Peter Neville Profile picture
Jan 2 20 tweets 4 min read
For those who don't fully understand what is up with the NHS, here is a thread for you that might help.

I'm a consultant physician working as a doctor in the NHS in Yorkshire and Wales for 32 years now. I have experienced the NHS at its best (2008) and its worst (2022).
Over at least the past 15 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer.
Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer.
(Immigrants, by the way, use much less care).
Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it.
Secondly, the NHS is not responsible for social or community care. When elderly folk come into hospital they decondition very quickly and require physio and OT to get back on their feet. Often a care package is required, sometimes even a care home place.
This is the responsibility of the local council to sort out. But council funding has been cut and social workers are dealing with huge case loads. So there are big delays. And we can't send the patients safely home until their care package is sorted out. So they wait. And wait.
And they sit on hospital wards waiting. Often bored and frustrated. About 33% of hospital beds are filled with 'fit for discharge' patients. UK hospitals can do nothing about this. We are effectively working on 66% capacity. Which is one of the key reasons why A&E is rammed.
So when I do my 'emergency take' ward rounds I am seeing patients in chairs, in corridors, in the back of ambulances. There is little privacy and dignity is impaired. We all do the best we can but it is a poor environment. This has become much worse over the past 5 years.
No self-respecting doctor or nurse enjoys working in this environment. No care worker likes to deliver poor care. Salaries were frozen for 7 years of austerity, and have never caught up since. Doctors and nurses now leave university with large debts to pay off.(Not like me!)
One of the biggest perks of the job was the NHS pension. In 2015 this was rearranged to save money, and ensure people have to work longer. It was not done well and this has led to some facing bizarrely massive tax bills - 5 figure sums are common.
If the pension is no longer an incentive to remain working for the NHS then medical and nursing staff can leave the NHS and do agency work. It pays a much higher rate, and you can work as much or as little as you want. It gives you control back - very attractive for parents.
So lots of folk are leaving the NHS to do agency or locum work. Once this happens we have a tipping point. There are lots of vacancies in the NHS that have to be filled by agency nurses who cost much more to employ - there are agency fees as well.
Those of us left are working in jobs with constant colleague absences. So we must work harder, often covering extra shifts at short notice. Because we have to. There is moral pressure to cover oncall gaps because the service cannot be allowed to collapse. We are all so tired.
We cannot recruit. About 30% of new consultant jobs in UK cannot be filled. There are simply not the people to fill the posts.

The nurses are striking because they have to. Not just because they personally are not paid enough, but because they need the vacant posts filling.
They know that if they do not improve pay and working conditions very soon, morale will collapse and we will face mass resignations and retirements. Because when you can earn more driving an HGV than running a ward, you know your profession is in trouble.
They know that if the government wins this, nursing will collapse anyway.

The junior doctors are militant. A strike vote very soon. This is about money. But it is also about working conditions. Because if conditions don't improve, the NHS will fall. The staff have had enough.
Please understand that the RCN has NEVER supported strike action. These are not militants. They are striking out of desperation. To try and make this morally bankrupt government understand that enough is enough. Because they cannot do this anymore.
I am taking my pension in 3 years. I have worked for the NHS all of my life. I have never known it anywhere near as bad as it is now. And this government are trying to blame it on the nurses. Shame on them.
Finally, don't be fooled by the comments about cost. The NHS needs more. If it doesn't get it, YOU will end up paying it somehow. Either through a new state insurance scheme. Or private insurance. Remember the UK spends 9% of GDP on healthcare. The USA spends about 15%.
All these people tweeting about how expensive the NHS should take a look overseas and see what people get for their money. Whatever happens the taxpayer will pay. I mean - who else is there?

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