Lol at this when you repeatedly post your boring Twitter account which is literally your full name.Quote:
Originally Posted by phonics
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Lol at this when you repeatedly post your boring Twitter account which is literally your full name.Quote:
Originally Posted by phonics
Wouldn't come up in a Google search because the username appears through a javascript. Thanks.
And it wouldn't come up in a Google search because this is a tiny basically closed forum about a game nobody plays.
I know.Quote:
Originally Posted by phonics
Reshuffle about to happen. Seems I may have to wait longer for the dream of Gove suicide bombing the NHS though.
You honestly have no idea how good you've got it with the NHS. 8 hour wait for 3 stitches in a country that regularly tops the 'best private healthcare' lists sucking at minimum 500 quid out of your paycheck every month for the lowest form of coverage.
The amount of money needed to fund it properly is not something that's available to us though. I'd advocate selling Wales to pay for it, but apparently that's not an option.
It'll never be funded properly because they spend every year giving it just enough to survive this year instead of giving it a wad of cash to invest in preventing those issues. How much of your monthly wedge goes to the NHS currently?
That's because they don't have a wad of cash (nor do they have one for schools, police, defence, roads, etc etc etc).
British Leyland suffered from similar government neglect.
I can think of some ways of making some cash. Even have some left over for a gulag or two.Quote:
Originally Posted by Jimmy Floyd
If you think the NHS has too many middle managers nicking all your money, wait till VirginHealth moves in with more salary going to marketing and lawyers than healthcare.
What were the statistics this year, 30% of the trains ran on time? 1 in 6 of those being an outright cancellation? They all stink of piss and are late/cancelled just as they were previously.Quote:
Originally Posted by Lewis
I know all about private healthcare, used to do customer satisfaction surveys for BUPA in a previous job. NHS is a better model but only if you can actually provide it, rather than pretending to do so.Quote:
Originally Posted by phonics
There's also no way of raising the money - wealth taxes and things may feel virtuous, but raise fuck all. The only way to sustainably fund it is to both do that, and also aggressively tax lower and middle incomes - you just won't raise enough otherwise.
Or force companies to pay better wages lifting huge swathes of non-tax payers into the bottom bracket by raising them above the deduction limit. etc. etc.
Companies will fire everyone if you force them to do anything. You've met accountants and CEOs, right? They're all wankers.
Sounds like a certain section of the population needs to be put into the labour force.
I have to Google Image 98% of MPs so this reshuffle is confusing.
Did Karl Pilkington get a hair transplant?
https://i.imgur.com/JuofaEs.png
The Tory scum are deliberately driving the NHS into the ground, let's no have any mistake about that. And there is plenty of money around.
Don't low and middle incomes contribute hardly anything via tax though?Quote:
Originally Posted by Jimmy Floyd
They contribute quite a lot.Quote:
Originally Posted by Magic
Quote:
Originally Posted by phonics
I can't remember his name, but I'm almost certain he lost his seat at the last election.
No, politicians just pretend so because raising taxes on them is the easiest method in the book to lose an election.Quote:
Originally Posted by Magic
Correct.Quote:
Originally Posted by Jimmy Floyd
Should have shaved the hair off and pretended to be Pilkington.
Cool, it wasn't funny the first time so...
Any sympathy I have with people moaning about trains (which is not a lot, since they moan about the wrong things) vanishes as soon as I see the token whopper on the news moaning about the cost of his season ticket from Brighton to London.Quote:
Originally Posted by phonics
I never understand the arguments for nationalising the railways. A shit monopoly is a shit monopoly whether it's private or public.
Well the public is already subsidizing the shit private monopoly so why not take the 3.5 billion the shit private monopoly made in profit last year and put it in the public purse instead of Richard fucking Bransons.Quote:
Originally Posted by Jimmy Floyd
Same with the internet, tax payers pay through the arse to pay Virgin to lay fiber that they do incredibly slowly and then provide you a shit service to boot.
What I'm saying is Richard Branson, put a pair of fucking shoes on you hippy and get in the gulag, you tax skimming beardy prick.
Branson in a gulag. :drool:
Also that fella with the tiny neck and stupidly over-large head is Gavin Barwell. Pretty sure he'd written some book about how to win a marginal seat then lost his seat at the last election. :D
There are lots of ways you could reduce cost in the NHS if there was a willingness to invest in the long-term rather than whatever is cheapest today, but there isn't.Quote:
Originally Posted by Jimmy Floyd
Things like preventative measures to stop old people falling over, breaking their hips and lying on the floor for two days so they can come and have a long and very expensive hospital stay where they get pneumonia. Or better funding for gastric bypass surgery - expensive up front, saves huge amounts of money in obesity-related complications long-term. Or making working conditions liveable so everyone doesn't leave to Australia and you have to spend a billion quid an hour on locums.
Etc.
On two moderately related notes, lol at Jeremy Hunt getting promoted and This is Going to Hurt by Adam Kay is a great read.
Also, all the stuff Lee used to spout about first and second year doctors not being in positions where they have to make life or death decisions is utter bollocks. It happens in every hospital every single day - mostly on night shifts, where there is less senior help around. It's all well and good saying "you'll never be on the ward without a registrar", but when the registrar is tied up with one dying person and another one decides to have a go you're on your own.
The Australians spend pretty much the same as us on health, so why would you move there when their system must also be a catastrophe?
They must be spending it better than we are.
No, they're just more localised. You're spending the majority of your healthcare on 3 cities across a population of 25 million. Not 70 million people across the whole lot. If Australia is spending a similar amount as us they're spending at minimum 20% more per person.
It is obviously per person, otherwise it would be a pretty pointless comparison.
He's not saying any different, just that the vast majority of their population are in a few concentrated spaces so you don't have to spread the money across such a large area.
Providing for 25 million people mostly in three large cities is much cheaper (per person) than 70 million across the whole of the UK.
Makes sense to me.
A mix of both if we're fair. Which is why I went from 33% to 20.
They aren't really 'concentrated spaces'. Their residential areas are huge and - compared to our population centres - barely populated.
Right, so the registrar is incapable of managing more than one patient at a time? Or getting a history from a junior and giving management advice? Nonsense.Quote:
Originally Posted by randomlegend
And it's easy to say this stuff but the reality is much more muddled - research into cost effectiveness of bariatric surgery shows very mixed outcomes depending on your cost benefit rationale, and is even more muddled when you try to extrapolate the benefits beyond the current surgery inclusion criteria in the uk. It looks very cost effective for young male diabetics with bmi over 35, but as soon as your inclusion criteria adds older patients or those without diabetes then it all gets a bit messy.Quote:
Originally Posted by randomlegend
You are of course right that the NHS tends to think short term, but the beneficial long term health economic strategies aren't always as easy to identify and implement as you'd think.
One thing that staggered me was that each trust is decentralised when it comes to buying. Is that really the case and if so, what's the rationale?
They are to a degree - there's still some central NHS supply, and large pools of collective purchasing for expensive devices like pacemakers and defibrillators if Trusts want to join them.Quote:
Originally Posted by Yevrah
The rationale was that each Trust is a seperate business entity and that they should have commercial freedom to buy what and where they like.
This has of course resulted in lost opportunities for massive scale NHS wide purchasing, and also resulted in huge expansions in each Trusts purchasing departments.
Not that the system was perfect before decentralisation - there was very little freedom to operate outside of the nationally set frameworks and the needs of local populations and services weren't always met.
I saw a patient yesterday who had a chest pain, went to his GP and had an ECG, the tabs were left on, he got in an ambulance, new ECG was applied as they use different tabs, then he got to a local hospital who applied a third different set of tabs, before moving him to the local cardiac centre who put on a 4th different set. A simple example of the lack of joined up approach and inefficiency that RL was talking about, and a fixable one, but right now none of these organisations plan together
It's not nonsense. Every junior I've come across has been in a situation at one time or another where they've ended up managing something way beyond their level of expertise without support, especially in the smaller district hospitals.Quote:
Originally Posted by McAvennie
You - like Lee - appear to be or have been an NHS manager who is very aware of how it's all meant to work but is either ignorant or wilfully blind to the things which actually go on.
If a registrar is dealing with a patient who is exsanguinating from their eosopogeal varices which have exploded, they sure as shit don't have a minute to spare to help you with someone else who's trying to die.
It happens all the time.
I have the joy to be both clinical and a manager in the NHS, working on the coal face with junior doctors every day of the week in A and E, coronary care and acute admissions wards, so I'm neither ignorant or blind to how it actually works or how it's supposed to work, I just think you are being dramaticQuote:
Originally Posted by randomlegend
It's tough in the NHS at the mo, and it's going to get worse, but I certainly don't think a junior doctors lot is any worse today than it was 10 years ago, and it's certainly better than it was in the 90s.
Having said all that junior doctors do have a very tough job, and I understand that the responsibility is daunting
Has Lee been pretending to have been gone for two years?
Not sure 'it's better than it was nearly 30 years ago' is a convincing argument mind.
I had my appendix removed by someone who was a junior doctor at the time and who was previously in my class at school. He'd been a little shit back then. Wasn't sure I wanted him messing with my insides.
I absolutely don't think it's worse than it was 30 years ago and I never said it was.Quote:
Originally Posted by McAvennie
I'm just going by what I hear and see from the juniors on the wards and from friends who have qualified before me and work as F1s and 2s. Maybe they are all making it up.
I'm not suggesting every F2 spends all day making life and death decisions, but they all have a story of a time they've been stuck managing something way out of their depth with nobody to help.
The settings you have said you work in also have much better senior support than most places in the hospital.
I have no reason to ham it up, it's not a situation I ever want to find myself in but I find the hard to believe it doesn't happen (quite a lot) based on my experience.
Virgin Trains have stopped carrying the Daily Mail because it's racist and homophobic and all of the rest.
Do they have the same policy with passengers?