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Dave Bloke

Should health spending be reduced post covid?

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Posted (edited)

News coming out of Switzerland and France is they are laying off doctors and nurses in non-covid regions there is so little work to do. GPs across France are seeing 80% less patients.

So is much of what the health service doing unnecessary? Are people going to the doctor because it is free?

Another consequence may be a defacto policy of euthanasia for the elderly. The medical head of an old peoples home in a high Covid-19 area of France said on TV "it is not in many of our guests best interests to be taken to hospital, there isn't the capacity anyway, we make them comfortable with Morphine and let nature take its course"

The post Covid world is going to see a lot of budget choices, should health be one of them?

Edited by Dave Bloke

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Posted (edited)

"An attractive product or service that is free will have infinite demand". Which is why the NHS keeps adding dubious services (eg. sex changes for kids). Hopefully this will lead to much stricter controls on what health conditions are spent on, although I very much doubt it.

Edited by The Idiocrat

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I have a recurrent problem with my back.  I usually prevent it occuring with stretching when I do sport but, with all the sports centres closed here in Germany I ended up last week in pain.  Normally in April if I tried to get an appointment with a chiropractor etc. I would be waiting till June or July at least but last week I called and got an appointment the same day.  The chiropractor confirmed that most of his patients had cancelled as they were non-critical.  I think there are huge numbers of people who normally clog up the doctors with trivial complaints.

I've also seen that in the past when I've taken my child to the emergency GP and seen that there was mybe one other child who looked ill from the dozen who were in the surgery.  My child had a temperture of 40C and I was told by my wife, a paediatric nurse, that they were ill before anyone tells me that I was clogging the place up as well :)

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I'm sure many genuine cases miss the face to face check up with a GP to keep an eye on long term issues - but this just shows a lot can and should be managed themselves outside of the healthcare system.

Whilst some of the dip at GPs and A&E is down to lower activity that causes these visits, it's clear a lot of these can be classed (as we expected) as unnecessary, or even 'recreational'.

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6 minutes ago, Great Guy said:

I think a lot of people treat a trip to the GP as a social outing. There should be a nominal charge for GP appointments like £10 and £5 for prescriptions.

The issue is, even at £10 a visit some with a low income will put buying cigarettes, alcohol or even scratch cards/lottery tickets before their health and/or will just turn up to A&E with a minor complaint.

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20 minutes ago, Dave Bloke said:

Another consequence may be a defacto policy of euthanasia for the elderly. The medical head of an old peoples home in a high Covid-19 area of France said on TV "it is not in many of our guests best interests to be taken to hospital, there isn't the capacity anyway, we make them comfortable with Morphine and let nature take its course"

Our Amazing NHS having a policy of euthanesia was completely unbelievable for many before this pandemic.

Now it is out in the open it is a huge shock for many that had little experience of what can happen.

That won't be put back in a box.

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I read in the Times today that there are 400,000 pensioners in residential care. At £40k a year each that's about £16 billion a year.... I don't know what to think. It's a lot of money to spend on people that will never get "better". However what else could do with them?

I do think we should probably be a little quicker in withholding life saving treatment. Just because you can do something it doesn't mean you should....

14 minutes ago, MrXxxx said:

The issue is, even at £10 a visit some with a low income will put buying cigarettes, alcohol or even scratch cards/lottery tickets before their health and/or will just turn up to A&E with a minor complaint.

Fair point. However other countries seem to manage. 

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Posted (edited)
15 minutes ago, Great Guy said:

I read in the Times today that there are 400,000 pensioners in residential care. At £40k a year each that's about £16 billion a year.... I don't know what to think. It's a lot of money to spend on people that will never get "better". However what else could do with them?

I do think we should probably be a little quicker in withholding life saving treatment. Just because you can do something it doesn't mean you should....

Fair point. However other countries seem to manage. 

The official figures are derived from the Census. In 2011 there were 291,000 people over 65 in residential care. The figure had hardly budged since the 2001 Census so I don’t know where the Times are getting their figures. If anything the number of residential care homes has declined in the UK over recent years.

Edited by Virgil Caine

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49 minutes ago, Dave Bloke said:

News coming out of Switzerland and France is they are laying off doctors and nurses in non-covid regions there is so little work to do. GPs across France are seeing 80% less patients.

So is much of what the health service doing unnecessary? Are people going to the doctor because it is free?

Another consequence may be a defacto policy of euthanasia for the elderly. The medical head of an old peoples home in a high Covid-19 area of France said on TV "it is not in many of our guests best interests to be taken to hospital, there isn't the capacity anyway, we make them comfortable with Morphine and let nature take its course"

The post Covid world is going to see a lot of budget choices, should health be one of them?

It's definitely not free in CH! Even if you never go it costs a bloody fortune.

I saw a senior medic in canton Vaud saying on TV that no-one was attending A@E because they were afraid to, and that they should if they have a really urgent problem because all the Covid stuff is kept separate.

In the UK you definitely have a point though - one remark made by a relative in the UK who used to be whatever-they-call-a-District-Nurse now - her ex-colleagues reported to her that the work has dropped off a cliff because all the oldies are scared of catching Covid19 from the visiting nurses/health workers so have suddenly decided that they can manage the necessary tasks on their own!

 

 

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Possibly..  but not necessarily for the reasons given.

If Covid kills off all the existing long term sick..  cancer patients,  oldies with on-going care needs etc..   then it will save the NHS a fortune in the long run.   

How much does a covid death cost.. ?  Those in care don't even get taken to a hospital !

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2 hours ago, MrXxxx said:

The issue is, even at £10 a visit some with a low income will put buying cigarettes, alcohol or even scratch cards/lottery tickets before their health and/or will just turn up to A&E with a minor complaint.

Triage them appropriately (i.e. ration the amount of attention such people can get). Or charge them at hospitals too. In lefty Sweden:

When visiting a hospital, the entrance fee covers all specialist visits the doctor deems necessary, like x-ray, rheumatism specialist, heart surgery operations and so on. The same fee is levied for ambulance services. After 1100 SEK have been paid, health-care for the rest of the year will be provided free of charge.

Cash payment might be politically impossible in the UK, maybe some kind of voucher system?

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It would help if they renegotiated the PFI 1 and 2 deals.

Quote

 

The Times speculates about interest rates of 1.1%, but in 2011 CPAC (Commons Public Accounts Committee) analysed PFI deals and found the average effective rate to be 14%. Even with a headline rate of 1.1%, finance companies are experts at building in ways to increase their profit margins.

CPAC’s report also pointed out that hardly any of the income earned on these deals resulted in any tax paid into the British economy, as the vast majority of beneficiaries are registered offshore.

https://skwawkbox.org/2017/04/10/tories-biggest-donors-to-profit-from-pfi2-nhsloans-and-wont-pay-tax/

 

 

2011 review!!!

Quote

 

The UK has 700 PFI contracts, with a further 61 projects in procurement and many others where PFI is being considered as an option.

But while PFI has delivered many new public buildings and services that might not otherwise have been built, it is far from clear that it has provided value for money. At present, PFI looks like a better deal for the private sector than for the taxpayer.

Government has treated PFI as the 'only game in town', but the use of this form of financing has been based on inadequate comparisons with conventional procurement which have not been sufficiently challenged. In future, the use of PFI must be based on a rigorous and transparent comparison with alternative funding methods.

We have seen information which strongly suggests that investors are making excessive profits from selling on shares in PFI projects. However, the Government currently lacks sufficient information on the returns made by investors, who have been able to hide behind commercial confidentiality.

The Government should extend freedom of information to private companies providing public services and should introduce arrangements for sharing equity gains.

The Treasury assumes tax revenues when assessing the value for money of a PFI project, yet does not monitor whether taxes are paid. In our evidence we found that tax revenue is being lost through the use of off-shore arrangements by PFI investors. The Treasury should measure the tax revenues from PFI deals and should ensure that this is taken into account in future assessments of PFI against conventional procurement.

Despite the billions of pounds of taxpayers' money at stake, the Treasury has so far not done enough to address the scope for greater efficiencies from existing PFI contracts.

https://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/pfi-report-publication/

 

Quote

 

The Government has announced that it will no longer use Private Finance 2 (PF2), the current model of Private Finance Initiative (PFI). • Existing PFI and PF2 contracts will not end because of this announcement – the Government will honour its commitments. The high upfront cost of compensation means that it is rarely value for money to voluntarily terminate a PFI or PF2. I

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/752173/PF2_web_.pdf

 

 

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The chances of health spending being reduced were pretty much zero before Covid-mania hit us. It's highly unlikely the government of a country which holds weekly national clapathons for NHS staff is going to contemplate reducing it now or at any time in the foreseeable future.

I wouldn't particularly mind large amounts of money going to the NHS if it was being spent in a reasonable, accountable way, but any hope of that happening is out the window now as well!

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3 hours ago, Great Guy said:

I read in the Times today that there are 400,000 pensioners in residential care. At £40k a year each that's about £16 billion a year.... I don't know what to think. It's a lot of money to spend on people that will never get "better". However what else could do with them?

I do think we should probably be a little quicker in withholding life saving treatment. Just because you can do something it doesn't mean you should....

Fair point. However other countries seem to manage. 

Best keep them alive to keep gdp contribution ticking over. 

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3 hours ago, MrXxxx said:

The issue is, even at £10 a visit some with a low income will put buying cigarettes, alcohol or even scratch cards/lottery tickets before their health and/or will just turn up to A&E with a minor complaint.

Easy solution which should exist anyway is that the entrance to A&E is a triage point staffed by padamedics [with a police bodyguard each with access to on-site cells] who put you in a very long queue to see the attached GP [target wait time: anything longer than 3 hours, longer the better, everyone invited to go to their regular GP if they'd prfer] unless you actually need A&E in which case they take you through as they would if you you arrive in an ambulance. Job done.

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Posted (edited)

Must be the 80 20 rule whereby 20% of the population make up 80% of the appointments, if not higher. Suspect c. 1% of population are hypochondriacs as well where they take up a v. high proportion of the 20%'s appointments. The vast majority of a doctor's time must be fobbing off elderly people with prescriptions that don't cure old age but where the placebo effect is good enough for the oldies. Somebody like me wouldn't go in a Doctor's surgery unless I was at death's door in which case I would most likely be down at A&E courtesy of the blues and twos anyway. I haven't been to the Doctors since I had a follow up bowel issue following an appendicitis op when I was 20.

Edited by SillyBilly

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10 minutes ago, BWW said:

Easy solution which should exist anyway is that the entrance to A&E is a triage point staffed by padamedics [with a police bodyguard each with access to on-site cells] who put you in a very long queue to see the attached GP [target wait time: anything longer than 3 hours, longer the better, everyone invited to go to their regular GP if they'd prfer] unless you actually need A&E in which case they take you through as they would if you you arrive in an ambulance. Job done.

That's pretty much how A&E works -- triage at entrance, if you're not 'emergency' then you wait (at least during busy periods).

The 'wait' is designed into the system to reduce demand -- when you see stats on average waiting time it is more a measure of '%age of users that aren't a real emergency' than a measure of the capability of the A&E department.

[That's not to say that medics aren't pressured in A&E -- just that the length of queue isn't a good measure of this pressure]

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5 minutes ago, SillyBilly said:

Must be the 80 20 rule whereby 20% of the population make up 80% of the appointments, if not higher. Suspect c. 1% of population are hypochondriacs as well where they take up a v. high proportion of the 20%'s appointments. The vast majority of a doctor's time must be fobbing off elderly people with prescriptions that don't cure old age but where the placebo effect is good enough for the oldies. Somebody like me wouldn't go in a Doctor's surgery unless I was at death's door in which case I would most likely be down at A&E courtesy of the blues and twos anyway. I haven't been to the Doctors since I had a follow up bowel issue following an appendicitis op when I was 20.

A couple of years ago I had to go register at a doctor for my offshore medical application as I'm over 60.

They called a couple of weeks later to confirm my previous doctor, apparently he retired in 1969 and died in 1974....

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4 hours ago, ste said:

I'm sure many genuine cases miss the face to face check up with a GP to keep an eye on long term issues - but this just shows a lot can and should be managed themselves outside of the healthcare system.

Whilst some of the dip at GPs and A&E is down to lower activity that causes these visits, it's clear a lot of these can be classed (as we expected) as unnecessary, or even 'recreational'.

Last time i was in A&E, the waiting rom was rammed. Must have been a couple of hundred in there. The names were flashing on a board as people were called to be treated. I didn’t see on e indigenous name until mine was called. 
 

stopping foreigners who have paid nothing or next to nothing in from accessing the service would massively drive down cost. 

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25 minutes ago, SillyBilly said:

Must be the 80 20 rule whereby 20% of the population make up 80% of the appointments, if not higher. Suspect c. 1% of population are hypochondriacs as well where they take up a v. high proportion of the 20%'s appointments. The vast majority of a doctor's time must be fobbing off elderly people with prescriptions that don't cure old age but where the placebo effect is good enough for the oldies. Somebody like me wouldn't go in a Doctor's surgery unless I was at death's door in which case I would most likely be down at A&E courtesy of the blues and twos anyway. I haven't been to the Doctors since I had a follow up bowel issue following an appendicitis op when I was 20.

That's exactly how it is. My mother in law had an appointment booked, but had forgotten what it was for. She decided to go anyway.

And like you, I last saw my quack 32 years ago when he mis-diagnosed appendicitis.

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27 minutes ago, One percent said:

Last time i was in A&E, the waiting rom was rammed. Must have been a couple of hundred in there. The names were flashing on a board as people were called to be treated. I didn’t see on e indigenous name until mine was called. 
 

stopping foreigners who have paid nothing or next to nothing in from accessing the service would massively drive down cost. 

did you then see & get treated by indigenous staff?

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