Stop voting for fucking Tories

[dpedin]

There is no simple answer to this, and certainly not one that will make a meaningful difference in the current political landscape

In the same way; in the NHS there were 100k empty positions before the UK cut itself off from it's obvious source of those employees; & has anything useful happened to fill those jobs ? I'm going to guess that if anything, the situation is worse; because the NHS is now trying to recruit from further away, with more conditions, & for lower wages; so the UK is now less attractive than say Ireland, & so the jobs take longer to fill, & if they do recruit, the wages paid by the recruit are lower.

How is any of this helping a UK teenager who wants to work in agriculture of nursing ?

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.

[epwc]

I agree with most of what you say but there are layers of complexity beyond that

You sound like a politician. His list of headline issues is exactly what’s wrong with UK and why it’s sliding down the shitter.

Me a politician? I don’t think anyone that knows me would describe me in that way.

There are huge complexities in both what got us here and how we got out

I will respond properly as soon as I get the time but right now I’m oiling more chopping boards because the ones I made for all 4 sessions have pretty much all gone at the first one

[tabascoboy]

[Yeeb]

Moist baps can be quite nice though

[Jockaline]

In the same way; in the NHS there were 100k empty positions before the UK cut itself off from it's obvious source of those employees; & has anything useful happened to fill those jobs ? I'm going to guess that if anything, the situation is worse; because the NHS is now trying to recruit from further away, with more conditions, & for lower wages; so the UK is now less attractive than say Ireland, & so the jobs take longer to fill, & if they do recruit, the wages paid by the recruit are lower.

How is any of this helping a UK teenager who wants to work in agriculture of nursing ?

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.

[Yeeb]

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.

Picture the scene:
Dr. Noob drilling away doing a new hip on some old biddy, the 3rd he’s done that day because he’s so good at hips.
Old biddy starts having complications with heart, Dr noob then goes “ah sorry I don’t do hearts” and replaces the hip just in time for Ethel to die.

[yermum]

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

[Sandstorm]

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.

[fishfoodie]

There is merit to having a certain amount of specialisation concentrated in specific hospitals.

If you've a really good head injury specialist unit in a hospital, you send your cases there, & don't make it a lottery as to whether or not a patient will get the best care.

A hospital can't be excellent at every speciality.

[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 !!!

[Sandstorm]

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......

I’m trying, but it’s tough when I’m so awesome.

[dpedin]

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.

No problem - hopefully helpful? It is my own view of the world and others will no doubt disagree, happy to discuss.

I agree people are being forced to go private due to lack of capacity within the NHS but that is down to a lack of investment to mirror growing demand due to growing population, an ageing population and covid backlog. It frustrates the hell out of surgeons etc who have to cancel elective theatre lists because of emergency demand or lack of beds due to delayed discharges. The whole system works on a knife edge and a small bump in the road can cause big problems - its a bit like a very busy bank holiday M1 motorway, one small accident and a lane closure can result in huge traffic queues and greatly increase journey times. Hospitals should run at 85% max bed occupancy to be efficient and ensure smooth flow but if you run them at 95+% then inevitably they will get clogged up when something goes wrong - the latest surge in flu cases is a classic example.

However there are some good reasons why the NHS is getting busier. For example not that long ago a cancer diagnosis was almost a death penalty, usually a round or two of chemo, radiotherapy and possibly surgery and that would be it. However we now see the 5 year survival rates vastly improved, many patients will survive an initial cancer diagnosis and treatment but might return a number of times for further treatments for cancer if it returns. Radiotherapy, drugs and surgical interventions have all dramatically improved, keep people alive but are increasingly costly. For example robotic surgery for certain prostrate cancers is a game changer with over 90% cure rates but isn't cheap and the technology is being rolled out for other surgical interventions. Bottom line is folk with cancer diagnosis live longer, healthier, happier lives than before but will require ongoing treatment, scans, reviews, etc and this all costs lots of money. Good luck getting a US medical insurance company to cover all of this!

[Biffer]

Farage whining about the person who threw a milkshake at him not going to prison (apparently it's an example of two tier justice, although what the other tier is, I'm unclear on).

Worth remembering the fella who hit John Prescott didn't even get charged.

[Hal Jordan]

I see the Branes Trust has decided a flat rate of tax might be a good idea. Specifically stolen from Reform, or just the latest "We're stupider and nastier than they are, vote for us"?

[Sandstorm]

Farage whining about the person who threw a milkshake at him not going to prison (apparently it's an example of two tier justice, although what the other tier is, I'm unclear on).

A milkshake on your shirt is almost as heinous as being attacked in a hostel by an angry mob, eh Nige?

[dpedin]

Farage whining about the person who threw a milkshake at him not going to prison (apparently it's an example of two tier justice, although what the other tier is, I'm unclear on).

A milkshake on your shirt is almost as heinous as being attacked in a hostel by an angry mob, eh Nige?

The individual was given a suspended sentence, in other words they were given a prison sentence but this was suspended as long as they meet certain criteria set by the judge , failure to do so would mean serving a custodial sentence. The sentence will appear on the individuals criminal record for a period of time. The judge will decide to suspend a sentence if there is a very good chance of rehab, little chance of reoffending and if prison would have a detrimental impact on others ie dependents. Over 40,000 were given a suspended sentence in the UK in 2022, often for minor crimes and also to save strain on a stretched prison service. A suspended sentence may also prevent the individual from gaining entry to certain countries ie the USA, so at least Farage is safe from this dangerous beast for now!

[fishfoodie]

Farage whining about the person who threw a milkshake at him not going to prison (apparently it's an example of two tier justice, although what the other tier is, I'm unclear on).

A milkshake on your shirt is almost as heinous as being attacked in a hostel by an angry mob, eh Nige?

The individual was given a suspended sentence, in other words they were given a prison sentence but this was suspended as long as they meet certain criteria set by the judge , failure to do so would mean serving a custodial sentence. The sentence will appear on the individuals criminal record for a period of time. The judge will decide to suspend a sentence if there is a very good chance of rehab, little chance of reoffending and if prison would have a detrimental impact on others ie dependents. Over 40,000 were given a suspended sentence in the UK in 2022, often for minor crimes and also to save strain on a stretched prison service. A suspended sentence may also prevent the individual from gaining entry to certain countries ie the USA, so at least Farage is safe from this dangerous beast for now!

The courts could force her to live in Clacton; then he'd never see her again !

[SaintK]

A milkshake on your shirt is almost as heinous as being attacked in a hostel by an angry mob, eh Nige?

The individual was given a suspended sentence, in other words they were given a prison sentence but this was suspended as long as they meet certain criteria set by the judge , failure to do so would mean serving a custodial sentence. The sentence will appear on the individuals criminal record for a period of time. The judge will decide to suspend a sentence if there is a very good chance of rehab, little chance of reoffending and if prison would have a detrimental impact on others ie dependents. Over 40,000 were given a suspended sentence in the UK in 2022, often for minor crimes and also to save strain on a stretched prison service. A suspended sentence may also prevent the individual from gaining entry to certain countries ie the USA, so at least Farage is safe from this dangerous beast for now!

The courts could force her to live in Clacton; then he'd never see her again !

Frogface must have tweeted his displeasure of her sentence from Florida yesterday as he was busy sticking his nose up Musk's arse under the watchful gaze of the young criminal!!!!

[fishfoodie]

The individual was given a suspended sentence, in other words they were given a prison sentence but this was suspended as long as they meet certain criteria set by the judge , failure to do so would mean serving a custodial sentence. The sentence will appear on the individuals criminal record for a period of time. The judge will decide to suspend a sentence if there is a very good chance of rehab, little chance of reoffending and if prison would have a detrimental impact on others ie dependents. Over 40,000 were given a suspended sentence in the UK in 2022, often for minor crimes and also to save strain on a stretched prison service. A suspended sentence may also prevent the individual from gaining entry to certain countries ie the USA, so at least Farage is safe from this dangerous beast for now!

The courts could force her to live in Clacton; then he'd never see her again !

Frogface must have tweeted his displeasure of her sentence from Florida yesterday as he was busy sticking his nose up Musk's arse under the watchful gaze of the young criminal!!!!

The grimace/rictus smile is probably because he just shoved his head up Space Karens arse looking for gazillions.

[Tichtheid]

Does the shitehawk spend any time in the constituency which had the misfortune to elect him?

They Work For You say this

This person has not voted on any of the key issues which we keep track of.

https://www.theyworkforyou.com/mp/26352 ... cton/votes

It looks like he's doing the same as he did in the EU - taking money as an elected official and not doing anything for it

[Sandstorm]

Elon needs a bigger leather jacket, fat Cnut.

[robmatic]

Does the shitehawk spend any time in the constituency which had the misfortune to elect him?

They Work For You say this

This person has not voted on any of the key issues which we keep track of.

https://www.theyworkforyou.com/mp/26352 ... cton/votes

It looks like he's doing the same as he did in the EU - taking money as an elected official and not doing anything for it

To be fair, it's not like the people who vote for him give a shit about those boring aspects of politics.

[_Os_]

The individual was given a suspended sentence, in other words they were given a prison sentence but this was suspended as long as they meet certain criteria set by the judge , failure to do so would mean serving a custodial sentence. The sentence will appear on the individuals criminal record for a period of time. The judge will decide to suspend a sentence if there is a very good chance of rehab, little chance of reoffending and if prison would have a detrimental impact on others ie dependents. Over 40,000 were given a suspended sentence in the UK in 2022, often for minor crimes and also to save strain on a stretched prison service. A suspended sentence may also prevent the individual from gaining entry to certain countries ie the USA, so at least Farage is safe from this dangerous beast for now!

The courts could force her to live in Clacton; then he'd never see her again !

Frogface must have tweeted his displeasure of her sentence from Florida yesterday as he was busy sticking his nose up Musk's arse under the watchful gaze of the young criminal!!!!

Worrying.

Musk is now worth $455bn. Giving Reform/Frog Face $100m, is fuck all for him, nowhere close to even 0.1% of his wealth. It would massively destabilise British politics. Reform's target of 150 seats starts looking very plausible if they're funded at multiples more than everything else put together. 150 starts looking like an underperformance.

Some white English speaking South Africans have a very strange view of the UK. It's not like I'm saying that without experience. Basically some see it as an ethnic homeland (not how UK citizenship/nationality works) and use it to put themselves above other South Africans (including other white South Africans). Their actual knowledge of the UK is limited and based on stereotypes as well as their own prejudices. Basically they read the Times/Telegraph/Daily Mail/Express online, love Thatcher, hate Labour, oblivious to Wales/Scotland and especially NI, hate the NHS, think someone not being white and being British/English is a bit of a joke (they associate themselves with the UK purely based on race/ethnicity, those people existing undermines their identity). When they emigrate to the UK, they eventually work out just about everything they thought the UK was does not exist, very often they re-emigrate. Musk's father was on LBC, he was quite open that they as a family are interested in the UK on some sort of racial/ethnic basis ("the motherland" blah blah), then raged about Starmer claiming he's a uniquely poor and anti-British PM.

Musk has also started a personal beef with Starmer. When he gets into these things he becomes obsessed. Basically he has decided Starmer is anti-free speech and therefore anti-British, because people were sent to jail for supporting mob violence/burning people out of buildings/attacking the homes and vehicles of people who aren't white/physically beating people who aren't white including women. Musk thinks that free speech means you can say anything, "it's just Facebook posts".

I suspect the version of Britain Musk wants to see is Truss/Farage, turbo Thatcherism, more privatisation and less tax, no worker rights, Special Economic Zones that get rid of democracy. Could be some personal interest too, it would be surprising if a man that wealthy didn't have holdings in corners of the UK's offshore banking system, could be concerned that if the UK was run properly he wouldn't be as tax efficient.

[fishfoodie]

Need to very rapidly introduce strict rules around the sources of any donations to Political parties, & have serious penalties, including the seizure of assets, life-time bans from public office, & gaol time for people breaking them.

Long overdue given the amount of State level interference in Elections worldwide

[Sandstorm]

Need to very rapidly introduce strict rules around the sources of any donations to Political parties, & have serious penalties, including the seizure of assets, life-time bans from public office, & gaol time for people breaking them.

Long overdue given the amount of State level interference in Elections worldwide

Amen

[fishfoodie]

It'd be nice to see the report on Russian interference too; now that the Bumblecunt isn't able to block it, & still has aspirations to return to Politics !!

[Yeeb]

The courts could force her to live in Clacton; then he'd never see her again !

Frogface must have tweeted his displeasure of her sentence from Florida yesterday as he was busy sticking his nose up Musk's arse under the watchful gaze of the young criminal!!!!

Worrying.

Musk is now worth $455bn. Giving Reform/Frog Face $100m, is fuck all for him, nowhere close to even 0.1% of his wealth. It would massively destabilise British politics. Reform's target of 150 seats starts looking very plausible if they're funded at multiples more than everything else put together. 150 starts looking like an underperformance.

Some white English speaking South Africans have a very strange view of the UK. It's not like I'm saying that without experience. Basically some see it as an ethnic homeland (not how UK citizenship/nationality works) and use it to put themselves above other South Africans (including other white South Africans). Their actual knowledge of the UK is limited and based on stereotypes as well as their own prejudices. Basically they read the Times/Telegraph/Daily Mail/Express online, love Thatcher, hate Labour, oblivious to Wales/Scotland and especially NI, hate the NHS, think someone not being white and being British/English is a bit of a joke (they associate themselves with the UK purely based on race/ethnicity, those people existing undermines their identity). When they emigrate to the UK, they eventually work out just about everything they thought the UK was does not exist, very often they re-emigrate. Musk's father was on LBC, he was quite open that they as a family are interested in the UK on some sort of racial/ethnic basis ("the motherland" blah blah), then raged about Starmer claiming he's a uniquely poor and anti-British PM.

Musk has also started a personal beef with Starmer. When he gets into these things he becomes obsessed. Basically he has decided Starmer is anti-free speech and therefore anti-British, because people were sent to jail for supporting mob violence/burning people out of buildings/attacking the homes and vehicles of people who aren't white/physically beating people who aren't white including women. Musk thinks that free speech means you can say anything, "it's just Facebook posts".

I suspect the version of Britain Musk wants to see is Truss/Farage, turbo Thatcherism, more privatisation and less tax, no worker rights, Special Economic Zones that get rid of democracy. Could be some personal interest too, it would be surprising if a man that wealthy didn't have holdings in corners of the UK's offshore banking system, could be concerned that if the UK was run properly he wouldn't be as tax efficient.

Jesus, not sure what kind of saffa you hang out with in the UK, what you’ve described is nothing like what I’ve experienced , sounds like you hang out with racist bigots who would find something to whinge about .

The only common ground saffas in Uk have, is how shit our weather is , especially if they from KZN - and that’s fair enough .

[Yeeb]

Only way Farage can become power is if there is a reverse merger with the conservatives and reform. Whilst they are splitting the right of centre vote, there is no chance he can buy his way into power.

Quite fun watching the lefties reaction on social media though now Labour are in power again

[robmatic]

Only way Farage can become power is if there is a reverse merger with the conservatives and reform. Whilst they are splitting the right of centre vote, there is no chance he can buy his way into power.

Quite fun watching the lefties reaction on social media though now Labour are in power again

What's left of the Conservatives are an absolute shitshow though. I don't think you can rule out a merger.

[Yeeb]

Only way Farage can become power is if there is a reverse merger with the conservatives and reform. Whilst they are splitting the right of centre vote, there is no chance he can buy his way into power.

Quite fun watching the lefties reaction on social media though now Labour are in power again

What's left of the Conservatives are an absolute shitshow though. I don't think you can rule out a merger.

Absolutely , right now though the gravitas , backing, organisation, political links and joined up thinking , is all coming from Reform and not the Tories - that’s why it would be a reverse merger with Farage as leader.
LD won in my area this year but had reform not split the vote, it would have remained Tory by a decent margin - if there was a GE tomorrow with Farage head of a Tory Reform right wing alliance Norsefire type thing, it would be interesting who would win.