Are we really going to sit by while they destroy the NHS?
- Thread starter Bernie Gunther
- Start date
LDC
On est tous des pangolins
If people think it's solely an under-funding issue, and that you can just blame the Tories, then they're deluded.
There's multiple factors across society that have led to this situation, and yes, made much worse by funding and staffing etc. but the upshot of it is poor housing, widespread anxiety and depression, alcohol and drug issues, a huge ageing population, isolated individual living situations (no social & family support), access to other services, lack of exercise, work related ill-health issues, loss of self reliance and an understanding of caring for your own health, shit diets and obesity, etc etc.
There's no way to fix this without a massive restructuring of how we live and work.
There's multiple factors across society that have led to this situation, and yes, made much worse by funding and staffing etc. but the upshot of it is poor housing, widespread anxiety and depression, alcohol and drug issues, a huge ageing population, isolated individual living situations (no social & family support), access to other services, lack of exercise, work related ill-health issues, loss of self reliance and an understanding of caring for your own health, shit diets and obesity, etc etc.
There's no way to fix this without a massive restructuring of how we live and work.
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kalidarkone
Bringing YOU round.....
I think I'm not making myself clear.
I understand about the private sector and what they are about.
What I'm questioning and trying to see is how any health service REGARDLESS of if it is private or NHS will be delivered- when the NHS has almost a 100K posts unfilled and this will continue to increase due to mandatory vaccines, retirement, poor take up of health degrees, Brexit....added to a increasing, ageing population and increasing poverty.
Nurses, healthcares, porters, ward clerks, pharmacists, secretaries, radiographers, physios, doctors, OTs, mortuary attendants, receptionists, ODPs. Don’t divide us, we are all on the front line.
LDC
On est tous des pangolins
I do wonder if one day I'll wake up and the entire population will somehow either be at their GP or on the phone to them, talking to 111, in A&E or waiting for an ambulance, admitted as an inpatient somewhere, or just having had a diagnosis of a chronic health condition, and the country will just suddenly stop...
The question that needs answering is "Why the fuck is everyone so ill?" Fix the reason for that and the NHS can start to get fixed.
The question that needs answering is "Why the fuck is everyone so ill?" Fix the reason for that and the NHS can start to get fixed.
existentialist
Tired and unemotional
I'll tell you part of the reason: mental health. Many GPs, etc, I speak to openly acknowledge that a very significant proportion of their patients are presenting with things which overlay often long-term mental health problems, and our NHS mental health, at every level right up to acute provision, is parlous. So the can gets kicked down the road, and chronic mental health problems flow into chronic physical health problems, and often the most time-consuming and expensive ones to treat.
I know it's not the whole problem, but it's definitely playing a part. Meanwhile, we let people twist in the wind until they get desperate, then spend over a grand a night warehousing them in acute psychiatric units, only to kick them out, no better, when someone comes along who needs the bed more. And it's been like that for at least 30 years.
ska invita
back on the other side
in lambeth and southwark there are new schemes of social provision where GPs pass on 'patients' with social problems to someone who workswith them and puts them in touch with services directly related to their needs (debt, housing, loneliness etc etc). It works. it needs more funding. there are other such new schemes in the UK - i expect it will become commonplace before long
existentialist
Tired and unemotional
We have something like that down here - they're calling them "community connectors". But all too often, it's just a way of funnelling people with social AND MH problems down a cheaper quick-fix route. Not to say that it is pointless, but it still misses addressing the elephant in the room.
Psychologists, advance nurse practitioners, dieticians, lab techs, midwives, physician associates… no wait, everyone hates them.
Only joking PAs, we love you really, no one resents you for being a cost saving exercise, your one of the team
LDC
On est tous des pangolins
Yeah totally, I included that with mentioning the ill-health stuff generally, although it's 'anxiety and depression' specifically that always stun me with how commonplace they are.
And I think for me mental health is also a bit of a fundamental question with what's going on, i.e. if things are so great, and the way we live is the 'right one', then why the actual fuck are so many people unhappy and/or mentally unwell?
When I first started (now going on 13 years ago) the hidden prevalence of depression and anxiety stunned me. And you’d have no idea walking down the street, older guys in manual jobs especially common.
ska invita
back on the other side
What's the elephant? Capitalism?
teqniq
DisMembered
With regard to mental health services, I think (someone please correct me if I'm wrong) that these services have been first in line for cuts and have pretty much been cut to the bone. If I am supporting someone with mental health issues and they agree to ask their GP to make a referral to the local community or primary mental health team they will get one phone call, which if they don't answer will mean the team will close the file and if their issues persist a new referral will need to be made. Down the line in large part, I believe to all the cuts this seems to have led to some degree to a culture of institutionalised indifference. Very often people in local mental health teams are virtually impossible to contact directly. They don't give out email addresses which means that you can't send them signed confidentiality and information disclosure forms authorising you to act on someone's behalf subsequently they won't talk on the phone without the person you are supporting being present which is not possible all the time, if the person has poor English necessitating an interpreter this can add another layer of difficulty and if someone's missed their call they simply say a new referral will need to be made and so round it goes.
That’s very well written, and an accurate portrait. It’s not just doctors with exit plans however.
Relatives texting patients to “tell him he’s a cunt”
The Great British Public. Gives you hope dunnit.
Spandex
A crazy bulbous punchbag of sound
A big part of what's pushing the NHS over the edge is the impacts of over a decade of austerity being exacerbated by the pandemic.
In the aftermath of the financial crash in 2008 local councils knew what was coming and started cutting funding to a lot of small charities that had started receiving funding during the Blair/Brown years. Often run by a handful of people they provided local support services to people in need - the nice, non-statutory stuff like support groups for disabled people, MH groups, etc. They did a lot of almost invisible work keeping people out of crisis. Councils also did a lot of efficiency savings in that '08 to '10 period.
That meant when Cameron/Clegg came to power and started austerity proper there were not many efficiency saving to be had and what followed was cuts, cuts, cuts. Drug and alcohol support, MH services, social services, housing, financial support, you name a support service and it's been devastated by austerity. Councils struggle (and often fail) to meet their most basic statutory obligations to people through lack of funds. People who have problems of any kind now can't get the help they need. There's youngsters waiting years for a CAMHS referral, their lives falling apart when early intervention could've steadied them. And the problems caused by this lack of support falls on the police and schools and the NHS to sort out. Then the pandemic hit and disrupted those threadbare services and the whole thing is teetering on the point of collapse. People who've had no help find their health suffers and they end up in the struggling health system.
Of course that's not the whole story. The structure of the NHS has been made into an unmanageable mess over the decades. Houses no longer seem to be about having somewhere to live instead being an investment opportunity for those who can afford it. That was going on well before austerity started thanks to Tory governments red and blue. And the housing crisis feeds into the other impacts. 'Efficiency savings' across all areas of work to maximise profits, to 'promote growth' have seen working conditions for people hit and hit, so that workers, working and middle class, are treated like disposable drones. The sense of being able to work hard and have a decent life is disappearing for everyone except the very well off and super rich. That has a knock on effect on people's mental health and sense of self worth. That's another process that's been going on for decades.
This would all take many years to sort out if there was a government who both wanted to and was capable of sorting it out and I don't even see one of those on the horizon.
In the aftermath of the financial crash in 2008 local councils knew what was coming and started cutting funding to a lot of small charities that had started receiving funding during the Blair/Brown years. Often run by a handful of people they provided local support services to people in need - the nice, non-statutory stuff like support groups for disabled people, MH groups, etc. They did a lot of almost invisible work keeping people out of crisis. Councils also did a lot of efficiency savings in that '08 to '10 period.
That meant when Cameron/Clegg came to power and started austerity proper there were not many efficiency saving to be had and what followed was cuts, cuts, cuts. Drug and alcohol support, MH services, social services, housing, financial support, you name a support service and it's been devastated by austerity. Councils struggle (and often fail) to meet their most basic statutory obligations to people through lack of funds. People who have problems of any kind now can't get the help they need. There's youngsters waiting years for a CAMHS referral, their lives falling apart when early intervention could've steadied them. And the problems caused by this lack of support falls on the police and schools and the NHS to sort out. Then the pandemic hit and disrupted those threadbare services and the whole thing is teetering on the point of collapse. People who've had no help find their health suffers and they end up in the struggling health system.
Of course that's not the whole story. The structure of the NHS has been made into an unmanageable mess over the decades. Houses no longer seem to be about having somewhere to live instead being an investment opportunity for those who can afford it. That was going on well before austerity started thanks to Tory governments red and blue. And the housing crisis feeds into the other impacts. 'Efficiency savings' across all areas of work to maximise profits, to 'promote growth' have seen working conditions for people hit and hit, so that workers, working and middle class, are treated like disposable drones. The sense of being able to work hard and have a decent life is disappearing for everyone except the very well off and super rich. That has a knock on effect on people's mental health and sense of self worth. That's another process that's been going on for decades.
This would all take many years to sort out if there was a government who both wanted to and was capable of sorting it out and I don't even see one of those on the horizon.
LDC
On est tous des pangolins
It's possible to sort out, but to do so (short of a massive grassroots movement to do so) there needs to be massive sweeping state interventions in most aspects of life; and people won't like or possibly even tolerate that tbh. And it's similar to the pandemic and climate stuff, it needs to be pretty much global in scope.
I reckon give me limitless power and I'd have a good go.
I’d vote you in. I’m serious.It's possible to sort out, but to do so (short of a massive grassroots movement to do so) there needs to be massive sweeping state interventions in most aspects of life; and people won't like or possibly even tolerate that tbh. And it's similar to the pandemic and climate stuff, it needs to be pretty much global in scope.
I reckon give me limitless power and I'd have a good go.
I’d get you and Marmot side by side.
Puddy_Tat
naturally fluffy
or until they do something that gets the police involved then spend however much it costs to lock them up in the nick instead
Shechemite
Be the sun and all will see you
What do you mean by ‘loss of self reliance’ LDC? We’re all more self reliant aren’t we these days? Got mindfulness apps etc
Christ you should see an average primary care list. People attend for verrucas. For a spot. For colds. I’m not even kidding.
Simultaneously those seriously ill cannot be seen, and the worried well queue.
It’s symptomatic of a loss of community, or family support, of care networks, of traditional wisdom even. A lack of confidence, or a presentation of struggle, but a struggle in our minds, in society. Engel was right in many ways.
Pickman's model
Starry Wisdom
After Thatcher, major, Blair, brown, Cameron, may and Johnson all doing their damndest to destroy communities and the things that fasten society together it's really no surprise. There's only three institutions that draw people together, the NHS, the army and the monarchy.* And imo that drawing together power is quite weak
*Yeh yeh I know loads of people don't care about the army or the monarchy but those three national institutions are effectively the only ones used by the state to draw people together now
Society was better in the 1950s to 70s you feel? Was that due to the loss of life in the Second World War leading to social cohesion would you say?
How we measure wellness is difficult isn’t it. Life expectancy is one measurement, but a crude proxy really. Income another, altho wealth & health inequality more important once abject poverty defeated.
Health isn’t the absence of disease. It’s determined by the quality of our relationships, starting with our relationship with ourselves. Disease can actually bring wellness, a stroke patient whose lesion irons out the conflict in their character. Or the diabetic patient who acts as a patient- expert teaching fellow patients how to manage their illness and forging health-promoting relationships. We all meet patients like these in our clinical practice.
The NHS is the tip of the iceberg.
Puddy_Tat
naturally fluffy
"there is no such thing as society"
Shechemite
Be the sun and all will see you
There’s certainly a relationship between the quality of ones community and family relationships and ones ‘self’ reliance.
“I have a problem, it’s the Government’s job to cope with it”. Said she.
Her point was where is the self reliance, the community reliance, in this attitude.
LDC
On est tous des pangolins
Yeah, I think it's a complex mix of both tbh. You're totally right, on one level we're all on our own as individual consumers/patients/etc, expected to be self reliant and able to sort our problems out; and if not then there's an app or a therapy or a pill on the market to fix you (or at least make you better enough to work and shop or not cause too many problems). (E2A: not that I am having a go at modern medicine, it's a fucking miracle the shit people can fix or help lots with now.)
But also people have deferred basic self care to experts, a professionalized class of people who specialize in health. Which is right for many things, but not loads of common non-serious general ailments that we all get throughout our life. There's also related to this (and other factors like less inter-generational living and the rise of individualized housing) been a loss of confidence and knowledge around basic health and healthcare and an understanding of bodies and how they work, a rise in self-diagnosis via the internet (anxiety related again), and a general fear of getting ill and old pushed by a market driven cult of youth and beauty and corresponding loss of status and role for older adults.
And wellness. Both physical and mental, altho I don’t hold with that Cartesian bullshit.
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