Aye Chris, we have something in mind but until we have exposed what little we can expose of a broken system which is kept on life support by fleecing taxpayers and evading questions in the Commons we will not reach the point that you have reached. We are not bean counting, Chris. Please bear in mind that 10,000 pensioners have been deprived of warmth this winter and the excuse is the 22 billion black hole (which has to be at least 5 times bigger). In reality chasing tax evaders and sink hole engineers is far more difficult than telling some poor sod: you are on the list, so no 200 quid for you this year.
Besides, you are clearly a perceptive person: what story do the NHS posts suggest? Why do you think we cannot even reconstruct the most basic wiring diagram of the NHS will the bodies and services in it?
The home page is full of out-dated articles, some from 2022. I note my comments on the Pfizer witch-hunt have disappeared, and now we are into a highly technical discussion about NHS funding.
Dear Carl and friends, old and grungy as you may be, where are you going with this? I am a paying subscriber because I think you carry a torch - or at least provide honest and balanced opinion.
As for the NHS, the one good thing to have emerged in the last 12 months is that a substantial number of people are starting to realise that there is a problem, a crisis even. For people like me who live mostly outside UK this is no surprise but in UK this is a discovery moment. And honestly, we don't need to count the beans, we need to start with the thickest of paint brushes and start outline how it ought to work. On this I think Carl and friends have some ideas, although perhaps they don't have all the evidence.
Crisis moments are opportunities for change, as is a new government. The last thing we should do now is to spend years on bean-counting and analysis and a Grenfell style inquiry.. One thing for sure there are too few hands on the coal face. Fix this by encouraging more young Brits to train as doctors and nurses and fix it now by raising the pay and the places in school! Next thing we need to fix the structure. One simple solution is to copy something that works better - there are many examples. I am familiar with the Dutch system. It works. Copy the Dutch. (Apologies to my Dutch friends who will point out hundreds of things that need improving).
Carl and friends, you are right on principle that Covid vaccinations did not endure due diligence as you would have it from a perfect view. We did not have time!! Nor do you in UK have time for a Grenfell style approach to proofing that inflammable cladding is a fire risk.
Carl, please grasp the nettle and campaign for something you and maybe I believe in. People who work in the NHS know what might work better. Let's hear from them for a change.
"One thing for sure, there are too few hands on the coal face."
Really?
Darzi would not agree:
"Overall, hospital productivity is at least 11.4% lower now than it was in 2019
The number of clinicians for each bed has increased by 13%, while key measures have declined.
A&E attendances per emergency medicine clinician are down 18%; outpatient appointments per consultant are down 7%; and surgical activity is down 12 percent
Given the very significant increase in resources in acute hospitals, it is implausible to believe that simply adding more resource will address performance. "
Kendrick did a good series on what is wrong with the NHS which complements this TTE series. In one of this series of posts there is photo of an A&E consultant lying on the floor next to the paperwork that has to be filled in when a patient arrives at the department:
In 1999 the typical GP consultation record would be an indecipherable one or two liner of spidery handwriting on a small Lloyd George paper record. A person's lifetime GP medical record would typically fit into one 130 mm × 180 mm envelope. In 2024 a digital copy of a patient's GP medical record in small font can now be an inch thick wad of A4 paper.
As an example, a locum GP at our practice recently wrote in excess of 20 lines of comprehensive text describing a barn-door clinically benign seborrheic wart, using the ABCDE melanoma assessment framework. This record would represent a medico-legal defence for their decision making in case someone at some point in the future tries to sue them about a missed diagnosis. That might have been a fairly extreme example but amplify this sort of thing across the entire NHS and you probably need twice as many people to do the same amount of actual work.
some of us have been saying for many years now; "you will get less and less .. as time goes by ...... and it will cost you more and more ......."
of course whilst BIG FOOD is making you all sick; and BIG HARMA is dispensing pills that nominally aid; but seemed packed with nihilism and adverse effects ....
I know 2 young folk who took up the challenge, one is training to be a GP currently on £14 an hour, with 100k of debt after 5 years at Uni. She is lucky to have a placement that enables her to live with her parents, because with that level of debt (it's not all student loan obvs), she's unlikely to be able to afford a mortgage or rent anytime soon. So there's one reason why young people are reluctant to train as doctors.
The other spent 4 years training to be a nurse, working on the wards unpaid for 30 odd hours a week, and being treated like sh1t because she was a student nurse. She's seen and done things I would not wish on my worst enemy. She has now left the profession. The education system for nursing is completely archaic - in what other industry would you expect staff to work 30-40 hour weeks including night shifts, unpaid? No wonder we import so many foreign nurses. No wonder young people don't want to do it.
Endless folks have tinkered with nursing training/education for the last 50 yrs; as medicine was 50 yrs, ago nursing was an 'on the job' training: student nurses were paid; albeit very poorly; and they learnt on the job; the pendulum swung so much that recently it seemed that those enrolling to 'train" did not get to see real wards and real people for some time; for some, this was a real shock; and some walked then; surely better to see quickly what you are signing on for; (ie like being a sailor; go to sea early; see if it is for you (ie the sea)); same for nursing; get exposed to the reality quickly;
new mothers can't change their minds surely; they must face nappies, urine, vomit and endless faeces; trainee nurses will face similar exposures, but must decide if they can face this; as volunteers soldiers must decide if they can face bullets and shells.
so many academic pseudo-pretensions to so many jobs through out hospital system; one can observe that the facts that so many learn; have ZERO connection to the skills that are needed to do the job; complete separation between what one could term 'Snobby knowledge' and the skills needed to do the work; some call it 'white mans' knowledge": there seemingly just to attempt to show superiority over others: I know more irrelevant facts than anyone else!! .. so hold my beer while I show off ......
this takeover of so many jobs; by elite ivory tower academics that started 45 or more years ago? ... is everywhere; nursing seems full of academics; who never get near a real person; write endless papers, of what some would allege are zero relevance; these souls are somehow lauded by some; that nursing is now 'academic': as if the last 4 yrs allows anyone to admire anything academic ......
friends in nz commented that the sailors from the ship that ran into the reef on Samoa; were immediately given psychological counselling when they flew back uninjured; they had just got their feet a bit wet; they had joined a branch of the armed services; lord knows how they would react to someone firing bullets at them; lord forbid that should happen
I don't have a problem with on the job training, it's the long hours for free, while also being expected to study, and being treated like sh1t by their future colleagues I object to. I've been that new mother you mention, and it's nothing like nursing because a) it's your own child and you will do anything for them, willingly, b) your child grows up and becomes needy in other less tiring ways. If you treat your prospective co workers badly, they will leave. Hers is not an isolated experience.
" If you treat your prospective co workers badly, they will leave. Hers is not an isolated experience."
Indeed; I fear I may have offended you; such was not the intention or the case; from the outside, nursing was always characterised as 'eating their young': older ladies could be a tad fierce to the younger ones; our mother would tell us endless stories of her experiences; it can be a fierce world;
No, you didn't offend me, I'm made of sterner stuff and debate is healthy. I have experienced behaviour my young friend has encountered, albeit in another setting, and it's just so unnecessary. Why do older workers believe they are entitled to make younger colleagues lives a misery? It baffles and saddens me.
Aye Chris, we have something in mind but until we have exposed what little we can expose of a broken system which is kept on life support by fleecing taxpayers and evading questions in the Commons we will not reach the point that you have reached. We are not bean counting, Chris. Please bear in mind that 10,000 pensioners have been deprived of warmth this winter and the excuse is the 22 billion black hole (which has to be at least 5 times bigger). In reality chasing tax evaders and sink hole engineers is far more difficult than telling some poor sod: you are on the list, so no 200 quid for you this year.
Besides, you are clearly a perceptive person: what story do the NHS posts suggest? Why do you think we cannot even reconstruct the most basic wiring diagram of the NHS will the bodies and services in it?
Keep asking, keep thinking. Best wishes, Tom.
The home page is full of out-dated articles, some from 2022. I note my comments on the Pfizer witch-hunt have disappeared, and now we are into a highly technical discussion about NHS funding.
Dear Carl and friends, old and grungy as you may be, where are you going with this? I am a paying subscriber because I think you carry a torch - or at least provide honest and balanced opinion.
As for the NHS, the one good thing to have emerged in the last 12 months is that a substantial number of people are starting to realise that there is a problem, a crisis even. For people like me who live mostly outside UK this is no surprise but in UK this is a discovery moment. And honestly, we don't need to count the beans, we need to start with the thickest of paint brushes and start outline how it ought to work. On this I think Carl and friends have some ideas, although perhaps they don't have all the evidence.
Crisis moments are opportunities for change, as is a new government. The last thing we should do now is to spend years on bean-counting and analysis and a Grenfell style inquiry.. One thing for sure there are too few hands on the coal face. Fix this by encouraging more young Brits to train as doctors and nurses and fix it now by raising the pay and the places in school! Next thing we need to fix the structure. One simple solution is to copy something that works better - there are many examples. I am familiar with the Dutch system. It works. Copy the Dutch. (Apologies to my Dutch friends who will point out hundreds of things that need improving).
Carl and friends, you are right on principle that Covid vaccinations did not endure due diligence as you would have it from a perfect view. We did not have time!! Nor do you in UK have time for a Grenfell style approach to proofing that inflammable cladding is a fire risk.
Carl, please grasp the nettle and campaign for something you and maybe I believe in. People who work in the NHS know what might work better. Let's hear from them for a change.
Number of FTE doctors in the NHS Hospitals and Community Health Service (HCHS) workforce, England from 1995 to 2023
1999 (When I was appointed as a consultant): 60,388
2011 (When I retired): 98,329
Now: 138,604
https://www.statista.com/statistics/679968/number-of-doctors-nhs-hchs-workforce-england/
"One thing for sure, there are too few hands on the coal face."
Really?
Darzi would not agree:
"Overall, hospital productivity is at least 11.4% lower now than it was in 2019
The number of clinicians for each bed has increased by 13%, while key measures have declined.
A&E attendances per emergency medicine clinician are down 18%; outpatient appointments per consultant are down 7%; and surgical activity is down 12 percent
Given the very significant increase in resources in acute hospitals, it is implausible to believe that simply adding more resource will address performance. "
Darzi (Chapter 5 para 65 -67)
Kendrick did a good series on what is wrong with the NHS which complements this TTE series. In one of this series of posts there is photo of an A&E consultant lying on the floor next to the paperwork that has to be filled in when a patient arrives at the department:
https://drmalcolmkendrick.org/2023/11/27/what-is-wrong-with-the-nhs-part-3/
In 1999 the typical GP consultation record would be an indecipherable one or two liner of spidery handwriting on a small Lloyd George paper record. A person's lifetime GP medical record would typically fit into one 130 mm × 180 mm envelope. In 2024 a digital copy of a patient's GP medical record in small font can now be an inch thick wad of A4 paper.
As Kendrick points out, there is now a medico-legal pressure to record absolutely everything about every single patient interaction: https://drmalcolmkendrick.org/2023/12/28/whats-wrong-with-the-nhs-part-five/
As an example, a locum GP at our practice recently wrote in excess of 20 lines of comprehensive text describing a barn-door clinically benign seborrheic wart, using the ABCDE melanoma assessment framework. This record would represent a medico-legal defence for their decision making in case someone at some point in the future tries to sue them about a missed diagnosis. That might have been a fairly extreme example but amplify this sort of thing across the entire NHS and you probably need twice as many people to do the same amount of actual work.
some of us have been saying for many years now; "you will get less and less .. as time goes by ...... and it will cost you more and more ......."
of course whilst BIG FOOD is making you all sick; and BIG HARMA is dispensing pills that nominally aid; but seemed packed with nihilism and adverse effects ....
Eye opener, for me at least, assuming the data is roughly correct!
I know 2 young folk who took up the challenge, one is training to be a GP currently on £14 an hour, with 100k of debt after 5 years at Uni. She is lucky to have a placement that enables her to live with her parents, because with that level of debt (it's not all student loan obvs), she's unlikely to be able to afford a mortgage or rent anytime soon. So there's one reason why young people are reluctant to train as doctors.
The other spent 4 years training to be a nurse, working on the wards unpaid for 30 odd hours a week, and being treated like sh1t because she was a student nurse. She's seen and done things I would not wish on my worst enemy. She has now left the profession. The education system for nursing is completely archaic - in what other industry would you expect staff to work 30-40 hour weeks including night shifts, unpaid? No wonder we import so many foreign nurses. No wonder young people don't want to do it.
Endless folks have tinkered with nursing training/education for the last 50 yrs; as medicine was 50 yrs, ago nursing was an 'on the job' training: student nurses were paid; albeit very poorly; and they learnt on the job; the pendulum swung so much that recently it seemed that those enrolling to 'train" did not get to see real wards and real people for some time; for some, this was a real shock; and some walked then; surely better to see quickly what you are signing on for; (ie like being a sailor; go to sea early; see if it is for you (ie the sea)); same for nursing; get exposed to the reality quickly;
new mothers can't change their minds surely; they must face nappies, urine, vomit and endless faeces; trainee nurses will face similar exposures, but must decide if they can face this; as volunteers soldiers must decide if they can face bullets and shells.
so many academic pseudo-pretensions to so many jobs through out hospital system; one can observe that the facts that so many learn; have ZERO connection to the skills that are needed to do the job; complete separation between what one could term 'Snobby knowledge' and the skills needed to do the work; some call it 'white mans' knowledge": there seemingly just to attempt to show superiority over others: I know more irrelevant facts than anyone else!! .. so hold my beer while I show off ......
this takeover of so many jobs; by elite ivory tower academics that started 45 or more years ago? ... is everywhere; nursing seems full of academics; who never get near a real person; write endless papers, of what some would allege are zero relevance; these souls are somehow lauded by some; that nursing is now 'academic': as if the last 4 yrs allows anyone to admire anything academic ......
friends in nz commented that the sailors from the ship that ran into the reef on Samoa; were immediately given psychological counselling when they flew back uninjured; they had just got their feet a bit wet; they had joined a branch of the armed services; lord knows how they would react to someone firing bullets at them; lord forbid that should happen
I don't have a problem with on the job training, it's the long hours for free, while also being expected to study, and being treated like sh1t by their future colleagues I object to. I've been that new mother you mention, and it's nothing like nursing because a) it's your own child and you will do anything for them, willingly, b) your child grows up and becomes needy in other less tiring ways. If you treat your prospective co workers badly, they will leave. Hers is not an isolated experience.
" If you treat your prospective co workers badly, they will leave. Hers is not an isolated experience."
Indeed; I fear I may have offended you; such was not the intention or the case; from the outside, nursing was always characterised as 'eating their young': older ladies could be a tad fierce to the younger ones; our mother would tell us endless stories of her experiences; it can be a fierce world;
No, you didn't offend me, I'm made of sterner stuff and debate is healthy. I have experienced behaviour my young friend has encountered, albeit in another setting, and it's just so unnecessary. Why do older workers believe they are entitled to make younger colleagues lives a misery? It baffles and saddens me.
thanks Chris; we look forward to some posts from you on "chris's substack": please enlighten us; all best wishes