Stop voting for fucking Tories

[Deepsouth]

Not really because you still need to understand the basics before specialising.

Yup, there's one thing you don't want to rush and that's medical training.

You now what takes a while too. Humility......

[Biffer]

We've gotten ourselves into a real pickle with domestic medical staff. We have thousands upon thousands of qualified domestic applicants turned away from doctoring and nursing because of the limited number of training places. Even if we wanted to we can't really open them up at this point because we lack sufficient staff to teach and train them without pulling them away from front line care.

And of course, as pointed out up thread by Slick, we also have thousands upon thousands of qualified nurses who are no longer in the profession due to pay and conditions who likely can't be tempted back. Fishing for migrant nurses to fill the roles is a sticking plaster solution to why the job is fundamentally unattractive for so many who've opted for it, in addition to being morally murky by brain draining less developed nations.

The last Gov completely fucked up the training pipeline for medical staff! They fucked up the push element - increased undergraduate places at medical schools in a panic, funded most but not all the required Foundation places and then realised that they couldn't increase the core/specialty training places by as much as they thought because of what epwc says - they require supervision, training and support by the very same staff being asked to work weekends etc to tackle waiting times who have less support from trainees as they were leaving for foreign lands. Oh ... and Specialty trainees cost a lot more money which wasn't budgeted for. The training pipeline is only as big as its narrowest point and the Gov failed miserably in recognizing this - probably because they knew they would be out of power by the time it hit the fan. The same argument applies for nursing and for more specialist nursing roles. Given medics take a minimum of 4 years undergraduate training plus another 5 years for a GP and 7 years for a consultant, and in many cases it is much more than this, the last 14 years has been a shitshow of medical workforce planning! The pull factors have also been completely fucked up - by putting below inflation increases that didn't take account of growing demand into the NHS the money just isnt there to pay decent salaries or enough of them to retain key clinical staff. Employers end up looking for cheap and fast solutions - recruit trained staff from abroad, recruit PAs and then abuse them or didn't provide the full range of services ie do the knee/hip replacement but dont give the physio or rehab required.

The new gov has begun to sort out the shit show of pay and conditions but the training issues is a far bigger problem and it will take some years and a lot of money to sort out, and it needs to be sorted out whether we have a NHS or not.

Being a complete ignoramus I often wondered if it would be possible to shorten the training for some health professionals and reduce costs by focusing on a training on a very narrow procedure i.e. 'doctors' that just do hips and knees etc with a few fully trained doctors overseeing l for complexities. Centralising these procedures in large specific 'hospitals'. Presumably a barking idea.

That causes problems because to be a specialist you have to be a generalist first. If a doctor never gets to do hip and knee replacements, or only ever gets to do hip and knee replacements, where do the doctors come from for more complex surgeries on hips and knees?

[Deepsouth]

No one wants to live in the UK. That is plain. Why is that...

[dpedin]

The last Gov completely fucked up the training pipeline for medical staff! They fucked up the push element - increased undergraduate places at medical schools in a panic, funded most but not all the required Foundation places and then realised that they couldn't increase the core/specialty training places by as much as they thought because of what epwc says - they require supervision, training and support by the very same staff being asked to work weekends etc to tackle waiting times who have less support from trainees as they were leaving for foreign lands. Oh ... and Specialty trainees cost a lot more money which wasn't budgeted for. The training pipeline is only as big as its narrowest point and the Gov failed miserably in recognizing this - probably because they knew they would be out of power by the time it hit the fan. The same argument applies for nursing and for more specialist nursing roles. Given medics take a minimum of 4 years undergraduate training plus another 5 years for a GP and 7 years for a consultant, and in many cases it is much more than this, the last 14 years has been a shitshow of medical workforce planning! The pull factors have also been completely fucked up - by putting below inflation increases that didn't take account of growing demand into the NHS the money just isnt there to pay decent salaries or enough of them to retain key clinical staff. Employers end up looking for cheap and fast solutions - recruit trained staff from abroad, recruit PAs and then abuse them or didn't provide the full range of services ie do the knee/hip replacement but dont give the physio or rehab required.

The new gov has begun to sort out the shit show of pay and conditions but the training issues is a far bigger problem and it will take some years and a lot of money to sort out, and it needs to be sorted out whether we have a NHS or not.

Being a complete ignoramus I often wondered if it would be possible to shorten the training for some health professionals and reduce costs by focusing on a training on a very narrow procedure i.e. 'doctors' that just do hips and knees etc with a few fully trained doctors overseeing l for complexities. Centralising these procedures in large specific 'hospitals'. Presumably a barking idea.

That causes problems because to be a specialist you have to be a generalist first. If a doctor never gets to do hip and knee replacements, or only ever gets to do hip and knee replacements, where do the doctors come from for more complex surgeries on hips and knees?

Plus many/most/all of these orthopedic surgeons will also do A&E cover dealing with folk who arrive with broken bones etc. Not being trained or able to do more general orthopedic stuff means reduced numbers at the front door doing emergency work when required. Having said that physically separating emergency and elective work is being pursued by the NHS but that is more to avoid elective beds or theatres being blocked up by emergency work coming via A&E. In these cases consultants might have elective lists at the Elective Centre for a day or two but also do a couple of shifts at the emergency/A&E hospital.

The private sector can and does just do elective work and will contract with consultants on that basis but if anything goes wrong with the patient then they pack them off in an ambulance to an NHS A&E dept, or they won't even touch high risk patients.

[SaintK]

Aaah those Tory peers

[fishfoodie]

Why is it that a Tory peer gets to spend a few weeks on the naughty step, while if a chav said something similar to say, an Bus driver, they'd get a visit from the Rozzers, & maybe be facing legal consequences ??

It's nice that this is the type of individual that gets elevated to the Lords, racist scumbags

[Jockaline]

Being a complete ignoramus I often wondered if it would be possible to shorten the training for some health professionals and reduce costs by focusing on a training on a very narrow procedure i.e. 'doctors' that just do hips and knees etc with a few fully trained doctors overseeing l for complexities. Centralising these procedures in large specific 'hospitals'. Presumably a barking idea.

That causes problems because to be a specialist you have to be a generalist first. If a doctor never gets to do hip and knee replacements, or only ever gets to do hip and knee replacements, where do the doctors come from for more complex surgeries on hips and knees?

Plus many/most/all of these orthopedic surgeons will also do A&E cover dealing with folk who arrive with broken bones etc. Not being trained or able to do more general orthopedic stuff means reduced numbers at the front door doing emergency work when required. Having said that physically separating emergency and elective work is being pursued by the NHS but that is more to avoid elective beds or theatres being blocked up by emergency work coming via A&E. In these cases consultants might have elective lists at the Elective Centre for a day or two but also do a couple of shifts at the emergency/A&E hospital.

The private sector can and does just do elective work and will contract with consultants on that basis but if anything goes wrong with the patient then they pack them off in an ambulance to an NHS A&E dept, or they won't even touch high risk patients.

I was kind of suggesting that within the NHS i.e. learn form the private model. Medics that didn't have to go through all the generalist training, but closely supported by those that have and are top of their game if there are any complexities, and/or airlift to nearest proper hospital. We seem to be set up well for emergency procedures leaving a lot more routine ops on a longer and longer waiting list.

[dpedin]

That causes problems because to be a specialist you have to be a generalist first. If a doctor never gets to do hip and knee replacements, or only ever gets to do hip and knee replacements, where do the doctors come from for more complex surgeries on hips and knees?

Plus many/most/all of these orthopedic surgeons will also do A&E cover dealing with folk who arrive with broken bones etc. Not being trained or able to do more general orthopedic stuff means reduced numbers at the front door doing emergency work when required. Having said that physically separating emergency and elective work is being pursued by the NHS but that is more to avoid elective beds or theatres being blocked up by emergency work coming via A&E. In these cases consultants might have elective lists at the Elective Centre for a day or two but also do a couple of shifts at the emergency/A&E hospital.

The private sector can and does just do elective work and will contract with consultants on that basis but if anything goes wrong with the patient then they pack them off in an ambulance to an NHS A&E dept, or they won't even touch high risk patients.

I was kind of suggesting that within the NHS i.e. learn form the private model. Medics that didn't have to go through all the generalist training, but closely supported by those that have and are top of their game if there are any complexities, and/or airlift to nearest proper hospital. We seem to be set up well for emergency procedures leaving a lot more routine ops on a longer and longer waiting list.

I know what you're suggesting but it doesn't work that way - almost all of the NHS consultants will do a mix of elective and emergency/on call work - if they didn't then there wouldn't be any emergency service! A&E or Emergency Medicine Docs deal with front door but depend on the range of specialists behind them to deal with the broad range of things coming through the front door ie orthopedic, cardiac, general surgery, neurological, ophthalmology etc plus radiology and anaesthetics back up. The front door is mostly about triaging, life saving and stabilizing patients who will then require expert emergency care from the range of specialists either immediately or soon as and will need a bed whilst waiting. Less urgent ie simple leg fracture in effect becomes an elective patient ie put leg into plaster and give appointment for next available fracture clinic.

However most consultants will specialize within their elective NHS work sessions ie orthopedic guys will specialize in surgery ie on feet/ankles, knees, hips, shoulders, spines, etc. They will probably deal with more complex cases or complex patients and leave much of the more simpler work to their wider team. So they might do a night on call, do the following day emergency surgery lists, have a day off then spend the next 2-3 days doing elective work ie outpatient clinics, ward rounds, surgery sessions, post surgery follow ups plus admin/teaching/audit/research, etc.

The emerging elective treatment centres are an attempt to try and physically split elective and emergency work but the medical workforce will have to work across both sites otherwise there would be no emergency service. The split of emergency and elective is to stop beds and theaters being blocked by a surge in activity at the front door.

The private sector is staffed mostly by NHS consultants who will do a day or two per week in private sector on a contractual basis. They mostly deal with simple routine cases and filter out more complex cases/patients as they don't have facilities to deal with emergencies that happen in the theatre. Most consultants don't want to just do private work as it is routine and 'boring' for many and they need/want to keep their skills and professional expertise up by dealing with complex or advanced clinical work plus lead on research and teaching in the NHS. Most of the guys I know who do private work view it as a means to pay for school fees/holidays/golf trips/etc. Having said that there are a few consultants who are setting up private provision/clinics to make a lot of money doing high volume/low complexity work where demand exceeds NHS supply ie cataracts, dermatology/cosmetics, simple surgical interventions, etc.

The problem isn't in the model, although improvements can always be made, but in the number of NHS doctors, beds, theatres, scanners, etc per capita compared to comparable countries who we benchmark ourselves against. Managing demand is very difficult and complex and as it rises faster than capacity then A&E waiting times and elective waiting lists are the inevitable outcome. We could of course adopt a US model where you can manage demand by making health costs/insurance too expensive for many and end up with many unable to access or afford care - a bit like we have done with dentistry here?

[Jockaline]

Plus many/most/all of these orthopedic surgeons will also do A&E cover dealing with folk who arrive with broken bones etc. Not being trained or able to do more general orthopedic stuff means reduced numbers at the front door doing emergency work when required. Having said that physically separating emergency and elective work is being pursued by the NHS but that is more to avoid elective beds or theatres being blocked up by emergency work coming via A&E. In these cases consultants might have elective lists at the Elective Centre for a day or two but also do a couple of shifts at the emergency/A&E hospital.

The private sector can and does just do elective work and will contract with consultants on that basis but if anything goes wrong with the patient then they pack them off in an ambulance to an NHS A&E dept, or they won't even touch high risk patients.

I was kind of suggesting that within the NHS i.e. learn form the private model. Medics that didn't have to go through all the generalist training, but closely supported by those that have and are top of their game if there are any complexities, and/or airlift to nearest proper hospital. We seem to be set up well for emergency procedures leaving a lot more routine ops on a longer and longer waiting list.

I know what you're suggesting but it doesn't work that way - almost all of the NHS consultants will do a mix of elective and emergency/on call work - if they didn't then there wouldn't be any emergency service! A&E or Emergency Medicine Docs deal with front door but depend on the range of specialists behind them to deal with the broad range of things coming through the front door ie orthopedic, cardiac, general surgery, neurological, ophthalmology etc plus radiology and anaesthetics back up. The front door is mostly about triaging, life saving and stabilizing patients who will then require expert emergency care from the range of specialists either immediately or soon as and will need a bed whilst waiting. Less urgent ie simple leg fracture in effect becomes an elective patient ie put leg into plaster and give appointment for next available fracture clinic.

However most consultants will specialize within their elective NHS work sessions ie orthopedic guys will specialize in surgery ie on feet/ankles, knees, hips, shoulders, spines, etc. They will probably deal with more complex cases or complex patients and leave much of the more simpler work to their wider team. So they might do a night on call, do the following day emergency surgery lists, have a day off then spend the next 2-3 days doing elective work ie outpatient clinics, ward rounds, surgery sessions, post surgery follow ups plus admin/teaching/audit/research, etc.

The emerging elective treatment centres are an attempt to try and physically split elective and emergency work but the medical workforce will have to work across both sites otherwise there would be no emergency service. The split of emergency and elective is to stop beds and theaters being blocked by a surge in activity at the front door.

The private sector is staffed mostly by NHS consultants who will do a day or two per week in private sector on a contractual basis. They mostly deal with simple routine cases and filter out more complex cases/patients as they don't have facilities to deal with emergencies that happen in the theatre. Most consultants don't want to just do private work as it is routine and 'boring' for many and they need/want to keep their skills and professional expertise up by dealing with complex or advanced clinical work plus lead on research and teaching in the NHS. Most of the guys I know who do private work view it as a means to pay for school fees/holidays/golf trips/etc. Having said that there are a few consultants who are setting up private provision/clinics to make a lot of money doing high volume/low complexity work where demand exceeds NHS supply ie cataracts, dermatology/cosmetics, simple surgical interventions, etc.

The problem isn't in the model, although improvements can always be made, but in the number of NHS doctors, beds, theatres, scanners, etc per capita compared to comparable countries who we benchmark ourselves against. Managing demand is very difficult and complex and as it rises faster than capacity then A&E waiting times and elective waiting lists are the inevitable outcome. We could of course adopt a US model where you can manage demand by making health costs/insurance too expensive for many and end up with many unable to access or afford care - a bit like we have done with dentistry here?

Thanks for the comprehensive reply. It just feels like people are being forced to go private, which is wrong IMO if they want any sort of life due to immobility and pain if their knees or hips are buggered.

[Tichtheid]

dpedin's post shows yet again that heroes don't wear capes, they wear clinical masks and gowns.

The Scottish Politics thread had a post today which was ultimately yet another right wing attack from the Times on our National Health Service - I think there is going to be a huge fight to come on this issue, currently we are skirmishing

[fishfoodie]

Having recently had some medical issues that have been regularly going to specialist clinics, I've had a chance to observe a well functioning clinic; & this is a very well functioning clinic, & it has a Prof at the top of the tree, & below him, there are a handful of registars, & then also a couple of tiers of specialist nurses, & what I saw that impressed me was the relationship between the Prof & all the staff below him, & the respect between them all.

In an ideal world, this well functioning team would have twice as many registars, & quadruple as many nurses below this Prof, so that more patients could get the level of care that I'm getting; but the real world doesn't work that way !

In the real world, a Senior Professor can tutor n registars, & adding more doesn't result in n more consultants in the future, it leads to n-(x) consultants, because there's optimum number that depends on the Professor, & just adding more doesn't make things better; it makes it worse.

Also; people piss & moan about the number of layers of management in Health systems, & I can understand that; but it just shows that people don't understand the problem; this isn't someone machining 10 pieces an hour, & they've done that for the last 5 years; there are a bazillion different variables, & at every level there are human factors that mean that you just can't predict how many, say ultrasound scan a lab will perform on any give day, because like me at the moment, in an ideal world, I'd have a scan before the new year, but I have zero faith that will happen.

My last scheduled appointment, I went in & the hospital was plastered with posters telling people that visiting was restricted & warning about a measles outbreak. It's now winter time, so all the seasonal factors are in play, & if you're trying to get out-patients in & out for their treatments, all of that requires a lot of work, & if you can do that with a shit load of administrative staff & the associated mangers, then well done to you !!!