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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

#321
post #231

Earlier quoted context omitted.

Yes, The ambulances are waiting outside the hospitals with the last patient so they can't go to get the next one. Source: Family members have recently waited some hours outside A&E in an ambulance.

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.

> Just wheel the patient through the front door

This is such a stellar use of the handwavey "just" that I feel we should have it bronzed.

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

#322
post #218

Earlier quoted context omitted.

A retrospective, observational (IE, after the fact data analysis from a population without controls) study found a risk factor (association). That's not enough to make any real conclusions as to whether this is causal.

It may not be conclusive on the subject of whether the 16% additional deaths were specifically influenced by the additional wait, but in light of that data point, you're going to need a whole lot more evidence to justify your original claim that the cohort that dies 16% more than the baseline population in the days that follow were, without exception, not in any urgent need of medical care...

All I said was: if you can wait 12 hours, it's not an emergency. The emergency room is for things where a person couldn't wait 1 hour without dying. People dying 30 days later: not an ER problem.

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

#323

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 issue is undoubtedly multifactorial.

I agree with you that we cannot persist with above-inflation spending increases. This is economic fact. Moreover, we're currently enjoying an artificially cheap healthcare system by underpaying nurses and doctors.

My partner and many friends and family work for the NHS, and these are my general observations, in order of significance.

1. The biggest problem is underfunded social care. If we took money out of the NHS and moved it into social care, we'd have a better NHS. At the moment, the NHS is full of inappropriate patients with nowhere to go. We also need to consider how we handle the elderly in this country. The idea of having elderly people stay at their suburban homes while the state pays for nurses and doctors to visit is hugely expensive. I suspect caring for your elderly relatives at home is going to need to become more common.

2. The NHS is inefficient BECAUSE there are to too few admin staff. In NHS terms, this includes IT and other similar roles. Currently, my partner spends over an hour a day just waiting to log in on one of her department's three computers. She then spends ages sending emails, following up transfers and doing a whole load of other jobs that should be done by an administrative person. Technology is massively underexploited because investing in technology costs money that we don't want to spend. It's like that death spiral that I'm sure many of us have seen in our careers, where you get nothing done because you spend all day firefighting, and everything eventually grinds to a halt.

3. We need to focus more on preventative care. Right now we largely leave problems until they are much more difficult to treat. This is in large part cultural, and partly due to the firefighting I mentioned before. We have a very unhealthy population (myself included) and more needs to be done to fix that. Other countries have deployed very successful strategies that we've so far failed to apply ourselves.

4. We need to look more at how we handle the end of life process. Sadly, death is an unavoidable reality currently, and we spend a ridiculous amount of resources trying to slightly delay the inevitable. Many of my partner's patients are in their 80s or older, and it seems borderline immoral to be performing such invasive surgeries on extremely unwell elderly people. Interventions continue to get more incredible, but also vastly more labour and resource intensive. Many of these patients may live an extra few months due to these interventions, but we really need to be honest with ourselves and ask whether it's worth it. Currently an intervention is deemed value for money depending on the average QALY added across all patients, but obviously in reality, the same intervention would be usually much more value for money on a healthy 40 year old, and much less on a frail 90 year old. This is an extremely controversial and morally difficult area with extremely challenging issues around every corner, however.

This isn't a problem of funding, either. This is a problem of basic population dynamics. We could throw hundreds of billions more at the problem, but where are we going to get all these new carers, nurses and doctors? Who's going to be left to build their houses and grow their food? If we import all these people from overseas, which is politically unpopular, how are we going to integrate them?

We could look into whether we continue with the Beveridge Model. Certainly some things about it don't work brilliantly. But honestly I don't think the model matters so much as the fundamentals, other than better aligning incentives will make it marginally easier to fix.

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

#324
post #219

Earlier quoted context omitted.

Problem: Politicians are corrupt! Solution: Give more power to politicians! Lack of power corrupts, need to give them more until they stop being corrupt! Not sure why anyone thinks that would work.

I really don't understand how people can simultaneously believe that governments are corrupt and the private sector would support the public's interests. Guess who is corrupting government: the private sector who only support their own interests.

Lobbyists are the solution man. These free market angels are here to protect us from ourselves.

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

#325
post #188

Earlier quoted context omitted.

the 12 hour wait is once the person enters the doors of the facility. In a hospital, if you walk into the ER, people are observing you closely and expediting people at immediate risk of death. A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care.

A few years ago I had an infected gallbladder. It was enormously painful, and I went to ER. It might not have been potentially fatal (I'm honestly not sure if you can die from it), but I didn't know that. I just knew I was in a ridiculously amount of pain. Anyway, so I went to the ER and to begin I did sit in a chair like you said, however I don't think anyone was keeping an eye on the patients, since by the time som…

Your last sentence is really my underlying point: people use the ER for non-urgent issues because it's available. Ideally, we'd have far more non-ER urgent care (which costs much less to staff and run than an ER) and that would be most people's place to go when their normal doctor couldn't see them.

For the gallbladder, if it's just an infection, not fatal. If it's a gallbladder attack, it can lead to rupture. Definitely needs emergency surgery.

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

#326
post #188
post #187

Earlier quoted context omitted.

And if you can't wait 12 hours you become excess mortality. Sometime before the 12 hour period, one must make a choice whether to seek care or not.

the 12 hour wait is once the person enters the doors of the facility. In a hospital, if you walk into the ER, people are observing you closely and expediting people at immediate risk of death. A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care.

> Instead, they were using the ER for non-urgent care.

FWIW, this isn't always a call that person makes - I've had multiple family members advised to attend by the non-emergency service (111) and ended up with a 6-8 hour wait.

You also can face lengthy waits for something that needs treatment soon but isn't immediately life-threatening (grandfather fell and hit his head on a table, requiring stitches - ~4 hour wait for a handover from the ambulance, another 2-3 before he received an MRI and stitches).

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

#327

Earlier quoted context omitted.

What is the situation of urgent care establishments in the UK? Places you can go for non life threatening but life stopping events, like say a broken leg?

It all goes through A&E, which unfortunately is meant for both the life threatening situations and urgent but not leathal ones yet. You have to go in, register and sit and wait - if it is "just" a broken leg yes you might wait a few hours before being seen.

There's a trend in the US to have urgent care facilities. For example, in my system if I have a problem I call (24/7) and they route me either to urgent care or the ER.

During my visit to urgent care (so early in the days of COVID that there was sign saying only people who had just flew in from Wuhan could be tested), I was seen immediately, the doctor stopped while seeing me, said "the person in the next room is having a heart attack and I have to send him to the ER immediately- I'll be back".

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

#328
post #188

Earlier quoted context omitted.

the 12 hour wait is once the person enters the doors of the facility. In a hospital, if you walk into the ER, people are observing you closely and expediting people at immediate risk of death. A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care.

> A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care. Or the ER was crap. Like the time I waited 12 hours (because I had no choice, I needed a surgeon) to have my foot put back together.

I had a similar situation (sitting in the ER absolutely needing immediate surgery at risk of death), but after a bit I called my parents, who called the surgeon, who saw me immediately (outside the hospital) and then immediately scheduled me for surgery back at the same hospital, all before I would even have been seen at an ER.

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

#329
post #226

Earlier quoted context omitted.

How can people benefit when in the free market system consumers are seen as a resource to be exploited?

Because the seller, in a free market, has to please is customer. The way to please the customer is to have the customer benefit from the transaction. For example, how long do you think McDonald's would last if its McBurgers tasted bad? McDonald's success is extremely tied to customer satisfaction. Tossing the ball back to you, under socialism, why would the socialist service care if you're pleased with the service or…

My family owns a bunch of McDonalds. Success is tied to location mostly. The product is pretty meh at best. The only products that have maintained quality are fries, coffee and coke. The rest are worse by any measure.

There’s a reason why Five Guys, etc are everywhere. People who want a good burger go there.

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

#330

Anecdotal, but I have twice in the last year heard from the same friend of 2 instances where the waiting time for an ambulance was around an hour. The first was when he observed an accident where a car hit a guy on a scooter. The guy was hurt, but not in a life threatened manner. The other was a guy in a bar who probably overdosed on something and his heart stopped. If someone hadn't been around who knew CPR, he woul…

Even more worryingly is that London has some of the fastest response times in the country.

Last two times I had to call 999, for ambulance and police respectively, I was on hold for more than 5 minutes before even being connected to an operator. The overall ambulance target response time is 8 minutes.

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