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Why has this issue not been mentioned earlier?

North Yorkshire PCT issued a statement earlier saying that they had a duty to remain solvent, and I agree with them entirely.

Surely IVF is a nicety? Its not like a serious health issue, its just wanting kids.

A desire isnt enough for the tax payers surely? I desire some new shows, im not going to bill the public for them.

http://www.bbc.co.uk/news/health-13670615

In a time of economic unrest, and a stark realisation just how much of an issue an exploding population is, why is this being criticized, when it seems to be the most sensible move!?

Won't someone think of the children!

But I agree with you. There are a number of programs and treatments that are not really needed from a medical or social point of view.

However, one of the biggest problems as I can see it is the horrible mis-management at pretty much every level within the NHS, combined with things such as PFI's which will absolutely cripple the NHS, forcing them to essentially "rent" their hospitals at stupid prices for years.

I'm torn. Not sure if I agree with it or not.

It's not a serious health issue - it doesn't stop the people themselves living healthy lives. But it could be construed as being psychologically damaging, not being able to have kids.

Same reason that some people manage to blag breast enhancement etc on the NHS (/opens another can of worms....)

Yeah, saw a similar 'story' on BBC Breakfast this morning and to be honest, it just smacked of trying to stir up trouble and outrage where none exists, a la Daily Mail. Its a bit of a non-story really; PCT's are under an obligation to act fiscally prudent and that includes taking potentially tough decisions on certain non-essential treatments.

What annoyed me, was the BBC story seemed to me to be suggesting that the IVF restrictions that were being considered were somehow wrong. Just to reiterate, these restrictions include not giving IVF to smokers and obese people, How can that be wrong? Surely that is sound health advice? After all, if a potential IVF patient can't be arsed to kick the fags and donuts then they shouldn't be thinking of being a parent, frankly.


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GazzyG wrote:I'm torn. Not sure if I agree with it or not.

It's not a serious health issue - it doesn't stop the people themselves living healthy lives. But it could be construed as being psychologically damaging, not being able to have kids.

Same reason that some people manage to blag breast enhancement etc on the NHS (/opens another can of worms....)

I think the annoyance comes from regional variation on what the PCT will/won't offer in terms of IVF and what restrictions they have applied. In an ideal world, all PCTs would act under the same restriction - the issue comes from PCTs ignoring the official guidance, which seems a little out of date given the financial conditions in which they are operating.

filbert wrote:Yeah, saw a similar 'story' on BBC Breakfast this morning and to be honest, it just smacked of trying to stir up trouble and outrage where none exists, a la Daily Mail. Its a bit of a non-story really; PCT's are under an obligation to act fiscally prudent and that includes taking potentially tough decisions on certain non-essential treatments.

What annoyed me, was the BBC story seemed to me to be suggesting that the IVF restrictions that were being considered were somehow wrong. Just to reiterate, these restrictions include not giving IVF to smokers and obese people, How can that be wrong? Surely that is sound health advice? After all, if a potential IVF patient can't be arsed to kick the fags and donuts then they shouldn't be thinking of being a parent, frankly.


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GazzyG wrote:I'm torn. Not sure if I agree with it or not.

It's not a serious health issue - it doesn't stop the people themselves living healthy lives. But it could be construed as being psychologically damaging, not being able to have kids.

Same reason that some people manage to blag breast enhancement etc on the NHS (/opens another can of worms....)

I think the annoyance comes from regional variation on what the PCT will/won't offer in terms of IVF and what restrictions they have applied. In an ideal world, all PCTs would act under the same restriction - the issue comes from PCTs ignoring the official guidance, which seems a little out of date given the financial conditions in which they are operating.

I agree almost entirely with you here, and I can see Gazzys point, well.. sort of, but then, Im a bit of a self confessed heartless bastard.

Sure it must suck if you really want kids, but hey ho, thems the breaks. If its not essential to your health, you shouldn't get it paid for. Wanting a kid is merely a want, not a need.

I agree with the move, and im stunned that the BBC is trying to insinuate that this is wrong, of course there should be restictions!

For example, I want a 12 inch penis, as im not that happy with my ten inch pork sword. Does that mean the NHS should pay for on op? I mean.. I really really want it!

The gist of this article can be summed up in its fourth sentence:

The MPs say the result is a postcode lottery of care and are calling on trusts to implement the official guidelines properly.

The issue being reported is that NHS trusts are breaking NHS rules on the provision of IVF. If you don't like NHS rules, that's a political issue to take up with politicians, not an admin issue to take up with managers.

Oh, and a penis that measures less than 12" is not a medical abnormality. An inability to have children is.

lindsay40k wrote: An inability to have children is.

The greatest challenge here is being able to create a policy which works on the basis of a medical abnormality. Which is notoriously difficult when the health service is driven more by politics than science.

For instance, a person who is unable to have children because of obesity-induced diseases (e.g. diabetes), do we give them IVF, as the inability can be solved much more effectively by them not being obese.

Where do couples stand when the CAN have children naturally, but the chances of conception are very slim?

What about a couple that already has children, but now requires IVF to have additional ones?

A single unemployed woman on benefits wants a baby by IVF.

If we were to consider these cases under a purely scientific rationale, then we could easily produce clear-cut yes-and-no answers. But since (especially in the UK) we don't always seem to follow the logical course, we have to consider all of them.

Take the last example, we know that giving that woman a baby by IVF would cost money in terms of the IVF treatment, subsequent neo and post-natal care, child benefits once the child is born, and that child is likely to grow up in impoverished surroundings etc etc etc. Logically it would make sense to refuse IVF, but if the woman claims that as a woman she has a right to bear children, we start muddying the waters a little

Leigen_Zero wrote:

The greatest challenge here is being able to create a policy which works on the basis of a medical abnormality. Which is notoriously difficult when the health service is driven more by politics than science.

For instance, a person who is unable to have children because of obesity-induced diseases (e.g. diabetes), do we give them IVF, as the inability can be solved much more effectively by them not being obese.

Where do couples stand when the CAN have children naturally, but the chances of conception are very slim?

What about a couple that already has children, but now requires IVF to have additional ones?

A single unemployed woman on benefits wants a baby by IVF.

If we were to consider these cases under a purely scientific rationale, then we could easily produce clear-cut yes-and-no answers. But since (especially in the UK) we don't always seem to follow the logical course, we have to consider all of them.

Take the last example, we know that giving that woman a baby by IVF would cost money in terms of the IVF treatment, subsequent neo and post-natal care, child benefits once the child is born, and that child is likely to grow up in impoverished surroundings etc etc etc. Logically it would make sense to refuse IVF, but if the woman claims that as a woman she has a right to bear children, we start muddying the waters a little

No challenge here, all of the above should pay for their own IVF.

Simples!

mattyrm wrote:

No challenge here, all of the above should pay for their own IVF.

Simples!

Providing we take a logical decision approach, something that health policies are not exactly known for taking.

A lot of places won't look at the logical side, and will instead argue for eternity about the rights of these cases to IVF (for whatever reason) despite the fact that logically it makes sense to deny it.

Same as the whole 'right to die' thing, If I was to become severely disabled, so disabled that I was declared 'brain dead' (i.e. all bodily functions controlled by machine, no conscious thought) they can switch my life support machine off. However, if I am severely disabled to the same extent as above (i.e. think 'the emperor of mankind') but I can still think and communicate in some means, then even at my request I am not allowed to die, even though my quality of life would likely be no better (if not worse) than if I had been declared brain-dead. So just because I can scream 'please someone kill me', we throw out the logical decision (end it here and now so I no longer suffer) and go with the 'right to life and ethics etc' decision of leaving me suffering as (apologies if it offends, but I am want of a better word) vegetable.

My point is, we really need to be having this conversation.

Really.

If the NHS wants to survive, we need to be talking about it. The Americans are talking about healthcare because its important, and we need to be doing the same. If the costs carry on spiralling, It WILL die on its feet, and people seem to just have a ridiculously naive "just give them more money" attitude to the NHS.

Usually Labour voters.

We talk about it, or eventually it ends. That seems to be logical to me. The pot isn't bottomless.

Radio 4 carried a report this morning about the proposed government changes to the NHS.

They said that "market" research showed the general public have no idea how the NHS works. They don't understand what the government is talking about.

It might be dangerous to talk about it when most people don't know what they are talking about.

mattyrm wrote:Why has this issue not been mentioned earlier?

North Yorkshire PCT issued a statement earlier saying that they had a duty to remain solvent, and I agree with them entirely.

Surely IVF is a nicety? Its not like a serious health issue, its just wanting kids.

A desire isnt enough for the tax payers surely? I desire some new shows, im not going to bill the public for them.

http://www.bbc.co.uk/news/health-13670615

In a time of economic unrest, and a stark realisation just how much of an issue an exploding population is, why is this being criticized, when it seems to be the most sensible move!?

I quite agree. One of the handful of areas I get right wing about is the whole 'right to parenthood'. Can't have kids of your own? Well, there are hundreds of little ones out there in need of loving parents, so why not adopt, save a kid, and save the public a lot of money.

Kilkrazy wrote:Radio 4 carried a report this morning about the proposed government changes to the NHS.

They said that "market" research showed the general public have no idea how the NHS works. They don't understand what the government is talking about.

It might be dangerous to talk about it when most people don't know what they are talking about.

So, what on earth is the answer then?

gak, im all for forcing people to take general knowledge exams and IQ tests before they are allowed to vote, but thats not going to be allowed with all the lefties is it?

Whats the answer? Most of society is either woefully ill-informed or wilfully ignorant of the matter, so what on earth are we supposed to do about it? Justt pretend its not happening then moan and whinge when the NHS bottoms out and all of the PCTs are insolvent?

MPs are paid to make decisions, they should make them. Im pretty sure thats what the conservatives are trying to do, but again, thats where the willfull ignorance comes in. How many of these screaming SWP types are fighting any and all changes to the NHS even though it clearly needs them?

Make the changes, and leave the peons to their ignorance.

Education.

Well, I'm all in favour of having a debate on the NHS.

I'd love to see more of a spotlight being given to the massive amounts of money that is haemorrhaged on overpriced PFI contracts, and on executive pay, and on the consequences of outsourcing cleaning services to for-profit companies racing to the bottom, and on the massive superprofits farmed by pharmaceutical companies, and on the massive admin costs in organising internal markets, and on subsidising for-profit dentistry in a manner that creates perverse incentives almost as appalling as those involved in means-testing and clumsy performance rewards that measure capability by ability to game high-score tables.

And if right-wingers want to intersperse their attempts to shift the debate into blaming poorly-educated poor people for being ill with derogatory terms for people who disagree with them and extremely reactionary rants about how they should get to choose which 'peons' are allowed to vote, I'm perfectly happy for them to lose the ear of most reasonable floating voters who judge speakers by their perceived civility as much as the content of their message.

How many of these screaming Tory types are supporting any and all changes to the NHs regardless of how many of them are steps backward that serve only to line the pockets of well-connected shareholders and execs?

Funny you mention new shoes. A friend of mine just got a pair bought for him by the jobcentre, to drastically improve the impression he makes in interviews and thus massively increase his chances of becoming a net contributor to the budget.

I used to work in Orthotics, where a lot of our time was spent fitting and issuing people with corrective shoes. It was amazing how many people completely took the wee-wee with their entitlement (which was for adults 2 pairs in reasonable repair at any one time, and children 1 pair in reasonable repair at any one time, per shoe size, with a certain number of adaptations (I believe it was 3) done per year and per shoe size and a certain number of repairs done per year and per shoe size before you had to start contributing towards the cost of the work being done).

Now, some people will go through shoes extremely quickly - you can tell just by watching them walk that they will wear the sole down, or destroy the toe units etc - these people would sometimes be given 2 pairs of shoes at a time to help keep a program of rolling repair going... but then instead of regularly bringing one pair in for repair, they would wait for one pair to be completely destroyed (and I mean completely - sole worn right through to the uppers, uppers worn through, etc) just so they could have a brand new pair of shoes (at £150-300 a go).

It is also amazing the number of dogs that eat people's shoes, the number of times shoes are stolen, and even how often they are simply lost.

And god forbid if you ever tried to get management to clarify or back you up on anything - they didn't want to know.

Trust me, I know this is just a drop in the ocean compared to other issues in the NHS, but this kind of front line problem of not knowing or not being told how to deal with people who are playing the system contributes towards the hole the NHS is digging.

...which is why I support de-centralisation in the NHS.


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I also love the idea that the Americans are having a 'debate' on healthcare.



Since when is a hysterical shrieking match considered 'debate'?

There is a real problem with people not knowing enough about the NHS. We don't just need NHS reform (contrary to what the government says) we need positive reforms, just shaking it up and hoping for the best isn't going to work. We can't get what is best for us if we don't know what it is.

A major problem with the NHS (and a large cause of variation) is that large parts of the system are private. We need one system and set of rules across the whole system but when the government tries to impliment it many private parts (doctors surgeries ect..) just refuse. We aren't going to be able to make the NHS consistent unless we are able to have some level of control over it. All these failed attempts at unifying the NHS are an expensive waste of money until we can pull the whole system together.

Albatross wrote:...which is why I support de-centralisation in the NHS.


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I also love the idea that the Americans are having a 'debate' on healthcare.



Since when is a hysterical shrieking match considered 'debate'?

Its hardly a hysterical shrieking match..

I'm not overly fond of Obama, but i don't dislike the guy either, he doesn't really get hysterical though does he? He is pushing forward new legislation and a small amount of people (The toothless rednecks that support the tea party) get hysterical, but that's hardly a shrieking match is it?

The NHS is haemorrhaging money. The fingers in your ears attitude that Lyndsey displays is ridiculous, as is KKs ridiculously simplistic "education" answer. Many people aren't interested in getting one, many people are fleecing the NHS, are people unable to face a harsh truth? Were financially in the gak.

We need to do something about it.

4M2A wrote:A major problem with the NHS (and a large cause of variation) is that large parts of the system are private. We need one system and set of rules across the whole system but when the government tries to impliment it many private parts (doctors surgeries ect..) just refuse. We aren't going to be able to make the NHS consistent unless we are able to have some level of control over it. All these failed attempts at unifying the NHS are an expensive waste of money until we can pull the whole system together.

How do "private parts" refuse to implement the set of rules? Are there doctors that refuse to perform certain procedures at the price paid by NHS? Are the drug companies refusing to provide drugs at a price demanded by the NHS? How do you propose to alleviate these problems? If the private companies aren't able to provide a service at the price demanded, how will the government make them more efficient?

The problem with the NHS isn't the pockets of private providers, it's the problem of price fixing and nearly infinite demand in a market of limited supply.

mattyrm wrote:

We need to do something about it.

What do you suggest?

There is a problem with private providers. Where I am working at the moment they are attempting to "outsource" various operations from a number of different departments to several private hospitals in the area.

The problem is that it creates a vast extra workload within the NHS (and yet more pointless managers). People with operation dates on the NHS (as in they actually have a date to come in and time in theatres) within their breach date (ie before they would be considered to have been wiating too long) are being taken off NHS lists and farmed out speculatively to these private hospitals, who are then at liberty (as has happened to a couple of patients I know of) of saying that they don't want to do that operation. This means that admin staff are constantly changing waiting lists, shipping notes to places and so on.

These private hospitals then cherry pick the cases they want (usually all the easy, quick surgeries where the patient is relatively healthy) leaving all the tricky surgeries with patients with significant risk factors to be done on the NHS, which means that theatre teams and everyone else involved is under additional pressure.

This means that the patient has been contacted by someone with an operation date, is contacted by someone else to say that they can go and have an operation done privately (paid for by the NHS), are removed from the waiting list, then get told they have to go back on the waiting list and end up with a date later than they had originally. Which, given that a lot of people who are having operations are in their 70's+ can lead to quite a bit of confusion, calls to the hospital, and all the extra admin work that entails.

The thing is that that the consultants who are doing these operations in private hospitals are often the same ones who are working in the NHS hospitals.

Kilkrazy wrote:Radio 4 carried a report this morning about the proposed government changes to the NHS.

They said that "market" research showed the general public have no idea how the NHS works. They don't understand what the government is talking about.

I thought this was an interesting point in that the government seems to be trotting it out as the main reason that the average voter is against their reforms to the NHS.

I'd hazard a guess that while it is true that most people have no clue how the NHS is run, the real reason that people are against the reforms is more likely to be the perception that putting a Tory in charge of reforming a public institution is commonly seen as being akin to putting a carving knife in a nutter's left hand and your penis in his right and leaving him to it.

Well i'm not an expert I just know people who work in those areas. From what I know:

The private areas still recieve funding from the NHS, however they aren't controlled by the NHS. In the past the NHS has said things along the lines of "we need you to change your record systems so that we can have the same system across the whole organisation. (seems small but its useful so we don't have to waste time and money moving between systems) or ask them to change the staff structure and they can just say that they are happy with it as it is so they won't change it. The NHS can control how much money private organisations get but not how they are run. This is quite a large problem as a lot of the NHS is private (e.g. all doctors surgeries). Personaly I think we should either take back control of them or at least change the situation so we have som econtrol.

Yes public healthcare is expensive but we are still paying a lot less than most countries. Healthcare is expensive you can only cut it so much. I don't know why so much focus is put on cutting healthcare as opposed to other services. The NHS is expensive because of its size and the amount of work it does. You can only cut it so far.

Carmine the Wolf Wrote:
I'd hazard a guess that while it is true that most people have no clue how the NHS is run, the real reason that people are against the reforms is more likely to be the perception that putting a Tory in charge of reforming a public institution is commonly seen as being akin to putting a carving knife in a nutter's left hand and your penis in his right and leaving him to it.

Might also have something to do with the fact almost all medical organisations have told the government these changes are rediculous.

Carmine the Wolf wrote:

Kilkrazy wrote:Radio 4 carried a report this morning about the proposed government changes to the NHS.

They said that "market" research showed the general public have no idea how the NHS works. They don't understand what the government is talking about.

I thought this was an interesting point in that the government seems to be trotting it out as the main reason that the average voter is against their reforms to the NHS.

I'd hazard a guess that while it is true that most people have no clue how the NHS is run, the real reason that people are against the reforms is more likely to be the perception that putting a Tory in charge of reforming a public institution is commonly seen as being akin to putting a carving knife in a nutter's left hand and your penis in his right and leaving him to it.

What do I suggest? The above post leads me nicely to my point.

Basically, I can label things that I would do but its of little use as Im not an expert on the subject. We need to reform the NHS, we need to cut services and only pay for medical treatment that NEEDS to be done, we need to cut management, I'd say feth it, cut salaries by 5% as well, we all need to tighten our purses.

The point is, I dont work with the NHS, but things can happen, thats what the government is for. Cuts and reform needs to happen. And if your saying otherwise you are wrong and I am right. Its that black and white.

If the cost keep on spiralling eventually it will be ran into insolvency and cease to exist as it is. It doesnt matter what government is in charge at the time, or what the year is, but it will happen. If the money isnt there, how can it not?

Basically it appears to me that party politics is interefering with a job that needs to be done. The quote above underlines the issue, the average Joe simply thinks "cuts = bad" and resist any and all plans to look at the NHS, but we NEED to look at it. The idea that we can just carry on as if nothing is wrong and throw more and more and more money at it is NOT an answer or a solution.

People dont have the intellect to grasp the situation, ive read numerous surveys in both the UK and the US and people seem to have an idiotically simple approach. ie. They outright reject all cuts and they outright reject paying more tax. Do you see what Im getting at? What else IS there?

We need to cut the NHS bill. Its as simple as that.

The NHS has run broadly OK for 50 years with private GP surgeries.

Most people are broadly satisfied with the NHS, that is why they get so nervous when they hear the Govt, talking about major reforms, especially in an era of national austerity. The British have come to regard the NHS as a cornerstone of national life.

At the same time, who couldn't find something to complain about?

Some of these complaints are petty and stupid. Others are justified.

Without proper understanding of what is going on, though, it is pointless to ask the public what they want to be done.

I wouldn't bother asking politicians since they are responsible for nine reorganisations between 1996 and 2008, all of which were aimed at making things better.

Well, its hard to disagree with everything you wrote there isnt it? I agree with you!

I dont want the NHS to cease existing, I dont want people to not have free healthcare (for important gak anyway!)

Im merely saying that its leaking money and we have a problem, and I hate the way that people seem to want to bury their heads in the sand and pretend their isnt an issue. Some people play the system and earn absurd amounts, or play the system to get cosmetic work done, or play the system and get gak paid for that they should be paying for themselves, and surely we have the brains to fix the issue!

To be entirely fair, most of the "reogranisations" that Labour imposed were pretty pants on head.

Exactly.

Above all, the relentless pace of reorganisation prevented the system from settling down properly into any kind of a steady state which would have provided a baseline for comparison.

mattyrm wrote:

Albatross wrote:...which is why I support de-centralisation in the NHS.


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I also love the idea that the Americans are having a 'debate' on healthcare.



Since when is a hysterical shrieking match considered 'debate'?

Its hardly a hysterical shrieking match..

I'm not overly fond of Obama, but i don't dislike the guy either, he doesn't really get hysterical though does he? He is pushing forward new legislation and a small amount of people (The toothless rednecks that support the tea party) get hysterical, but that's hardly a shrieking match is it?

Really? When you have prominent politicians talking about 'death panels'? Come off it - the standard of debate is shocking, particularly on one side...

And whilst we're on the subject of bad debate... why are you talking about people 'fleecing' the NHS? That's not the issue here, neither is the fact that the NHS budget is being cut, because that's not what's happening. The issue is that the NHS is a bloated, expensive, practically impenetrable bureaucracy that costs us the gdp of a small country, and delivers results that are, at best, bowel-clenchingly adequate. Let's be real. The NHS is being reformed, and as part of that reform, efficiencies need to be made. That means cuts in certain areas, but the budget will remain roughly the same, as the money saved will be used to increase financing in other areas.