said to a friend ( who doesn't have diabetes but has other medical problems, losing his sight is one of them)this week that you only seem to be taken 'seriously' when you are rushed into hospital or at deaths door( I am pleased to say after diagnosis in 1989, I have never been taken into hospital for diabetes related problems

Yes we have an NHS, and many, many countries would give there right arm for some sort of good healthcare system, but my mum who was an auxially nurse in later years and my ex sister in law who trained as a nurse and went on to be a health visitor, have said it has all changed and the care is not what it used to be. Too many unecessary guidelines, too many pen pushers, too many 'Executives' sitting on their wealthy behinds behind a desk, my SIL really goes off on that subject and she's normally such a quietly spoken woman and was very hardworking, but retired now and says its all gone to pot.

We have to manage our diabetes or other medical problems, as best we can and to be responsible, but the NHS certainly needs a big shake, to wake up and listen to it's a pateints, after all, we know our bodies only too well and one size doesn't fit all :roll:

I would say my Diabetes care is adaquet, but thats about it.

All the best RRB

 

[Yorksman]

Workhouses were renamed Public Assistance Institutions in 1930 when the running of them was transferred to the Local Councils. They still existed for the same purpose and continued to operate as before until the start of the NHS in 1948. Some closed but some were used as Old People's Homes.

The workhouse system was introduced as part of the Poor Law Ammendment Act of 1834 which ammended the Poor Law Act of 1601 which firmly placed the responsibility of the poor on the parish in which they were settled, as defined by the Settlement Act. The circumstances of the mothers of illegitimate children that you mention goes back to the earlier Acts. A person was most usually settled in the parish of birth and that included illegitimate children. The parish had a legal duty to care for its poor and did so from monies levied by a rate on the parishoners, administered by the Overseers. As the Overseers too were parishoners, they had a vested interest in keeping the rate and expenses low. Any young women who fell pregnant out of wedlock was a serious blow to the parish and attempts were always made to identify the father and persuade him to marry the woman. She, and the child, would then become his reponsibility and not that of the parish. Sometimes, inducements were even made to persuade father to marry mother. If all attempts failed, more unscrupulous Overseers were known to have waited until the very last moment before baby was born and then dump the poor woman over the border in neighbouring parish so that she, and baby, would become their problem.

The parish system however started to break down with industrialisation. In order to supply the new emerging industrial towns with workers, the Rules of Settlement had to be relaxed. Normally, a worker in one parish could only work for one year less one day in a neighbouring parish but towns like Oldham, Lancs. were growing at exceptional rates. The textile machinery manufacturer of Platts of Oldham for example employed 400 people in 1820 yet by 1881 they employed 12,500. They producd the machinery, not the textiles themselves. There were more cotton spindles in Oldham in 1880 than in the rest of the world outside of the UK combined. And that was just Oldham. The same story could be told of Bury, Bolton, Rochdale, Burnley etc etc. Workhouses were introduced as Unions of parishes, usually 6 and replaced the individual parish as an administrative unit.

My gt gt grandfather, born in rural Worcestershire and a blacksmith by trade became head foundryman at Platts of Oldham. By the late 1870s the workhouse in Oldham had started to change as victorian philanthropists started to fund things like schools and hospitals out of the enormous wealth they were gathering. As a blacksmith, my gt gt grandfather still tended the horses for the Platt family and one day he was kicked by one of them, resulting in a broken leg. Platt was already funding a hospital wing in the Oldham poor house and my ancestor became the first person to be treated there for a broken limb and his leg was placed in traction, a new technique which involved tying a brick to his foot. Some parts of the current Royal Oldham are still the original poor house.

 

[donnellysdogs]

Trouble is as well, the populatio is growing rapidky, we are all living longer, and medicine is still less than 100 years old.....without these meds we would all be on lettuce leaves and water... And that would be a very hard diet for some people!!
Medicines are all having to be so tested and analysed, to avoid the claim culture...the drug companies want to make profits... So its the nhs that have to pay for their shareholders dividends!!!
Then on top of that there's the inressed holiday pay period paid for now by law, nhs has final salary pensions etc, etc...then all the legal claims for their negligence...
The govt, got it wrong when they guestimated how many immigrants would come over here(i'm not racist), we will have a further influx in the near future. How are the nhs managers meant to forecast their budget when they cant even get correct information for the size of their communitys?

Its sad, really sad.

 

[Yorksman]

nhs has final salary pensions etc, etc...

Not any more. NHS pension reforms took place before the last election and have been revised downwards a 2nd time since the new government took over, including a 50% increase in contributions. That's why so many are complaining. The reforms negotiated around 2007 were meant to be a final reform but have simply resulted in it being the start. It is a rather special type of pension whereby your pension contributions are directly linked to your current earnings but your paid out pension is linked through the average salary scheme to the salary that you got when you started. They have to work longer and pay more now to get less. NHS are not alone in this of course. It is widespread in the pubic sector.

 

[1505helen]

I have admit to only skimming this thread but you all seem to be making some excellent points.

My daughter was basically dismissed by the GP when she presented with classic type 1 symptoms and BG level of 22.5. If she'd been referred to the hospital at this point on Tuesday it would have saved the NHS the cost of a visit to the minor injuries unit, followed by appointment with the practice nurse who then sent us to A&E. She was then admitted as an emergency case with ketone levels of 3.1 spent the night and following day in hospital taking up a bed on a drip being closely monitored. The diabetic team we were referred to the next day were appalled. If she'd been referred on Tuesday it would have saved the NHS a fortune!

Will the GP be picking up the bill now she's under the care of the hospital? If so was this his motivation for sending her away on Tuesday with the advice to avoid sugar and make an appointment with the practice nurse (earliest appointment was 10 days later!) she would have been in a coma by then if she lived alone!

The hospital team were excellent gave her 3 sets of all the equipment and meds one to keep here one to keep at her dads and one to carry around! We are so lucky in that respect when I see others struggling to get hold of just one, I suspect the GP won't like the prescription I handed in yesterday which covered meds needles and 2types of strips for the monitor more money from his budget.

Can't fault the hospital but the GP? Can't post what I think of him as I'd probably be banned!

Phew! Well if anyone reads this rant to the end well done and thanks for keeping with me I just needed to get it off my chest! I suspect as Arnie would say 'I'll be back!'

Helen

 

[mrman]

Hi helen, this is all too familiar, I also was tested in surgery, eventually after 2 years of back and for decided to test me. At surgary i showed ketones in urine but only by the sticks so no result. Took blood and told go away, you are diabetic but come back in a week for results of blood. 4 days later at home felt alot worse, phoned surgery and eventually spoke to a doctor after getting past secretary, my results were in and they actually said I was in dka, ketones off the scale and bloods in the thirties. Still can't believe I wasn't contacted as I was told by hospital If id gone to sleep that night would of been in a coma. Anyway, gp said get to a &e, 3 days later after being on a drip, loads of blood taken and tested was told type 1. Let out with long lasting insulin, and set doses of qa. No monitor or strips as diabetic nurse wanst available
For 3 days and had to get them then. the whole thing was a farce now I know better, but had no idea at the time.

If any type of diabetes is thought gp should not be allowed to diagnose, and instead all done through the hospital in a matter of days with relevant blood tests carried out.

Feel better now lol
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