Puja wrote: ↑Fri Mar 17, 2023 8:52 am
Agreed on the ethics of poaching - it's amoral, especially when done to developing countries, but it might be the only way out of the mess we've ended up in and, as long as it's not being touted as a long-term solution, I'm okay with it as a very short-term fix.
Puja
Yes folks, it's ok to fuck over poor countries as long as it's only for a little while.
Hmm. When stated like that, that's clearly a very dickish opinion I've just evinced there.
Good point, well made, I revoke that idea and apologies for not catching it before it came out of my internet mouth.
I work in the NHS, think alot of these takes miss the mark significantly.
Training twice the number of medical students still won’t help the massive bottleneck there is on speciality training. Anaesthetics doctors are hugely in demand country wide yet competitions ratios are roughly 6 to 1.
Even GP and Psychiatry, where you used to be able to walk into a job are almost 3 to 1 competitions ratios. The big problem is theres not enough training jobs, so people leave abroad or take multiple locum years. And there reason for this is the government won’t fund enough training posts.
The idea of “poaching” doctors denies the autonomy of the doctor to make their own decisions and move abroad for their own reasons. Any policy to deny international medical graduates to come to the UK doesn’t sit right with me, even if well intentioned. UKIP could easily have made a stop “foreign doctors coming over here” policy.
morepork wrote: ↑Sat Mar 18, 2023 8:57 pm
Pad....good insight. What do you mean by competition ratios.....6 candidates for the one position?
So british doctors complete 2 years of foundation training, and then apply for further training (surgery, GP, medicine etc). You used to be able to walk into most of these jobs, now you can’t.
So yes, for last year 2337 people applied for 588 training posts in anaesthetics, so actually closer to 4 to 1.
2231 people applied for 362 radiology jobs, so 6 to 1 ratios.
It can all be found in the link below. Not a single speciality is under subscribed. British junior doctors realise they wont be competivie enough alot of the time to apply for foundation years, so take multiple years out.
morepork wrote: ↑Sat Mar 18, 2023 9:16 pm
If there is a shortage of anesthetists, for example, why aren't there more training posts?
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
morepork wrote: ↑Sat Mar 18, 2023 9:16 pm
If there is a shortage of anesthetists, for example, why aren't there more training posts?
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Useful knowledge; thanks. So the bottleneck is further up the pipeline than I thought, which suggests that fixing it would be a shorter term endeavour than I thought - a matter of 2-3 years instead of 10-11. Is the problem just money? If there was a political will to fund properly, could it be sorted fairly easily or are there other things I'm not taking into account?
Also not forgetting that you need facilities to take people who are fit for release out of the NHS, or home care provision. Both of which are in very short supply. And many care home workers either left due to Brexit or have found better paid jobs stacking shelves in Sainsburys or serving at McDonalds.
morepork wrote: ↑Sat Mar 18, 2023 9:16 pm
If there is a shortage of anesthetists, for example, why aren't there more training posts?
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Useful knowledge; thanks. So the bottleneck is further up the pipeline than I thought, which suggests that fixing it would be a shorter term endeavour than I thought - a matter of 2-3 years instead of 10-11. Is the problem just money? If there was a political will to fund properly, could it be sorted fairly easily or are there other things I'm not taking into account?
Puja
Takes between 6-8 years to train most consultants so much longer than 2-3 years I’d imagine. Registrars (consultants in training) can do alot but need supervision from consultants, especially in surgery/ anaesthetics. There also needs to be enough nurses and health care assistants to staff the wards and theatres.
But this isn’t to defeat the point that if there was political will to fund the NHS properly it would make a massive difference. Sandy also has it right with social/ nursing care in the community, as between 1/4 and 1/3 of hospital beds are currently bed blocked by those awaiting social care placement. I think I’m right in saying the majority of funding for this is through the council, so we need more more money raised in council tax effectively.
morepork wrote: ↑Sat Mar 18, 2023 9:16 pm
If there is a shortage of anesthetists, for example, why aren't there more training posts?
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Isnt the bed reduction in hospitals also down to moving capacity into the community, eg mental health beds? According to the Kings fund anyway (they quoted 400k beds in 74, 191k in 2022). That said, my experience with Acute trusts is they have gradually taken over community services, so murky, esp combined with yours and sandys comments non in hospital care.
I can think of others. Require doctors and nurses to work a certain percentage of hours in the NHS or lose their right to NHS-paid training and development. Go a-poaching abroad for doctors and nurses with liberalised visas and golden handshakes for working exclusively for the NHS, and pay for it with increased tax on private hospital groups. Proffer golden handcuffs to the next graduating class of medical students to keep them in the NHS for 10 years.
The pensions thing is a good idea, were it targetted solely towards medical professionals. As it is, it just feels like a blatant bribe to affluent voters, under the figleaf of helping the health service.
Puja
Phase out private health entirely. This should be the goal, if we want to live in a fair society.
Bang on. Same for private schools. There shouldn't be a higher tier in education or health for the privileged.
Puja
No.
Alternative education exists for a reason. You take away ALL private and you take away Waldorf and Montessori and so on. Which is not a good idea.
There should be more choice when it comes to schooling, not less.
morepork wrote: ↑Sat Mar 18, 2023 9:16 pm
If there is a shortage of anesthetists, for example, why aren't there more training posts?
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Isnt the bed reduction in hospitals also down to moving capacity into the community, eg mental health beds? According to the Kings fund anyway (they quoted 400k beds in 74, 191k in 2022). That said, my experience with Acute trusts is they have gradually taken over community services, so murky, esp combined with yours and sandys comments non in hospital care.
Yes, but saving money as the primary driver as opposed to improving patient outcomes. There are benefits to community based healthcare (patients generally recover better at home and its a better experience) but that doesn’t paper over the fact we just don’t have enough hospital beds to staff demand currently. There are certain conditions that you simply need to be in hospital for.
Mental health beds and asylum’s need was lessened by the introduction of anti-psychotic medications in the 50s-70s, allowing more people to be treated in the community. There are still however no where near enough beds for people in mental crisis who need ongoing support.
Boris is up in front of the committee today, accused of having mislead Parliament by saying that there were no parties. His argument is that he has WhatsApp messages from people telling him there were no parties, so he was acting on the best of his own knowledge, but that line of defence requires someone to believe him to be so stupid as to miss parties happening downstairs from his flat, not to mention him actually being present for parts of them. His supporters are already leaping on the committee to say that it's biased, despite having a Conservative majority, so I suspect he doesn't hold out much hope for his defence being successful. If he gets a 10 day ban from the Commons, it'll allow for a recall petition, and the polls do not favour him being able to win a by-election, which would be highly amusing.
Puja wrote: ↑Mon Mar 20, 2023 1:08 pm
Boris is up in front of the committee today, accused of having mislead Parliament by saying that there were no parties. His argument is that he has WhatsApp messages from people telling him there were no parties, so he was acting on the best of his own knowledge, but that line of defence requires someone to believe him to be so stupid as to miss parties happening downstairs from his flat, not to mention him actually being present for parts of them. His supporters are already leaping on the committee to say that it's biased, despite having a Conservative majority, so I suspect he doesn't hold out much hope for his defence being successful. If he gets a 10 day ban from the Commons, it'll allow for a recall petition, and the polls do not favour him being able to win a by-election, which would be highly amusing.
Puja
Pretty sure that's Wednesday.
I hope it's Wednesday, that way I'll be able to have it on in the background
morepork wrote: ↑Sat Mar 18, 2023 9:16 pm
If there is a shortage of anesthetists, for example, why aren't there more training posts?
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Isnt the bed reduction in hospitals also down to moving capacity into the community, eg mental health beds? According to the Kings fund anyway (they quoted 400k beds in 74, 191k in 2022). That said, my experience with Acute trusts is they have gradually taken over community services, so murky, esp combined with yours and sandys comments non in hospital care.
I can only speak from personal experience, but family members who have received hospital care have been delayed in leaving due to a lack of care home beds. It stressed the system, and also the patient. Speaking to others its the same. If the government were to throw money into something, then a functioning care home system must surely be it. Although that might risk acknowledging that Brexit has caused real problems there.
Puja wrote: ↑Mon Mar 20, 2023 1:08 pm
Boris is up in front of the committee today, accused of having mislead Parliament by saying that there were no parties. His argument is that he has WhatsApp messages from people telling him there were no parties, so he was acting on the best of his own knowledge, but that line of defence requires someone to believe him to be so stupid as to miss parties happening downstairs from his flat, not to mention him actually being present for parts of them. His supporters are already leaping on the committee to say that it's biased, despite having a Conservative majority, so I suspect he doesn't hold out much hope for his defence being successful. If he gets a 10 day ban from the Commons, it'll allow for a recall petition, and the polls do not favour him being able to win a by-election, which would be highly amusing.
Puja wrote: ↑Mon Mar 20, 2023 1:08 pm
Boris is up in front of the committee today, accused of having mislead Parliament by saying that there were no parties. His argument is that he has WhatsApp messages from people telling him there were no parties, so he was acting on the best of his own knowledge, but that line of defence requires someone to believe him to be so stupid as to miss parties happening downstairs from his flat, not to mention him actually being present for parts of them. His supporters are already leaping on the committee to say that it's biased, despite having a Conservative majority, so I suspect he doesn't hold out much hope for his defence being successful. If he gets a 10 day ban from the Commons, it'll allow for a recall petition, and the polls do not favour him being able to win a by-election, which would be highly amusing.
Puja
Pretty sure that's Wednesday.
I hope it's Wednesday, that way I'll be able to have it on in the background
You are quite right. I was thrown by the fact that all of his defence has been published in the press already, as is de rigeur.
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Isnt the bed reduction in hospitals also down to moving capacity into the community, eg mental health beds? According to the Kings fund anyway (they quoted 400k beds in 74, 191k in 2022). That said, my experience with Acute trusts is they have gradually taken over community services, so murky, esp combined with yours and sandys comments non in hospital care.
I can only speak from personal experience, but family members who have received hospital care have been delayed in leaving due to a lack of care home beds. It stressed the system, and also the patient. Speaking to others its the same. If the government were to throw money into something, then a functioning care home system must surely be it. Although that might risk acknowledging that Brexit has caused real problems there.
well they did plan to hike NI to do that, but that got lost. Huge issue trying to look after a growing aging population, and we are going to have to pay a lot more. That said, the gaps between hospital and community also need fixing- the acute trusts have tried to do that in many places by taking back community budgets in house, but then you just create other issues. Its a mess.
Austerity, reduction in hospital beds (300,000 in 1987, 100,000 now) and consultants/ registrars are expensive. Increasing training posts means increasing money allocated to wages for those staff.
Basically, money.
Increasing the amount of medical students sounds great politically, but will have little no effect on people awaiting cancer treatment/ operations/ outpatient clinic appointments. What will help that will be increasing training posts. And with that you need more hospital beds.
Eventually you will need more medical students if training becomes less competitive because there are more posts available, but that is a long way away.
Isnt the bed reduction in hospitals also down to moving capacity into the community, eg mental health beds? According to the Kings fund anyway (they quoted 400k beds in 74, 191k in 2022). That said, my experience with Acute trusts is they have gradually taken over community services, so murky, esp combined with yours and sandys comments non in hospital care.
Yes, but saving money as the primary driver as opposed to improving patient outcomes. There are benefits to community based healthcare (patients generally recover better at home and its a better experience) but that doesn’t paper over the fact we just don’t have enough hospital beds to staff demand currently. There are certain conditions that you simply need to be in hospital for.
Mental health beds and asylum’s need was lessened by the introduction of anti-psychotic medications in the 50s-70s, allowing more people to be treated in the community. There are still however no where near enough beds for people in mental crisis who need ongoing support.
I can't comment on the original drivers, just confirming that its not quite as straightforward as beds being 'lost'; as you say, there are some/many patients who would benefit from good community care, esp the elderly (to Sandy's point)- and obviously others who should be in an acute environment. One of the (many) problems, associated with funding, is that the acute/community interface is pretty average (certainly in the ICS's I was working with) and the 'solution' is that the Acutes nab the community budgets in some speciality areas, where in others the budgets stay with local govt. Its a mess, frankly, and exacerbated by the money issues- we have to face up to the fact that in our current model we need much much higher taxation to fund the increasingly ageing and unhealthy population with more complex physical and mental needs allied with more sophisticated and novel treatments. Big big issue, and no-one wants to take it head on. I've not even mentioned GPs
Isnt the bed reduction in hospitals also down to moving capacity into the community, eg mental health beds? According to the Kings fund anyway (they quoted 400k beds in 74, 191k in 2022). That said, my experience with Acute trusts is they have gradually taken over community services, so murky, esp combined with yours and sandys comments non in hospital care.
I can only speak from personal experience, but family members who have received hospital care have been delayed in leaving due to a lack of care home beds. It stressed the system, and also the patient. Speaking to others its the same. If the government were to throw money into something, then a functioning care home system must surely be it. Although that might risk acknowledging that Brexit has caused real problems there.
well they did plan to hike NI to do that, but that got lost. Huge issue trying to look after a growing aging population, and we are going to have to pay a lot more. That said, the gaps between hospital and community also need fixing- the acute trusts have tried to do that in many places by taking back community budgets in house, but then you just create other issues. Its a mess.
I suspect the answers are to either pay more in taxation to look after the elderly, or those who otherwise need care, or people revert back to looking after their own families in the home (as far as is reasonably possible given some very complex needs). Since we live in a country where we are encouraged to be mobile to support the workplace, the second option is rarely available, so its got to be the first one. I seem to recall some people talking about how unfair it is to pay for someones care when you might not need it yourself, which is a strange argument as you may never need the NHS that much. Until you do and want it there.
I can only speak from personal experience, but family members who have received hospital care have been delayed in leaving due to a lack of care home beds. It stressed the system, and also the patient. Speaking to others its the same. If the government were to throw money into something, then a functioning care home system must surely be it. Although that might risk acknowledging that Brexit has caused real problems there.
well they did plan to hike NI to do that, but that got lost. Huge issue trying to look after a growing aging population, and we are going to have to pay a lot more. That said, the gaps between hospital and community also need fixing- the acute trusts have tried to do that in many places by taking back community budgets in house, but then you just create other issues. Its a mess.
I suspect the answers are to either pay more in taxation to look after the elderly, or those who otherwise need care, or people revert back to looking after their own families in the home (as far as is reasonably possible given some very complex needs). Since we live in a country where we are encouraged to be mobile to support the workplace, the second option is rarely available, so its got to be the first one. I seem to recall some people talking about how unfair it is to pay for someones care when you might not need it yourself, which is a strange argument as you may never need the NHS that much. Until you do and want it there.
As I saidn, we are going to have to pay a lot more.
System reform, pop health, money. All needed.
Banquo wrote: ↑Mon Mar 20, 2023 4:29 pm
well they did plan to hike NI to do that, but that got lost. Huge issue trying to look after a growing aging population, and we are going to have to pay a lot more. That said, the gaps between hospital and community also need fixing- the acute trusts have tried to do that in many places by taking back community budgets in house, but then you just create other issues. Its a mess.
I suspect the answers are to either pay more in taxation to look after the elderly, or those who otherwise need care, or people revert back to looking after their own families in the home (as far as is reasonably possible given some very complex needs). Since we live in a country where we are encouraged to be mobile to support the workplace, the second option is rarely available, so its got to be the first one. I seem to recall some people talking about how unfair it is to pay for someones care when you might not need it yourself, which is a strange argument as you may never need the NHS that much. Until you do and want it there.
As I saidn, we are going to have to pay a lot more.
System reform, pop health, money. All needed.
Quite. I seem to recall that conversation ending badly for Theresa May when it was raised a few years ago. Who will have the guts to revisit it? I certainly don't think the younger generation should be hammered to look after pensioners, so its either a tax for everyone for its somehow linked to property (which seems obvious but you still need a pot of money for when there isnt a convenient house to sell to cover the costs).
I suspect the answers are to either pay more in taxation to look after the elderly, or those who otherwise need care, or people revert back to looking after their own families in the home (as far as is reasonably possible given some very complex needs). Since we live in a country where we are encouraged to be mobile to support the workplace, the second option is rarely available, so its got to be the first one. I seem to recall some people talking about how unfair it is to pay for someones care when you might not need it yourself, which is a strange argument as you may never need the NHS that much. Until you do and want it there.
As I saidn, we are going to have to pay a lot more.
System reform, pop health, money. All needed.
Quite. I seem to recall that conversation ending badly for Theresa May when it was raised a few years ago. Who will have the guts to revisit it? I certainly don't think the younger generation should be hammered to look after pensioners, so its either a tax for everyone for its somehow linked to property (which seems obvious but you still need a pot of money for when there isnt a convenient house to sell to cover the costs).
Or...and this may be radical...linked to corporate profit? Say, like, an actual system for taxing corporations.
Banquo wrote: ↑Mon Mar 20, 2023 4:59 pm
As I saidn, we are going to have to pay a lot more.
System reform, pop health, money. All needed.
Quite. I seem to recall that conversation ending badly for Theresa May when it was raised a few years ago. Who will have the guts to revisit it? I certainly don't think the younger generation should be hammered to look after pensioners, so its either a tax for everyone for its somehow linked to property (which seems obvious but you still need a pot of money for when there isnt a convenient house to sell to cover the costs).
Or...and this may be radical...linked to corporate profit? Say, like, an actual system for taxing corporations.
Explain more? Do you want corp tax raised higher than 25% ?
