Whatever is happening to the NHS?

[StephenM]

Because I am a long term (well into fifth decade) diabetic there have been some background changes to my eyes. These have caused false positives a number of times and I was therefore put under the local ophthalmology department. I therefore see the consultant every nine months. The last time was three months ago. My follow up appointment came through two weeks later. This morning I got a new appointment three months later apparently due to a lack of resources. What the hell is going on?

This seems to be part of a general decline in NHS services. A diabetic friend had routine surgery cancelled as the hospital did an HbA1c and felt it was outside range - ~9% above their upper level. Part of the problem is that the (non-diabetic) problem is limiting his mobility and having an adverse effect on his fitness. A friend?s wife has also had planned surgery postponed as she fell outside their weight criteria (just). This was after making heroic efforts and losing over two stone in three months. I could quote other examples but you get my gist. It seems that we are heading back to the grim old days pre 1997!

 

[Northerner]

Cuts and an expensive and rushed reorganisation of services? I remember my first 'annual' review was postponed by 4 months, then when that date came around the clinic had disappeared and I received a letter a week AFTER the appointment telling me not to attend and to look for another consultant or go back to my GP! 😱

Having said that, it is a massive logistical nightmare with a declining workforce trying to deal with an increasing demand,and we probably forget the times when things went smoothly, as they mostly have for me.

 

[Pumper_Sue]

Hi Steven,
with an A1c of 9% the surgical team would be deemed negligent in going ahead with surgery due to the guaranteed complications.
Same goes for the weight loss it was obviously not enough to make the op safe for the patient.

There's a lady a few doors down from me who weighs in at over 20 stone has a serious heart condition, tells the Drs she is dieting etc, you walk into her house and think 😱 if that's dieting what does she normally eat.
She though blames anyone and everyone except herself for her weight problems and the things she calls the specialist because he says he can not and will not operate on her until she loses the weight is again 😱 She has even been told she will die unless she complies.
The guidelines are there for a reason.

 

[StephenM]

Pumper Sue ? sorry but I may have used bad examples but I was trying to highlight that delays and cancellations have increased markedly in most areas of the NHS during the past year ? eighteen months. One of the people is in danger of a strangulated hernia and this would mean an operation regardless of any guidelines! Locally one person successfully received a gastric band despite a BMI of 35 and a HbA1c nudging the teens!

The NHS was in a mess in 1997 and improved over the years until it got overloaded with managers and administrators. Now the coalition is justifiably cutting costs but all too often in the wrong areas. The reason ? most ministers can afford private health care whist the majority of the populace cannot!

P.S. I have postponed your ?O? level as you spelt my name wrong!

 

[Twitchy]

Stephen, I can relate to your frustration - my father in law has a chronic heart problem. He was told back in early october that he needed a pacemaker & defib op 'within 2 months'. His op is now scheduled for March. A member of staff has confirmed that he is very seriously ill, but the delay is for 'funding reasons.' The 'good news' is that if he survives that long it will tip over the magic 6 months which will trigger treatment outside the nhs if necessary. It almost feels like survival of the fittest when it comes to elderly care - f you survive a prolonged wait, it might be worth their investing in you. It sucks. He's a lovely man, paid into the system all his life & now he really needs it he's treated like he's over his best before date & let down big time. So much for protecting the nhs cameron...

 

[Caroline]

The thing I find frustrating and annoying is we all pay for the NHS through taxes and stuff, and there are groups that raise moneys for their local hospitals and we still get bad service.

If I wanted to see my GP now, I'd have to wait till the new year before I could see my own doctor, although I am lucky as there are a couple of good drop in centres near my home and an out of hours service for advice. Not everyone has that.

 

[Pumper_Sue]

P.S. I have postponed your ?O? level as you spelt my name wrong!

How kind of you.
When you are perfect let me know and I will announce it it the times.

 

[Ellie Jones]

Sometimes there are very validated reasons to why an individual patient's treatment/appointment has been postponed , cancelled or refused...

And yes sometimes it is purely based on Budget, and having to cut back services because of lack of money....

Wonder how many people don't get their pacemakers, hip, knee operations or other treatments that will improve their health and quality of life!

Because money for this has been diverted to Diabetic Eye Screening!

A whole department of people, running costs etc purely based on patients failure to help themselves and book a yearly optician's appointment.....

Diabetics ended up with needing some very extensive treatment, losing their eyesight... Not because the didn't have access to check up in that area...

But because the failed to adhered to simplistic advice about ensuring that they regularly got their eye-examinationed via their own opticians....

Back before screening, our hospital did a couple of helpful things, they set up a emergency eye clinic to run alongside their daily specialist eye clinic (Mon-Fri) they also implemented that optician could make direct referral to see a consultant. Taking out the longer route of optician contacting your GP and GP making the referral...

A simple fast system, you could go to your optician in the morning and been seen by a consultant in the afternoon, with one phone call to the emergency eye clinic if deemed necessary, or a quicker normal referral...

The only problem with this, it totally relies in our case the diabetic, to actually make the appointment with our optician, if we don't go then it can't be utilised to it's best effect...

Now this system is still in place but also our PCT is paying to run a Screening department just for diabetics who in the past couldn't be bothered to put themselves out once a year to visit their optician!


Even though having to wait for treatment sometimes does have an impact on our quality of life...

But perhaps a reminder to what we do have...

In a list of 24 things, that reinstalls faith in humanity posted on the internet...

A photo of a Sign out Side of a Doctors in New York after hurricane Sandy.

Free Medical Treatment!

A doctor offering medical treatment free of charge to New York citizen's who had been hurt during the hurricane and don't have medical insurance.

 

[Andy HB]

Because money for this has been diverted to Diabetic Eye Screening!

A whole department of people, running costs etc purely based on patients failure to help themselves and book a yearly optician's appointment.....

I'm not sure that you are quite right in your assessment here.

The yearly retinopathy scans are over and above what you can get on the street and do something entirely different.

Andy 🙂

 

[Ellie Jones]

Andy not sure how long you've been diabetic for...

But I was having photograph's of the back of my eyes by my optician a long time before screening was brought in... And the photographs that my optician took is identical to the ones done at screening.

All be it I had to pay ?20 as the photograph wasn't included as part of the NHS eye-examination.. But my optician explained the merits of having the photographs, as he explained.

The practice of hand drawing information, which the consultants still do as regular practice, can be open to interpenetration and a degree of inaccuracy etc...

But the photograph, gives a concise image, and one that is easier to compare with a previous one...

And to me, ?20 was a bargain.

When I started insulin pumping, I landed in the eye clinic under a consultant, as I've got an embolism in one eye, non-diabetic related first discovered when I was about 18... Their were concerns that starting on the pump might cause problems... I was monitored for over a year before discharged, and not once in all that time did I have a photograph taken of the back of my eye, all information was hand drawn into my medical records...

Same as hubby he has never had screening done, as he's been under the eye clinic for 25 years or more, and in all that time they've taken one photograph..

So I don't think I'm far wrong...

A lot of diabetics lost their sight due to not going to the opticians until they visually noticed something amiss!

 

[AJLang]

I've ALWAYs gone to the optician at least once a year and had eye photos via the hospital every year for more than 23 years it still didn't stop me needing to have diabetes related laser two years ago.

 

[Northerner]

I've had regular retinopathy screening since diagnosis 4.5 years ago. Not sure when it was brought in, but it's one of the major 9 checks under NICE guidelines so should be available to everyone with diabetes. Some people go to a local optician's to have the photos done, I never have but I live in a big city.

 

[Andy HB]

Andy not sure how long you've been diabetic for...

But I was having photograph's of the back of my eyes by my optician a long time before screening was brought in... And the photographs that my optician took is identical to the ones done at screening.

All be it I had to pay ?20 as the photograph wasn't included as part of the NHS eye-examination.. But my optician explained the merits of having the photographs, as he explained.

The practice of hand drawing information, which the consultants still do as regular practice, can be open to interpenetration and a degree of inaccuracy etc...

But the photograph, gives a concise image, and one that is easier to compare with a previous one...

And to me, ?20 was a bargain.

When I started insulin pumping, I landed in the eye clinic under a consultant, as I've got an embolism in one eye, non-diabetic related first discovered when I was about 18... Their were concerns that starting on the pump might cause problems... I was monitored for over a year before discharged, and not once in all that time did I have a photograph taken of the back of my eye, all information was hand drawn into my medical records...

Same as hubby he has never had screening done, as he's been under the eye clinic for 25 years or more, and in all that time they've taken one photograph..

So I don't think I'm far wrong...

A lot of diabetics lost their sight due to not going to the opticians until they visually noticed something amiss!

I've had a retinopathy scan every year organised through my GP ever since diagnosis in October 2009.

I think that you and your husband should be making sure that you DO have a regular retinopathy scan too. I suspect that you have fallen through a crack somewhere.

I may be wrong, but it is also my understanding that most (if not all) high street opticians no longer take photos (but am willing to be proven wrong if someone knows better) ... which Northey just has!! lol

Andy 🙂

 

[Ellie Jones]

Andy

Not all high street optician's do photographs, and as norther said, Some PCT's have opted to use high-street opticians, others like my PCT prefer to keep it all in house.

No Les hasn't fallen through the net, he was called for Screening when they brought it in... So phoned them explained he's under a eye consultant already. So they said he need not attend.

Les has been under the eye consultant since 1980, so with a consultant peering into his eyes on a regular bases, nothing more would be achieved with a screening scan...

When I was under the consultant I didn't go for screening, I do now that I've been discharged from clinic, time my optician appointment 6 months after my screening appointment..

 

[trophywench]

Ellie, it depends where you live clearly.

I have gone to the optician every 12 months without fail from age 14 before I was diabetic and ever since. I have astygmatism in one eye and long sight in both. Then I became diabetic. Once a year, the hospital would put the eye drops in and have me sat in a darkened room peering into the corners whilst the consultant squinted at me eyes through his hand held doo-dah. The optician used also to do this, but without the drops.

One day the optician said I had the start of background changes in one eye and as I had a clinic appt the next week, I mentioned it to the consultant who had another look and pronounced that 'Mr J must have better eyesight than me then, cos I can't see anything' - but anyway as the years went on, he could see it.

Then in 1998 I moved to Coventry. Coventry had a specialist eye unit, so we got a separate appt to go there where a consultant looked at you through one of those slit thingies, where your head is in the same frame with the lights on, that is used in the retinal photography. Then they as you say, drew what they saw. Subsequently that changed to retinal photography with a mobile unit coming to GP surgeries once a year and that still happens now.

I have never ever been offered photography at any optician I have ever been to in my whole life.

I'm damn sure if they'd ever offered it, despite having to pay, I would have paid and gone. There is absolutely no doubt whatsoever in my mind that I would. I did see during that time, either in Balance or elsewhere, that it was available at Moorfield's privately and thought about it - but the cost of going there (travelling cost plus fee) seemed disproportionate to what everyone was agreeing was actually wrong with my eyes. And I would still say that now with 'background changes' in both eyes.

You have also to consider that many diabetics - esp T2 - may have had D without symptoms, for a good many years before it's accidentally discovered ! So if their eyes go or their feet go numb - it AIN'T necessarily THEIR fault, is it?

 

[bev]

Personally I dont think its a problem. One appointment changed hardly means the NHS is on its knees!😉

I am not keen on NHS bashing - I think we are lucky to have what we have. If clinics had full attendance from patients perhaps it would be more efficient - but many people just dont bother to go and dont bother to ring to cancel - so a full clinic is still held paying all staff and Consultants for someone to not bother turning up. Recently we had a member on the CWD list who forwarded an email from DUK and a GP network asking why there was such a high percentage of Type 2's who choose not to attend any appointments. I personally dont understand why someone would refuse care or attend at clinic - but they do and it has an impact on the services offered.

Clearly the NHS is having problems in terms of funding - but I dont feel it is all down to Politics - we all have to take responsibility for how we use it. I know of people who actually go to A&E for a cough and cold!😱That is abusing the system in my view - all because they cant be bothered making an appointment at their GP's. NHS staff do an amazing job and I dont know how they cope with some patients - from drunks to drugs - to violence - they see it all and mop up the mess. I couldnt do what they do. I would much rather have our NHS than live in the USA and worry if I didnt have sufficient medical insurance.🙂Bev

 

[bev]

I have never ever been offered photography at any optician I have ever been to in my whole life.

Hi Trophywench,

Until a child is 12 they are not offered retinal screening so we took Alex (diagnosed at 10) to our local Opticians who provided this service as do quite a few now - it cost ?15 but worth every penny.🙂Bev

 

[StephenM]

How kind of you.
When you are perfect let me know and I will announce it it the times.

As Pop (David Jason) said "perfick"!

 

[Andy HB]

I actually think that the NHS is extremely well funded (even now).

The problem is that it is not spent efficiently. To many high and middle management and not enough clear and consistent thinking. Disjointed IT systems and poor management of IT projects etc etc.

My partner works in the NHS and some of the stories she tells me make my hair stand on end! The amount of waste (both in time and material) is staggering.

But despite all that, I have to say that I am, on the whole, very happy with how I was treated by the NHS and I wouldn't have improved so much without that care. So it isn't all doom and gloom.

Andy 🙂

 

[Northerner]

When I was in hospital I have never seen people work so hard and I was very humbled. Out of the hundreds of people who cared for me only one or two fell a little below par, but I felt moved to write to the hospital manager afterwards in praise of two nurses in particular. The man managing the beds was outstanding - how he maintains those levels of stress and doesn't end up in one of his own beds I have no idea.

As I said before, it's a massive organisation with hundreds of thousands of staff dealing with millions of people, many of whom present critical and extremely challenging problems. Again, I would say that the problems arise due to the pressure caused by underinvestment in staff and the sheer complexity of the timetable.