Discussion in 'Serious' started by Nexxo, 23 Jan 2011.
good monkeh-points about Hawaii, which is why I'm a firm federalist and not a statist.
Time to bump an old thread seeing as the health reforms are back in the news again...
Nick Clegg (deputy prime minister) is again talking about how patients want choice within the NHS. A choice of which GP they see, where they go for treatment and what type of treatment they receive. I've stated before in this thread that because of geographic reasons It's a redundant policy for me and I expect its the same for large parts of the UK.
So bit-techers. Do you think patient choice is important and do you want it?
I think it's important, and I'd want it, yep.
Where I'm living now (Cardiff city centre), the local GP isn't too far away, however it's a fairly small practice, it can sometimes have quite long queue times, and whilst the two GPs seem fine, the GP surgery where I used to live (near Swansea) was a lot better and more organised overall. Naturally I'm not saying that I'd live in Cardiff but go to a Swansea GP; I'm just pointing out that the quality can vary a fair bit.
So I'd definitely like the choice. To be honest, I've never understood the 'you get what you're given, based on your postcode' style of Government.
I'm glad to see some of the initially proposed plans being scaled back (even though Clegg taking control of the scaling back - despite strongly supporting the initial plans in their entirety - is fairly annoying), although I do think the NHS needs an overhaul, and things such as more patient choice seems good to me.
Heres the perfect representation of condem policy as a whole not just thier policy towards the NHS
upside down and back to front
puodsǝɹ oɥʍ ǝǝs oʇ ƃuıɥɔʇɐʍ ǝq ןןıʍ ı ˙snʇɐʇs ɹnoʎ uı sıɥʇ ǝʇsɐd puɐ ʎdoɔ ˙uoıʇuǝʇʇɐ sʎɐd ʎןןɐnʇɔɐ ʇsıן spuǝıɹɟ ʎɯ uı oɥʍ
From the patient's POV, they want control over what happens to them. This does not necessarily mean that they want to make all the decisions, but that they want to have control over who they delegate expert decision making to, and that they want to be involved in the process. The more serious the health problem, the more involved patients want to be.
From the clinician's point of view, patients who are ill, in pain and/or anxious are rarely in a very rational and informed place. This becomes more of an issue in situations where patients are so incapacitated or impaired through illness, injury, distress and/or pain that they cannot make valid and informed decisions (and then there is the question of capacity with psychosis or learning dufficulties). On the other hand the NHS has limited resources and of course cannot perform miracles. As such there is only a limited overlap between what patients want, what they need and what clinicians can actually deliver.
Patient choice starts with empowerment. Empowerment starts with being informed and taking responsibility. The relationship needs to be a collaborative one, not one of demanding children vs paternalistic clinicians.
So I have mixed feelings about this. Banging on about patient choice (want) is a neat government distraction from patient need and NHS delivery. You should not have to choose your GP, your Consultant, your hospital (which is kind of tricky anyway, when you are in the back of an ambulance crippled with pain due to a burst appendix). You should be able to rely on the one you get being good enough.
On the other hand NHS Trusts won't improve if they don't listen to the patient, and they are only going to do that if they can vote with their feet.
So I guess it comes down to collaboration: patient involvement, not just choice.
Patient choice. No.
I want good hospitals with a good service that I can access throughout the country. I don't want a choice between good and not so good, what sort of a choice is that?
This sums up my POV really. It is a tricky issue, although sadly there is variety across GP surgeries and NHS trusts (same as with schools), and so I can fully understand the arguments in favour of more patient choice - especially since, as you point out, people voting with their feet should theoretically increase quality.
I understand that, and in a 'perfect' World there wouldn't be such inconsistencies (with health, schools, etc). But since there are such inconsistencies, is it fair that some people could get good healthcare and some could get lower quality healthcare - based solely on where they live?
patient choice - no
patient review - yes
No it's not fair and that's why you shouldn't accept them. Service needs to be equally good across the board, giving choice just perpetuates the inherent problems.
I believe there should be a basic standard of health care no matter where you are.
Especially the local GP Where I live the the local Practice has adopted a system which imo is a farce if not unethical
First you have to phone the practice early between 8:30- 9:30 then you wait and some time in the day a Doctor will phone back he ask's you some questions and makes a diagnosis based on a couple of questions and prescribes you medication and you pick it up from the chemist having never seen a doctor, If you actually want to see the doctor then that could take a month.
I have yet to see a GP who has been of any use whatsoever over the past 30 years or so.
Well, perhaps if they had more time to see patients, it wouldn't be such an issue. People give GPs a hard time, but I have to say, I'd hate to do it, and is the one area of medicine that I really do not want to work in.
No it's not the time issue it's the knowledge and people skills. Yes you can't know about everything but you can at least read up about it.
Misdiagnosis, being sent to the wrong places and the phrase, the day after my father died, of 'we need a second doctor just so you know we're not doing a Shipman' are just a few of my experiences.
My current GP is fantastic. When I lived in the city the city centre GP I attended was a shambles. There where seven doctors, I never saw the same one twice and the biggest battle was getting past the receptionists. You had to call for an appointment between 8.30-9.30am if it was an 'emergency' you could get an appointment within 48 hours or if it was not an emergency, 3-4 weeks. Probably due to workload you were in out the door as quick as they could get rid of you.
Now I live back within the village I grew up in the its completely different. 3 GP's and you can choose who you get to see. I can normally get an appointment the same day I phone and the doctors have time to actually talk to you. The first five or ten minutes of an appointment is normally a general chat about how your doing and your general welfare. They couldn't be any better and Its a real shame every GP can't be like that.
I have recently had an operation on my stomach to fix the valve at the top, and to remove my hiatus hernia, which was done under BUPA in a private hospital.
From going to the doctor to the surgery was just over a month. It would have taken me upto 8 weeks to be referred via the NHS. Hoowever, the thing that got me was they different way they do simple things in the private hospital, there is no faffing.. for the endoscopes, they do a group of 25 people in about 2 hours, hot bedding the machine, with only one person on the camera for the entire session.. this meant I spent about 10 mins with the doctor and the machine out of my 1 hour session. When i had one of these done on the NHS, it was a 1 hour session, but during that time, no one else was allowed to use the machine.
That would have meant it would have taken 12.5 times longer to process 25 people.. It has always struck me that the biggest problem with the NHS is the simple lack of common sense and intelligence in how they sort themselves out.. there seems to be an awful lot of faffing going on.
On the other hand, taking it a bit slower reduces the risk of cross-infection and allows room for dealing with unexpected complications that can occur when you shove a long object down orifices (no giggling at the back). Faster is not always better.
I agree that the NHS could be more efficient, but this has to be balanced with patient needs and safety. Private health care does not always do that.
I've had two of those repairs-honestly, I wanted them to take their time (I get stricture surgery this time, as third time's a charm) rather than try to get more people processed. Funnily enough, when that tube was down my throat I just wanted it done right.
I would disagree with this actually. Time is money, and the more patients a private hospital can see in a set amount of time means the more money they can make - and because they're out to make money, this becomes the goal.
25 people in two hours for an endoscope is ridiculous, especially with a single machine. 10 minutes total between the doctor and endoscopy? Sorry, but that's just rushing things for the sake of money and patient turnover.
Further, if you actually go and work in the NHS you'll realise it isn't all inefficiencies and lazy staff. One of the outpatient departments I work in will see 80+ patients a day, and the support services (Radiology, Haematology etc.) have to be able to cater for a totally random number of patients - whereas in the private sector they know that on a given day they'll see a small number of patients for a certain procedure which entails a precise number of additional investigations.
I will freely admit that private hospitals will have shorter waiting lists. This is entirely due to less patients, and is something you have to pay for if you think it is worth it.
Good day to bury news... https://twitter.com/benparfitt/status/93390641475760128
Thin edge of the wedge?
Will proably see more of the NHS opened up to private companies, money is no longer there to fund it.
Separate names with a comma.