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Collapse of emergency healthcare in England may be costing 500 lives every week

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Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#281

Post by oliwarner »

Ferrotin wrote: post #243
oliwarner wrote: post #116

This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards ha…

It’s almost as if centralized control of resources doesn’t allocate them optimally.

No, you've learned the wrong lesson.

It's almost as if a locally allocated choice between collecting the bins and homing grandma will always go with what inconveniences voters least.

Areas with poor, old populations can never pay their way. The excess gets dumped on the centrally funded NHS.

It's a bad model that is a massive disservice to us all.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#282

Post by MichaelCollins »

captainredbeard wrote: post #279
MichaelCollins wrote: post #236

Earlier quoted context omitted.

This is hard to believe. Just wheel the patient through the front door and let the hospital do the babysitting. There is no sense in using an ambulance as a waiting room.

An ambulance is a portable "mini" ER room...

Using a parked ambulance as an ER room is gross mismanagement because the 'waiting room' for an ambulance 'ER room' is casualties spread across the entire city, such that the worst cannot be prioritized.

Even if the hospital's ER room has saturated capacity, moving all the casualties to the hospital waiting room as rapidly as possible still has utility because that allows the hospital to prioritize the worst, which they can't do if the worst is laying on the street a mile away with the ambulances all parked at the hospital.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#283

Post by b1n »

mattlondon wrote: post #234

As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are people's solutions to this? It seems like the NHS budget keeps on going up and up and up [1], as does the number of doctors and nurses (while "managers" has either declined or stayed relatively static) [2]. So NHS is getting more funding, and there are more doct…

The solution is for young people (tax payers) to form a "Youth Union" and start demanding that older people pay more towards their health care.

When this doesn't work, the solution is for the members of this union to leave.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#284

Post by lotsofpulp »

oliwarner wrote: post #281
Ferrotin wrote: post #243

Earlier quoted context omitted.

It’s almost as if centralized control of resources doesn’t allocate them optimally.

No, you've learned the wrong lesson. It's almost as if a locally allocated choice between collecting the bins and homing grandma will always go with what inconveniences voters least. Areas with poor, old populations can never pay their way. The excess gets dumped on the centrally funded NHS. It's a bad model that is a massive disservice to us all.

>Areas with poor, old populations can never pay their way.

The root of the issue is that this area is now the country. Giving all old people the labor necessary to support them in old age was easier when the ratio of working people to non working people was much higher, in conjunction with old people not living as long.

Turn that population pyramid upside down due to drastically reduced birthrates and medical technology allowing people to live longer, and you get the current situation.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#285

Post by oliwarner »

MichaelCollins wrote: post #228
oliwarner wrote: post #116

This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards ha…

> This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. How does that manifest as ambulance wait times? Do you think ambulance drivers are sitting around for an hour before re…

If you come to our local DGH's A&E in an ambulance and you're not a trauma or cardiac or stroke, you face seven to twenty hour wait in the carpark.

You will see multiple paramedics as they change shifts in situ.

In fairness the ambulance service has scaled amazingly well given most of their staff are now pegged in hospital carparks, but yes, waiting times for critical calls are extended, people are dying because ambulances aren't available.

All because they can't hand over to A&E. Because A&E can't ingest patients. Because wards can't discharge. Because care homes don't exist.

It's that simple. If you doubled the number of community care placements, staff, etc, you'd buy the NHS another ten years.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#286

Post by Scoundreller »

betaby wrote: post #97
cmrdporcupine wrote: post #65

Earlier quoted context omitted.

There's a public sector salary cap in many parts of Canada, despite roaring inflation. And a general vibe from the public and the government that generally despises public sector unions and would almost certainly backlash against nurses and teachers should they sensibly decide to go on strike. For two years they busted their asses for the public in tough straits and now COVID numbers in the hospital system are still…

At the same time there are plenty of medical specialists in the sunshine list making 400K+ CAD. Keeps me wondering why radiologists are paid that well, compared say with oncologists. Also do not forget 1) province caps on medial school admission and 2) administrative bloat. Nurses shortage is only one of the many issues with the healthcare in Canada.

Only the small fraction of doctors that are government/hospital employees will show up on that list. The vast majority that are contractors or under non-governmental employee arrangements will not.

I think radiologists tend to be employees since they usually don't physically see most of their patients, but not sure.

And those showing up on that list as employees may still have other revenue from services they can bill for as contractors.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#287

Post by simonh »

s1artibartfast wrote: post #278
simonh wrote: post #272

Earlier quoted context omitted.

We still use QALYS. The problem is you don’t get to choose how much a given level of health care costs, and I think 1% of GDP is woefully inadequate. You spend about 4% of GDP just on Medicare alone. As a US tax payer you pay about as much for Medicare, Medicaid and CHIP as tax payers in most developed countries do on health care in total. But then to actually get health care yourself you have to pay about the same a…

>and I think 1% of GDP is woefully inadequate. You spend about 4% of GDP just on Medicare alone. That all depends on the spending ROI. If the first 1% of GDP gets you 90% of the benefit and is universal, it may be just fine.

The problem is I don’t think it would. That logic just doesn’t scale. If one tenth of spending gave 90 of the benefit, then one hundredth of the spending should give you 90% of that, or about 80% of the benefit. That’s not how skilled labour intensive service costs work though. It’s probably more like one tenth of the spending would get you about 20% of the benefits. That’s certainly more efficient, but it’s just not going to be acceptable.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#288

Post by willyt »

mattlondon wrote: post #234

As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are people's solutions to this? It seems like the NHS budget keeps on going up and up and up [1], as does the number of doctors and nurses (while "managers" has either declined or stayed relatively static) [2]. So NHS is getting more funding, and there are more doct…

From your first source; The combination of a mismanaged economy plus an aging population has meant that the NHS spend is 50BN less than projected but is a now a larger share of GDP compared to other EU economies because the UK economy has performed so badly compared to the rest of the EU. Productivity has flatlined while people bought more and more expensive houses of each other on credit. My theory is that the conservatives have fucked the economy by being too tight fisted with public sector pay causing a drop in disposable income for about 1/4 of UK workers leading to lower spend in small businesses like pubs and hairdressers etc which has caused 10 years of general stagnation.

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#289

Post by fencepost »

cmrdporcupine wrote: post #171
dmix wrote: post #167

Earlier quoted context omitted.

No comment on unions but I never understood the salary caps, especially that new one for nurses. That's the opposite of what we should be doing.

It's the opposite of what you'd be doing if you wanted the system to function correctly... But what if you didn't? Because you wanted to replace it, but it was dangerous to say that out loud? The Conservatives (and to some extent some Liberals as well) have been playing a long game -- since the 70s when it was introduced -- to get rid of medicare. It's incredibly popular with Canadians as a whole, but if you take con…

Hey, if you object to privatizing healthcare, why do you hate the free market? Don't you think that private healthcare and insurance companies should be able to skim billions of dollars off the top of all health-related spending? Are you some kind of commie?

Re: Collapse of emergency healthcare in England may be costing 500 lives every week

#290

Post by Scoundreller »

ilamont wrote: post #42
dmix wrote: post #13

Canada is having the same issue with 20hr waits in the emergency room and others being rejected outright https://globalnews.ca/news/9066662/emergency-rooms-canada-bi... I’ve heard a big part is all the doctors have been going on vacation all at once now that COVID is largely over, after not taking them for two years. They don’t have enough staff to cover even partial shortages. That plus the elephant in the room of p…

Family member recently received emergency care in northern NY. Several of the nurses were Canadian coming over the bridge for better pay.

There's somewhere from 1000-2000 health care workers that work in the Detroit area, but live on the Canadian side.

When the borders were sealed shut-ish, they were going back and forth regularly and not required to quarantine upon return at any point during COVID like most everyone else returning was.

Kinda defeated the purpose of trying to keep a virus out of Canada when you literally have Canadians caring for the most afflicted people regularly with relatively few restrictions upon return.

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