IOM DHSC & MANX CARE

[snowman]

11 minutes ago, Boris Johnson said:

Should of happened years ago.

We don't have the numbers to make a general hospital viable in this day and age, things have moved on - a lot.

Bring it on.

Imagine being on the NHS UK waiting list. Zero ability to complain about waiting lists or NHS policy. No ability to influence government policy since you don't have a MP

[Dr. Grumpy]

1 hour ago, Boris Johnson said:

Should of happened years ago.

We don't have the numbers to make a general hospital viable in this day and age, things have moved on - a lot.

Bring it on.

Looks like you'll get your wish pretty soon, except English NHS hospitals have Zero spare capacity to take Manx Care's work on.

Don't know if the Republic's hospitals have spare capacity, but hope they do.

[The Chief]

On 12/9/2021 at 9:25 AM, Andy Onchan said:

This I think:

this is the biggest load of fucking bollocks i've seen for a long time, the transport costs alone would be astronomical and FYI you aren't flying a 40 week pregnant woman off anywhere for a elective c-section and i would assume this would mean a centralisation of all services and an immediate closure of Ramsey hospital wards and the staff and patients moved to nobles.

edit: and the TT couldn't run as the medical facilities would not be up to standard or they would need a dozen life flights ready to airlift racers to the UK.

Utter nonsense.

Edited December 10, 2021 by The Chief

[wrighty]

18 minutes ago, The Chief said:

this is the biggest load of fucking bollocks i've seen for a long time, the transport costs alone would be astronomical and FYI you aren't flying a 40 week pregnant woman off anywhere for a elective c-section and i would assume this would mean a centralisation of all services and an immediate closure of Ramsey hospital wards and the staff and patients moved to nobles.

edit: and the TT couldn't run as the medical facilities would not be up to standard or they would need a dozen life flights ready to airlift racers to the UK.

Utter nonsense.

We (the medical body) at Noble's have been assured by the Chairman of Manx Care, the CEO of Manx Care, and the Medical Director of Manx Care that there are no plans to downgrade Noble's to what is suggested in that newspaper piece.  In fact they assured us that the opposite is true - we want to carry out as much elective surgery as possible here, as long as it can be done safely and is clinically and cost effective.

[Boris Johnson]

3 minutes ago, wrighty said:

We (the medical body) at Noble's have been assured by the Chairman of Manx Care, the CEO of Manx Care, and the Medical Director of Manx Care that there are no plans to downgrade Noble's to what is suggested in that newspaper piece.  In fact they assured us that the opposite is true - we want to carry out as much elective surgery as possible here, as long as it can be done safely and is clinically and cost effective.

"as long as it can be done safely and is clinically and cost effective"

That's the issue long term and why I said what I said before

I really don't see how as just 85k residents can finance or staff a modern hospital any more.

 

[wrighty]

35 minutes ago, Boris Johnson said:

"as long as it can be done safely and is clinically and cost effective"

That's the issue long term and why I said what I said before

I really don't see how as just 85k residents can finance or staff a modern hospital any more.

 

Well unless we become part of the UK and are getting subsidised by London, we're going to have to finance the health service whether it's here or across, so your last point is moot.

As a small health service we will never be able to carry out everything that is clinically effective here, and certain things will need to be sent to larger centres.  The bulk of services however can be provided.  What I've always said is that we should do the simple, common effective stuff here, the complex, rarer effective stuff across, and the ineffective stuff not at all.  Take my own specialty for example.  About 75% of trauma admissions are accounted for by 4 things - hip fractures, ankle fractures, wrist fractures and hand injuries.  We can manage almost all of those here, and several other things too, such that I'd estimate that 90%+ of trauma admissions can be handled safely and effectively in house.  The same goes with joint replacement surgery.  When operating at full capacity, in our best year we carried out 280 hip and knee replacements.  I personally carry out more hip replacements here than 50% of surgeons who replace hips across the UK, that is to say I'm in the upper half of the distribution for volume (we submit data to the National Joint Registry - all of this is in the public domain).  If we accept that we need surgeons to do trauma, then they may as well also do elective work that is within their experience.  And there you have a clinically effective service that can cope with 90%+ of what is thrown at it, and costs far less to run than sending everyone across.  Apply the same thinking to other areas and you have a functioning hospital.  It has to evolve though, and we need to ensure that when staff are replaced, or if caseload falls, that the procedure mix is still appropriate.  Over the years I've stopped doing procedures that I used to just crack on with either because techniques changed, or evidence evolved, or because I couldn't do enough to maintain competence.  We all do, I hope.

[The Phantom]

8 minutes ago, wrighty said:

When operating at full capacity, in our best year we carried out 280 hip and knee replacements.  I personally carry out more hip replacements here than 50% of surgeons who replace hips across the UK, that is to say I'm in the upper half of the distribution for volume (we submit data to the National Joint Registry - all of this is in the public domain). 

Really?  Wow, that's actually quite impressive. 👍

On a vaguely related note you might be interested in.  I was following a thread a couple of days ago for a guy who used his dead dad's titanium hip replacement as the gear shift on his car!  "It's what he would have wanted" 

[wrighty]

3 minutes ago, The Phantom said:

Really?  Wow, that's actually quite impressive. 👍

On a vaguely related note you might be interested in.  I was following a thread a couple of days ago for a guy who used his dead dad's titanium hip replacement as the gear shift on his car!  "It's what he would have wanted" 

It probably wasn't his dead dad's.  I've got a couple of hip prostheses at home (either went out of date, or dropped on the floor or something - not explanted) and I sent my youngest to school with one once for 'show and tell'.  Made a change from the usual pictures of the dog I imagine.

[The Phantom]

3 minutes ago, wrighty said:

It probably wasn't his dead dad's.  I've got a couple of hip prostheses at home (either went out of date, or dropped on the floor or something - not explanted) and I sent my youngest to school with one once for 'show and tell'.  Made a change from the usual pictures of the dog I imagine.

He had a 'before' photo of it in a box covered in ash.  Allegedly from the cremation... 

[Augustus]

Roald Dahl (a very tall man) kept his femur joint as a paperweight on his desk.

[wrighty]

OK, if we’re onto hip replacement stories try this one, which I often tell patients. 
 

An old boss of mine once had a patient who asked him what he’d do with the extracted femoral head, and he explained they were just disposed of. So the patient asked if he could have it. This was in the days before infection control and health and safety, so my boss said ok, didn’t see why not.  After the operation he gave the chap his femoral head in a sealed plastic pot. 
 

6 weeks later my boss asked what he’d done with the femoral head. Reply: “Gave it to the dog. The bugger’s given me enough pain over the years I wanted to really see it gone”

[Andy Onchan]

2 hours ago, wrighty said:

Well unless we become part of the UK and are getting subsidised by London, we're going to have to finance the health service whether it's here or across, so your last point is moot.

As a small health service we will never be able to carry out everything that is clinically effective here, and certain things will need to be sent to larger centres.  The bulk of services however can be provided.  What I've always said is that we should do the simple, common effective stuff here, the complex, rarer effective stuff across, and the ineffective stuff not at all.  Take my own specialty for example.  About 75% of trauma admissions are accounted for by 4 things - hip fractures, ankle fractures, wrist fractures and hand injuries.  We can manage almost all of those here, and several other things too, such that I'd estimate that 90%+ of trauma admissions can be handled safely and effectively in house.  The same goes with joint replacement surgery.  When operating at full capacity, in our best year we carried out 280 hip and knee replacements.  I personally carry out more hip replacements here than 50% of surgeons who replace hips across the UK, that is to say I'm in the upper half of the distribution for volume (we submit data to the National Joint Registry - all of this is in the public domain).  If we accept that we need surgeons to do trauma, then they may as well also do elective work that is within their experience.  And there you have a clinically effective service that can cope with 90%+ of what is thrown at it, and costs far less to run than sending everyone across.  Apply the same thinking to other areas and you have a functioning hospital.  It has to evolve though, and we need to ensure that when staff are replaced, or if caseload falls, that the procedure mix is still appropriate.  Over the years I've stopped doing procedures that I used to just crack on with either because techniques changed, or evidence evolved, or because I couldn't do enough to maintain competence.  We all do, I hope.

What's your view on actually expanding some services to become a centre of excellence whereby Nobles sells it services to other trusts and the private sector etc??

[wrighty]

1 hour ago, Andy Onchan said:

What's your view on actually expanding some services to become a centre of excellence whereby Nobles sells it services to other trusts and the private sector etc??

It's a non-starter, primarily because of the geography.  Most people want to be treated near home, and I can't see why they might choose to come here instead of a centre of excellence they could drive to and family could visit. The only thing we might be able to do would be something really niche dealing only with people who are otherwise fit and well - if they're medically complex you'd need a full range of services and we can't have that for reasons of size - such as top secret celebrity cosmetic surgery, hair transplants, etc.  But that's never going to happen.  We could become the British Dignitas, but I don't see that happening politically.

Specialist hospitals such as Wrightington tend to grow organically around a pioneering expert such as Charnley and his self-made hip replacements in that case (or for Oswestry, my old teaching unit, around Sir Robert Jones linking up with Dame Agnes Hunt at an old TB sanatorium).  Those days are gone though.

[Anyone]

I’ve resigned myself to the fact I can’t rely on the NHS so if I get like really ill I will probably die. Minor stuff I’ll have to pay for myself. Not blaming anyone but let’s stop treating the NHS like it’s the greatest thing since sliced bread because it’s not.

[Anyone]

Our GP practice won’t accept calls or email because they are ‘too busy’ . I drive past it most days , it’s got big open windows and there is nobody there. Have to book on some online system. Today got a message saying due to sickness we can’t - click here for more info - so clicked to a link that was blank. Also refusing to to flu jabs due to overwork. So got one at the local chemist instead. She was scathing about GP’s. Said she was redressing wounds because GP surgeries refused because of ‘covid risk’.