Brilliant - ZERO !

[redsturgeon]

Simple. The NHS is a lottery. You happened to be a winner.

I do feel fortunate for more than that, if it had been 12 months later I would have in hospital for 3 weeks surrounded by Covid
and comparing war wounds to others I had one of the best surgeons in the country, and a brother and sister-in-law who gave me excellent after care
lucky indeed !

This is very true, for instance, this baby's parents just won the lottery to the rune of 1.79 million!

https://www.bmj.com/content/355/bmj.i5797

John

[UncleEbenezer]

Simple. The NHS is a lottery. You happened to be a winner.

I do feel fortunate for more than that, if it had been 12 months later I would have in hospital for 3 weeks surrounded by Covid
and comparing war wounds to others I had one of the best surgeons in the country, and a brother and sister-in-law who gave me excellent after care
lucky indeed !

Good for you. Next time you may not be so lucky. And of course among those not so lucky are many who never live to express their customer satisfaction. They only feed in to those dry statistics about how, for example, cancer survival rates are much higher in many countries than here.

Re: Snorvey - I have an idea you're talking about the most direct kind of A&E. I think that's less of a lottery: there may be elements of luck in getting good doctors and nurses and a comfortable environment (or not), but there's no question over your admission, your priority treatment, or of repeatedly postponing your life-saving operation until it's too late.

[pje16]

I do feel fortunate for more than that, if it had been 12 months later I would have in hospital for 3 weeks surrounded by Covid
and comparing war wounds to others I had one of the best surgeons in the country, and a brother and sister-in-law who gave me excellent after care
lucky indeed !

Good for you. Next time you may not be so lucky.

Thanks a lot for that thought !

[UncleEbenezer]

I do feel fortunate for more than that, if it had been 12 months later I would have in hospital for 3 weeks surrounded by Covid
and comparing war wounds to others I had one of the best surgeons in the country, and a brother and sister-in-law who gave me excellent after care
lucky indeed !

Good for you. Next time you may not be so lucky.

Thanks a lot for that thought !

One to look out for is the receding promise. The "week after next" timescale that just slides while the cancer spread. In the absence of NHS promises, we could have gone private or abroad four months earlier, and my relative might be alive and well today.

Then there's the gatekeeper. I had similar alarming symptoms twice in my life. First time (2007) I couldn't get seen by the NHS at all. Second time (2015) I won the lottery, and they diagnosed a serious condition that means I'm now regularly monitored. The lottery there was getting admitted in the first place!

[Julian]

One to look out for is the receding promise. The "week after next" timescale that just slides while the cancer spread. In the absence of NHS promises, we could have gone private or abroad four months earlier, and my relative might be alive and well today.
…

Sorry to hear about your relative.

The “receding promise” is something that concerns me too and it’s something that makes me somewhat annoyed whenever I hear the reasonably widespread narrative re COVID-19 that now only hospitalisations and deaths matter and that, in the absence of those, case numbers are not an issue.

I have a condition, luckily not life-threatening but potentially life-altering, that arose in the last 5 months. I was referred very promptly by my GP, my referral was triaged by the hospital, and I was given an appointment with a consultant about 10 weeks after referral. 2 days before my appointment I was called to say that my consultant had been told to self-isolate, that they had no idea when he would be back, and that they would contact me in due course to reschedule the appointment. I have now had that appointment 4.5 months after diagnosis and after the cancellation I did book a private appointment but not everyone can afford to do that. The random disappearance of consultants for weeks at a time due to contact tracing really worries me if case numbers rise even if most are asymptomatic. Unfortunately right now one needs no clinical trials to determine the efficacy of any of the vaccines against contact tracers, the efficacy (to 5 decimal places0 is 0.00000%. ‘You’ve been in contact with an infected person, please self isolate for 10 days after contact”. “you’re fully vaccinated? Don’t care. The rules are the same. Self isolate and cancel your appointment list for the duration, maybe longer if you test positive on an ongoing basis”.

Is the above a polemic against contact tracing? If we are at the stage when most infections are benign then I”m honest;y not sure, and I speak as someone who over the lockdowns raged against the failure to build a decent test, trace and isolate system (my view test excellent, trace not too bad, isolate poor). I’m genuinely confused and conflicted about all of this.

- Julian

[absolutezero]

Instant perverse incentive: go for unnecessary treatment at inflated prices. There may be a problem now of big pharma incentivising doctors, but it pales into insignificance compared to presenting Joe Public those incentives. Indeed, you'd soon (instantly?) start seeing kickbacks to consumers.

The UK housing market is a chronic mess, in large part due to similar perverse incentives: benefits determined by market prices, market prices supported by benefits. And if you go back to the 1977 rent acts, it offers a demonstration of how such a broken market isn't cured but rather made worse by statutory price controls - and demonstrates the potential for other Bright Ideas to go disastrously wrong.

Thought about that too.
GPs would continue to be the gatekeepers. You couldn't just refer yourself for a colonoscopy. A GP referral would still be needed for treatment.
GPs are already privatised, but that also needs reform.

[CliffEdge]

Works well when it works!
But traditionally (the world over) there's a higher proportion of eejits taking up resources in hospitals at the weekend (apparently they restrict their efforts during the week)
- so... if you're going to break your arm you'll get faster service on a Tuesday
-sd

This is why you can't beat the NHS
day to day minor stuff (eg A&E I've got a runny nose !) not so hot
but when it's an emergency, they are Superb !

Disagree. Many countries regularly 'beat the NHS' on a range of measures.
I would privatise the lot except for an NHS run A&E unit in every large town. A&E is the only bit of the NHS that actually works.
Citizens would get a taxpayer funded health insurance card with unlimited budget (as now) but the actual medical services would be provided by a range of competing providers. As it is elsewhere in the world (except you have to have insurance from your own pocket in most places).
The NHS would be welcome to be one of these providers but would have to be competitive along with all the others.
Providers would have to meet care standards and prices set by the DoH. Good ones thrive and can expand. Crap ones go bust.
Government can deal with the logistics of it but that would be my plan to restructure RNHS.

You are so wrong. (Obviously you've never had cancer or any other life threatening medical issue.)

[pje16]

You have NO idea what I had wrong with me, so you are not in a position to make that sort of statement

[XFool]

I would privatise the lot except for an NHS run A&E unit in every large town.

The NHS would be welcome to be one of these providers but would have to be competitive along with all the others.
Providers would have to meet care standards and prices set by the DoH. Good ones thrive and can expand. Crap ones go bust.

Could you perhaps mean "profitable ones thrive", "unprofitable ones go bust"?

Where "profitable" = nice and simple, short stay, one-off operations; "unprofitable" = long term, chronic disease patients.

[Lootman]

I would privatise the lot except for an NHS run A&E unit in every large town.

The NHS would be welcome to be one of these providers but would have to be competitive along with all the others.
Providers would have to meet care standards and prices set by the DoH. Good ones thrive and can expand. Crap ones go bust.

Could you perhaps mean "profitable ones thrive", "unprofitable ones go bust"?

Where "profitable" = nice and simple, short stay, one-off operations; "unprofitable" = long term, chronic disease patients.

It is the exact opposite. If you are running a for-profit healthcare facility then you want very expensive treatments because they are much more profitable than someone coming in to get their bunions sorted. Because you bill the insurance company for the work.

Anyway the point here is surely that we have now had a number of zero deaths days. Cases may be up but sickness is down, which is exactly what one would expect with high vaccination rates and a relaxing of restrictions. The one odd thing is how the government seems to be tightening travel restrictions, seemingly without a rationale. The G7 meeting apart, of course.

[XFool]

Where "profitable" = nice and simple, short stay, one-off operations; "unprofitable" = long term, chronic disease patients.

It is the exact opposite. If you are running a for-profit healthcare facility then you want very expensive treatments because they are much more profitable than someone coming in to get their bunions sorted. Because you bill the insurance company for the work.

Ah. There's always a little snag somewhere with these magically "efficient", private enterprise, alternative solutions, isn't there.

[9873210]

Anyway the point here is surely that we have now had a number of zero deaths days.

Because zero and one are perfectly fine numbers.

for "Deaths within 28 days of positive test by date of death" the number of zero death days since January is zero.
for "Deaths within 28 days of positive test by date reported" the number of zero death days since January is one.*


https://coronavirus.data.gov.uk/details/deaths

* Even bureaucrats need a holiday once in a while.

[Lootman]

Where "profitable" = nice and simple, short stay, one-off operations; "unprofitable" = long term, chronic disease patients.

It is the exact opposite. If you are running a for-profit healthcare facility then you want very expensive treatments because they are much more profitable than someone coming in to get their bunions sorted. Because you bill the insurance company for the work.

Ah. There's always a little snag somewhere with these magically "efficient", private enterprise, alternative solutions, isn't there.

You were talking about profitability, not efficiency. Efficiency would come with competition rather than size of operation.

Anyway the point here is surely that we have now had a number of zero deaths days.

Because zero and one are perfectly fine numbers.

for "Deaths within 28 days of positive test by date of death" the number of zero death days since January is zero.
for "Deaths within 28 days of positive test by date reported" the number of zero death days since January is one.*

*Even bureaucrats need a holiday once in a while.

The report I read had the number at three. But regardless the point is surely that we are tending to zero deaths per day even as the infection rate may be increasing. Which is surely exactly where we should be. If infection now means light to no symptoms then the issue has become manageable and contained. The infection numbers will then take care of themselves.

[Mike4]

The report I read had the number at three. But regardless the point is surely that we are tending to zero deaths per day even as the infection rate may be increasing. Which is surely exactly where we should be. If infection now means light to no symptoms then the issue has become manageable and contained. The infection numbers will then take care of themselves.

Perhaps there were a couple of days last summer with zero deaths reported within 28 days etc etc. I noticed on Tuesday 12 deaths were reported but that didn't make the headlines in the popular media, nor did the 18 deaths reported on Wednesday (or perhaps it was Thursday) this week. So it was just a blip in the method of collection, probably.

I think the government have actually finally learned their lesson with the Delta (India) variant in that early action based on incomplete data works better than waiting for reams of data before deciding what to do. Hence their reluctance to open up earlier than their timetable (oddly called a "road map"). I think they are taking into account that each new variant coming along is a bit better at vaccine evading and there are a couple on the horizon beyond Delta we know very little about yet.

A new variant with even higher transmissibility and significant vaccine evading ability getting a grip would be an embarrassing political disaster for Boris et al, don'tcha think?

[murraypaul]

But regardless the point is surely that we are tending to zero deaths per day even as the infection rate may be increasing. Which is surely exactly where we should be. If infection now means light to no symptoms then the issue has become manageable and contained. The infection numbers will then take care of themselves.

While I am hopeful that vaccination rates will mean the death rate stays low in the upcoming months, what we are seeing, with cases rising but deaths not, is exactly what you would expect regardless or vaccination rates.

Hospitalisations lag cases, and deaths lag hospitalisations.

So it will be a couple of weeks more before we really see what effect the current case numbers have on deaths.

[Mike4]

But regardless the point is surely that we are tending to zero deaths per day even as the infection rate may be increasing. Which is surely exactly where we should be. If infection now means light to no symptoms then the issue has become manageable and contained. The infection numbers will then take care of themselves.

While I am hopeful that vaccination rates will mean the death rate stays low in the upcoming months, what we are seeing, with cases rising but deaths not, is exactly what you would expect regardless or vaccination rates.

Hospitalisations lag cases, and deaths lag hospitalisations.

So it will be a couple of weeks more before we really see what effect the current case numbers have on deaths.

The risk as I understand it is if a large mass of virus is allowed to circulate freely in the unvaccinated, it still matters despite those people not dying of it. It would mean the chances of a vaccine-evading mutation emerging sooner rather than later are greatly enhanced. Then the vaccine-evading mutation will start killing off those of us who are vaccinated while we all wait for a new vaccine to be designed, developed and tested.

[XFool]

It is the exact opposite. If you are running a for-profit healthcare facility then you want very expensive treatments because they are much more profitable than someone coming in to get their bunions sorted. Because you bill the insurance company for the work.

Ah. There's always a little snag somewhere with these magically "efficient", private enterprise, alternative solutions, isn't there.

You were talking about profitability, not efficiency. Efficiency would come with competition rather than size of operation.

The question is (as ever): whose "efficiency"?