This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist.
Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door.
Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards have turned into medically-fit nursing homes. They spend half their days trying to send people (who don't have care requirements) home faster than they'd like.
Why? Because central government withdrew funding. Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out.
Turns out the whole endeavour was yet more myopic, Tory penny-pinching.
It is too bad that corrupt government officials keep systemically defunding Social Health programs with the objective of pushing private for-profit healthcare (which just doesn't make sense). Then they point to the deficient healthcare and blame the "socialized" aspect of it for the issues.
Here in Mexico we've seen it all play out: We had an amazing social healthcare system (in the form of the IMSS) in the 70s and 80s. But the corrupt government officials kept dismantling it and allowing corruption to run rampant within the system. All to get a piece of the private for-profit health system including Health Insurance.
Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s. I seriously hope it doesn't have the same outcome as our system had in Mexico. For-profit health is inhumane.
>with the objective of pushing private for-profit healthcare (which just doesn't make sense)
Maybe it doesn't make sense for you, but it makes their buddies in the private sector a lot of money. And that's the game in capitalism, making a lot of money.
The government competing with affordable options for everyone against the private sector is "bad for business".
You're correct that the game is to make a lot of money but the key to making that work is ensuring transactions are beneficial to all parties.
It doesn't matter how you structure things you end up with some way to climb the hierarchy. The problem with pure communist systems is they try to prevent all hierarchies. Human nature attempts to circumvent this, the only way to do so is via corruption and political power. Corruption and political power exist in abundance in free markets as well, but there is another outlet for personal ambition. People can get rich. The hope is that you can build a system that incentivizes people to get rich by providing value for everyone. You can have private for-profit healthcare but you have to make sure that people get a good deal out of that. Normally we rely on competition to ensure customers always get a good deal. I don't think that works in this setting. Healthcare is tricky, I don't think we've found a good way to setup incentives for heath systems to have the best outcomes. We will need strong government regulation no matter what we do. Competition will not provide sufficiently good outcomes.
In the US you have great hospitals but at astronomical costs, the entire system is distorted by insurance companies and massive bureaucracies. Here in NZ the hospitals are terrible underfunded socialist messes. We can't hold on to staff because we don't pay enough. Emergency waits are hours. My friends wife just spent 3 days before getting emergency surgery to reattach nerves and tendons in her hand. She had to travel 3 hours to another city to get that care. The last two times I required emergency care the wait was over 8 hours. I can't pay for better service and there is no private emergency option.
If a hospital were worked owned and controlled, they’re not gonna bribe their Tory buddies to shutdown public medical services because most people aren’t that ridiculously selfish and no one individual gets wealthy. And if it’s a private hospital, the doctors and nurses will use profits to pay themselves well and cut down on costs, because again, they are face to face with people trying to pay foe their medical care.
> It doesn't matter how you structure things you end up with some way to climb the hierarchy. The problem with pure communist systems is they try to prevent all hierarchies.
That is a massive non-sequiter though, nobody is suggesting that factory workers rise up and sieze control of the hospitals. Or even that nurses do so. The proposals for healthcare usually involve the oligarchs being in control and the public enforcing standards. Which typically turns out to be unsustainable because the middle class is where the people who know how to run things come from and they just got cut out.
The problem here is excessive centralisation where if (more practically, when) the government becomes corrupt or makes a bad decision it becomes illegal to do something different to the regulatory standard.
Politics by people with communist leanings isn't helping the situation, but the fundamental issue here is people keep proposing 'solutions' that don't work and effectively block people from actually solving the problems. Eg, I bet someone with a good idea of how to organise an independent emergency healthcare service wouldn't be allowed to do it in England.
The only reason I mentioned a pure communist system is to compare it to a pure capitalist system. I then argued that neither will solve this problem.
I agree that centralization causes huge problems.
My main point was that I don't think we've found a good system for providing hospital care and whatever that solution is I don't think it lies at either extremes of the left - right political spectrum.
We need to change human genes. That's the best long term way out of this. Corruption is just gene trickery. "Best for me, not for thee". Unless "thee" is genetically related.
Unbelieavable wealth and seeking power is gene survival. More wealth more survival resources. More power more survival and reproductive resources.
Genes drive everything that is "wrong" with the way things are.
It definitely came across that way to me in your comment as well. You associated corruption with capitalism via "and that's the name of the game" as though the objective of capitalism is to destroy public institutions, when what's actually the case is that the objective of corrupt people is to destroy or co-opt public institutions for their own benefit. The economic system is largely immaterial in that effort. Actually, you could argue the opposite in that capitalism helps prop up public institutions versus other economic systems because there are minimum levels of regulation, rule of law, and security that are required for capitalistic economies (ranging from the US, to Sweden, to Singapore) to function and for capital owners to profit.
The Soviet Union accrued massive debt due to internal production inefficiencies caused by corruption and mismanagement. Russia has extraordinary natural resources, by all rights they should be one of the most wealthy countries on earth.
Notice how on that list none of South America countries appear after 1990s? Venezuela has been hostile to the US, yet they are still there. Brazil, Argentina, Chile, Ecuador, Peru, Bolivia have elected socialism-leaning governments multiple times during the last 30 years. Not to mention Nicaragua or Mexico, that are not considered South America. Colombia is the latest example. So they are poor because of US meddling, and not even a tiny part due to their policies? You have to try harder if you want to blame their issues on the US.
> Notice how on that list none of South America countries appear after 1990s?
This is regime change /that we know about/. Intelligence agencies haven't made a huge habit of discussing their covert successes.
> Venezuela has been hostile to the US, yet they are still there.
Yes, because the international response would be quite severe if the US decided to what - destroy Venezuela?
Foreign occupations and coups decimate countries who then have to deal with the effects for generations. The new regime is usually beholden to the powers that put it there (or the old one has to abide by the occupier's demands), permanently crippling the government or the economy or both. Many countries continue to suffer under the conditions created by their overthrowers, so maybe they share some blame but it's largely the longlasting effects of foreign incursions.
> You have to try harder if you want to blame their issues on the US.
It's really not that difficult to understand cause and effect here. If you destroy a country's economy, divide its people, cripple it's infrastructure, and install an authoritarian government, it's going to take a long time to recover.
Yes, the US had its hand in Argentina as well - they supported the violent military junta that saw Peron overthrown and leftist journalists and activists murdered by the thousands during the Dirty War. When I was studying there, the family I stayed with had relatives who had been abducted and "disappeared," which was such a widespread phenomenon under the right wing government that they have a name: "Los Desaparecidos". Here's a Wikipedia article about how the CIA contributed: https://en.wikipedia.org/wiki/Operation_Condor#Argentina
Also, your article is unfortunately paywalled, but an op-ed from someone at the WSJ isn't going to change my mind.
Exactly. They should know better and vote for governments that are aligned with the US government's interests, so they don't need to go through a CIA-sponsored coup.
Much of that poverty has its roots way back in the time of the Conquistadors and the generations of Spanish and Portuguese families that looted the riches of the Inca empire.
The descendants of those families still have huge wealth and influence in South America.
I really don't understand how people can simultaneously believe that governments are corrupt and the private sector would support the public's interests. Guess who is corrupting government: the private sector who only support their own interests.
I know this is difficult to understand how it works, but the beauty of the free market is everyone benefits while selfishly working for their own self-interest.
Socialism, however, requires altruistic behavior, and very few people are consistently altruistic and self-sacrificing for the common good.
> I know this is difficult to understand how it works
Are we going to pretend that free market capitalism and its magical benefits haven't been pounded into all of our heads from every angle from the moment we were being taught anything about how the world works? It's not difficult to understand, it's difficult to see in a world where companies commit crimes and collapse in mountains of debt, but no one goes to jail. Not a situation that Adam Smith would approve of.
The reason the benefits capitalism are spread out to any degree is because there are riots when they aren't, so you need to at least reward the people responsible for putting those riots down through violence, technology, and bureaucracy. Hence, the middle class.
> Socialism, however, requires altruistic behavior, and very few people are consistently altruistic and self-sacrificing for the common good.
"Socialism" requires cooperation, and people do it just fine. Even capitalists are socialist amongst themselves when it comes to keeping out competition.
Are you really going to pretend -- to this audience -- you haven't enjoyed the (yes) magical benefits of profit-seeking innovation?
Progressivism conquered America a century ago. Antitrust law. Central bank. Income tax. Universal suffrage. Old age pensions. Public education, research grants. National parks. Interstate highways. Welfare, public housing. Equal opportunity employment. Disaster relief. Socialized medicine for the poor and elderly. Workplace safety. Automobile safety and emissions standards. Space shuttle.
Recently, a flirtation with Universal Basic Income.
People are (hopefully) concerned with growing inequality, wealth centralising into small pockets of society, the lawlessness in which multinational corporate entities operate, the damage being caused to the environment by heavily promoted consumerism..
> Are we going to pretend that free market capitalism and its magical benefits haven't been pounded into all of our heads from every angle from the moment we were being taught anything about how the world works?
My dad was a professor of finance in a midwestern college. He'd have students coming up to him saying "I didn't know there even was a case for free markets!"
> "Socialism" requires cooperation, and people do it just fine.
Both socialism and free markets require cooperation. The difference is that socialism requires forcible cooperation, and in free markets the cooperation is voluntary.
The driving force between market capitalism isn't selfishness Walter. It's competition.
People innately like to compete and will do so over the dumbest things, like who can get the little puck in the net with sticks the most, or who can correctly guess the sum of a pair of dice.
Market capitalism coopts this most basic of human instincts,not greed, and selfish greed is actually the root of many failures of capitalism endeavors, and human endeavors in general.
Because a socialist system is ran by the public. It is beholden to the public as its shareholders. Mcdonalds needs to taste tasty, but only to get you hooked enough to choose mcdonalds over other foods. You think the shareholders would rather their customers actually eat healthy which means limiting consumption of Mcdonalds? No, they are practically in the business of selling cigarettes but in the form of fats and sugars. They want you addicted. The goal of the capitalist isn't to make their customer happy, its to extract as much of their available disposable income as possible.
Every country that tried having the government run food production produced starvation.
Those goalposts were just fine where they were, put them back and address the actual argument. Nobody was advocating for 'government run food production'.
Pleasing the customer is not always good for the customer. I'm sure nicotine addicts get a lot of pleasure from smoking a pack a day. In fact i think that is still Newport's slogan.
Plus your quip is a little bit dated honestly. The soviets had famines because they literally didn't support evolution for quite some time. They believed Lysenko and allowed him to execute his critics. Meanwhile today, look at China the past few decades when modern agricultural practices were finally well established around the world. Another 600 million people in 50 years. Huge population growth doesn't happen because of starvation.
> Pleasing the customer is not always good for the customer.
Ah, the arrogance of knowing what is best for others. (Of course, I know what's best for everyone else, too, but my arrogance stops at taking the next step of being entitled to force it on them.)
> The soviets
You can make excuses for the Soviets. But you gotta explain the starvation from every other communist country. The starvation in Jamestown when they tried communist agriculture. The starvation in the Pilgrims' first year when they tried communist food production. The failure of the Kibbutzen in Israel to feed themselves without government subsidy.
It goes on and on.
P.S. China stopped starving when the stopped collectivist agriculture.
Now for the flip side. Which was the first country to eliminate famine? The US, around 1800, with free market agriculture. Next, which free market agricultural system has suffered from a famine?
lol you misspelled "ran by corrupt authoritarian governments that don't give 2 shits about the public unless they can exploit them"
You can ding corporations... but the real world socialist examples are worse.
Corporations aren't perfect (and we don't live in pure capitalism anyways. Common sense controls exist for good reason). But they are better than socialist governments.
McDonalds is able to sell garbage food because most Americans are addicted to sugar. Your free-market evangelism is the economic equivalent of their junk food.
I enjoy a meal at McD's regularly. I just have a QP, I never buy shakes or soft drinks. The QP is healthy food.
Besides, the US under free market agriculture produced the tallest people in the world up until WW2. It's kinda hard to believe that Americans grew that tall from eating garbage.
Well, socialism isn't communism, and money still exists under socialism, so if the service center isn't doing their job, then, as you capitalists like to say, money talks.
Capitalism, like democracy, is the worst form of government, except for all the others. To believe that the US brand of capitalism can do no wrong is to be as deluded as the communists were. If the free market were perfectly efficient, there would be no such thing as conmen or MLM scams, and every consumer would be 100% informed and perfectly rational. That's ridiculous, so the government needs to step in at times, to promote a freer market than one without regulation.
Go eat at a restaurant in Times Square. They exist only because of their location, and the fact that tourists don't stay long. So their food is bad AND they don't need to try and harder because it doesn't hurt their business. They're a total ripoff and a tourist trap and that's with capitalism's vaunted free market backing the enterprise.
My family owns a bunch of McDonalds. Success is tied to location mostly. The product is pretty meh at best. The only products that have maintained quality are fries, coffee and coke. The rest are worse by any measure.
There’s a reason why Five Guys, etc are everywhere. People who want a good burger go there.
it works like this. In a free market, you dont have to buy my services, but you will if it is better for you on the whole than not. I may consider you cattle to be exploited for profit, but you probably wont just give me your money if i try to sell you my grass offcuttings for $10k. If i somehow come up with a way to produce a great lawnmower that costs me $1 to make, and I sell it to you for $100, you would perhaps think this is a great thing, while I make out like a troll. win/win. If I offer you a shitty lawnmower for $100k, you simply decline.
Socialism would absolutely not require selfless people-it would simple require that workers control and own the companies they work in, and the knowledge that fixing other people’s problems makes everyone’s life better. Less theft, violence, better mental health, no more mass shootings, no more homeless encampments.
Imagine if that co-worker that doesn’t contribute or might even drag the team down can just quit and play PS5. Glorious.
How do I know people don’t need coercion or even pay to produce great products? Open source software. Windows is capitalism and Linux is socialism. Which do you prefer?
The politicians you vote for can regulate those companies, that is how the system is intended to work. If those politicians takes bribes to not regulate those companies, then the problem is corrupt politicians taking bribes, you don't fix that by giving those politicians more power you fix it by voting them out and voting in politicians who does what you want.
> Guess who is corrupting government
How are they corrupting the government? Is the private sector deciding who gets power in the government somehow? Sounds like your democracy doesn't work then. Giving all the power to politicians when the democracy doesn't work just leads to the same scenario as in Soviet.
Bribing the government isn't "corrupting" them, a politician who accepts bribes or tit for tat deals is already corrupt.
How about we have a national vote on what phone you get? Which car you get? Whether carrots or tomatoes get produced? What movies get produced? What clothes are produced? Which diseases get funding? What apartment you get? How many ounces of meat you get per week? What music you get to listen to?
Corruption is a human ingrained need for trickery to gain advantage of potential gene competition. It is ubiquitous for humans and increases with perceived genetic difference, up to a maximum.
2004 was the peak of Blair-Brown Labour party investment.
They didn't get it all right. They used PFI and outsourcing to fudge the sums on major investments, and I dare say they didn't invest in mental and social health care in the amount required. But nobody ever has.
The job of fixing this is so expensive and requires so much political force. We're still worried French immigrants are going to eat our dingos, or something. I'm fairly certain now we're destined to limp into an American insurance model; eat the poor.
PFI was used because it was a way to get "free money" for the NHS by pushing the real costs into the future.
The core problem for the socialized model is that nobody can assemble a voter coalition that agrees to raise taxes. The poorer Labour voters say no, the rich should pay, or alternatively, the money already exists it's just the evil Tories refusing to fund the system. The more affluent conservative voters say no, because either, the NHS is wasting money and should fix that first e.g. the massive spend on diversity officers, or, the NHS is always overloaded due to uncontrolled immigration, so fix that first. The NHS doesn't have enough admin support as a result. Then the woke middle classes say no, reducing immigration is awful and we will fight it all the way and of course we won't pay higher taxes because if we allowed unlimited immigration the new taxes from all the highly skilled doctor/engineer immigrants would fix the problems.
In the UK there's also the issue that the social care workforce was one of the only professions forced to take vaccines. Lots quit and the rest learned that they have fewer human rights than other people. So having treated the social care workforce like shit, which was already overstretched, the system is now in total collapse for lack of workers.
State run systems always have problems like this. It's one size fits all, so the different groups with their different priorities can never agree and the result is deadlock and collapse. The people who run it are too far removed from the front line and the "too big to fail" problem rears its ugly head. The NHS could never survive as is, it's just a pity that it had to end like this.
> Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s.
In a lot of respects, this isn't very accurate. It got pretty bad in the early '90s, anything that needed to go beyond the GP had really bad wait times, people stuck on trolleys in A&E, etc. By 2004 it was much better, so that anything which required a hospital visit would be dealt with much more quickly and effectively but the GPs were coming under more pressure from a growing and aging population so the first point of contact had a less personal touch.
I have to wonder how much of the current "crises" we are seeing right now are simply because of a massive aging population. Of course the medical system is going to have issues, no matter if it is public or private, if you suddenly increase the demand, as the older you get the more health care you need, while at the same time all your most capable and experienced doctors are retiring.
Another is housing, right now we have one generation coming up right as the most populous generation is towards the end of their life, resulting in an increased demand and price, in 20 years as more and more the later generations start passing on they'll be leaving behind houses and properties, it's not like those disappear when the people do.
I've noticed that the media seems very engaged in making everything the crises of the moment and the focus on looking at things over the course of years or decades is often ignored in favor of sensationalism.
An aging population is a significant factor, another one is the increasing range of treatments available today - and of course they combine because most medical expenditure happens during the last part of a person's life.
> Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s.
That sounds like some seriously rose-tinted nostalgia to me. Yes, the NHS certainly has its problems. But within the past decade, my wife has been through several fairly major health issues, including cancer, and our overall experience of UK healthcare has been quite positive.
She is from the US (and had "good" insurance there), but feels that the UK system has served her far better than the American ever did.
When you put politicians in charge of healthcare they will play politics with it. Politicians playing politics doesn't make sense to you? Remember most don't really care that much about the healthcare itself, only how it can be used to further their agenda and be spun for their constituency. It's the tradeoff from private where the money rules.
In 2004 when I worked in NHS emergency care we had such a problem with no space in ED to unload ambulances that the ambulance service threatened to put a mass casualty tent in the hospital car park.
Seen exactly this in my local area. Libraries closing or cutting hours/resources. The number of children's centres (where you go for check-ups/weigh-ins of young kids, to get feeding advice, etc.) reduced by 80+% in some counties. It's dire.
you're misunderstanding the issue. NHS funding _always_ increases. Its not increased by enough and social care (a different budget) has been cut meaning that hospitals have to deal with patients that have nowhere to be discharged.
This is all due to 2008 can kicking. The needed to cut, didn't want to get blamed for cutting so just massively cut central funding for councils who were left to make the hard decisions. Year on year the cuts increased the drive for "efficiencies" grew. There is no slack left and nothing left to cut that isn't obvious.
I hope that someone learns that just because you've taken the cost of the balance sheet doesn't mean the problem it was solving goes away, it just ends up as an inefficiency somewhere else, in this case in the NHS where staff cannot discharge perfectly healthy patients.
Cash doesn't help bedflow if it's not going towards the places required for getting people out of hospital… which I've already said is now a local issue.
Job deterioration, Brexit and the pension cap have all lead to an increase in more expensive locum cover. Few people want to be locked into a job where you have a daily meeting to be shouted at by your site team for not discharging people who have nowhere to go.
Still not in line with what is required. An aging population which is also living longer couple with poor staff retention and management has left it in a much worse state that 12 years ago.
>Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out.
It could be phrased as - social care was a way to paper over cultural and societal cracks, by paying peanuts to people with limited job choices.
As in most things, our response to Covid has just exposed the endgame much quicker than expected.
People can’t be sent home because English people don’t give a shit about their family members. Brits think that the government should provide everything for them, even something simple as looking after an elderly person who is otherwise fine. What happened to family bonds and a bit of responsibility? Every winter around Christmas young family members (40-50 year olds) refuse to take their parents home because “they don’t want them at home over Christmas as it’s inconvenient for them” so they literally demand from the hospital staff to keep them in hospital for 1 or 2 weeks longer. Unfortunately the NHS is not allowed to dump these patients on the street. The problem is brazen entitlement. The NHS needs reform. Zero tolerance for those parasites, charge people for not showing up to appointments, charge people for simple medicines, charge people for choosing to be obese through an obesity tax.
> This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door.
How does that manifest as ambulance wait times? Do you think ambulance drivers are sitting around for an hour before responding to calls for help because... the hospital is full? That's like saying my train to the airport was late because the airport was full, it doesn't make much sense. How does one back up into the other?
If you come to our local DGH's A&E in an ambulance and you're not a trauma or cardiac or stroke, you face seven to twenty hour wait in the carpark.
You will see multiple paramedics as they change shifts in situ.
In fairness the ambulance service has scaled amazingly well given most of their staff are now pegged in hospital carparks, but yes, waiting times for critical calls are extended, people are dying because ambulances aren't available.
All because they can't hand over to A&E. Because A&E can't ingest patients. Because wards can't discharge. Because care homes don't exist.
It's that simple. If you doubled the number of community care placements, staff, etc, you'd buy the NHS another ten years.
On top of that, it's also now significantly harder to get a GP appointment vs 2-3 years ago so more people are ending up in A&E instead. My own GP surgery has gone from offering "turn up and wait for an appointment" at set times 4 days a week (and call to book a day ahead otherwise) to "you can't do anything without booking in the online system and then the GP will call you at a totally unpredictable time 3 days later when you're not available" because they think its "better" (which I suspect means because it has cut GP workload).
Yes, The ambulances are waiting outside the hospitals with the last patient so they can't go to get the next one. Source: Family members have recently waited some hours outside A&E in an ambulance.
This is hard to believe. Just wheel the patient through the front door and let the hospital do the babysitting. There is no sense in using an ambulance as a waiting room.
Babysitting? These are patients deemed medically unfit enough to bring in. Who's looking after them after they're turfed out the ambulance? Every bed in every bay in A&E is occupied, each with an allocated nursing provision.
Oh we just double the number of nurses? Yeah, but no. They don't grow on trees. The current ones don't stretch (we asked). You can't just absorb 20-40 patients into your acute departments without space and staff. The paramedics are acting as those staff, their ambulances the space. Yes it's far from optimal.
I don't really see how patients so severely ill that they need a bed in A&E with dedicated nursing provision could be discharged into community social care, though maybe I'm missing something...
About a third of beds are blocked at our local DGH by medically fit people who still require community care provision. These are people waiting to go home (or to a home) from an inpatient stay.
Until they go, A&E can't admit people through to the beds they're currently in.
Even if you lie to the population and claim you'll add 7000 beds this winter, those beds aren't staffed. We can't surge 5000 nurses and 2000 support staff out of nowhere. They're all busy.
I think perhaps their point is that, if some of the patients not discharged are consuming a nurse budget that isn’t required (because they are healthy and can be discharged), then this nurse budget could be redeployed to those waiting in admissions. Not sure how reasonable this is, I’m sure the hospitals will have thought of it themselves. But it does seem particularly silly to have the paramedics stuck in place and unable to serve anybody who may be even more critically ill.
The emergency department fills up because they can't find beds to admit people to. When the emergency department is full, there's nowhere for the ambulance patients to be put.
The patients are waiting in the ambulance because the waiting room is full, but I see your point. Why not just tip the patient onto the pavement outside the waiting room? I'm sure a full hospital with a full waiting room won't be to busy to sort that out.
> Why not just tip the patient onto the pavement outside the waiting room? I'm sure a full hospital with a full waiting room won't be to busy to sort that out.
Literally yes. Keeping them in an ambulance instead of the sidewalk won't get them into the ER any faster. And keeping the ambulance tied up at the hospital won't do any good for the next guy who has an emergency and is sitting on the sidewalk at the site of the accident either. At least if you move the injured people to the sidewalk at the hospital, the nurses can look outside and prioritize the worst. And the problem will be highly visible to the public, instead of papered over by using ambulances as waiting rooms.
What they're doing now is obviously prioritizing for appearances, not patient outcome.
Then you only rush to another patient who you can't treat either. Paramedics also need to hand off their treatment to hospital staff, if that doesn't happen then hospitals won't know what treatments were administered.
Using a parked ambulance as an ER room is gross mismanagement because the 'waiting room' for an ambulance 'ER room' is casualties spread across the entire city, such that the worst cannot be prioritized.
Even if the hospital's ER room has saturated capacity, moving all the casualties to the hospital waiting room as rapidly as possible still has utility because that allows the hospital to prioritize the worst, which they can't do if the worst is laying on the street a mile away with the ambulances all parked at the hospital.
I can promise you that the many smart people working in hospitals have considered this issue.
If someone is walking-wounded, they WILL be unloaded to sit and wait for 6 hours in a corridor.
The people who the ambulances are holding for long periods are those who are too sick to be left without attention. The paramedic staff continue to monitor them in order to escalate further if their condition deteriorates, and depending on the situation, medical staff from the hospital will be involved in this.
The ambulance staff obviously have a moral and legal duty of care, and can't just leave a seriously unwell patient on the floor outside the hospital entrance to get to the next call, which would likely be a patient no more ill than the one they just abandoned.
I’m happy that healthcare workers tend to be more empathic than what you are suggesting and will take care of patients end-to-end. You can’t load balance sick humans on the fly to achieve some optimal outcome.
> Do you think ambulance drivers are sitting around for an hour before responding to calls for help because... the hospital is full?
Yes, this happens - my grandfather attended with a head injury, and we were stuck in a side room with the ambulance crew (along with another patient and a second ambulance crew) waiting to do a handover.
>Areas with poor, old populations can never pay their way.
The root of the issue is that this area is now the country. Giving all old people the labor necessary to support them in old age was easier when the ratio of working people to non working people was much higher, in conjunction with old people not living as long.
Turn that population pyramid upside down due to drastically reduced birthrates and medical technology allowing people to live longer, and you get the current situation.
It's actually through the local governments, many of which are Labour yet have the same issue.
Root cause: the law says to raise local taxes beyond a certain amount councils must hold a referendum. They systematically refuse to do this because they know they will lose.
Voters by and large think local councils are wasteful and don't really need more money. There's also another issue: some local councils especially in the North have a history of deliberately cutting front line services whilst e.g. expanding the central bureaucracy, because they know they can blame the Tories for not giving them "enough" money and the voters will fall for it. The councils could raise taxes, or rebalance spending, but that wouldn't energize their base.
Well I suggest you visit Norfolk. Councils have sold off their long-held land to developers, dumped their investments to their mates, stripped down services and tendered the rest. Serco does everything.
Save the odd blip, Norfolk is as blue as it gets. Interestingly they also blame central government.
And local tax raising is pretty blunt. How much your house would have been worth in April 1991, if you're working. High-retirement or high-unemployment areas usually have lower rates, and much lower incomes, while needing more than rich areas.
Yes, I said "many of which are Labour yet have the same issue" i.e. it's an issue with local governments of all stripes. There's a culture of spending more than tax levels allow then expecting central government to make up the difference.
On your second part, this study also shows a significant 25y fall in the number of 85yo+ who are in homes. We aren't increasingly relying on the state.
Your statistics show an actual fall in the past 10 years. It's worse than that because the true picture needs to factor in local government spending now.
If we pretend there's been steady investment, and imagine stable demand, the same thing can cost more than it did before.
But irl, budgets have collapsed, demand is soaring and costs have already risen and are about to explode due to fuel-driven inflation.
So no, starved on three counts. The baseline cost is deviating from the investment. And yes, there are many, many elements to why.
>>Your statistics show an actual fall in the past 10 years.
From 22.79% of GDP in 2010, to 21.49% in 2016 (the last year provided). This is after an increase from 10.44% to 1964 to 22.79% in 2010. The big picture is a massive multi-generational increase in social welfare spending, interspersed with tiny downward fluctuations over a small proportion of the years covered.
>>It's worse than that because the true picture needs to factor in local government spending now.
This is aggregate public spending, so it should already be factoring in local government spending.
>>If we pretend there's been steady investment, and imagine stable demand, the same thing can cost more than it did before.
Per capita GDP has increased in inflation-adjusted terms, so when social welfare spending as a percentage of GDP increases, that means a real (inflation-adjusted) increase in per capita social welfare spending.
The only possible way this leads to less support for citizens in need is growing mismanagement of the funds by the social welfare programmes.
You asked how this amounted to Tory penny pinching in another stub but you're answering it. Since Tories came to power in 2010, a 1.3% fall in all social spending in an economy that has grown slower than inflation means an actual terms cut.
It's important to note that social welfare also covers housing, unemployment and other things not care in the same sense as being discussed. Housing costs have exploded in price so even more of that stagnant budget has been diverted away from care.
Once you allow for inflation, there is a growing underspend in care. A starvation. Yes, generations of growth, but not finding it appropriately now (and for a decade) means it's being starved.
I'm leaving it with the Health Foundation, there. I'd suggest you read that if you really want an appreciation of how budgets and inflation work together but if you just want to tell me "they have more money, so it's being wasted more" you don't understand how money works; I can't help you.
And if you're reading around, be wary of COVID era numbers as they include boosts for testing and extraordinary measures. Nothing that increases provisionable service.
If spending was the issue, the doubling of social welfare spending's share of GDP would have provided such a massive amount of resources to these programs that a 1.3 percent drop in relative spending wouldn't lead to the dire outcomes this article references.
And if you call the Tories reducing spending by 1.3 percent of GDP, what do you call a doubling of spending as a share of GDP? The Big Picture here is massive spending growth over the long run, that totally eclipses this minute drop.
>>Once you allow for inflation, there is a growing underspend in care
Wrong. The UK has seen significant per capita GDP growth, after accounting for inflation.
So rising social spending as a percentage of GDP means rapidly rising inflation-adjusted spending per capita.
Community care is far cheaper for society than having families take on extra dependants, especially at the most taxable end of their lives. Its interactions with the economy are very much like childcare.
But neither are happening. Old people are abandoned to healthcare providers. This, in turn impacts on the life expectancy of much younger people requiring emergency care who won't get it because the hospital and ambulances are full. It's not sustainable for patients or providers.
There are two ways out. Choose to do this properly, or choose a much uglier withdrawal of care for the old and infirm.
Before you choose, remember that these are people who worked for 45 years being told that their National Insurance payments were paying it forward for this kind of care. If you're going to change the rules —and especially if you're going to start incinerating grandmas when they get "too costly"— you have to expect the next generation probably isn't going to stick around. Many of that exodus will be doctors.
Seems to work better in this case, as essentially the only buyer of pharmaceuticals in the country the NHS are in a better position to negotiate deals in bulk than if hospitals had to negotiate individually. The UK has higher life expectancy than the USA for 2.5x less per capita healthcare spending.
Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door.
Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards have turned into medically-fit nursing homes. They spend half their days trying to send people (who don't have care requirements) home faster than they'd like.
Why? Because central government withdrew funding. Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out.
Turns out the whole endeavour was yet more myopic, Tory penny-pinching.