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Collapse of emergency healthcare in England may be costing 500 lives every week

270 points by buro9 4y ago

vfclists 4y ago
Someone should ask the guy to publish on a blog and link his twitter to it.
- pacifika 4y ago
  It’s an article on the Financial Times
- nindalf 4y ago
  Blogs don’t make sense for the most prolific creators. Here’s something I saw recently > I gave up blogging after decades because the ROI simply wasn’t there any more. Why spend hours on a post that will get hundreds of views when a tweet composed in minutes gets tens of thousands to millions? https://twitter.com/carnage4life/status/1559852146601799683 https://twitter.com/carnage4life/status/1559852146601799683 And it’s the same with Scott Hanselman, who’s quoted in that tweet. Hasn’t blogged since last year, stopped after 20 years. He’s big on YouTube and Tiktok now.
  - skeeter2020 4y ago
    Scott Hanselman states he stopped because he was tired, not that he's switched mediums. The Tiktok / YT comment was a joke; he still does lots of media for his job though.
  - vfclists 4y ago
    If you are serious about communicating then you MUST blog in addition to tweet. Twitter is for soundbites, not lengthy articles. You can't expect people to read tweet after tweet when they would rather read a long continuous article. The dude probably has the software that breaks down lengthy articles and tweets them in reverse order but that shouldn't be abused. And what happens when you fall foul of twitter's rules and get banned?
    - robotnikman 4y ago
      Not sure why you were downvoted, as those are valid points. Twitter is the best medium when it comes to talking about subjects in depth. It is good when it comes to making a quick hot take, but not in depth articles or explanations. Unfortunately, a lot of people don't engage much in long form discussion as much as they would a tweet. Tweets are much easier to discover, find, and view compared to a blog post. It's much easier to click like on a tweet or retweet something, and bigger engagement numbers == better. So people instead will write out tweets instead of blog posts. I don't care for it much myself, but such is the modern internet I guess.
- boffinism 4y ago
  Sure, here you go: https://www.ft.com/john-burn-murdoch https://www.ft.com/john-burn-murdoch
Havoc 4y ago
Meanwhile the prime minister is on perma vacation and the replacement candidates are focused on banning on shore renewables and squabbling among each other
- mhh__ 4y ago
  Don't forget our prison camp in Rwanda!
- smcl 4y ago
  The replacement candidates are also both sure that the main issues facing the UK public are "woke" politics and trans people[0], and seem entirely unphased about the pending crisis around energy bills and the price of food. And the opposition seem pretty uninterested in taking advantage of this massive open goal. Incredible. [0] no, not in a nice "let's all remember to treat LGBTQ+ compassionately and with respect" way
  - rsynnott 4y ago
    > And the opposition seem pretty uninterested in taking advantage of this massive open goal. Never interrupt your opponent while they are making a mistake. Right now, Labour and the Lib Dems don't have a particularly credible method to cause an election. Given that, their best _political_ option is probably to allow the Tories to run themselves into the ground.
    - smcl 4y ago
      I'll believe that they have a response to these things when I see it. While I've seen polling putting Labour ahead of the Tories but no big movement on the problems I've mentioned (in addition to some worrying anti-worker sentiment @ party level relating to the rail strikes)
LatteLazy 4y ago
That is what people voted for...
- grnmamba 4y ago
  Yep it's the people's own fault that they died while waiting in the emergency room. The politicians are sacrosanct and must not be criticized under any circumstances. So, you see, all these excess deaths are really suicides.
- DethNinja 4y ago
  I don’t buy that explanation. Democracy turned out to be easily manipulatable with large sums of money and media control. At this point, an average person can’t have much of an affect on how government is acting. Very few people can take a day off to protest, and even if they do, protests tend to be meaningless too. I’m not saying that average person is blameless but most of the fault lies with the ruling classes.
  - Nokinside 4y ago
    >Democracy turned out to be easily manipulatable with large sums of money and media control. People being easy to manipulate is feature of humanity, not evidence that democracy does not work. People are in charge for allowing that to happens, allowing to continue etc. If things go shit under heavy influencing and manipulation it's the failure of the people. "ruling classes" in democracy works is the fault of the non ruling majority.
    - selfhoster11 4y ago
      > People being easy to manipulate is feature of humanity, not evidence that democracy does not work. Maybe it's both. Much like communism assumes altrustic spherical humans in a vacuum, so does democracy assume that each voter will both bother to vote, and that they are rational enough to vote close to what they actually want without being swayed. This could be evidence that democracy, much like communism, does not work very well.
simonswords82 4y ago
Here's the thread roll out for those of you like me that find this hard to read: https://threadreaderapp.com/thread/1562004612172873728.html https://threadreaderapp.com/thread/1562004612172873728.html
elif 4y ago
- t3rabytes 4y ago
  (Not) Luckily the US healthcare system is already collapsing without social medicine, so it’s not a great talking point. Staffing and supply shortages paint a bleak picture over the next few years.
  - Overtonwindow 4y ago
    "the US healthcare system is already collapsing" What do you mean by this, specifically? People not having insurance? Increasing deaths inside the hospital? Large numbers of people turned away from emergency rooms? I'm questioning this because with the exception of malpractice, the U.S. healthcare system seems to be working quite well, despite the large numbers of uninsured and those who cannot pay. I just don't buy this argument that the U.S. healthcare system is "collapsing" because if you call an ambulance they will take you to the hospital, and if your life is in danger regardless of your ability to pay, there's a higher chance of surviving in an American medical facility than most places on earth.
    - wincy 4y ago
      People just love to talk about how horrible the US healthcare system is but my disabled daughter has never paid a dime for care in her life (in Kansas, of all places!) via Medicaid. Even her birth was free due to retroactive Medicaid. Her 9 months in the NICU was billed at over $2 million. Thanks taxpayers. I was having chest pains last week and got triaged within minutes at the ER. I’m pretty sure I “owe” them $500 for a previous ER visit which nobody mentioned during my stay. My 65 year old uncle hasn’t had insurance in 20 years but when he got cancer three ago the social worker helped him sign up for disability and they got him on Medicare so fast your head would spin. He started chemo basically immediately and while his cancer is terminal the treatment has kept him alive for a long time, even longer than the doctors predicted. My wife got billed $200,000+ for a visit in the hospital when she had a critical illness and almost died. She ended up paying $2000. This was more than ten years ago and it didn’t ruin her credit and nobody ever came after her for it. And One more. The hospital messed up the billing for our first daughter’s birth and called us two years later saying we didn’t have insurance (we did). My wife said that was their problem. We never heard from them again or got a bill. I guess they just ate the cost? No idea. But it was over seven years ago and there were zero consequences and we never paid a dime.
dmix 4y ago
Canada is having the same issue with 20hr waits in the emergency room and others being rejected outright https://globalnews.ca/news/9066662/emergency-rooms-canada-big-small/ https://globalnews.ca/news/9066662/emergency-rooms-canada-bi... I’ve heard a big part is all the doctors have been going on vacation all at once now that COVID is largely over, after not taking them for two years. They don’t have enough staff to cover even partial shortages. That plus the elephant in the room of paying nurses/doctors more to keep them in Canada is always an issue.
- Cthulhu_ 4y ago
  I'm happy for them that they made it to the point they can actually take time off. A big issue over here (NL) is that the doctors and nurses have fallen ill themselves, either from the 'rona or long covid, or from being overworked for so long. And because of the workload, a lot of people have quit as well.
- ilamont 4y ago
  Family member recently received emergency care in northern NY. Several of the nurses were Canadian coming over the bridge for better pay.
  - magicalist 4y ago
    Nurses are leaving a ton of places in the US for better pay elsewhere, too.
    - Scoundreller 4y ago
      They're not leaving the US, they're re-allocating themselves internally.
      - magicalist 4y ago
        Yes, and the places they're leaving are experiencing major service delays and cancellations. I'm not sure of your point?
Overtonwindow 4y ago
What if the government allowed private enterprise to open emergency clinics in times of great need? There are probably a lot of people who would be willing to pay out of pocket for medical care, especially in an emergency, if it meant getting seen sooner.
- Cthulhu_ 4y ago
  Private enterprises are already running a significant chunk of UK health care at the moment; the Tory government is dismantling the socialized health care in favor of short-term profit. It's not about whether people are willing, it's whether they can afford it or if they have no choice but to go into debt. Anyway, the NHS has also paid private clinics already because their own facilities are at capacity.
  - simonswords82 4y ago
    The nhs also has a shedload of funding. Let’s not overlook the aging population in the UK please. There are many more factors than simply “the Tories are to blame”
    - X0Refraction 4y ago
      This is the actual issue, spending isn't keeping up with the demand. I'd agree that "the Tories are to blame" doesn't capture it, but I don't think they're equipped to deal with the problem. Real terms spending per age adjusted capita appears to have been on a downwards trend [0] since they took power. I think this has gone up since the pandemic, but I think it's likely too little too late and will probably be a short term increase. I'm also skeptical the IFS have managed to accurately estimate the required increase in funding. They don't go into their workings from what I can see, but I doubt they've accurately included the effect of the lifetime allowance on pensions causing doctors to avoid overtime or the £100k tax bracket where you lose your personal allowance not moving since 2009 which more and more doctors will fall into. I'd imagine they've underestimated it, but would be happy to hear evidence to the contrary. That's not to say that I think any other party has a solution or is properly holding the Tories to account on this. I'll admit I haven't thought too hard about the problem, but I think the fairest solution would be to make pensioners pay national insurance on their income. It wouldn't affect the poorest pensioners and since national insurance is no longer ring fenced for pensions/healthcare I'm not sure what the justification for a tax break based on age even is anymore. As someone who intends to subsist on more in retirement that change would negatively affect me, but I still think it's fair. I know that this would be deeply unpopular though, so I don't hold out much hope of it happening anytime soon. Maybe that isn't the best solution, but I really wish we'd start to have real discourse on how we need to restructure our society as the demographic of the country continues to skew older. [0] https://ifs.org.uk/publications/9186 https://ifs.org.uk/publications/9186 (figure 5)
WithinReason 4y ago
They subtract COVID deaths from excess deaths to get the baseline, forgetting that COVID deaths were counted somewhat liberally, and some percentage of non-COVID deaths were counted as COVID deaths if someone was infected close to their time of death. This can be seen in the following chart: https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2021-12-31..latest&facet=none&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&country=~GBR https://ourworldindata.org/explorers/coronavirus-data-explor... (You need to change the "Metric" dropdown) If you compare excess deaths in 2022 to COVID deaths in the same period: Peaks in COVID deaths don't produce peaks in excess deaths. So saying that excess deaths are higher now than they were in the past is likely due to the underestimation of con-COVID excess deaths during COVID, and not a real effect.
- armada651 4y ago
  > They subtract COVID deaths from excess deaths to get the baseline, forgetting that COVID deaths were counted somewhat liberally, and some percentage of non-COVID deaths were counted as COVID deaths if someone was infected close to their time of death. If COVID deaths were counted liberaly and even after subtracting those inflated numbers you still have excess deaths, then that only further underlines their point that these excess deaths are not COVID-related. Just because you think the criteria for counting COVID deaths were wrong doesn't make every conclusion based on those numbers incorrect.
  - WithinReason 4y ago
    No, they say that current non-COVID excess deaths are higher than non-COVID excess deaths were during COVID. They underestimate non-COVID excess deaths during COVID because of the subtraction, which makes current excess deaths higher than average. In reality, they underestimated the average that they compare to. Hope it's clear now.
    - armada651 4y ago
      I see what you mean, yes it does make it difficult to prove a trend between periods with high rates of COVID infection and low rates of COVID infection. But proving such a trend is problematic regardless of what the criteria for a COVID excess death is. Simply because during a period of high COVID infection a lot of people are dying from COVID before they have the chance to die from other causes.
simonswords82 4y ago
For those not from the UK there’s a wider narrative at play here. Any and all government bashing is almost a national sport and pastime at this stage. Throw in some numbers to try to prove your point and you’re going to be well received. So there’s a lot of misinformation out there. Perhaps this Twitter chap is talking rubbish too. For the record not saying our government is perfect but holy heck it’s hard to keep up with the negativity
- M2Ys4U 4y ago
  "This Twitter chap" is a journalist at the Financial Times and is a senior fellow at the London School of Economics. He's not just some rando bashing government...
  - jokethrowaway 4y ago
    Logical Fallacy: Appeal to Authority I would trust a rando more than a journalist these days
    - M2Ys4U 4y ago
      > Logical Fallacy: Appeal to Authority It's putting the source in the proper context.
    - ben_w 4y ago
      Even though I frequently make note of the Gell-Mann amnesia effect, I'd still rate journalists higher than randos.
    - nobody9999 4y ago
      You might want to check this out: https://en.wikipedia.org/wiki/The_Death_of_Expertise https://en.wikipedia.org/wiki/The_Death_of_Expertise https://www.c-span.org/video/?426290-1/tom-nichols-discusses-the-death-expertise https://www.c-span.org/video/?426290-1/tom-nichols-discusses... Unrelated, but the second link also provides the best definition of fake news I've ever heard.
  - 4y ago
cirrus-clouds 4y ago
This twitter thread is excellent. Here are selected tweets to highlight the crisis from hospital and ambulance waiting times. --- "England & Wales as the only part of Europe that has recorded sustained and rising excess mortality over the last few months with no obvious natural explanation." "Patients who waited 8-12 hours had a 16% higher chance of dying in the subsequent 30 days than average." "This was after adjusting for a huge range of possible confounders, i.e this was not due to those patients’ characteristics, conditions etc, but due to the length of the wait." "You may have heard almost 30,000 people waited 12 hours in English A&Es in July, but that figure actually only refers to the wait after initial assessment" "Thanks to @Rebeccasmt’s reporting, we know that if you include all time spent waiting, 100,000 people waited 12+ hours!!" "Take ambulance delays, for example: for emergency situations including suspected strokes and heart attacks, the average wait for an ambulance to arrive on the scene is now one hour, and 40,000 people with these sorts of emergencies waited 2 hours last month." "As before, the peaks in ambulance-related harms broadly coincide with peaks in England’s non-Covid excess mortality. "It’s a grim picture, and an increasingly conclusive one."
- deleted 4y ago
  [deleted]
- simonswords82 4y ago
  As somebody else in this thread pointed out the numbers don’t stack up. This thread is subjective at best
  - pas 4y ago
    could you link to that pointing out? which parts don't stack up? the 12+ hour wait times, the hospital occupancy, the discharge rate, the aging population and the slashed spending are all seem to be hard numbers (dare I say facts?) ... what doesn't add up?
    - dekhn 4y ago
      If you can wait 12 hours, you didn't have an emergency.
JustSomeNobody 4y ago
Sooo... are they trying to destroy HC so they can rebuild it as the monstrosity we have here in the USA?
- pid_0 4y ago
- badcppdev 4y ago
  Yes there are significant and multiple areas where private healthcare companies are being paid to 'provide' services to the NHS in a classic outsourcing process similar to what you would see in IT. Private company charge a lot more, pay their staff a bit more to attract workers from the NHS, extend their contracts to provide more services where there are NHS staff shortages. Taxpayer money turns into company profits. I wouldn't object if it provided more efficient care but it doesn't seem to.
  - DanBC 4y ago
    It's a bit complicated. Private providers can have different staff mixes, so you might have more healthcare assistants and fewer nurses. You might have more unregistered nurses and fewer registered nurses. You might find more staff are on zero-hour contracts, or things like "hotel services" (food, cleaning) are contracted out to companies that are low pay poor condition companies.
    - pkaye 4y ago
      Don't most countries in the EU have a mix of public and private health care providers? How do they manage it?
      - DanBC 4y ago
        In England we can talk about NHS funding and private funding, and we have both. We can also talk about NHS providers and private providers of NHS services, and again we have both.
spywaregorilla 4y ago
I don't have time to go in depth on this but I'm a bit skeptical of the claims here After adjusting for age, the english excess death rate is 5% above. It is the highest. But it also just came from being the lowest several months ago. How much natural variance is in this data. Is this moment noteworthy? Is it possible we're not seeing more people die sooner but rather a large chunk of people putting off death a few months all kicking the bucket now for some reason? Twitter confuses me a bit but reading all the thread here seemed to hide some additional posts which were important. The rate of people going into the emergency room is normalish. The rate of people leaving it is slow but not clearly slower than normal. This does suggest the general problem is really that we don't know where to put all these incapable poor health old people. But... If we assume that people are leaving the system at the same rate as before (afaict no data here), and that the health system had large inflows of patients from covid earlier, it seems likely that this is just the system slowly returning to equilibrium and dealing with that excess bulge of patients who entered and are hard to get rid of. The problem is probably not that patient outflows have gotten worse. It's just that there are more patients in there now because there were a lot more new patients shortly before now. He's got one critical chart which shows that hospital occupancy % has been growing from 6% to 8% 2010-2020. It is now at 12%. But the data is missing for the pandemic period for some reason. So... that seems like an important bit. Is this problem correcting itself? Kind of depends on the rate of change we're seeing in this figure if the rest of the analysis is to be believed. But it's hidden and too short term to make a good forecast on just the recent months.
- pjc50 4y ago
  > This does suggest the general problem is really that we don't know where to put all these incapable poor health old people. This has been the case for years: there are plenty of people who should not be discharged home to fend entirely on their own, but there's no social care in place to look after them, so they aren't discharged. This is also technically the responsibility of the local council rather than central government. During the pandemic there was almost unlimited money available for Test and Trace, some for the entirely temporary "Nightingale" hospitals, .. and basically no effort to increase staffing levels or solve the social care issue.
bananapear 4y ago
But what has caused the collapse of emergency healthcare in the UK? A lack of supply or an increase in demand?
- iam-TJ 4y ago
  Increase in demand - much of which is attributed (by the NHS itself) for people having poor life-styles (meaning tending to obesity [0] and not maintaining physical and mental fitness), and the tendency for people to be kept alive longer existing with chronic conditions that a few decades ago would have naturally expired (dead!). There's been an endemic problem for the last 30+ years where-by a large proportion of the population has a sense of entitlement to NHS care without at the same time bearing responsibility to keep themselves reasonably fit and healthy. @ [0]: "Nearly two-thirds of adults in England are overweight or obese. In 2016/17, 617,000 admissions to NHS hospitals recorded obesity as a primary or secondary diagnosis" [0] https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/obesity/ https://www.longtermplan.nhs.uk/online-version/chapter-2-mor...
  - Auracle 4y ago
    Meanwhile in the US there’s been a push to limit the copays for insulin, pushing the cost of all of those almost entirely preventable type 2 diabetics on to everyone else.
    - the_why_of_y 4y ago
      This would only be a problem due to how incredibly, absurdly expensive insulin is in the USA. https://www.bbc.com/news/world-us-canada-47491964 https://www.bbc.com/news/world-us-canada-47491964
  - deleted 4y ago
    [deleted]
  - cjrp 4y ago
    617k is roughly 11% of admissions for that year. That alone doesn't explain the situation.
jrochkind1 4y ago
I hadn't (here in the USA) heard anything about "collapse of emergency healthcare in England" -- can anyone provide some links for some context? What is actually going on, and (to the extent people know/educated guess) why? Have wait times been gradually increasing, or has there been a sudden increase? ("collapse" sounds sudden?) Etc etc.
- buro9 4y ago
  The Conservative Party have been in power for 12 years. When they gained power they pursued a policy of "austerity" to reduce the size of the govt and local govt, reduce the funding of nationally funded things, and to replace such govt owned things with "public private partnerships". This can be seen everywhere from social care (private care homes), schools (academy schools), transport (where area contracts are bid for by private companies), etc. With health specifically the goal is to have more privately owned profit making companies in the NHS. The NHS as it is constructed doesn't allow for this. But for the Conservatives this opportunity for them and their backers. For the public, there is a national pride in the NHS. So we entered the pandemic with an already under-funded and stretched health care system. Much to the chagrin of those in charge though... this has not led to any calls for privatisation. Nor has it led to a boom in people taking out private health care cover. It turns out that the British stiff upper lip response to something they're nationally proud of is that they'd rather die than embrace health privatisation. So we're in uncharted territory... the playbook that had allowed the privatisation of almost everything else isn't working now, it's just killing people.
  - gadders 4y ago
    >> The Conservative Party have been in power for 12 years. When they gained power they pursued a policy of "austerity" to reduce the size of the govt and local govt, reduce the funding of nationally funded things, and to replace such govt owned things with "public private partnerships". You seem to be missing a bit of context here - this was after the Global Financial Crisis when even the outgoing Labour Chancellor of the Exchequor admitted there was no money left https://www.theguardian.com/politics/2010/may/17/liam-byrne-note-successor https://www.theguardian.com/politics/2010/may/17/liam-byrne-... >> So we entered the pandemic with an already under-funded and stretched health care system. It's 12% of GDP currently, which isn't that out of step globally.
cpr 4y ago
- swores 4y ago
  Not much groupthink needed to downvote somebody who feels a single short sentence, with no citations or.. anything really, yet one that goes against current mainstream medical and scientific opinions, is worth writing. If you actually wanted to try to convince anyone that you might be even somewhere in the vicinity of having a point, you've given up before even trying and opted for pre-complaining about downvotes (something which, on HN, almost guarantees you downvotes even if you're saying something people agree with, btw) rather than suggesting a single piece of data that would lead to any reasonable person thinking "hmm, yeah maybe worth investigating further this theory that vaccines are the cause of UK's current high excess mortality rates". But I suspect you didn't have much choice, if there actually were a compelling argument to make in support of your claim then, well, you'd be making it.
  - cpr 4y ago
    You're right in that I'm being lazy and shouldn't have commented without backup data. There's plenty of data out there, but why try to collect if the HN readership's thinking is so mainstream that they'll reject any such attempts out of hand?
drumhead 4y ago
Emergency care hasn't "collapsed". It's under strain from a backlog cases unseen during the pandemic. But collapsed? No.
- DanBC 4y ago
  What would collapse look like? If people are queueing in an ambo for 12 hours why isn't that a sign of collapse? If people are dying of stroke or heart attack at greater rates, because they can't get ED care, why isn't that a sign of collapse?
  - DanBC 4y ago
    So, for example: https://twitter.com/mattdiscombe/status/1562108007407919104?s=20&t=BJAW04MJxuhV9i9PNVDhjA https://twitter.com/mattdiscombe/status/1562108007407919104?... > Almost 333,000 hours were lost by ambulance crews because of handover delays in the 12 months to July 2022 – 18 TIMES higher than the 17,600 hours lost during the same period in 2019 to 2020. What's this if it's not collapse?
oliwarner 4y ago
This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards have turned into medically-fit nursing homes. They spend half their days trying to send people (who don't have care requirements) home faster than they'd like. Why? Because central government withdrew funding. Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out. Turns out the whole endeavour was yet more myopic, Tory penny-pinching.
- xtracto 4y ago
  It is too bad that corrupt government officials keep systemically defunding Social Health programs with the objective of pushing private for-profit healthcare (which just doesn't make sense). Then they point to the deficient healthcare and blame the "socialized" aspect of it for the issues. Here in Mexico we've seen it all play out: We had an amazing social healthcare system (in the form of the IMSS) in the 70s and 80s. But the corrupt government officials kept dismantling it and allowing corruption to run rampant within the system. All to get a piece of the private for-profit health system including Health Insurance. Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s. I seriously hope it doesn't have the same outcome as our system had in Mexico. For-profit health is inhumane.
  - oliwarner 4y ago
    2004 was the peak of Blair-Brown Labour party investment. They didn't get it all right. They used PFI and outsourcing to fudge the sums on major investments, and I dare say they didn't invest in mental and social health care in the amount required. But nobody ever has. The job of fixing this is so expensive and requires so much political force. We're still worried French immigrants are going to eat our dingos, or something. I'm fairly certain now we're destined to limp into an American insurance model; eat the poor.
cas14655 4y ago
- nobodyandproud 4y ago
  Compared to the cesspool that is the US system? The NHS was amazing. We don’t talk about it, but people still die for non-COVID emergencies because hospitals in the Us are routinely full in 2022. Privatization of hospital systems in the US have lead to very warped incentives, where C sections are the norm because it’s faster and more money for the hospital and Drs.
  - adventured 4y ago
    > Privatization of hospital systems in the US have lead to very warped incentives, where C sections are the norm because it’s faster and more money for the hospital and Drs. The US rate of c-sections was 32% in 2017 (and roughly the same for 2020), the same as Switzerland. It's 27.7% in Canada, 33.7% in Australia and 27.4% in the UK. 28% across the OECD, 30% in Germany, 45% in South Korea, 34% in Italy. So much for that. https://www.oecd-ilibrary.org/sites/fa1f7281-en/index.html?itemId=/content/component/fa1f7281-en https://www.oecd-ilibrary.org/sites/fa1f7281-en/index.html?i...
    - nobodyandproud 4y ago
      Your own source disagrees. Per your own link: “ Variations in caesarean section rates across countries have been attributed to a number of factors, including financial incentives, malpractice liability concerns, differences in the availability and training of midwives and nurses, and the proportion of women who access private maternity care. For example, there is evidence that private hospitals tend to perform more caesarean sections than public hospitals. In Switzerland, caesarean sections were found to be substantially higher in private clinics (41%) than in public hospitals (30.5%) (OFSP, 2013[1]).” Privatization correlates to more C-Sections.
  - pookha 4y ago
    Here in the US I had stage III cancer. I was receiving full blown cancer treatment(s) less than a week after I went to the ER with symptoms (chest port + three types of chemo drugs). And that's routine. The US health care failures are mostly the fault of administrators and insurance companies gaming the public. The care is fast + extensive and it's not a cesspool. And the "full hospital" meme isn't entirely accurate. The US hospital wards are -- by design -- supposed to be full. If 100 beds are allocated for severe flu cases (example) but there's only 25 patients they'll shift the flu ward to 35. Thus they achieve a 75% capacity for the flu beds and allocate the additional beds to other sections. Sometimes the American media (sensationalist by design) will report this as "OH MY GOD THE FLU WARD IS NEAR CAPACITY. 75% FULL!!" without reporting total beds vs flu beds.
adamredwoods 4y ago
The thread reminds me of the Guardian's podcast "Sewage Sleuths" which uncovered catastrophic sewage being dumped into England and Wales's rivers and streams. Very informative and enlightening how bad some government infrastructure can be (hint: in the podcast they also enlightened HOW the failure got bad). https://www.theguardian.com/news/audio/2022/aug/15/sewage-sleuths-slow-dirty-death-of-welsh-and-english-rivers-podcast https://www.theguardian.com/news/audio/2022/aug/15/sewage-sl...
- WhyIsItGlowing 4y ago
  It's worth clarifying that the issue with the government infrastructure is with the regulatory agencies, rather than the water infrastructure itself which is privatised. There's also a good text article version; https://www.theguardian.com/environment/2022/aug/04/sewage-sleuths-river-pollution-slow-dirty-death-of-welsh-and-english-rivers https://www.theguardian.com/environment/2022/aug/04/sewage-s...
- jmfldn 4y ago
  It's a failure of privitisation 30 years in the making since water and waste management was privatised in 1989 here in the UK. Of course you can lay some blame at the door of the regulator but let's not forget the tens of billions that have been siphoned off to shareholders and fatcat CEOs, some of whom are arguably criminally negligent and should be put on trial for the catastrophes that have become apparent in recent years.
  - lambdadmitry 4y ago
    I really don't like this kind of knee-jerk "privatisation bad, fatcat CEOs bad" reaction sadly prevalent in the UK. Let's talk about the underlying argument, shall we? Firstly, you're talking about a failure of a regulator to regulate an industry and prosecute alleged perpetrators, and the implied solution is to… nationalise the industry, somehow assuming the nationalised entity will be managed better by the very same regulator? I don't think it's a good argument really Secondly, if we go even deeper, what pressures would such an entity have to provide good service and not be wasteful with their resources? Right now there's at least market pressure, the companies trying to outcompete their peers, cut costs, and ensure future profitability by investment. What pressures do you think exist for a nationalised entity that don't exist for a regulator? Thirdly, do you actually have any evidence to prove that those companies are uniquely profitable? Because unless they are, it's only fair that people investing their own money into infrastructure (remember, that was one of the goals of privatisation, tapping private budgets in addition to tax money) get some return on it, otherwise they'd just invest it elsewhere, e.g. into Apple stock, which would benefit British people much less. Privatisation per se is not the problem, political failures are.
FpUser 4y ago
I think Canada can match England in this area. It is borderline criminal what happens here in some cases.
buscoquadnary 4y ago
I don't think it is coincidental that there is also now a large push in England for State sanctioned suicide. Especially after reading how administrators in Canada are treating it.
- bambataa 4y ago
  What are you talking about?
  - n4r9 4y ago
    Not sure what OP is referring to exactly either, but there has been a bit of talk about euthanasia in the press following the case of a man who killed his wife who was dying of cancer (and then attempted unsuccessfully to kill himself): https://www.theguardian.com/society/2022/jul/22/law-euthanasia-assisted-suicide-uk-graham-mansfield https://www.theguardian.com/society/2022/jul/22/law-euthanas... My impression is the attitude towards euthanasia is becoming more favourable. I wouldn't be surprised if it becomes an Labour election promise over the next decade (the Lib Dems already support it I believe).
- standardUser 4y ago
  Decriminalization of physician-assisted suicide is becoming more popular in a lot of places because it is far more humane than the status quo.
c7DJTLrn 4y ago
My 80 year old grandfather was due for a knee operation and it was delayed twice. On the day after the second time it was delayed, his knee collapsed and he smacked his head on the concrete floor. His speech was slurred, his vision was affected, and he was in extreme pain. Bearing in mind in his younger years he's had eyes slashed open and fingers cut off, so he has a high pain threshold. The ambulance took six hours to arrive. If his brain was bleeding he would have died. When they arrived at the hospital they were waiting a further six hours to be seen. The NHS is a tragedy and I almost wish they'd just hurry up and privatise it so I don't have to pay with it with my taxes anymore, which means the Tories achieved their goal. If I didn't have private healthcare I'd have left the UK by now. I was born and raised here, so I think that says something.
- asdff 4y ago
  As someone in the U.S., don't expect the timeliness to improve any with private healthcare.
  - rajup 4y ago
    Why do you say that, do you have any evidence to back it up? Not saying the US healthcare system is anything to write home about, but it always seemed to me that as long as your pockets are deep enough you should be able to get healthcare when you need it in the US.
    - scarecrowbob 4y ago
      "as long as your pockets are deep enough" Is doing a lot of work there. In the state where I grew up, 18% of people have no health insurance at all.
    - nitwit005 4y ago
      It's not too difficult to find comparisons of countries wait times: https://www.oecd.org/health/waiting-times-for-health-services-242e3c8c-en.htm https://www.oecd.org/health/waiting-times-for-health-service... There are some private practices that will let you pay a premium for quick appointments, but if you need a hospital, you're probably going to experience some wait.
mattlondon 4y ago
As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are people's solutions to this? It seems like the NHS budget keeps on going up and up and up [1], as does the number of doctors and nurses (while "managers" has either declined or stayed relatively static) [2]. So NHS is getting more funding, and there are more doctors and nurses. Yet there is still outcry about how we need MOAR MOAR MOAR! We're spending ~10% of GDP on the NHS at the moment [3] - how much more do people want? 10% appears to be roughly comparable to other developed nations (except USA...) and the data says that nurses and doctors are increasing in numbers while "managers" are not, so the usual cries about the money being spent on "management consultants" appears to be ill-founded, as does the complaints that it is the Tory party reducing funding. Throwing money at the problem appears not to be working because the budget keeps going up, the numbers of doctors and nurses keeps going up, yet people are still complaining about it being awful? What gives? What is the solution when just spending more money isn't working? 1 - https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/nhs-funding-data-analysis https://www.bma.org.uk/advice-and-support/nhs-delivery-and-w... 2 - https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#how-many https://www.kingsfund.org.uk/audio-video/key-facts-figures-n... 3- https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#how-much-does-it-cost https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...
- rdl 4y ago
  The best thing about NHS (from my perspective as a US person, although I lived in the UK for a while) is the use of QALYS to allocate budget, rather than spending huge sums on a small number of interventions at extreme cost and limited benefit. Has that focus shifted? (My personal belief is there should be a level of universal medical care funded by some public entity, probably the nation state currently, but it should be capped at a relatively low level, probably closer to 1% of GDP and allocated on a QALYS and emergency or communicable biased, with private care in a relatively unregulated market outside of that. Probably would end up in the 5% range overall, but with universal access to basic and cost-optimized care and probably a wider variety of private, charity, experimental care.) We should not spend excessively on medical care vs. other interventions -- it's absurd that in the US we can have homeless people on the street with extremely limited assistance on housing or lifestyle interventions, but as soon as they develop some medical condition, they get essentially unlimited much higher cost intervention to remediate those things, but still nothing to address the underlying cause. There are a bunch of cases where we could shift $1k out of medical spend for $10 in other spend and achieve a better outcome for the person and for broader society.)
lkramer 4y ago
Anecdotal, but I have twice in the last year heard from the same friend of 2 instances where the waiting time for an ambulance was around an hour. The first was when he observed an accident where a car hit a guy on a scooter. The guy was hurt, but not in a life threatened manner. The other was a guy in a bar who probably overdosed on something and his heart stopped. If someone hadn't been around who knew CPR, he would have been dead. Both instances was in London.
- cameronh90 4y ago
  Even more worryingly is that London has some of the fastest response times in the country. Last two times I had to call 999, for ambulance and police respectively, I was on hold for more than 5 minutes before even being connected to an operator. The overall ambulance target response time is 8 minutes.
diogenescynic 4y ago
Boris Johnson really historically screwed over his country. Even as bad as some of our leaders have been, it seems like Boris significant eclipses their incompetence.
stereoradonc 4y ago
Whats the point of emigrating to the west when this is facing a spectacular failure?
bongoman37 4y ago
phendrenad2 4y ago
When are people going to realize that medical care is the cornerstone of advanced society. Increasing average lifespans raises the collective memetic IQ of the population, and lets us build more advanced things.

270 points by buro9 4y ago

vfclists 4y ago

Someone should ask the guy to publish on a blog and link his twitter to it.

pacifika 4y ago
It’s an article on the Financial Times
nindalf 4y ago
Blogs don’t make sense for the most prolific creators. Here’s something I saw recently > I gave up blogging after decades because the ROI simply wasn’t there any more. Why spend hours on a post that will get hundreds of views when a tweet composed in minutes gets tens of thousands to millions? https://twitter.com/carnage4life/status/1559852146601799683 https://twitter.com/carnage4life/status/1559852146601799683 And it’s the same with Scott Hanselman, who’s quoted in that tweet. Hasn’t blogged since last year, stopped after 20 years. He’s big on YouTube and Tiktok now.
- skeeter2020 4y ago
  Scott Hanselman states he stopped because he was tired, not that he's switched mediums. The Tiktok / YT comment was a joke; he still does lots of media for his job though.
- vfclists 4y ago
  If you are serious about communicating then you MUST blog in addition to tweet. Twitter is for soundbites, not lengthy articles. You can't expect people to read tweet after tweet when they would rather read a long continuous article. The dude probably has the software that breaks down lengthy articles and tweets them in reverse order but that shouldn't be abused. And what happens when you fall foul of twitter's rules and get banned?
  - robotnikman 4y ago
    Not sure why you were downvoted, as those are valid points. Twitter is the best medium when it comes to talking about subjects in depth. It is good when it comes to making a quick hot take, but not in depth articles or explanations. Unfortunately, a lot of people don't engage much in long form discussion as much as they would a tweet. Tweets are much easier to discover, find, and view compared to a blog post. It's much easier to click like on a tweet or retweet something, and bigger engagement numbers == better. So people instead will write out tweets instead of blog posts. I don't care for it much myself, but such is the modern internet I guess.
boffinism 4y ago
Sure, here you go: https://www.ft.com/john-burn-murdoch https://www.ft.com/john-burn-murdoch

Havoc 4y ago

Meanwhile the prime minister is on perma vacation and the replacement candidates are focused on banning on shore renewables and squabbling among each other

mhh__ 4y ago
Don't forget our prison camp in Rwanda!
smcl 4y ago
The replacement candidates are also both sure that the main issues facing the UK public are "woke" politics and trans people[0], and seem entirely unphased about the pending crisis around energy bills and the price of food. And the opposition seem pretty uninterested in taking advantage of this massive open goal. Incredible. [0] no, not in a nice "let's all remember to treat LGBTQ+ compassionately and with respect" way
- rsynnott 4y ago
  > And the opposition seem pretty uninterested in taking advantage of this massive open goal. Never interrupt your opponent while they are making a mistake. Right now, Labour and the Lib Dems don't have a particularly credible method to cause an election. Given that, their best _political_ option is probably to allow the Tories to run themselves into the ground.
  - smcl 4y ago
    I'll believe that they have a response to these things when I see it. While I've seen polling putting Labour ahead of the Tories but no big movement on the problems I've mentioned (in addition to some worrying anti-worker sentiment @ party level relating to the rail strikes)

LatteLazy 4y ago

That is what people voted for...

grnmamba 4y ago
Yep it's the people's own fault that they died while waiting in the emergency room. The politicians are sacrosanct and must not be criticized under any circumstances. So, you see, all these excess deaths are really suicides.
DethNinja 4y ago
I don’t buy that explanation. Democracy turned out to be easily manipulatable with large sums of money and media control. At this point, an average person can’t have much of an affect on how government is acting. Very few people can take a day off to protest, and even if they do, protests tend to be meaningless too. I’m not saying that average person is blameless but most of the fault lies with the ruling classes.
- Nokinside 4y ago
  >Democracy turned out to be easily manipulatable with large sums of money and media control. People being easy to manipulate is feature of humanity, not evidence that democracy does not work. People are in charge for allowing that to happens, allowing to continue etc. If things go shit under heavy influencing and manipulation it's the failure of the people. "ruling classes" in democracy works is the fault of the non ruling majority.
  - selfhoster11 4y ago
    > People being easy to manipulate is feature of humanity, not evidence that democracy does not work. Maybe it's both. Much like communism assumes altrustic spherical humans in a vacuum, so does democracy assume that each voter will both bother to vote, and that they are rational enough to vote close to what they actually want without being swayed. This could be evidence that democracy, much like communism, does not work very well.

simonswords82 4y ago

Here's the thread roll out for those of you like me that find this hard to read: https://threadreaderapp.com/thread/1562004612172873728.html https://threadreaderapp.com/thread/1562004612172873728.html

elif 4y ago

t3rabytes 4y ago
(Not) Luckily the US healthcare system is already collapsing without social medicine, so it’s not a great talking point. Staffing and supply shortages paint a bleak picture over the next few years.
- Overtonwindow 4y ago
  "the US healthcare system is already collapsing" What do you mean by this, specifically? People not having insurance? Increasing deaths inside the hospital? Large numbers of people turned away from emergency rooms? I'm questioning this because with the exception of malpractice, the U.S. healthcare system seems to be working quite well, despite the large numbers of uninsured and those who cannot pay. I just don't buy this argument that the U.S. healthcare system is "collapsing" because if you call an ambulance they will take you to the hospital, and if your life is in danger regardless of your ability to pay, there's a higher chance of surviving in an American medical facility than most places on earth.
  - wincy 4y ago
    People just love to talk about how horrible the US healthcare system is but my disabled daughter has never paid a dime for care in her life (in Kansas, of all places!) via Medicaid. Even her birth was free due to retroactive Medicaid. Her 9 months in the NICU was billed at over $2 million. Thanks taxpayers. I was having chest pains last week and got triaged within minutes at the ER. I’m pretty sure I “owe” them $500 for a previous ER visit which nobody mentioned during my stay. My 65 year old uncle hasn’t had insurance in 20 years but when he got cancer three ago the social worker helped him sign up for disability and they got him on Medicare so fast your head would spin. He started chemo basically immediately and while his cancer is terminal the treatment has kept him alive for a long time, even longer than the doctors predicted. My wife got billed $200,000+ for a visit in the hospital when she had a critical illness and almost died. She ended up paying $2000. This was more than ten years ago and it didn’t ruin her credit and nobody ever came after her for it. And One more. The hospital messed up the billing for our first daughter’s birth and called us two years later saying we didn’t have insurance (we did). My wife said that was their problem. We never heard from them again or got a bill. I guess they just ate the cost? No idea. But it was over seven years ago and there were zero consequences and we never paid a dime.

dmix 4y ago

Canada is having the same issue with 20hr waits in the emergency room and others being rejected outright https://globalnews.ca/news/9066662/emergency-rooms-canada-big-small/ https://globalnews.ca/news/9066662/emergency-rooms-canada-bi... I’ve heard a big part is all the doctors have been going on vacation all at once now that COVID is largely over, after not taking them for two years. They don’t have enough staff to cover even partial shortages. That plus the elephant in the room of paying nurses/doctors more to keep them in Canada is always an issue.

Cthulhu_ 4y ago
I'm happy for them that they made it to the point they can actually take time off. A big issue over here (NL) is that the doctors and nurses have fallen ill themselves, either from the 'rona or long covid, or from being overworked for so long. And because of the workload, a lot of people have quit as well.
ilamont 4y ago
Family member recently received emergency care in northern NY. Several of the nurses were Canadian coming over the bridge for better pay.
- magicalist 4y ago
  Nurses are leaving a ton of places in the US for better pay elsewhere, too.
  - Scoundreller 4y ago
    They're not leaving the US, they're re-allocating themselves internally.
    - magicalist 4y ago
      Yes, and the places they're leaving are experiencing major service delays and cancellations. I'm not sure of your point?

Overtonwindow 4y ago

What if the government allowed private enterprise to open emergency clinics in times of great need? There are probably a lot of people who would be willing to pay out of pocket for medical care, especially in an emergency, if it meant getting seen sooner.

Cthulhu_ 4y ago
Private enterprises are already running a significant chunk of UK health care at the moment; the Tory government is dismantling the socialized health care in favor of short-term profit. It's not about whether people are willing, it's whether they can afford it or if they have no choice but to go into debt. Anyway, the NHS has also paid private clinics already because their own facilities are at capacity.
- simonswords82 4y ago
  The nhs also has a shedload of funding. Let’s not overlook the aging population in the UK please. There are many more factors than simply “the Tories are to blame”
  - X0Refraction 4y ago
    This is the actual issue, spending isn't keeping up with the demand. I'd agree that "the Tories are to blame" doesn't capture it, but I don't think they're equipped to deal with the problem. Real terms spending per age adjusted capita appears to have been on a downwards trend [0] since they took power. I think this has gone up since the pandemic, but I think it's likely too little too late and will probably be a short term increase. I'm also skeptical the IFS have managed to accurately estimate the required increase in funding. They don't go into their workings from what I can see, but I doubt they've accurately included the effect of the lifetime allowance on pensions causing doctors to avoid overtime or the £100k tax bracket where you lose your personal allowance not moving since 2009 which more and more doctors will fall into. I'd imagine they've underestimated it, but would be happy to hear evidence to the contrary. That's not to say that I think any other party has a solution or is properly holding the Tories to account on this. I'll admit I haven't thought too hard about the problem, but I think the fairest solution would be to make pensioners pay national insurance on their income. It wouldn't affect the poorest pensioners and since national insurance is no longer ring fenced for pensions/healthcare I'm not sure what the justification for a tax break based on age even is anymore. As someone who intends to subsist on more in retirement that change would negatively affect me, but I still think it's fair. I know that this would be deeply unpopular though, so I don't hold out much hope of it happening anytime soon. Maybe that isn't the best solution, but I really wish we'd start to have real discourse on how we need to restructure our society as the demographic of the country continues to skew older. [0] https://ifs.org.uk/publications/9186 https://ifs.org.uk/publications/9186 (figure 5)

WithinReason 4y ago

They subtract COVID deaths from excess deaths to get the baseline, forgetting that COVID deaths were counted somewhat liberally, and some percentage of non-COVID deaths were counted as COVID deaths if someone was infected close to their time of death. This can be seen in the following chart: https://ourworldindata.org/explorers/coronavirus-data-explorer?time=2021-12-31..latest&facet=none&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&country=~GBR https://ourworldindata.org/explorers/coronavirus-data-explor... (You need to change the "Metric" dropdown) If you compare excess deaths in 2022 to COVID deaths in the same period: Peaks in COVID deaths don't produce peaks in excess deaths. So saying that excess deaths are higher now than they were in the past is likely due to the underestimation of con-COVID excess deaths during COVID, and not a real effect.

armada651 4y ago
> They subtract COVID deaths from excess deaths to get the baseline, forgetting that COVID deaths were counted somewhat liberally, and some percentage of non-COVID deaths were counted as COVID deaths if someone was infected close to their time of death. If COVID deaths were counted liberaly and even after subtracting those inflated numbers you still have excess deaths, then that only further underlines their point that these excess deaths are not COVID-related. Just because you think the criteria for counting COVID deaths were wrong doesn't make every conclusion based on those numbers incorrect.
- WithinReason 4y ago
  No, they say that current non-COVID excess deaths are higher than non-COVID excess deaths were during COVID. They underestimate non-COVID excess deaths during COVID because of the subtraction, which makes current excess deaths higher than average. In reality, they underestimated the average that they compare to. Hope it's clear now.
  - armada651 4y ago
    I see what you mean, yes it does make it difficult to prove a trend between periods with high rates of COVID infection and low rates of COVID infection. But proving such a trend is problematic regardless of what the criteria for a COVID excess death is. Simply because during a period of high COVID infection a lot of people are dying from COVID before they have the chance to die from other causes.

simonswords82 4y ago

For those not from the UK there’s a wider narrative at play here. Any and all government bashing is almost a national sport and pastime at this stage. Throw in some numbers to try to prove your point and you’re going to be well received. So there’s a lot of misinformation out there. Perhaps this Twitter chap is talking rubbish too. For the record not saying our government is perfect but holy heck it’s hard to keep up with the negativity

M2Ys4U 4y ago
"This Twitter chap" is a journalist at the Financial Times and is a senior fellow at the London School of Economics. He's not just some rando bashing government...
- jokethrowaway 4y ago
  Logical Fallacy: Appeal to Authority I would trust a rando more than a journalist these days
  - M2Ys4U 4y ago
    > Logical Fallacy: Appeal to Authority It's putting the source in the proper context.
  - ben_w 4y ago
    Even though I frequently make note of the Gell-Mann amnesia effect, I'd still rate journalists higher than randos.
  - nobody9999 4y ago
    You might want to check this out: https://en.wikipedia.org/wiki/The_Death_of_Expertise https://en.wikipedia.org/wiki/The_Death_of_Expertise https://www.c-span.org/video/?426290-1/tom-nichols-discusses-the-death-expertise https://www.c-span.org/video/?426290-1/tom-nichols-discusses... Unrelated, but the second link also provides the best definition of fake news I've ever heard.
- 4y ago

cirrus-clouds 4y ago

This twitter thread is excellent. Here are selected tweets to highlight the crisis from hospital and ambulance waiting times. --- "England & Wales as the only part of Europe that has recorded sustained and rising excess mortality over the last few months with no obvious natural explanation." "Patients who waited 8-12 hours had a 16% higher chance of dying in the subsequent 30 days than average." "This was after adjusting for a huge range of possible confounders, i.e this was not due to those patients’ characteristics, conditions etc, but due to the length of the wait." "You may have heard almost 30,000 people waited 12 hours in English A&Es in July, but that figure actually only refers to the wait after initial assessment" "Thanks to @Rebeccasmt’s reporting, we know that if you include all time spent waiting, 100,000 people waited 12+ hours!!" "Take ambulance delays, for example: for emergency situations including suspected strokes and heart attacks, the average wait for an ambulance to arrive on the scene is now one hour, and 40,000 people with these sorts of emergencies waited 2 hours last month." "As before, the peaks in ambulance-related harms broadly coincide with peaks in England’s non-Covid excess mortality. "It’s a grim picture, and an increasingly conclusive one."

deleted 4y ago
[deleted]
simonswords82 4y ago
As somebody else in this thread pointed out the numbers don’t stack up. This thread is subjective at best
- pas 4y ago
  could you link to that pointing out? which parts don't stack up? the 12+ hour wait times, the hospital occupancy, the discharge rate, the aging population and the slashed spending are all seem to be hard numbers (dare I say facts?) ... what doesn't add up?
  - dekhn 4y ago
    If you can wait 12 hours, you didn't have an emergency.

JustSomeNobody 4y ago

Sooo... are they trying to destroy HC so they can rebuild it as the monstrosity we have here in the USA?

pid_0 4y ago
badcppdev 4y ago
Yes there are significant and multiple areas where private healthcare companies are being paid to 'provide' services to the NHS in a classic outsourcing process similar to what you would see in IT. Private company charge a lot more, pay their staff a bit more to attract workers from the NHS, extend their contracts to provide more services where there are NHS staff shortages. Taxpayer money turns into company profits. I wouldn't object if it provided more efficient care but it doesn't seem to.
- DanBC 4y ago
  It's a bit complicated. Private providers can have different staff mixes, so you might have more healthcare assistants and fewer nurses. You might have more unregistered nurses and fewer registered nurses. You might find more staff are on zero-hour contracts, or things like "hotel services" (food, cleaning) are contracted out to companies that are low pay poor condition companies.
  - pkaye 4y ago
    Don't most countries in the EU have a mix of public and private health care providers? How do they manage it?
    - DanBC 4y ago
      In England we can talk about NHS funding and private funding, and we have both. We can also talk about NHS providers and private providers of NHS services, and again we have both.

spywaregorilla 4y ago

I don't have time to go in depth on this but I'm a bit skeptical of the claims here After adjusting for age, the english excess death rate is 5% above. It is the highest. But it also just came from being the lowest several months ago. How much natural variance is in this data. Is this moment noteworthy? Is it possible we're not seeing more people die sooner but rather a large chunk of people putting off death a few months all kicking the bucket now for some reason? Twitter confuses me a bit but reading all the thread here seemed to hide some additional posts which were important. The rate of people going into the emergency room is normalish. The rate of people leaving it is slow but not clearly slower than normal. This does suggest the general problem is really that we don't know where to put all these incapable poor health old people. But... If we assume that people are leaving the system at the same rate as before (afaict no data here), and that the health system had large inflows of patients from covid earlier, it seems likely that this is just the system slowly returning to equilibrium and dealing with that excess bulge of patients who entered and are hard to get rid of. The problem is probably not that patient outflows have gotten worse. It's just that there are more patients in there now because there were a lot more new patients shortly before now. He's got one critical chart which shows that hospital occupancy % has been growing from 6% to 8% 2010-2020. It is now at 12%. But the data is missing for the pandemic period for some reason. So... that seems like an important bit. Is this problem correcting itself? Kind of depends on the rate of change we're seeing in this figure if the rest of the analysis is to be believed. But it's hidden and too short term to make a good forecast on just the recent months.

pjc50 4y ago
> This does suggest the general problem is really that we don't know where to put all these incapable poor health old people. This has been the case for years: there are plenty of people who should not be discharged home to fend entirely on their own, but there's no social care in place to look after them, so they aren't discharged. This is also technically the responsibility of the local council rather than central government. During the pandemic there was almost unlimited money available for Test and Trace, some for the entirely temporary "Nightingale" hospitals, .. and basically no effort to increase staffing levels or solve the social care issue.

bananapear 4y ago

But what has caused the collapse of emergency healthcare in the UK? A lack of supply or an increase in demand?

iam-TJ 4y ago
Increase in demand - much of which is attributed (by the NHS itself) for people having poor life-styles (meaning tending to obesity [0] and not maintaining physical and mental fitness), and the tendency for people to be kept alive longer existing with chronic conditions that a few decades ago would have naturally expired (dead!). There's been an endemic problem for the last 30+ years where-by a large proportion of the population has a sense of entitlement to NHS care without at the same time bearing responsibility to keep themselves reasonably fit and healthy. @ [0]: "Nearly two-thirds of adults in England are overweight or obese. In 2016/17, 617,000 admissions to NHS hospitals recorded obesity as a primary or secondary diagnosis" [0] https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/obesity/ https://www.longtermplan.nhs.uk/online-version/chapter-2-mor...
- Auracle 4y ago
  Meanwhile in the US there’s been a push to limit the copays for insulin, pushing the cost of all of those almost entirely preventable type 2 diabetics on to everyone else.
  - the_why_of_y 4y ago
    This would only be a problem due to how incredibly, absurdly expensive insulin is in the USA. https://www.bbc.com/news/world-us-canada-47491964 https://www.bbc.com/news/world-us-canada-47491964
- deleted 4y ago
  [deleted]
- cjrp 4y ago
  617k is roughly 11% of admissions for that year. That alone doesn't explain the situation.

jrochkind1 4y ago

I hadn't (here in the USA) heard anything about "collapse of emergency healthcare in England" -- can anyone provide some links for some context? What is actually going on, and (to the extent people know/educated guess) why? Have wait times been gradually increasing, or has there been a sudden increase? ("collapse" sounds sudden?) Etc etc.

buro9 4y ago
The Conservative Party have been in power for 12 years. When they gained power they pursued a policy of "austerity" to reduce the size of the govt and local govt, reduce the funding of nationally funded things, and to replace such govt owned things with "public private partnerships". This can be seen everywhere from social care (private care homes), schools (academy schools), transport (where area contracts are bid for by private companies), etc. With health specifically the goal is to have more privately owned profit making companies in the NHS. The NHS as it is constructed doesn't allow for this. But for the Conservatives this opportunity for them and their backers. For the public, there is a national pride in the NHS. So we entered the pandemic with an already under-funded and stretched health care system. Much to the chagrin of those in charge though... this has not led to any calls for privatisation. Nor has it led to a boom in people taking out private health care cover. It turns out that the British stiff upper lip response to something they're nationally proud of is that they'd rather die than embrace health privatisation. So we're in uncharted territory... the playbook that had allowed the privatisation of almost everything else isn't working now, it's just killing people.
- gadders 4y ago
  >> The Conservative Party have been in power for 12 years. When they gained power they pursued a policy of "austerity" to reduce the size of the govt and local govt, reduce the funding of nationally funded things, and to replace such govt owned things with "public private partnerships". You seem to be missing a bit of context here - this was after the Global Financial Crisis when even the outgoing Labour Chancellor of the Exchequor admitted there was no money left https://www.theguardian.com/politics/2010/may/17/liam-byrne-note-successor https://www.theguardian.com/politics/2010/may/17/liam-byrne-... >> So we entered the pandemic with an already under-funded and stretched health care system. It's 12% of GDP currently, which isn't that out of step globally.

cpr 4y ago

swores 4y ago
Not much groupthink needed to downvote somebody who feels a single short sentence, with no citations or.. anything really, yet one that goes against current mainstream medical and scientific opinions, is worth writing. If you actually wanted to try to convince anyone that you might be even somewhere in the vicinity of having a point, you've given up before even trying and opted for pre-complaining about downvotes (something which, on HN, almost guarantees you downvotes even if you're saying something people agree with, btw) rather than suggesting a single piece of data that would lead to any reasonable person thinking "hmm, yeah maybe worth investigating further this theory that vaccines are the cause of UK's current high excess mortality rates". But I suspect you didn't have much choice, if there actually were a compelling argument to make in support of your claim then, well, you'd be making it.
- cpr 4y ago
  You're right in that I'm being lazy and shouldn't have commented without backup data. There's plenty of data out there, but why try to collect if the HN readership's thinking is so mainstream that they'll reject any such attempts out of hand?

drumhead 4y ago

Emergency care hasn't "collapsed". It's under strain from a backlog cases unseen during the pandemic. But collapsed? No.

DanBC 4y ago
What would collapse look like? If people are queueing in an ambo for 12 hours why isn't that a sign of collapse? If people are dying of stroke or heart attack at greater rates, because they can't get ED care, why isn't that a sign of collapse?
- DanBC 4y ago
  So, for example: https://twitter.com/mattdiscombe/status/1562108007407919104?s=20&t=BJAW04MJxuhV9i9PNVDhjA https://twitter.com/mattdiscombe/status/1562108007407919104?... > Almost 333,000 hours were lost by ambulance crews because of handover delays in the 12 months to July 2022 – 18 TIMES higher than the 17,600 hours lost during the same period in 2019 to 2020. What's this if it's not collapse?

oliwarner 4y ago

This isn't a collapse of emergency healthcare, it's a very predicted collapse of community social care: hospitals can't discharge if they need a care home place that doesn't exist. Without inpatient bed availability, ERs and AMUs can't admit to specialties and everything gums up at the front door. Let's be clear: we do need many more doctors and nurses, but the existing ones can't do their jobs because their wards have turned into medically-fit nursing homes. They spend half their days trying to send people (who don't have care requirements) home faster than they'd like. Why? Because central government withdrew funding. Social care is now on the council to fund and many councils have squashed social care, along with libraries and early years provisions. The trap of outsourcing caught many councils out. Turns out the whole endeavour was yet more myopic, Tory penny-pinching.

xtracto 4y ago
It is too bad that corrupt government officials keep systemically defunding Social Health programs with the objective of pushing private for-profit healthcare (which just doesn't make sense). Then they point to the deficient healthcare and blame the "socialized" aspect of it for the issues. Here in Mexico we've seen it all play out: We had an amazing social healthcare system (in the form of the IMSS) in the 70s and 80s. But the corrupt government officials kept dismantling it and allowing corruption to run rampant within the system. All to get a piece of the private for-profit health system including Health Insurance. Back in 2004 when I lived in the UK, the NHS was really good. And I remember hearing at that time that it was nothing compared to the NHS in the 80s and 90s. I seriously hope it doesn't have the same outcome as our system had in Mexico. For-profit health is inhumane.
- oliwarner 4y ago
  2004 was the peak of Blair-Brown Labour party investment. They didn't get it all right. They used PFI and outsourcing to fudge the sums on major investments, and I dare say they didn't invest in mental and social health care in the amount required. But nobody ever has. The job of fixing this is so expensive and requires so much political force. We're still worried French immigrants are going to eat our dingos, or something. I'm fairly certain now we're destined to limp into an American insurance model; eat the poor.

cas14655 4y ago

nobodyandproud 4y ago
Compared to the cesspool that is the US system? The NHS was amazing. We don’t talk about it, but people still die for non-COVID emergencies because hospitals in the Us are routinely full in 2022. Privatization of hospital systems in the US have lead to very warped incentives, where C sections are the norm because it’s faster and more money for the hospital and Drs.
- adventured 4y ago
  > Privatization of hospital systems in the US have lead to very warped incentives, where C sections are the norm because it’s faster and more money for the hospital and Drs. The US rate of c-sections was 32% in 2017 (and roughly the same for 2020), the same as Switzerland. It's 27.7% in Canada, 33.7% in Australia and 27.4% in the UK. 28% across the OECD, 30% in Germany, 45% in South Korea, 34% in Italy. So much for that. https://www.oecd-ilibrary.org/sites/fa1f7281-en/index.html?itemId=/content/component/fa1f7281-en https://www.oecd-ilibrary.org/sites/fa1f7281-en/index.html?i...
  - nobodyandproud 4y ago
    Your own source disagrees. Per your own link: “ Variations in caesarean section rates across countries have been attributed to a number of factors, including financial incentives, malpractice liability concerns, differences in the availability and training of midwives and nurses, and the proportion of women who access private maternity care. For example, there is evidence that private hospitals tend to perform more caesarean sections than public hospitals. In Switzerland, caesarean sections were found to be substantially higher in private clinics (41%) than in public hospitals (30.5%) (OFSP, 2013[1]).” Privatization correlates to more C-Sections.
- pookha 4y ago
  Here in the US I had stage III cancer. I was receiving full blown cancer treatment(s) less than a week after I went to the ER with symptoms (chest port + three types of chemo drugs). And that's routine. The US health care failures are mostly the fault of administrators and insurance companies gaming the public. The care is fast + extensive and it's not a cesspool. And the "full hospital" meme isn't entirely accurate. The US hospital wards are -- by design -- supposed to be full. If 100 beds are allocated for severe flu cases (example) but there's only 25 patients they'll shift the flu ward to 35. Thus they achieve a 75% capacity for the flu beds and allocate the additional beds to other sections. Sometimes the American media (sensationalist by design) will report this as "OH MY GOD THE FLU WARD IS NEAR CAPACITY. 75% FULL!!" without reporting total beds vs flu beds.

adamredwoods 4y ago

The thread reminds me of the Guardian's podcast "Sewage Sleuths" which uncovered catastrophic sewage being dumped into England and Wales's rivers and streams. Very informative and enlightening how bad some government infrastructure can be (hint: in the podcast they also enlightened HOW the failure got bad). https://www.theguardian.com/news/audio/2022/aug/15/sewage-sleuths-slow-dirty-death-of-welsh-and-english-rivers-podcast https://www.theguardian.com/news/audio/2022/aug/15/sewage-sl...

WhyIsItGlowing 4y ago
It's worth clarifying that the issue with the government infrastructure is with the regulatory agencies, rather than the water infrastructure itself which is privatised. There's also a good text article version; https://www.theguardian.com/environment/2022/aug/04/sewage-sleuths-river-pollution-slow-dirty-death-of-welsh-and-english-rivers https://www.theguardian.com/environment/2022/aug/04/sewage-s...
jmfldn 4y ago
It's a failure of privitisation 30 years in the making since water and waste management was privatised in 1989 here in the UK. Of course you can lay some blame at the door of the regulator but let's not forget the tens of billions that have been siphoned off to shareholders and fatcat CEOs, some of whom are arguably criminally negligent and should be put on trial for the catastrophes that have become apparent in recent years.
- lambdadmitry 4y ago
  I really don't like this kind of knee-jerk "privatisation bad, fatcat CEOs bad" reaction sadly prevalent in the UK. Let's talk about the underlying argument, shall we? Firstly, you're talking about a failure of a regulator to regulate an industry and prosecute alleged perpetrators, and the implied solution is to… nationalise the industry, somehow assuming the nationalised entity will be managed better by the very same regulator? I don't think it's a good argument really Secondly, if we go even deeper, what pressures would such an entity have to provide good service and not be wasteful with their resources? Right now there's at least market pressure, the companies trying to outcompete their peers, cut costs, and ensure future profitability by investment. What pressures do you think exist for a nationalised entity that don't exist for a regulator? Thirdly, do you actually have any evidence to prove that those companies are uniquely profitable? Because unless they are, it's only fair that people investing their own money into infrastructure (remember, that was one of the goals of privatisation, tapping private budgets in addition to tax money) get some return on it, otherwise they'd just invest it elsewhere, e.g. into Apple stock, which would benefit British people much less. Privatisation per se is not the problem, political failures are.

FpUser 4y ago

I think Canada can match England in this area. It is borderline criminal what happens here in some cases.

buscoquadnary 4y ago

I don't think it is coincidental that there is also now a large push in England for State sanctioned suicide. Especially after reading how administrators in Canada are treating it.

bambataa 4y ago
What are you talking about?
- n4r9 4y ago
  Not sure what OP is referring to exactly either, but there has been a bit of talk about euthanasia in the press following the case of a man who killed his wife who was dying of cancer (and then attempted unsuccessfully to kill himself): https://www.theguardian.com/society/2022/jul/22/law-euthanasia-assisted-suicide-uk-graham-mansfield https://www.theguardian.com/society/2022/jul/22/law-euthanas... My impression is the attitude towards euthanasia is becoming more favourable. I wouldn't be surprised if it becomes an Labour election promise over the next decade (the Lib Dems already support it I believe).
standardUser 4y ago
Decriminalization of physician-assisted suicide is becoming more popular in a lot of places because it is far more humane than the status quo.

c7DJTLrn 4y ago

My 80 year old grandfather was due for a knee operation and it was delayed twice. On the day after the second time it was delayed, his knee collapsed and he smacked his head on the concrete floor. His speech was slurred, his vision was affected, and he was in extreme pain. Bearing in mind in his younger years he's had eyes slashed open and fingers cut off, so he has a high pain threshold. The ambulance took six hours to arrive. If his brain was bleeding he would have died. When they arrived at the hospital they were waiting a further six hours to be seen. The NHS is a tragedy and I almost wish they'd just hurry up and privatise it so I don't have to pay with it with my taxes anymore, which means the Tories achieved their goal. If I didn't have private healthcare I'd have left the UK by now. I was born and raised here, so I think that says something.

asdff 4y ago
As someone in the U.S., don't expect the timeliness to improve any with private healthcare.
- rajup 4y ago
  Why do you say that, do you have any evidence to back it up? Not saying the US healthcare system is anything to write home about, but it always seemed to me that as long as your pockets are deep enough you should be able to get healthcare when you need it in the US.
  - scarecrowbob 4y ago
    "as long as your pockets are deep enough" Is doing a lot of work there. In the state where I grew up, 18% of people have no health insurance at all.
  - nitwit005 4y ago
    It's not too difficult to find comparisons of countries wait times: https://www.oecd.org/health/waiting-times-for-health-services-242e3c8c-en.htm https://www.oecd.org/health/waiting-times-for-health-service... There are some private practices that will let you pay a premium for quick appointments, but if you need a hospital, you're probably going to experience some wait.

mattlondon 4y ago

As a UK tax payer, and as a UK tax payer that winces every time they see how much they lose to taxation in their P60 each year (six figures in tax), what are people's solutions to this? It seems like the NHS budget keeps on going up and up and up [1], as does the number of doctors and nurses (while "managers" has either declined or stayed relatively static) [2]. So NHS is getting more funding, and there are more doctors and nurses. Yet there is still outcry about how we need MOAR MOAR MOAR! We're spending ~10% of GDP on the NHS at the moment [3] - how much more do people want? 10% appears to be roughly comparable to other developed nations (except USA...) and the data says that nurses and doctors are increasing in numbers while "managers" are not, so the usual cries about the money being spent on "management consultants" appears to be ill-founded, as does the complaints that it is the Tory party reducing funding. Throwing money at the problem appears not to be working because the budget keeps going up, the numbers of doctors and nurses keeps going up, yet people are still complaining about it being awful? What gives? What is the solution when just spending more money isn't working? 1 - https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/funding/nhs-funding-data-analysis https://www.bma.org.uk/advice-and-support/nhs-delivery-and-w... 2 - https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#how-many https://www.kingsfund.org.uk/audio-video/key-facts-figures-n... 3- https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#how-much-does-it-cost https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...

rdl 4y ago
The best thing about NHS (from my perspective as a US person, although I lived in the UK for a while) is the use of QALYS to allocate budget, rather than spending huge sums on a small number of interventions at extreme cost and limited benefit. Has that focus shifted? (My personal belief is there should be a level of universal medical care funded by some public entity, probably the nation state currently, but it should be capped at a relatively low level, probably closer to 1% of GDP and allocated on a QALYS and emergency or communicable biased, with private care in a relatively unregulated market outside of that. Probably would end up in the 5% range overall, but with universal access to basic and cost-optimized care and probably a wider variety of private, charity, experimental care.) We should not spend excessively on medical care vs. other interventions -- it's absurd that in the US we can have homeless people on the street with extremely limited assistance on housing or lifestyle interventions, but as soon as they develop some medical condition, they get essentially unlimited much higher cost intervention to remediate those things, but still nothing to address the underlying cause. There are a bunch of cases where we could shift $1k out of medical spend for $10 in other spend and achieve a better outcome for the person and for broader society.)

lkramer 4y ago

Anecdotal, but I have twice in the last year heard from the same friend of 2 instances where the waiting time for an ambulance was around an hour. The first was when he observed an accident where a car hit a guy on a scooter. The guy was hurt, but not in a life threatened manner. The other was a guy in a bar who probably overdosed on something and his heart stopped. If someone hadn't been around who knew CPR, he would have been dead. Both instances was in London.

cameronh90 4y ago
Even more worryingly is that London has some of the fastest response times in the country. Last two times I had to call 999, for ambulance and police respectively, I was on hold for more than 5 minutes before even being connected to an operator. The overall ambulance target response time is 8 minutes.

diogenescynic 4y ago

Boris Johnson really historically screwed over his country. Even as bad as some of our leaders have been, it seems like Boris significant eclipses their incompetence.

stereoradonc 4y ago

Whats the point of emigrating to the west when this is facing a spectacular failure?

bongoman37 4y ago

phendrenad2 4y ago

When are people going to realize that medical care is the cornerstone of advanced society. Increasing average lifespans raises the collective memetic IQ of the population, and lets us build more advanced things.