An "Irish NHS" - what needs to change?

karlitob

Economics101 wrote: »

My last paragraph was in response to some other posters suggesting that total nationalisation of health services was somehow warranted: in what purports to be an open society it is an impossibility. And with reference to another poster, Nye Bevan did not nationalise everything: there were still private hospitals and doctors in private practice, albeit for a very small minority.

Sure we have an ageing population, which has required, and in future will require, more resources. But recurrent expenditure on the public system in Ireland has rocketed in the past 5 years, and we have the spectacle of agreed budgets being exceeded year after year. As for extra beds (5000?), a physical impossibility in a year. But even a multi-year capital programme will be a huge challenge. The Children's hospital debacle shows that something radical needs to be done in terms of capital programme management before more money is wasted. (My suspicion is that the detailed specifications are not properly worked out prior to contracts being signed: you need to "freeze" the specs at some stage - this holds for all complex projects).

As for my misnaming ED as A&E, big deal. When I was much younger they were known as Casualty Departments. Heavens knows what they will be called in a few years, although that decision will probably have to await the deliberations of a HSE Taskforce (or is it Working Group?) :rolleyes:

No - making is a big deal. That’s why the ‘Cork Spastic Clinic’ in the old regional no longer exists.

Casualty is a somewhat derogatory word to the ED people. It hasn’t been A&E in 20 or so years. The HSE didn’t decide anything - it’s clinical advice from the clinical leaders. The people who you go to see in the ED. Maybe you can roll your eyes to them.

Nationalisation. I take your point. But as I’ve said before - the two linchpins of our primary care service are GPs and pharmacists. All private. All are gatekeepers to the accessing the public purse. All need individual contracts to be signed. GPs see out medical card patients, write prescriptions and sick certs that we pay for, then go to the private company to dispense who then charge us for the pleasure. As you’ll see in my other post - there’s a fascination with private obstetric care. But clearly this is unsustainable that private companies are gatekeepers to the public purse. We have limited authority over them to make change. So while I’m not a fan of the extreme nationalisation that you are defending I don’t think our current model is fit for purpose. Something’s gotta change.

Funding has rocketed as the DoH didn’t fund the basic increase is normal activity based on population for years - it’s not just caught up. The funding wasn’t ‘agreed’. The DoH dictate. They didn’t give us enough. How else can you reason out that we have a bed occupancy rate of over 100%. That means we always fill all of our beds always. What more ‘management by the HSE’ do you want? Our OPD and ip service are reported in the ntpf website every month. 600,000 people waiting to be seen. Do you think the docs are just scratching their arse? The clinics are full. The theatres are full. What sort of management do you think is required to create capacity for 1/7th of the population (presuming I have my numbers right). Yes there is slack - better processes and structure are needed. Ict in particular but as I allude below - it’s a capital cost and large scale structural investment is costly on time and money. Local investment and structures are put in place but it’s piecemeal and can create problems of integration down the line. Real problems. As for improving processes - all I can say is that change costs money. Our clinicians are so busy they don’t have the headspace for full review of their processes. Nor do they necessarily have the headspace. There are excellent pockets of course but not everywhere. And if you think a HSE manager can swan in to w consultants clinic and offer help to improve - ha some fun.


An icu bed is a million - as highlighted through the pandemic there has been a requirement for about 450 icu beds to reach international norms. That 1/2bn - on a budget at the time of 12 to 16bn. Which service are gonna pick to not get a little bit of the pot to improve their service to their patient. Icu is only one small part of the our health service.

As for capital plans, it seems like your suggesting that all required builds and equipment upgrades can come out of this years allocation. It’s in the service plan what will be built. There’s a published capital plan of what’s needed now - just to keep the show on the road. It’s in the billions. Everyone keeps referencing the highly politicised children’s hospital but no one references the national forensic service in portrane. Large build, on time and on budget. See what can happen when healthcare is not politicised.

karlitob

CramCycle wrote: »

As did my partner, the horror story that was Holles St a few years ago if you had any issues or were, god forbid, unmarried was nothing short of abuse. Second time we went private, never regretted it for a second, it was a totally different experience. Now you can argue that both children were delivered successfully, and no one died but there was a difference in overall care that simply should not exist.

Catastrophising language aside (‘horror stories’ come on - you go to a crash in zone 1 or watch a baby die - then talk to me about ‘horror stories’) - I would argue that yes everyone is safe and healthy so a good outcome and I would agree that there shouldn’t be a difference in ‘care’ which is my point about removal of private care from healthcare/obstetrics. You’re basically saying that you paid for the midwives and doctors to be nice to you. And that if you don’t pay they’re not nice to you. Not clearly that’s not the case for all 60000 births every year. And even if it was - money has caused that difference, not need.

Furthermore - if you believe your partner or you has suffered ‘abuse’ at the hands of healthcare professionals you are entitled to your medical notes, you can make a complaint (backed by legislation) to the hospital, you can complain to the ombudsman (backed by legislation) or you can complain directly to the regulatory body of the individual who abused you ( also backed by legislation). In other words, your tax money has funded avenues for you to report and seek a review of your care by structures and process put in by our publicly funded legislature. Interestingly, some of those avenues are not covered for private hospitals - hiqa, complaints etc. Which is another example of how the private sector is not held to the same account as the public sector. I also disagree that ‘abuse’ as you put it doesn’t happen in the private sector. There are plenty of complaints about GPs and pharmacists. And rightly so.

CramCycle wrote: »

I say this as someone who fully believes private care should not exist here, it should be fully nationalised, we should flood the healthcare system with doctors and nurses so that no one has to do overtime, so that none of them are constantly exhausted. As someone with many friends and family in the area, nearly all would be happier with no overtime in return for adequate staffing.

Fine. Of course healthcare is more than just doctors and nurses.


Twitter.com/drmarkmurphy/status/1168269599231631366

Some excellent insights here for those interested

Geuze

Economics101 wrote: »

Sure we have an ageing population, which has required, and in future will require, more resources. But recurrent expenditure on the public system in Ireland has rocketed in the past 5 years, and we have the spectacle of agreed budgets being exceeded year after year.

Yes, h/c expenditure in Ireland is too high, relative to the age profile of our population.

We are spending as much per person, as countries with older populations.

The reason for this is high prices, not high volumes of activity.

karlitob

Geuze wrote: »

Yes, h/c expenditure in Ireland is too high, relative to the age profile of our population.

We are spending as much per person, as countries with older populations.

The reason for this is high prices, not high volumes of activity.

Exactly. While our population is ageing. It’s not the oldest in Europe nor is it the largest population share in Europe. In other words we have a smaller and younger older person population in ireland.

If you think it’s bad now....

Geuze

An update on Slaintecare today.

https://www.rte.ie/news/health/2021/0512/1221154-slaintecare-launch/

Spanish Eyes

A quick question, at the moment is everyone entitled to use Primary Medical Care centres in Ireland, regardless as to whether or not they hold a medical card?

Geuze

If a GP is based in the PCC, then you pay the GP as normal.

As in, people with GMS don't pay.

People without GMS do pay.



Regarding the other possible services in a PCC, I presume they are all tax-financed?

karlitob

Spanish Eyes wrote: »

A quick question, at the moment is everyone entitled to use Primary Medical Care centres in Ireland, regardless as to whether or not they hold a medical card?

I not sure the question but generally no, Ireland is the only country in the oecd with no universal primary health care service. But if there’s a gp in there you can pay to see. There are a number of primary healthcare centres rhay are effectively public private partnerships with the gps. I might have that arseways - I’m sure someone here can comment.

Geuze

karlitob wrote: »

Ireland is the only country in the oecd with no universal primary health care service. .

What exactly does this mean? I often wonder.
Does it mean that people abroad don't have to pay to go to the GP?

karlitob

Geuze wrote: »

If a GP is based in the PCC, then you pay the GP as normal.

As in, people with GMS don't pay.

People without GMS do pay.



Regarding the other possible services in a PCC, I presume they are all tax-financed?

It doesn’t mean they’ll accept. Lots of services don’t accept referrals without a gp / GMs. In other words, if you pay for a gp and she refers you to physio in the primary health centre they won’t see you privately - you go on the list like everyone else. If you go see the gp on gms and they refer to physios - you still go on the list.

A lot of services not use the medical card as the sole method for managing their waiting lists. In the instance above, they might not accept the private patient at all as they’re not gms. As I note, Ireland is the only country on oecd where Primary care is not universal.

Mad really

karlitob

Geuze wrote: »

What exactly does this mean? I often wonder.
Does it mean that people abroad don't have to pay to go to the GP?

As a legislative right, Irish citizens do have a universal entitlement to primary care treatment. GMS holders do, but all other persons don’t. We have subsided hospitals and medication care. Very good subsidies in my view. But full cost in the community.


https://www.tandfonline.com/doi/full/10.1080/23288604.2018.1551700

Geuze

karlitob wrote: »

As a legislative right, Irish citizens do have a universal entitlement to primary care treatment. GMS holders do, but all other persons don’t. We have subsided hospitals and medication care. Very good subsidies in my view. But full cost in the community.


https://www.tandfonline.com/doi/full/10.1080/23288604.2018.1551700

"The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care.1"

Surely everybody has equal access to a GP?

Some may have to pay, yes, okay.

But all people have the right to go to a GP, nobody is excluded, and there isn't a waiting list that can be jumped if you have insurance.


In France, people also have to pay to go to a GP.

How can it be then said that France has something that Ireland doesn't have?

mariaalice

The one thing I do believe is totally wrong is the fact that you can't access the public health nursing services for a lot of services unless you have a medical card.

As for pregnancy, you do not need to see a consultant unless there is an issue, it should be midwife-led care all the way, in the UK the woman would be seen by a midwifery team all through pregnancy and would spend very little time in a hospital even a first time mother could be discharged 6 hours after giving birth, however, they would be visited at home by the team and a lactation consultant would visit them in their home Appointments are much better coordinated and organised.

Hear it can be a bit shambolic not in terms of care but in terms of appointments.

lazygal

I had no interest in midwife led maternity care when pregnant.

PhoneMain

lazygal wrote: »

I had no interest in midwife led maternity care when pregnant.

Midwives are going to be vastly more experienced than a lot of the doctors that you may encounter during your pregnancy!! A lot of the doctors you will see may be SHOs (level above intern but below regs who are below consultants) and in reality they may have max 6 months experience (if they're GP trainees) or have less than 2 years experience in obstetrics.

mariaalice

lazygal wrote: »

I had no interest in midwife led maternity care when pregnant.

That is interesting why? all the evidence would say it's the best way to go.

lazygal

PhoneMain wrote: »

Midwives are going to be vastly more experienced than a lot of the doctors that you may encounter during your pregnancy!! A lot of the doctors you will see may be SHOs (level above intern but below regs who are below consultants) and in reality they may have max 6 months experience (if they're GP trainees) or have less than 2 years experience in obstetrics.

I had the master of the hospital as my consultant. She did all my c sections. A midwife would have been no good to me.

Antares35

karlitob wrote: »

Firstly - this just isn’t true. Sure who do you think holds the clinics and delivers the babies. If you think a private consultant is at every private baby’s birth you’ve another thing coming. What do you think a public consultant is doing when they’re not in private rooms? Also, you get reviewed based on need. If you’ve a healthy pregnant why do you need to be seen by an obstetrician at every appointment. People can waste €5k to make themselves feel better but paying does nothing for the outcome of th woman or the child NOTHING. Could you imagine the newspaper headlines if it did.

Secondly - I can see no clinical reason. We have the safest and best obstetric service in the world. The lowest (or close) maternal and baby mortality in the world.

I went for midwife led care on both my pregnancies because I wanted that continuity of care. Mostly saw the same midwife each time. I cannot find one single fault with the care I received. The only long wait time I had was at the initial booking appointment but that is generally expected to be around two hours because you're in and out for different tests etc. When I needed an epidural, there was an anesthetist there within ten minutes. When it looked like I might need an assisted birth (which thankfully in the end I didn't) they already had someone in place for that. I really don't think anyone will be deprived medical attention they require simply because they are public or have gone midwife led.

lazygal

mariaalice wrote: »

That is interesting why? all the evidence would say it's the best way to go.

I wanted a consultant and a specific consultant. As I needed sections I'm even more glad it wasn't midwife led. And if you've any issues you need a consultant anyway so I'd rather have one I know and not whoever is available. I'm done with pregnancies but I'd go consultant led every time.
I found the advice on breastfeeding atrocious from all the nurses on my first.

mariaalice

The state should provide the best evidence-based health care it can, but the state cant support the choices people are making because of a nonevidence base perception that private hospitals or private health care will have 'better'.

lazygal

mariaalice wrote: »

The state should provide the best evidence-based health care it can, but the state cant support the choices people are making because of a nonevidence base perception that private hospitals or private health care will have 'better'.

Thankfully in Ireland we have that choice.
I know people who sing the praises of midwife led care. I'm very happy that's available to them.

mariaalice

lazygal wrote: »

I wanted a consultant and a specific consultant. As I needed sections I'm even more glad it wasn't midwife led. And if you've any issues you need a consultant anyway so I'd rather have one I know and not whoever is available. I'm done with pregnancies but I'd go consultant led every time.
I found the advice on breastfeeding atrocious from all the nurses on my first.

In the UK it would have been a specially trained lactation consultant would come to your house so it's a better system.

CramCycle

Geuze wrote: »

"The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care.1"

Surely everybody has equal access to a GP?

Some may have to pay, yes, okay.

But all people have the right to go to a GP, nobody is excluded, and there isn't a waiting list that can be jumped if you have insurance.


In France, people also have to pay to go to a GP.

How can it be then said that France has something that Ireland doesn't have?

It says equitable not equal, so there is a huge difference, not from France though so can't say how its different but here the medical card would address it somewhat but lots of people don't have one and also would avoid a GP due to cost.
As for no one being excluded, several GP practices are full in my local area so newcomers can't register with them at all, with several practices flat out refusing to take on more clients, so people are excluded but not for obvious reasons, simply a lack of space.

Geuze

CramCycle wrote: »

It says equitable not equal, so there is a huge difference, not from France though so can't say how its different but here the medical card would address it somewhat but lots of people don't have one and also would avoid a GP due to cost.

In France, a GP charges 25, and the rate is regulated by the State.

The patient pays up front.

Everybody (most people) has public insurance, which covers 70% of the cost of much healthcare.

The patient later makes a claim, and is reimbursed 17.50.

The net cost is 7.50.

Many people voluntarily choose to buy insurance to cover the other 30% of healthcare costs.

lazygal

mariaalice wrote: »

In the UK it would have been a specially trained lactation consultant would come to your house so it's a better system.

There are lactation consultants in Ireland too.

I didn't need the services of one.

I found the PHN system in one area abysmal-one nurse told me I only needed to breastfeed for 15 minutes each side. We moved when I had my third and it was like a different world. Absolutely phenomenal advice and support.

karlitob

Geuze wrote: »

"The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care.1"

Surely everybody has equal access to a GP?

Some may have to pay, yes, okay.

But all people have the right to go to a GP, nobody is excluded, and there isn't a waiting list that can be jumped if you have insurance.


In France, people also have to pay to go to a GP.

How can it be then said that France has something that Ireland doesn't have?

Because everyone has to pay a bit on everything in France. Whereas in Ireland some people pay nothing for some services, some bits are subsidised and some bits aren’t.

It’s not universal.

karlitob

lazygal wrote: »

I had no interest in midwife led maternity care when pregnant.

Well let’s set up a service about what people may or may not want and have no recourse to international outcomes evidence or cost.
I can tel you how many patients have ‘no interest’ in being in a nursing homes or having to travel miles for chemotherapy in a centre of excellent.

And besides midwifery led care is only one part of one service for some people. It all depends.

lazygal

karlitob wrote: »

And besides midwifery led care is only one part of one service for some people. It all depends.

Lots of people choose it, and are happy with it. The choice is there for those who don't want it.

Anita Blow

mariaalice wrote: »

In the UK it would have been a specially trained lactation consultant would come to your house so it's a better system.

Lactation consultants are also common in Ireland. All major maternity units have them and a lactation outpatient service

karlitob

lazygal wrote: »

I had the master of the hospital as my consultant. She did all my c sections. A midwife would have been no good to me.

Must have been interesting to have undergone surgery with only one person in the room. The ‘master’ - wow. And was the master the only obstetrician/gynaecologist in the hospital that can perform c sections or can all trained obstetricians and gynaecologists conduct c sections.

If I was gonna have surgery I’d want to have more than one person in the room with me. an anaesthetist, a registrar and a whole wealth of theatre midwives who’ve spent years training that you deem were ‘no good for you’.

You probably think that all c sections are always appropriate. You other enlighten us how at Luke’s Kilkenny has the highest c sections in the country - nearly double the lowest.

karlitob

lazygal wrote: »

I wanted a consultant and a specific consultant. As I needed sections I'm even more glad it wasn't midwife led. And if you've any issues you need a consultant anyway so I'd rather have one I know and not whoever is available. I'm done with pregnancies but I'd go consultant led every time.
I found the advice on breastfeeding atrocious from all the nurses on my first.

You misunderstand midwifery led care and healthcare in general. You don’t who you want just cos you want them. You get who you need.

A low risk pregnancy should have a midwife led pregnancy as it’s the most cost effective with excellent outcomes - clinical and psychological. You get a consultant when you’re sick. If you’re not sick you shouldn’t get a consultant because pregnancy isn’t an illness.

If you’ve a high risk pregnancy you won’t be in a midwifery led service. It wouldn’t apply to you. Even if you wanted it - you wouldn’t get it. You wouldn’t have the choice.

And as for breastfeeding. Ireland has one of the lowest uptake rates on breastfeeding in any county in the world. That’s a cultural issue and is not the responsibility of midwives only. That’s like saying America is the fattest country in the world and it’s the fault of healthcare.

Could they be better - you’re damn right they could. Is a day or so post partum before you’re discharged sufficient to learn a brand new skill for a brand new human being. Obviously not. Their midwives - not teachers of human milestones. You’d be more accurate in saying that public health nurses should do more. Which is still not true.

Far more support is needed in the community to improve rates of breast care. But it’s an inter generational cultural issue. And an ‘ol midwife should not be moaned about by you cos you and your child - like every other first time mother ever - couldn’t figure out breast feeding straight away. Was the midwife even a mother - how would she know?

The are unreasonable and unrealistically high expectations in maternity care in Ireland that leads people to believe that it’s ****e rather than brilliant with lots of areas to improve upon.

And if you think obstetrics is **** - wait till you get older.

karlitob

lazygal wrote: »

Thankfully in Ireland we have that choice.
I know people who sing the praises of midwife led care. I'm very happy that's available to them.

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

karlitob

Geuze wrote: »

In France, a GP charges 25, and the rate is regulated by the State.

The patient pays up front.

Everybody (most people) has public insurance, which covers 70% of the cost of much healthcare.

The patient later makes a claim, and is reimbursed 17.50.

The net cost is 7.50.

Many people voluntarily choose to buy insurance to cover the other 30% of healthcare costs.

As discuss earlier - we need to rethink our funding model for health. James Reilly started it - the gps didn’t like it. He was a gp.

French citizens are taxed 20 per cent of their income toward social insurance. This social insurance fund pays 70 per cent of the cost of treatment. French citizens take out private health insurance (mutuelle) for the remaining 30 per cent for therapies, vision, and dental. So with an income of €40,000, social insurance would come to €8,000 and citizens also need private insurance to the tune of €200-€500 per annum. For comparison, in ireland PRSI is taxed at 4 per cent (if you are above exemption limits) and circa 40 per cent of the population has some form of health insurance and about 40 per cent has a medical card

Antares35

karlitob wrote: »

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

Can c-sections not be elective?

lazygal

Antares35 wrote: »

Can c-sections not be elective?

One of mine was. I decided at the first appointment to have a section. Of course people can choose how to give birth.

lazygal

karlitob wrote: »

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

I had a section because I wanted it. I had no interest in giving birth vaginally and that is of course my choice.

lazygal

karlitob wrote: »

You misunderstand midwifery led care and healthcare in general. You don’t who you want just cos you want them. You get who you need.

A low risk pregnancy should have a midwife led pregnancy as it’s the most cost effective with excellent outcomes - clinical and psychological. You get a consultant when you’re sick. If you’re not sick you shouldn’t get a consultant because pregnancy isn’t an illness.

If you’ve a high risk pregnancy you won’t be in a midwifery led service. It wouldn’t apply to you. Even if you wanted it - you wouldn’t get it. You wouldn’t have the choice.

And as for breastfeeding. Ireland has one of the lowest uptake rates on breastfeeding in any county in the world. That’s a cultural issue and is not the responsibility of midwives only. That’s like saying America is the fattest country in the world and it’s the fault of healthcare.

Could they be better - you’re damn right they could. Is a day or so post partum before you’re discharged sufficient to learn a brand new skill for a brand new human being. Obviously not. Their midwives - not teachers of human milestones. You’d be more accurate in saying that public health nurses should do more. Which is still not true.

Far more support is needed in the community to improve rates of breast care. But it’s an inter generational cultural issue. And an ‘ol midwife should not be moaned about by you cos you and your child - like every other first time mother ever - couldn’t figure out breast feeding straight away. Was the midwife even a mother - how would she know?

The are unreasonable and unrealistically high expectations in maternity care in Ireland that leads people to believe that it’s ****e rather than brilliant with lots of areas to improve upon.

And if you think obstetrics is **** - wait till you get older.

Why are you so combative?
How may times have you given birth in Ireland?

karlitob

Antares35 wrote: »

Can c-sections not be elective?

Of course they can.

karlitob

lazygal wrote: »

One of mine was. I decided at the first appointment to have a section. Of course people can choose how to give birth.

No. They can’t. You cannot operate on someone just cos you want them to. There has to be a clinical reason. That bar can be lower or higher depending on the consultant but you can’t demand it.

In the same way you can’t demand a vaginal birth of the life of the mother and child are in imminent danger and the correct course of treatment is surgical.

You don’t get to decide on your own. It’s a partnership between healthcare professional and patient.

Antares35

lazygal wrote: »

One of mine was. I decided at the first appointment to have a section. Of course people can choose how to give birth.

That's what I thought alright

lazygal

karlitob wrote: »

No. They can’t. You cannot operate on someone just cos you want them to. There has to be a clinical reason. That bar can be lower or higher depending on the consultant but you can’t demand it.

In the same way you can’t demand a vaginal birth of the life of the mother and child are in imminent danger and the correct course of treatment is surgical.

You don’t get to decide on your own. It’s a partnership between healthcare professional and patient.

Women get to decide what's best for themselves. We don't live under the eighth amendment any more.

Antares35

karlitob wrote: »

Of course they can.

Are you just contradicting yourself or have I confused the matter?

karlitob

lazygal wrote: »

Why are you so combative?
How may times have you given birth in Ireland?

How many times have you treated a patient and how many years have you spent training?

Does your cancer doctor have to have had cancer before you are happy to be treated by them?

Is a male obstetrician allowed to treat women in your world?

If I’m combative, you’re closed minded. Choice A don’t make me laugh.

Antares35

karlitob wrote: »

No you don’t have that choice. A surgeon will not perform an operation just cos the patient wants it. It doesn’t work like that.

You reference midwifery led care. If you are a high risk patient you will not be seen in midwifery led care just cos you want it. It’s outside of the midwifes scope of practice. And clinical governance of the hospital. You can’t choose what you want.

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

lazygal

karlitob wrote: »

How many times have you treated a patient and how many years have you spent training?

Does your cancer doctor have to have had cancer before you are happy to be treated by them?

Is a male obstetrician allowed to treat women in your world?

If I’m combative, you’re closed minded. Choice A don’t make me laugh.

You sound exactly like one doctor in Holles St I requested not be allowed to treat me based on how he spoke to me.

lazygal

Antares35 wrote: »

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

Public patients can choose consultant led care. But they won't get to choose which consultant and are under a team rather than one consultant. Semi private care is also an option.

karlitob

Antares35 wrote: »

Are you just contradicting yourself or have I confused the matter?

No. It’s the same point. Elective is planned. Trauma is not planned. Just because it’s elective doesn’t mean someone can demand to have it. It just means that the patient AND the healthcare professional agreed - at a planned time - to undertake a procedure or treatment.


Consider, it’s clearly silly to say that a surgeon can operate on you without your consent. Equally a surgeon can’t operate on you without her consent. And they don’t operate because you want to - only if it’s clinically indicated. It doesn’t matter what the clinical speciality is - that’s just that.

karlitob

Antares35 wrote: »

At your booking appointment you will see a consultant and they assess if you are high risk and if so, that will preclude you from opting for midwife led care. So in that sense you are right, you cannot choose to go midwife led just because you want to, if you are high risk.

However this does not mean that you HAVE to be high risk to go consultant led, if you are paying privately. My understanding that private patients can opt for consultant led, notwithstanding that their pregnancy might be low risk and they would qualify for MWL if they wished.

That’s not what I said.

Antares35

karlitob wrote: »

No. It’s the same point. Elective is planned. Trauma is not planned. Just because it’s elective doesn’t mean someone can demand to have it. It just means that the patient AND the healthcare professional agreed - at a planned time - to undertake a procedure or treatment.


Consider, it’s clearly silly to say that a surgeon can operate on you without your consent. Equally a surgeon can’t operate on you without her consent. And they don’t operate because you want to - only if it’s clinically indicated. It doesn’t matter what the clinical speciality is - that’s just that.

Elective is where the patient chooses i.e. she has a choice.

lazygal

karlitob wrote: »

That’s not what I said.

You're spitting so much venom about choice in maternity care its hard to keep track of what you said.