the latest NHS reforms

[worm]

The NHS can only give an assurance like that if it is certain of the finances to provide it.

[eFestivals]

No, it's that they have a philosophy in place that means that everyone involved with my treatment are duty bound to give me the best possible information about my condition and the available services.

What is contrary to this is having a philosophy in place that allows only certain people access to this service.

No, it's the same thing.

"the available services" are different, that's all.

[llcoolphil]

And I realise that some dementia sufferers had lived previously healthy lives. My suggestion wouldn't target any particular illness tho, so the effect would be across all of those people beyond the age-line (where ever that might be) - the point of it would be to not extend lives beyond their natural ability once past that line, so that there were fewer oldies overall, so that the financial burden of supporting them wasn't more than the economically active people could or would bear.

[sifi]

What was that Peter Cook film where he was a mad PM and had all people aged over 75 jump off cliffs?

[pink_triangle]

As someone who works in the NHS I feel I know a little about these reforms. The primary care trust system isnt perfect but I think its as good as any other option. Rather than spend all this money on reorganisation why not invest in respite services, decent primary prevention and financial assistance for carers. The trouble is that politicians try and make out the NHS is just a collection of doctors and nurses as they are the only ones that impact when people go into a polling booth. This idea that GPs are the best people to control the NHS buget is naive, from my experience some are good but many dont have a clue what role other health profesionals do.

The move to encourage private firms to come into the NHS concerns me greatly. From experience private companies are generaly happy to employ someone with inadeaquate experience just to get someone into a role and making the company money. There is also little interest in clinical supervision as patient care is seen secondary to profit.

[eFestivals]

You're missing my point. We are on the cusp of a huge dementia problem. Dementia in itself isn't life threatening, nor is it directly associated with other life threatening conditions. People can and do carry on living for many, many physically healthy years after the onset of dementia, so there is little that can be done about not prolonging the life of someone suffering with dementia. Regardless of whether you dont treat any other condition or do, there will still be a huge population of people that need support with dementia. If you're talking about not supporting people with dementia, you're talking about leaving them to starve, or die of cold or get run over by a bus etc etc etc - which would fit in with your notion of not supporting beyond their natural ability to support themselves, but hardly seems worthy of a civilised society.

I'm not missing your point about dementia, not a jot. That's fully within my thinking.

But you appear to be missing the point of what I'm saying. And what I'm saying is that conditions such as dementia will only over-whelm the health services if we allow by default people to live so long that so many of them start to suffer from dementia.

The instances of dementia are growing, not because dementia is becoming (by itself) more prevalent, but because more people are living longer, where that extra length of life gives them the opportunity to show signs of dementia - if they'd all died at (say) 65, then they'd be almost no dementia. If (say) 50% of the people who now live to a ripe age and get dementia died before the point of getting dementia, then dementia would be cut in half.

In very basic form, what I'm saying is that we should be lowering the average life expectancy. Doing so makes some of the problem of the number of instances of dementia disappear. The more that we keep extending the average length of people's lives thru better medical treatments, the worse such problems become.

If - say (this is a simple example) - 5% of the people that go on to suffer dementia have previously had cancer which has been cured by cancer treatments of some sort, then if those cancer treatments weren't available, then the instances of dementia would be reduced by 5%.

I'm not saying that those who do suffer dementia don't get cared for. I'm saying that some life saving treatments prior to them getting to the age where they get dementia should be withdrawn, so fewer live to an age where they suffer dementia.

You can throw in words like 'civilised society' all you want, but the simple truth is that we already operate a health system much along the lines I'm saying. If (say) a person had terminal cancer and terminal heart disease, with the cancer going to kill them 1 month after the heart disease would, and the heart disease could be cured, would the NHS spend the money to give them that extra month? It's hugely unlikely.

There's a benefit analysis made over treatments now - just think of the stories going around in the last 5 years or so about "NICE have decided that the NHS will not fund new drug". These currently aren't worked on a purely financial basis (and nor should they be) tho it does come into the thinking, but are worked on what benefit that treatment would be to a sufferer. What is considered in that benefit analysis needs to be expanded, so that there's an "impact on society of this treatment" part to what is considered along with the other parts they consider now.

And if we're talking about not supporting people who are perfectly healthy physically but not mentally, what do we do with babies born in a condition where they will never be able to fully support themselves - leave them to die?

Not in my world.

I'm working this idea on the basis that everyone has a right to live a life, but they don't have the right to go on and on and on and on with their life into a stupidly old old-age, to the point where it essentially makes those economically active little more than their slavish support staff.

[diddly-dee]

And before we can even consider that, what exactly is a natural life?

an easy question.

One that isn't being artificially maintained, by drugs or machines.

[eFestivals]

And before we can even consider that, what exactly is a natural life?

there's lots of factors that could be argued about with that. But there's also lots of factors that couldn't - which are the ones I'm on about.

It doesn't look good for people with type one (insulin dependant) diabetes then...

If you'd properly read what I've said, then you'd already know that you're wrong about that.

The thing that is hugely in need of addressing is oldies that the economically active are finding it more and more difficult to support as it is, before starting to think of the far greater healthcare resources they consume. It's the issues around this that need to be better considered, and not other things - in comparison, the costs of diabetics and other such things for their whole lifetime are minuscule.

It's all very well thinking about things on a purely individual basis, that each individual would like to have a healthy existence for as long as they can, but there's much more than that which needs considering which aren't currently being considered. The world is not a world of fully independent individuals, it's a society where the doings of any individual has an impact onto all others. That impact onto others needs factoring in.

[worm]

It doesn't look good for people with type one (insulin dependant) diabetes then...

[worm]

The thing that is hugely in need of addressing is oldies that the economically active are finding it more and more difficult to support as it is, before starting to think of the far greater healthcare resources they consume.

[eFestivals]

Neil, illnesses are natural phenomena and trying to heal them is also a natural response. As is inventing technology to assist us.

first part right, second part totally wrong. The desire is natural, the doings are not.

But anyway, you're taking my 'natural life' words far more literally than they were meant; what was meant is pretty clear from all the words around them.

All you're talking about is how the NHS should perceive and administer this process as a service provider.

Correct.

It already operates policies of what it will do and what it won't, based on individual medical benefit of a treatment against the cost of that treatment.

All I'm saying is that the consideration needs to be widened, so that along with those factors there is also a consideration of the benefit (or not) to society as a whole from any treatment. And as the benefit to society as a whole from any treatment decreases with the increasing age of a patient, the outcome would be fewer life-saving treatments for those in later life.

As I keep saying, it's all very well having pie-in-the-sky dreams of medical perfection creating very long and healthy lives, but those need to be paid for in some way. Sooner or later those costs will be greater than the willingness to pay for them - I'm simply recognising that certain fact, and saying that it's better if we have the discussion about that sooner rather than later. Society burying its head in the sand will not make that certainty go away.

You can be sure that we'll continue to undergo this process however we can if the NHS refuses to offer support. You're just making the NHS service a one of priviledge.

Yeah, you'll continue to do it even when it's an impossibility.

Ostrich.

[llcoolphil]

If I wasn't on my phone id give a longer answer but the day we have a society that actively advocates shortening life expectancy because old people contribute a decreasing amount of value is the day to give it up. By simply seeking to contradict worm you have gone down an argument of such nonsense it defies belief

[eFestivals]

''As a result of our modern sentimental humanitarianism we are trying to maintain the weak at the expense of the healthy.''

a very spot-on statement, if referring to the elderly as the weak.

By leaving them out in the cold you're just cutting off the weak to maintain the resources of the strong.

Nope, that's not it at all.

I'm on about cutting the assistance given to the elderly who have been able to live a reasonable life in their younger days, so that younger generations have the same opportunity as those oldies have had to live a reasonable life.

You haven't actually solved the problem of getting better resources,

until you discover infinite resources, there is no solution to the problem of getting the needed infinite resources for your take on things to work.

you've just priviledged a certain sect of society.

Nope, utterly wrong.

My idea is about ensuring that the oldies don't get all of the priveliges at the expense of the young - which is what's going to happen if we don't take a different path.

You've stopped them from being recognised by the state. You've made pariah's of them.

No I haven't, I've done neither.

Only rich families will be able to help their older generations.

And that's different to now, how exactly? The rich already get far better medical care, all thru their lives.

I agree, this side of things is an issue, but it'll be less of an issue than you're imagining it to be if/when society chooses to have a different idea about the burden the elderly place on those younger than them.

There's simply no getting away from the fact that if we keep on the path we're on, the burden of the elderly will grow and grow, until there's an inevitable revolt against it of some kind, when a different way of dealing with things will come about.

To my mind, it's far better that we have a rational conversation about it so that society is able to make informed choices for the future, than have a scenario forced onto us by the changed circumstances at that tipping point.

[eFestivals]

By simply seeking to contradict worm

PMSL. If that's what you think is driving a single word I've posted on this subject, you're an unthinking fool.

I'm posting nothing different to what I've posted on countless occasions in the thirteen years I've been running efests.

... you have gone down an argument of such nonsense it defies belief

What, more non-sensicle than putting forwards the impossible?

the day we have a society that actively advocates shortening life expectancy because old people contribute a decreasing amount of value is the day to give it up.

f**k me, how narrow is your thinking? I've not said anything like this at all.

I'm advocating that life expectancy isn't forever extended (the outcome of your take on things), so that younger generations have the same opportunities to live their lives as those older people had, rather than having a life of abject poverty so that the oldies can be maintained, and where the life of most younger people is spent only wiping shit from the arse of those oldies.

I don't wish my life to be at the expense of the lives of other people. Why do you think your old age should be at the expense of other people?

[worm]

If I wasn't on my phone id give a longer answer but the day we have a society that actively advocates shortening life expectancy because old people contribute a decreasing amount of value is the day to give it up.

[eFestivals]

The argument being presented is utterly moronic

You might not like the argument I'm putting forwards, but it's certainly less moronic than thinking we can keep going forwards as we are indefinitely.

In fact, we're much nearer to what I'm saying right now than we've ever been to what you're saying. There's no getting away from that.

Sooner or later the tipping point will come, and none of what you say will stop that happening.

Edited January 21, 2011 by eFestivals

[worm]

You might not like the argument I'm putting forwards, but it's certainly less moronic than thinking we can keep going forwards as we are indefinitely.

[eFestivals]

what is it that you know that the rest of us don't?

just read worm's posts in this thread, where he states his belief that old people can live forever and that those supporting them in that will forever happy do so at the expense of being able to live their own lives.

[eFestivals]

I'm not interested in reactionary and simplistic responses to media sensation.

PMSL .... the reactionary and simplistic are your replies to my considered thoughts, where you put forwards the standard tabloid outrage that oldies aren't being supported to the full extent of medical science.

What I am interested in are well researched and/or reasoned ideas formulated around an ethical principle that sees the task ahaead as the extremely complex problem that it is.

which is what I'm giving you! They are based on solid facts (tho not deeply researched), and reasoning, with an ethical basis to them. I am not pretending that the problem isn't complex, but the basic solution that we'll end up is.

If you were really interested in what you say you are, your responses would manage far better than the ostrich impression you've responded with.

[eFestivals]

I have

it doesn't help me knowing what you might have in mind though

Less medical support for oldies, so that youngers are able to have the same quality of life as those oldies managed to have.

The alternative is that youngers will be essentially enslaved by those oldies. And however much some people might like to say they'd go along with that to the nth degree, not a single individual will do eventually.

I'm simply recognising the fact that health cannot take an ever-increasing amount of resources without a back-lash to that happening at some point. And from that, I realise that it's better if we have an adult discussion about those facts (rather than pretending things can go on forever in the way that they are - the childish and impossible view) and reach a properly considered conclusion than allow circumstances to dictate the outcome of the scenario.

[lost]

Reading this thread I was just thinking I'd seen a documentary on this very subject, googled and managed to find it:

If... The Generations Fall Out shown on the beeb in 2004.

interestingly I've noticed on that page the beeb ran a survey about which generation was worse off students or pensioners and students came out on top, I believe that would of been done at a time when tuition fee's were only £1k as they didn't rise to £3k until July 2004.

[eFestivals]

I wouldn't have thought you were particulalry alone in realising that tbh

Oh, I realise that - but I also realise that this is a subject that some don't think should be discussed, as some of the rather predictable Daily Mail style responses to my words have got to show.

there are a lot of problems being caused by one thing; an ever increasing population explotion. Almost any major problem the future has in store would be helped by there being less people.

If we're scared to think about how that could be resolved (by a measure of prevention), I don't see how we're going to be brave enough to deal with it at the other end.. by letting people die

Spot on. But none of that addresses the inevitability of it.

and as has been said, where would the line be drawn

if we're never allowed to have the discussion because some refuse to discuss the subject, we'll never know.

That line has actually already been drawn as things stand today, but people like to pretend that it hasn't been. Unfortunately, where the line currently is is somewhere that still isn't sustainable, and so the line will be re-drawn more in the direction I'm saying whether people like it or not.

But there's two ways that the line can be re-drawn - via a grown-up debate which recognises the situation, or by circumstances reaching the critical point where a line is imposed by circumstances (and so outside of the people's direct control).

I'd far rather that we were able to have the debate, so that 'the people' can decide for themselves.

Edited January 21, 2011 by eFestivals

[Ed209]

Neil, if/when the time comes, will you be leading by example and doing your bit to prevent the enslaving of the young?

[eFestivals]

Neil, if/when the time comes, will you be leading by example and doing your bit to prevent the enslaving of the young?

Yup, more than happy to.

[worm]

I'm simply recognising the fact that health cannot take an ever-increasing amount of resources without a back-lash to that happening at some point.