IOM DHSC & MANX CARE

[wrighty]

With regard to the charging issue (and this is me talking - I'm not a spokesperson for Manx Care, or DHSC, or the BMA etc), most health services worldwide have some sort of co-payments or insurance scheme.  Some have other sorts of rationing of health services.

We cannot continue to pretend that we can provide a fully comprehensive, safe, high quality health service funded out of general taxation, particularly when that taxation is low.  Something has to give.  An analogy I used the other day is that you might want to eat out at a high class restaurant, have loads of drinks and expect high class service and decent surroundings.  If you then said to the restaurant proprietor that you only had £5 and you expected him to provide everything you wanted, you would be disappointed.  But this is what the public expect of their underfunded health services.

The options are:

• Increase funding, or
• Reduce services, or
• Cut corners and reduce safety

We can't keep making 'efficiency savings', and in any case how is a 2% saving going to help when we have 10% inflation? 

[asitis]

Additional contributions for the NHS may be the only way forward sadly. However it must be done in such a way to keep Governments grubby mitts off it !

[germann]

Manx Care Board Meeting

[Banker]

23 minutes ago, asitis said:

Additional contributions for the NHS may be the only way forward sadly. However it must be done in such a way to keep Governments grubby mitts off it !

NI needs to be increased & the upper limits increasing substantially so higher earners pay more, our rates are lower than Uk but everyone expects healthcare on demand!!

[GD4ELI]

Just now, Banker said:

NI needs to be increased & the upper limits increasing substantially so higher earners pay more, our rates are lower than Uk but everyone expects healthcare on demand!!

Pensioners don't pay NI; there are many wealthy pensioners. Should be a tax increase all round.

[wrighty]

8 minutes ago, GD4ELI said:

Pensioners don't pay NI; there are many wealthy pensioners. Should be a tax increase all round.

I think the headline 20% rate is sacrosanct, because Jersey. 
 

I would scrap NI and incorporate it into income tax. I’d scrap the cap, and have a genuinely progressive tax system, not the pseudo-progressive system we have now (that becomes regressive for very high earners)

[In case people don’t know - I didn’t until a few years ago, despite hearing the terms bandied about - progressive/flat/regressive refers to how the overall proportion of your income taken as direct tax changes as income gets higher. A flat tax means everyone pays a fixed proportion of what they earn. No thresholds, no tax-free starting amounts. A progressive system means the more you earn, the higher the rate of tax you pay. Regressive is the opposite. Here we have a system that is progressive up to a certain level of income, then it flattens out as NI has an upper limit, then it reduces at very high incomes (over about £600k) as the tax cap means they can earn as much as they like. If you’re on £600k a year you pay 20% tax. If you’re on £6m a year you’re only paying 2% tax. Hence it’s regressive]

[Dirty Buggane]

Just goes to show how high  Hoopers FOSI (full of shit indicator) is. Got to be in the high fifty's

[Two-lane]

As posted above "The average BMI of my hip replacement patients is 29 (national joint registry data). ".

It is interesting to know if there is any research into if the joint problems are inevitably a result of a high BMI.

In my case my BMI is probably not far off 30, and I am beginning to get knee problems. In my opinion the knee problems are a result of the years I spent running around like a blue-assed fly (and wearing 20 inch waist jeans) - and it is nothing to do with my height now (which is decreasing) or my weight now (which I do not regard as excessive for my age).

So is the BMI cut-off a justification for not operating on people who are beyond hope, or merely a justification to reduce waiting lists without any medical opinion involved (i.e. decisions made by managers rather than medical people).

[I am also suspicious of round numbers - why is the figure of 30 quoted, and not for instance 31.5. Well, it's probably because MHKs can only handle round numbers.]

[Gladys]

4 minutes ago, Two-lane said:

As posted above "The average BMI of my hip replacement patients is 29 (national joint registry data). ".

It is interesting to know if there is any research into if the joint problems are inevitably a result of a high BMI.

In my case my BMI is probably not far off 30, and I am beginning to get knee problems. In my opinion the knee problems are a result of the years I spent running around like a blue-assed fly (and wearing 20 inch waist jeans) - and it is nothing to do with my height now (which is decreasing) or my weight now (which I do not regard as excessive for my age).

So is the BMI cut-off a justification for not operating on people who are beyond hope, or merely a justification to reduce waiting lists without any medical opinion involved (i.e. decisions made by managers rather than medical people).

[I am also suspicious of round numbers - why is the figure of 30 quoted, and not for instance 31.5. Well, it's probably because MHKs can only handle round numbers.]

We have to manage a finite resource which exactly what the NHS is.  Funnily enough there is a meme going round to remind us that it is not a charity but a state funded service.  We have long grown used to, and expect, that it is there for everything and for free. 

It is no longer sustainable in its present form.  I don't have the answer because I am not directly involved to see where there is scope for proper focusing of its services.  Whether that is shifting the focus to preserving quality of life rather than longevity, I don't know.  It is a difficult debate.  

 

[Omobono]

it looks to me that Hooper has been caught  with his pants down ,  no excuse for not reading  properly  and digesting  your own departments future business plan , he is clearly way out of his depth , and becoming a toothless  tiger abrogating his responsibility    to Manx Care  who in most peoples opinions are just another level   of high earners who don't actually deliver any services on the front line  where all the problems seem to be , 

[asitis]

1 hour ago, GD4ELI said:

Pensioners don't pay NI; there are many wealthy pensioners.

Nope but they paid it all their working lives ! there may be wealthy pensioners but there are many who aren't !

[wrighty]

27 minutes ago, Two-lane said:

As posted above "The average BMI of my hip replacement patients is 29 (national joint registry data). ".

It is interesting to know if there is any research into if the joint problems are inevitably a result of a high BMI.

In my case my BMI is probably not far off 30, and I am beginning to get knee problems. In my opinion the knee problems are a result of the years I spent running around like a blue-assed fly (and wearing 20 inch waist jeans) - and it is nothing to do with my height now (which is decreasing) or my weight now (which I do not regard as excessive for my age).

So is the BMI cut-off a justification for not operating on people who are beyond hope, or merely a justification to reduce waiting lists without any medical opinion involved (i.e. decisions made by managers rather than medical people).

[I am also suspicious of round numbers - why is the figure of 30 quoted, and not for instance 31.5. Well, it's probably because MHKs can only handle round numbers.]

Joint registry stores as whole numbers - if I enter 28.6 it rounds to 29. The average I quoted is the median, not the mean, so is very likely to be a whole number when the list of data points are whole numbers. 
 

Being overweight doesn’t cause joint problems - there are many possible causes, generally it’s impossible to be certain for most people. But, carrying too much weight provokes symptoms. Lose weight and there is less stress on the joint so it’ll feel better. Combine weight loss with muscle strengthening and balance exercises and pain can be virtually abolished in some cases. So if you’re beginning to get knee problems you should shed some pounds and start building up your quads and hamstrings. Go to the gym, see a trainer. You won’t necessarily need to come to me, which you should see as a good thing. 
 

Having a high BMI doesn’t mean a poor surgical outcome, but it does make surgery more difficult, we have to make bigger incisions, there are higher rates of complications such as infection, and anaesthesia is riskier and more difficult - getting a spinal needle in a patient with a BMI of 40 is challenging to say the least. 
 

In my world BMI isn’t a single factor when it comes to surgical decisions. But it certainly influences the decision and if your BMI is over 40 I’d be very unlikely to list you for surgery unless it’s an emergency. 
 

Whatever you might think about your weight not being excessive for your age, it possibly is. As we get older we lose muscle, so it’s possible to have a normal BMI but be over-fat and under-muscled. That is not great either, in fact it’s a recipe for a hip fracture. It’s never too late to exercise, and nothing bad ever happened by getting fitter and stronger. 

[cissolt]

2 hours ago, wrighty said:

Joint registry stores as whole numbers - if I enter 28.6 it rounds to 29. The average I quoted is the median, not the mean, so is very likely to be a whole number when the list of data points are whole numbers. 
 

Being overweight doesn’t cause joint problems - there are many possible causes, generally it’s impossible to be certain for most people. But, carrying too much weight provokes symptoms. Lose weight and there is less stress on the joint so it’ll feel better. Combine weight loss with muscle strengthening and balance exercises and pain can be virtually abolished in some cases. So if you’re beginning to get knee problems you should shed some pounds and start building up your quads and hamstrings. Go to the gym, see a trainer. You won’t necessarily need to come to me, which you should see as a good thing. 
 

Having a high BMI doesn’t mean a poor surgical outcome, but it does make surgery more difficult, we have to make bigger incisions, there are higher rates of complications such as infection, and anaesthesia is riskier and more difficult - getting a spinal needle in a patient with a BMI of 40 is challenging to say the least. 
 

In my world BMI isn’t a single factor when it comes to surgical decisions. But it certainly influences the decision and if your BMI is over 40 I’d be very unlikely to list you for surgery unless it’s an emergency. 
 

Whatever you might think about your weight not being excessive for your age, it possibly is. As we get older we lose muscle, so it’s possible to have a normal BMI but be over-fat and under-muscled. That is not great either, in fact it’s a recipe for a hip fracture. It’s never too late to exercise, and nothing bad ever happened by getting fitter and stronger. 

But not too fit or strong is it may negatively affect your BMI!  My exhusband was a sturdy rugby player and was flagged as obese in a medical exam, once he gave up playing the obesity was likely drink and idleness related.

[Shake me up Judy]

Almost every man over a certain weight, no matter how fit and athletic, will invariably be classed as obese on the BMI scale. 

[Banker]

16 minutes ago, Shake me up Judy said:

Almost every man over a certain weight, no matter how fit and athletic, will invariably be classed as obese on the BMI scale. 

Only if they’re overweight, my BMI is 23 & most reasonably healthy individuals should be under BMI of 30