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So....here we are... the future of the NHS

Discussion in 'Personal' started by HelenREMfan, Jun 16, 2019.

  1. florian gassmann

    florian gassmann Star commenter

    We have indeed already been through all this. The documentation makes it clear that if the need for, say, a hip replacement is causing pain and mobility issues, it will be done on the NHS at no charge. The "My Choice" option is for people who have been diagnosed as needing a hip replacement at some unspecified time in the future but who have not yet met the NHS criteria (which includes pain even at rest, and mobility issues).

    I don't see why this is so difficult to understand. Can you enlighten me, perhaps?

    Just because somebody "needs" something, such as a vasectomy reversal, circumcision for religious reasons or surgery for cosmetic reasons, it no longer follows that the NHS is willing to pay for it.
     
  2. chelsea2

    chelsea2 Star commenter

    Yes, I get all of this. My issue has been that people who can afford to pay can get their hip replaced sooner by filling a vacant slot, which could just as easily be filled by someone in pain waiting for a hip replacement, who subsequently has to wait longer.

    I also get all of this, and don't have a problem with it.

    But I still don't get why hip replacements are judged as of the same level of 'need' as skin tag removal or vasectomies for example, nothwithstanding that they are eventually done when the pain is really bad.

    I understand all the points you have made.
    I still disagree with the system as described and explained.
     
  3. florian gassmann

    florian gassmann Star commenter

    My impression is that the WHH Trust can service both patients. They do, after all, make it clear that their MY Choice service in no way impacts on normal NHS operations.

    The NHS these days works on criteria. If a patient does not meet the criteria for hip replacement, it will not normally be offered, just as skin tag removal will not normally be offered. Vasectomies WILL be offered, but vasectomy REVERSAL will not.

    As I explained to needabreak, the hospital says that it if does not fill its vacant slots with self-funded patients, the slots are likely to disappear and will then be available to nobody, whatever their need.
     
    Last edited: Jun 18, 2019
  4. Stiltskin

    Stiltskin Lead commenter

    You don't avoid the waiting list with Criteria Based Clinical Treatments. They are treatments which the patient circumstances deem the procedures not worth the Trust's expenditure. The person ends up on the same list as someone who is deemed by the Trust as needing the procedure. Some on that list I can understand but cataracts! Not offering that goes against NICE guidelines and tbh is going to cost the NHS more in the long run.
     
    agathamorse likes this.
  5. HelenREMfan

    HelenREMfan Star commenter

    Here.... this is what is happening in my borough.

    It has come to our attention that a private company has been given a contract for both the Widnes and the Runcorn Urgent Care Provision (walk in centres) by the Halton CCG.
    In addition, Warrington Hospital are now offering private services (self funded) for services no longer available on the nhs. The worry is that the list will grow, as the government are working towards a health insurance model of healthcare. This feels like the start of a two tier service - a well resourced one for those who can pay, and eventually no doubt, a poorly resourced one for those who can’t."

    As I posted originally in that there is a priceless for the ops the NHS doesn't seem to be going to do in our area.
     
    chelsea2 likes this.
  6. florian gassmann

    florian gassmann Star commenter

    Indeed so. I think that is what I said.

    You are mistaken. The NHS continues to offer cataract surgery but, like all treatments, patients have to meet the criteria for the procedure:
    https://www.sath.nhs.uk/wp-content/uploads/2016/08/Threshold-for-cataract-surgery.pdf

    The option for self-funded treatment is for people who don't meet the criteria for NHS treatment listed in the above document but who would nevertheless prefer their cataracts to be removed.
     
  7. florian gassmann

    florian gassmann Star commenter

    A CCG cannot just "give" a contract to a private provider. It is legally required to hold a competitive tendering process in which the NHS can be (and usually is) tendering against private companies. The King's Fund noted some years ago that private providers have been more successful than NHS providers in winning contracts put out to tender,

    No. The service offered to self-funders is exactly the same as that offered to NHS patients: same doctors, same nurses, same wards, same operating theatres, same waiting lists.

    The list of CBCTs is the same for all NHS areas. Basically they are treatments which the NHS has deemed as not meeting its criteria because they are merely cosmetic, inessential, ineffective or non-urgent, and so represent poor value for the CCG. When a patient meets the criteria - such as the need for hip replacement - it is offered on the NHS as it always has been.

    In your area you have hospitals which have the capacity to offer these inessential treatments to those who wish to pay. In most areas, that is not the case. So, if you want your vasectomy reversed you have to go private (fully private, that is, not the reduced price rate offered by your CCG)..

    (There is an argument that if the NHS offers vasectomies, it should offer to reverse them - but reveral has a poor success rate and it is something that the NHS has always been reluctant to offer.)
     
  8. Stiltskin

    Stiltskin Lead commenter


    You did. Sorry! I wrote that a while back and forgot to post it. When I went back into TES it was still in there and I accidently posted it (so missing 4 pages of replies since).

    Regarding cataract surgery NICE guidelines are being ignored by a lot of trusts who are setting the threshold too high as noted in the RNIB report:
    https://www.rnib.org.uk/patients-are-being-denied-vital-cataract-surgery
     
    agathamorse likes this.
  9. florian gassmann

    florian gassmann Star commenter

    I shall probably discover that for myself this summer, as I have been told for a couple of years now that I am developing cataracts.
     
    agathamorse likes this.
  10. chelsea2

    chelsea2 Star commenter

    Followed the link on this site to 'Rationwatch'.
    Its purpose:
    To demonstrate the extent of the problem, the MTG has established Ration Watch, an online resource which will showcase evidence of rationing of NHS treatments across England. Ration Watch will highlight the impact of rationing and the damage it does to patients and the NHS. Through raising awareness of this issue, we hope to drive NHS leaders to do more to ensure patients do not face a postcode lottery in accessing lifesaving and enhancing medical technology.

    I got the following message:
    The site rationwatch.co.uk has been disabled. Please contact support.

    Interesting....
     
  11. needabreak

    needabreak Star commenter

    It's not about what I like, it's about you only just providing a link with any figures to represent your previous assertion... Incidentally the link you just posted illustrated early and late starts of in the region of +/- 30mins amounting to 16% under capacity use, doesn't seem like anything like the figure you said earlier and thus makes my spare capacity comment early all the more pertinent.

    I would imagine most people would prefer their surgeon was not rushed.

    Meanwhile that report you just posted a, link to also gives the option of increasing patients numbers from NHS waiting lists, which is as Chelsea pointed out possible and in our view preferable to selling off even 16% spare capacity.

    In response to your question I'd prefer that the NHS spent its time and resources using their spare capacity rather than selling it to the private sector who should incidentally be using their own facilities.
     
  12. Stiltskin

    Stiltskin Lead commenter

    fingers crossed for you being the better third of trusts!
     
  13. Stiltskin

    Stiltskin Lead commenter

    That usually gets put up when an internet host discovers malware or similar on a website.
     
  14. HelenREMfan

    HelenREMfan Star commenter

  15. florian gassmann

    florian gassmann Star commenter

    Are you sure you have understood the My Choice scheme under discussion? There is no private sector involvement. It is a service offered by the NHS, using NHS staff and NHS facilities. All income goes to the NHS.
     
  16. needabreak

    needabreak Star commenter

    Yes I understand perfectly well thank you, they are selling use of NHS resources.
     
  17. florian gassmann

    florian gassmann Star commenter

    But not to the private sector, as you falsely claimed:

    You claim to "understand perfectly well" and yet you come out with nonsense that the private sector should be using their own facilities. How can they when the private sector is not involved? :D
     
  18. needabreak

    needabreak Star commenter

    Ok on the "market" for health care, though I thought you said surgeons were using the facilities in their own time if not then there is some justification as if their time is not well used then that can legitimately be offloaded, but plans to use their time more effectively would be more appropriate in the long term as your report says.

    Apologies posting in between work so not reading every post.
     
    Last edited: Jun 19, 2019
  19. Jolly_Roger15

    Jolly_Roger15 Star commenter

    Circumcision looks a snip at £2000.
     
    needabreak and agathamorse like this.
  20. EmanuelShadrack

    EmanuelShadrack Star commenter

    It was up and running when I tried it just now.
     

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