NHS

"I know what NHS stands for!" announced mini-Insomniac as he visited his mum in hospital. "It's Natural History Science!"

I can only presume he's alluding to his two favourite London museums. And it beats "No Help Service" that I've heard bandied about in the past... 

The best I could come up with in a hurry? "Not Healthy? Sick!"

Any other ideas? 

More Big Problems

Rather than a reply in the comments section of the Big Problems post, it seemed easier and probably more effective to write a continuation. I know I'm not very good at replying to comments, something at which I intend to improve, but just so you know, I read and appreciate them all! Well, except the spam ones wanting to sell me watches, bank accounts in the Far East and prescription drugs...

It's a difficult issue to tackle, because I genuinely believe that there's no one simple solution, much like a large number of issues within health care. Luckily, I'm not big, brave, clever or well paid enough to make these decisions, but as they do impact me directly, I see no reason why I shouldn't have my say.

Paying for health care has always been, and will continue to be a contentious issue in these shores. In North America this argument, to a certain extent, is incongruous with reality, as the vast majority pay into an insurance scheme and receive their health care dependant on if and what they've paid. However, on both sides of the Atlantic - times, they are a changin'...

As far as taxing foods that are bad for us, and those taxes going directly to health care, well, in truth, that already happens. There's no VAT (purchase tax) on food that isn't considered a luxury. Fruit and vegetables are tax free. Chocolate isn't. Simple. Putting up tax in a way that would make these luxuries only affordable to the upper echelons, will only mean that we have very fat rich people. Well, maybe not. But the question remains of how much of a nanny state do we want to live in? Do we want a government scheme by which you must clock in the exact number of calories you've consumed every day? The idea is impossible to manage, and is the antithesis of living in a land where we are free to make our own choices. And as Fee said, taxing cigarettes and alcohol more and more every year, seems to have done nothing to reduce the overall number of smokers and drunks.

Girliebob made a fantastic point. We can't judge whether a person's worthy of an ambulance just because they're overweight. She's paid umpteen years worth of income tax and national insurance into the system with no obvious return from health care, and should be no less entitled than the young mum next door who's feeding three kids on state benefits, despite having paid in nothing. Irrefutable logic.

A private message I received also questioned the charging of patients who self-harm. More often than not, self harm is caused by mental health issues, whether short-term, temporary issues, acute moments of madness if you will, or some who are chronically ill, clinically depressed, and on a downwards spiral that society struggles to understand and accept. Do these people, those who take blades to their arms, those who genuinely attempt suicide, deliberately overdose on drugs, also deserve to be charged when using the health care system? I'd find it very difficult to justify that these people should be charged, despite the fact that these injuries are self inflicted.

Charging for medical services does occur,  even in the UK. We have to pay for prescriptions (certainly in England and Scotland, although the Welsh get them, errr, scot free), we pay at least part for dental care, even under the NHS, and I suspect that more charges are coming. Minty mentioned frequent callers and also questioned at what point on the overweight scale would we start charging. They're good points, and I wish I had the answers. But then, I'd be a politician and have to make them up, so I think I'll stick to what I hope I'm good at.

I've said it before. The NHS is the victim of its own success, and we're all going to have to get used to the idea that the free ride is well and truly over, at least to some extent. I still don't have the answers, but the questions are fascinating, and the discussions you all prompt are even more so.

I'll leave you with yet another point to ponder.

What about the smoker who improves their life by giving up the cigarettes, but then puts on the weight because of it?

Cutbacks

Cuts need to be made. We knew they were coming. The NHS, like all other government departments, is facing some major changes to help it through these financially unstable times. Ambulance Driver is using this piece of news to the tunes of "I told you so" in reference to the changes being proposed over in the States - the so-called "ObamaCare".

So whilst over the other side of the pond they're trying to change public health care to be a little more like the UK, we over here are travelling in the opposite direction. Surely there must be some sort of middle ground, although I'm not sure where it is. A socialist health system in a capitalist society are always going to clash.

I don't profess, or pretend for that matter, to understand all the ins and outs of the NHS, but I do know a little about the very tiny corner of it that I occupy. The NHS, to a certain degree, has been a victim of its own success.

People live longer, healthier lives. That costs money.

Chronic conditions are better treated than ever before. Sometimes they are cured, other times merely managed long-term. That costs money.

Some prescriptions, at least in England and Wales, have a minimum charge. The rest of the cost is covered by the state. That costs money.

Trauma victims have a better chance of survival. Then they need rehab. That costs money.

Operations cost money.

Drugs cost money.

Staffing the NHS costs money.

Everything costs money. And slowly but surely, we're running out of it. The promise that there would be no front line cutbacks is proving to be another of the broken promises that has become the norm for any political party seeking to seize or retain power at general elections.

Read that linked article at the top, and have a glance through the threatened cuts. One in particular caught my eye. The one that has most relevance to my little corner. They want to reduce the number of people using Accident and Emergency departments, whether through GP referrals, or at a guess, also by self-admission. Only having the newspaper article to go on, I can't be certain what that means for the ambulance world. I'd love there to have been something in there about reducing the number of inappropriate ambulance calls.

Sometimes, to save money, like the NHS needs to, there's a need to spend some money. Money spent on education, for starters.

Education on when to use the NHS. Can you manage your symptoms at home? Does your child really need to go to the doctor? Do you really need to go to A&E at 3am for something that has been bugging you for a fortnight?

Education on how to use the NHS. How do you access the most appropriate care? How do you ensure that you get the follow up you need? How do you call an ambulance, and what for?

As ambulance staff, we are front-line providers. And also have the chance to be front-line advisors and educators. But to do this effectively, we need back up. From the state, from our employers, from the system. Even from our colleagues. There are too many who opt either for one extreme or the other.

Too many who turn up to calls that are a totally inappropriate use of the NHS in general and the ambulance service in particular, and yet do nothing but transport to A&E. It's an opportunity missed.

Then there are too many who get so angry about that same call, that all they do is rant and rave at the patient. The chances of said patient paying attention to a telling off are slim to none.

We trialled a system of not sending ambulances, but unless the pressure on the ambulance service is so severe that it is on the verge, or possibly past the point of collapse, it's not utilised. So for now, we need to take it down one level, and give that responsibility to the crews on scene. If only we could devise a system where we can legally refuse to transport someone to A&E, and at the same time use our skills and knowledge to educate them about all the things I've mentioned. As things stand, we're not allowed to refuse to send an ambulance, and we're not allowed to refuse to convey to A&E. And that's money we could be saving.

Instead of employing managers at astronomical salaries who are paid for nothing more than concentrating on fictitious targets, spend that money on educating both the public and the front-line staff. There seems to be a culture shift in the ambulance service at the moment of taking decision-making and skills away from the staff, leaving those decisions to faceless, albeit trained, phone operators. There seems to be a train of thought that cost-cutting can only be done by employing lower grade staff for the front-line on lower wages, whilst maintaining staff on high wages just to hold clip boards and tick boxes.

Cost cutting within the NHS has to be brutal, but it has to be honest too.

It cannot be that the top few percent hold on to their precious jobs, whether necessary or not, whilst those at the coal-face have their jobs threatened.

It cannot be that those who most rely on the NHS, bear the full brunt of its savings.

At the same time, the general population must accept that they need to help the system, if they still want the system to be there to help them.