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UK ambulance services on brink of collapse


Eldorado
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Ambulance services are under intense pressure, with record numbers of callouts and the most urgent, category-one, calls last month.

BBC Two's Newsnight programme spent from 08:00 to 20:00 on Monday at six hospitals with the longest delays handing patients over from paramedics to accident-and-emergency staff.

This should take 15 minutes or less - but crews often wait many hours and sometimes whole 12-hour shifts, with ambulances queuing outside unable to respond to other emergency calls.

https://www.bbc.co.uk/news/health-62166818

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I think the popular term is..'not fit for purpose'

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1 hour ago, itsnotoutthere said:

I think the popular term is..'not fit for purpose'

That's what happens when you're mismanaged, underfunded and understaffed for so long.

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Here in Cornwall, it was thought to be a good idea to send several of our ambulances to Ukraine.

Anyone else think that the NHS started tumbling downhill at the exact moment they began hiring managers?

Edited by ouija ouija
It fixed itself!
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1 hour ago, Eldorado said:

That's what happens when you're mismanaged, underfunded and understaffed for so long.

Mismanaged...agreed, underfunded...hell no. If the NHS can't manage on £190 billion a year then perhaps a different approach is required.

According to the figures I'm paying the NHS £2253 per year. To be honest, I don't think I'm getting my monies worth. I rang my local GP surgery last week for an appointment to be told all six doctors were off with covid, but a nurse would call me back. £2253 PER YEAR.

Edited by itsnotoutthere
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34 minutes ago, ouija ouija said:

 

Here in Cornwall, it was thought to be a good idea to send several of our ambulances to Ukraine.

Anyone else think that the NHS started tumbling downhill at the exact moment they began hiring managers?

The NHS has always had managers, just never so many or so hopeless.

I reckon it all began when our new narcissistic Britain got itself a new set of priorities.  Me, me, me!

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Plus I think we've tipped over that finely balanced point where we have too many using it that don't actually contribute.

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9 minutes ago, itsnotoutthere said:

Plus I think we've tipped over that finely balanced point where we have too many using it that don't actually contribute.

It's being managed by self-serving clowns and both Labour and Tory governments have failed to address it.  Cushy jobs for their old uni pals.

"A review into leadership in the health service is claimed to have been commandeered by 'wholesale wokery'.

"Former Thatcher cabinet minister Peter Lilley blasted the report into NHS management for mentioning ‘woke’ strategy of Equality, Diversity and Inclusion (EDI) 'three times as often as patients'. 

"He claimed that the report by Iraq General Sir Gordon Messenger also failed to look at 'clinical failures' and reducing inefficiency in the health service."

https://www.dailymail.co.uk/news/article-10931429/NHS-review-Woke-issues-mentioned-three-times-patients-NHS-review-says-Lord-Lilley.html

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1 hour ago, itsnotoutthere said:

Mismanaged...agreed, underfunded...hell no. If the NHS can't manage on £190 billion a year then perhaps a different approach is required.

According to the figures I'm paying the NHS £2253 per year. To be honest, I don't think I'm getting my monies worth. I rang my local GP surgery last week for an appointment to be told all six doctors were off with covid, but a nurse would call me back. £2253 PER YEAR.

It would cost you that and more for a single visit to A&E and some investigations if you lived in the US. You should support the NHS not knock it, it is valuable.

It is also under-funded compared to similar countries to the UK:Spending on and availability of health care resources | The King's Fund (kingsfund.org.uk)

Edited by The Silver Shroud
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I have to say when I have visited a hospital to see relatives the staff seem to be missing or on a go slow. I have found drinks for patients, not my own relative, when a pressed button is ignored. 

Many a time I have witnessed a gaggle of nurses discussing their night out or what a boy friend had been up to, or what was eaten in a bush tucker challenge.

There was a push to bring back matrons but from my experiences it only looks partially successful in kicking some a**e.  :rolleyes:

Some staff seem to think they are in a holiday camp. :blink:

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3 hours ago, The Silver Shroud said:

It would cost you that and more for a single visit to A&E and some investigations if you lived in the US. You should support the NHS not knock it, it is valuable.

It is also under-funded compared to similar countries to the UK:Spending on and availability of health care resources | The King's Fund (kingsfund.org.uk)

Disagree. The way it is run now it could have three times the amount of money spent on it & would still be dysfunctional. It's not about the money, it's about bad management & work ethic.

If it was just about money, they wouldn't be advertising for so many 'diversity & inclusion' managers at £50,000 a pop. They are not short of money, it's just spent on the wrong things & people.

https://www.dailymail.co.uk/health/article-4176406/Meet-Nigerian-cost-500-000-IVF-triplets.html

https://www.express.co.uk/news/uk/726817/London-hospital-used-Nigerian-mums-flying-free-maternity-care-UK-NHS

https://www.thesun.co.uk/news/8910736/ten-ineligible-women-a-day-are-flying-into-the-uk-to-give-birth-on-nhs-maternity-wards/

https://www.bbc.co.uk/news/uk-politics-38809530

Edited by itsnotoutthere
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42 minutes ago, itsnotoutthere said:

Disagree. The way it is run now it could have three times the amount of money spent on it & would still be dysfunctional. It's not about the money, it's about bad management & work ethic.

If it was just about money, they wouldn't be advertising for so many 'diversity & inclusion' managers at £50,000 a pop. They are not short of money, it's just spent on the wrong things & people.

https://www.dailymail.co.uk/health/article-4176406/Meet-Nigerian-cost-500-000-IVF-triplets.html

https://www.express.co.uk/news/uk/726817/London-hospital-used-Nigerian-mums-flying-free-maternity-care-UK-NHS

https://www.thesun.co.uk/news/8910736/ten-ineligible-women-a-day-are-flying-into-the-uk-to-give-birth-on-nhs-maternity-wards/

https://www.bbc.co.uk/news/uk-politics-38809530

I agree with some of what you said. It is not the NHS wasting money so much as the government. The Tories stole £37 billion of tax payers money to give to private firms for Track n Trace, and hundreds of millions for unusable PPE from private firms, including mates of Hancock and that Mone woman. 

From the BBC article:

Chairwoman of the Public Accounts Committee Meg Hillier attacked the government's "failure to get a grip" as "simply unacceptable".

The Department of Health said it would be announcing "further steps very shortly to recover up to £500m a year".

Ms Hillier, MP for Hackney South and Shoreditch, said the NHS was missing out on "vital funds".

"The public rightly expects the government to enforce the rules, and more can and should be done to recover money," she said.

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Our national health service continues to disintegrate into chaos and, in some places, paralysis. Fêted for decades as the jewel in the crown of our welfare state, it has fallen for its own rhetoric and thinks that it only needs to exist to merit praise. When troubles beset it, it points to external forces, blames underfunding and inevitably holds out its bottomless begging bowl in expectation of another health directed handout. But it continues to deteriorate in terms of the service it delivers.

Its only answer, it seems, is increasingly to address the progressive ‘woke’ agenda in the hope of not offending a minority of megaphoned moaners, while ignoring the majority of people who simply want to know that when they are sick, they can see a doctor. More to the point, should they become suddenly and acutely become ill at home or collapse in the street, they will be transported swiftly to an emergency department and have, at least, a fighting chance of returning home to their families.

The NHS displays the worst aspects of Stalinist democratic centralism combined with the worst aspects of autonomous mini dictatorships. In its Stalinist guise, it continues to absorb vast amounts of our hard-earned taxes and exists to serve the state rather than the people. 

In some parts of the country and regarding certain services it still seems like it is closed. Many general practitioners, having discovered the joys of misdiagnosing illness from the comfort of their own kitchens are now trying to make a virtue out of this nastiness by ‘offering’ their patients video consultations, as if this was some great leap forward in community medical practice. Our densely populated and small country is being offered a service that would make the Flying Doctors in Alice Springs blush with embarrassment.

Yet another review of the NHS, with particular emphasis on its management, has taken place, but nothing will change. The captains of this great industry will continue to conduct the orchestra as the ship sinks and, instead of plugging the holes, they will build more cabins on top in the form of equality and diversity managers; issuing badges with pronouns on them, declaring yet another day to celebrate, yet another addition to the alphabet soup of sexual identities and insisting on referring to proud young mums as ‘people who give birth’. If we are lucky, another expensive review will be commissioned and the whole service reorganised into whatever shape it was last time before it was reorganised.

There is a reason that the NHS is not the best health service in the world and way down the league table of health services in developed countries. There is also a reason why it has never been replicated by any other country: it simply does not work.

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Fire Brigade is under pressure too.

Quite a few large fires going on at the moment around London, some whole blocks of houses have burned down, fields on fire, its going to be a rough night for some people.

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If you were about to start the NHS from scratch then it would look nothing like it does today.

When nearly every person in the UK is saying the same thing you know something is broken.

Too many fat cats obstructing change and losing sight of patient needs.

One example from my visit to hospital this week... nurse calls me through. I meet the doc. Doc finishing notes from last patient. Nurse stands there. Doc finally turns to look at me. Spends half the appointment writing notes and other half doing the check up and administering meds. Nurse does next to nothing this whole time. She was obviously bored. Instead, why not get the doc to call me through while the Nurse writes the notes. The nurse can keep note taking through the appointment and as the doc is speaking, and during the treatment. Result: that'd save approx 10 minutes an appointment. My appointment was about 25 minutes. 8 hour shift would yield a minimum extra 160 minutes which is 6 patients a day and an extra 10 minutes break for the doc and nurse or, one less doc and nurse required in that department saving £100k per annum. 

The intelligent, highly paid, doc then tells me they are so busy and underfunded... hmmm, nope. Badly managed even at the micro level. 

The hospital is huge.

Reckon I could find £1M a year in savings during every week they let me wander round. I'd do it for a one off payment of £500,000. If the NHS did it, I reckon they'd take 3 years to do the same project and pay themselves £1.1M a year, while moaning they are underfunded.

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22 hours ago, itsnotoutthere said:

Our national health service continues to disintegrate into chaos and, in some places, paralysis. Fêted for decades as the jewel in the crown of our welfare state, it has fallen for its own rhetoric and thinks that it only needs to exist to merit praise. When troubles beset it, it points to external forces, blames underfunding and inevitably holds out its bottomless begging bowl in expectation of another health directed handout. But it continues to deteriorate in terms of the service it delivers.

There is a reason that the NHS is not the best health service in the world and way down the league table of health services in developed countries. There is also a reason why it has never been replicated by any other country: it simply does not work.

There is a reason that the NHS is not the best health service in the world and way down the league table of health services in developed countries. And that reason is it is underfunded:

-In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD (£2,913 per person).

-However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).

-As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.How does UK healthcare spending compare with other countries? - Office for National Statistics (ons.gov.uk)

You are the perfect voter as far as the Tories are concerned, you fall straight into the culture wars trap they are creating to have someone apart from themselves to blame for their failings.

I agree with you about diversity managers on £50k being a waste of money, but they are not the reason the NHS is falling behind with waiting lists. It wouldn't matter if they worked from home or just went on holiday: what matters is that clinical teams are understaffed and so are not able to hit their targets. If our hospitals, ambulances and care homes were properly funded and staffed, there wouldn't be long waiting lists. The UK could easily afford it, if the priority was not giving the wealthy and shareholders ever larger bonuses and profits (In the last 10 years, and especially since Covid and Brexit, the gap beween the richest and the poorest in the UK has become bigger). But the Tories don't want you to consider that, they want you to blame "wokeness" and diversity for the mess the UK is in due to their mismanagement.

 

 

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6 hours ago, OpenMindedSceptic said:

If you were about to start the NHS from scratch then it would look nothing like it does today.

When nearly every person in the UK is saying the same thing you know something is broken.

Too many fat cats obstructing change and losing sight of patient needs.

One example from my visit to hospital this week... nurse calls me through. I meet the doc. Doc finishing notes from last patient. Nurse stands there. Doc finally turns to look at me. Spends half the appointment writing notes and other half doing the check up and administering meds. Nurse does next to nothing this whole time. She was obviously bored. Instead, why not get the doc to call me through while the Nurse writes the notes. The nurse can keep note taking through the appointment and as the doc is speaking, and during the treatment. Result: that'd save approx 10 minutes an appointment. My appointment was about 25 minutes. 8 hour shift would yield a minimum extra 160 minutes which is 6 patients a day and an extra 10 minutes break for the doc and nurse or, one less doc and nurse required in that department saving £100k per annum. 

The intelligent, highly paid, doc then tells me they are so busy and underfunded... hmmm, nope. Badly managed even at the micro level. 

The hospital is huge.

Reckon I could find £1M a year in savings during every week they let me wander round. I'd do it for a one off payment of £500,000. If the NHS did it, I reckon they'd take 3 years to do the same project and pay themselves £1.1M a year, while moaning they are underfunded.

One of the dumbest posts I have ever read. I mean, it ticks all the boxes: unresearched, biased, written by someone gullible to right-wing propagana. Obviously written by someone "educated in the University of Life".

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On 7/15/2022 at 12:23 PM, itsnotoutthere said:

Plus I think we've tipped over that finely balanced point where we have too many using it that don't actually contribute.

I think one of the biggest problems is people booking an appointment or ringing an ambulance when they don't need to at all. Wastes the NHS time and resources. 

I collapsed in work a few years ago, hit my head on the floor, had a few seizures and briefly stopped breathing. Manager rung the ambulance and they said I'd be quicker walking to A&E so my dad had to come out to work to take me down.

I'd like to say I like the NHS but like other parts of the nation its in a right mess and it doesn't seem to be getting better.

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1 hour ago, The Silver Shroud said:

There is a reason that the NHS is not the best health service in the world and way down the league table of health services in developed countries. And that reason is it is underfunded:

-In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD (£2,913 per person).

-However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).

-As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.How does UK healthcare spending compare with other countries? - Office for National Statistics (ons.gov.uk)

You are the perfect voter as far as the Tories are concerned, you fall straight into the culture wars trap they are creating to have someone apart from themselves to blame for their failings.

I agree with you about diversity managers on £50k being a waste of money, but they are not the reason the NHS is falling behind with waiting lists. It wouldn't matter if they worked from home or just went on holiday: what matters is that clinical teams are understaffed and so are not able to hit their targets. If our hospitals, ambulances and care homes were properly funded and staffed, there wouldn't be long waiting lists. The UK could easily afford it, if the priority was not giving the wealthy and shareholders ever larger bonuses and profits (In the last 10 years, and especially since Covid and Brexit, the gap beween the richest and the poorest in the UK has become bigger). But the Tories don't want you to consider that, they want you to blame "wokeness" and diversity for the mess the UK is in due to their mismanagement.

 

 

NHS budget 2007/8 = £111 billion   ----   NHS budget 2021/22 = £190 billion

So the conservative government are spending £80 billion more each year than Labour did when Gordon Brown was prime minister.....and it's still not enough. (and getting an appointment with a GP is less likely than getting an audience with the pope.)

https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

Edited by itsnotoutthere
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6 hours ago, The Silver Shroud said:

One of the dumbest posts I have ever read. I mean, it ticks all the boxes: unresearched, biased, written by someone gullible to right-wing propagana. Obviously written by someone "educated in the University of Life".

Thanks Silver.

Your proposition or observance is what? Or was it just to get personal?

So glad you're here with your input. It was insightful.

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5 hours ago, OpenMindedSceptic said:

Thanks Silver.

Your proposition or observance is what? Or was it just to get personal?

So glad you're here with your input. It was insightful.

I apologise. I was tired when I wrote it, the heat stops me sleeping properly. It was not personal.

I was responding to your observation that the nurse should write the doctors notes up. That would be a complete waste of resources. Why train someone to be a nurse if they spend their time as a PA?

Maybe the nurse could have spent her time more usefully, but often doctors and nurses work as teams. She and he (doctors and nurses can be either, of course) should be doing stuff to speed up the whole examination.

 An example: a patient presents with a persistant headache. The nurse may have triaged the patient, or took a handover from the nurse who did the triage. The doctor examines the patient,does neurological tests there and then and might want to take bloods, makes an assessment, perhaps discusses the patient with a colleague in person or on the phone. The doctor doesn't want to miss meningitis, a sub-arachnoid haemorrhage or a tumour. He might want to get corroborating evidence from a family member.He has to decide whether to admit overnight or send the patient home. As the doctor who is seeing the patient when they present, he has a lot of responsibility and may have to justify his actions in court later.

When he writes up his notes, he has to put in all the salient findings and his justification for coming to his decision. Dictating all this to a nurse so she can write it up would take more time, not less. A lot of the notes are written in shorthand anyway, using medical jargon, which is quicker to jot down than explain how to jot down.

A better way to speed up the clinical experience would be to fund a department properly, which we don't do in the UK ( @itsnotoutthere  quoted higher spending over the last year or two, but of course that is due to the massive impact of Covid). He also said he was paying £2253 per year to the NHS- I'll tell you now for nothing that is an absolute bargain. When you consider any of us could be involved in an accident, and be assured of care all the way from first response to long-term rehabilitation, it is something worth preserving.

I'm not saying it is faultless, far from it, but the NHS is something we will miss when the Tories have finally sold it off.

 

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9 hours ago, The Silver Shroud said:

 

"I'm not saying it is faultless, far from it, but the NHS is something we will miss when the Tories have finally sold it off."

 

"PFI, or Private Finance Initiatives were deals set up with the private sector companies to organise over 100 NHS hospitals building schemes from 1992 onwards. The policy was  conceived by the Conservative government of John Major but predominantly advanced under Labour.

The reputation of PFI came steadily more damaged, so much so that the policy is now almost redundant. However the poor PFI arrangements will continue to negatively affect NHS hospitals for years to come."

https://www.nhsforsale.info/privatisation/other-issues/pfi-new/#:~:text=PFI%2C or Private Finance Initiatives were deals set,of John Major but predominantly advanced under Labour.

Edited by itsnotoutthere
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I don't live there or know allot about it, but from what is posted here, it seems like mismanagement is the #1 issue.  

It is mismanagement that would hire a diversity managers at £50k instead of 1 or 2 nurses.

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20 minutes ago, itsnotoutthere said:

"PFI, or Private Finance Initiatives were deals set up with the private sector companies to organise over 100 NHS hospitals building schemes from 1992 onwards. The policy was  conceived by the Conservative government of John Major but predominantly advanced under Labour.

The reputation of PFI came steadily more damaged, so much so that the policy is now almost redundant. However the poor PFI arrangements will continue to negatively affect NHS hospitals for years to come."

https://www.nhsforsale.info/privatisation/other-issues/pfi-new/#:~:text=PFI%2C or Private Finance Initiatives were deals set,of John Major but predominantly advanced under Labour.

I know Labour introduced the disasterous PFIs, but that was at least debated in parliament. The sell off continues, but without public scrutiny, and with plenty of graft:

Matt Hancock has promoted a healthcare startup whose shareholders have made donations to the health secretary and the Conservative party, the Guardian can reveal.

The revelations about investors in Babylon Healthcare, a startup that offers smartphone-based NHS GP consultations and symptom-checker services, raise questions about possible conflicts of interest for Hancock.

Babylon, a company founded in 2013 by the British-Iranian former banker Ali Parsa, is in the process of a listing in the US, which is expected to value the company at $4.2bn (£3bn).

Shareholders of firm backed by Matt Hancock have donated to the Tories | Matt Hancock | The Guardian

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19 hours ago, The Silver Shroud said:

I apologise. I was tired when I wrote it, the heat stops me sleeping properly. It was not personal.

I was responding to your observation that the nurse should write the doctors notes up. That would be a complete waste of resources. Why train someone to be a nurse if they spend their time as a PA?

Maybe the nurse could have spent her time more usefully, but often doctors and nurses work as teams. She and he (doctors and nurses can be either, of course) should be doing stuff to speed up the whole examination.

 An example: a patient presents with a persistant headache. The nurse may have triaged the patient, or took a handover from the nurse who did the triage. The doctor examines the patient,does neurological tests there and then and might want to take bloods, makes an assessment, perhaps discusses the patient with a colleague in person or on the phone. The doctor doesn't want to miss meningitis, a sub-arachnoid haemorrhage or a tumour. He might want to get corroborating evidence from a family member.He has to decide whether to admit overnight or send the patient home. As the doctor who is seeing the patient when they present, he has a lot of responsibility and may have to justify his actions in court later.

When he writes up his notes, he has to put in all the salient findings and his justification for coming to his decision. Dictating all this to a nurse so she can write it up would take more time, not less. A lot of the notes are written in shorthand anyway, using medical jargon, which is quicker to jot down than explain how to jot down.

A better way to speed up the clinical experience would be to fund a department properly, which we don't do in the UK ( @itsnotoutthere  quoted higher spending over the last year or two, but of course that is due to the massive impact of Covid). He also said he was paying £2253 per year to the NHS- I'll tell you now for nothing that is an absolute bargain. When you consider any of us could be involved in an accident, and be assured of care all the way from first response to long-term rehabilitation, it is something worth preserving.

I'm not saying it is faultless, far from it, but the NHS is something we will miss when the Tories have finally sold it off.

 

Thanks for the apology. Lack of sleep is a bummer, hope you're rested.

Triage would be a cool idea.

Where there is a nurse and a doctor though, I think the nurse should write up the notes. A doctor in the UK is probably a cost of £50 an hour whereas a nurse is probably £17 an hour. 

Far better to utilise the more expensive resource in high value tasks eg: diagnosis and interventions. The nurse was redundant for about 80% of my appointment  while the doctor is slowing down the process by writing notes. Notes that could've been written up by the nurse and then just signed off by the doctor. 

Faster process, more patients seen, cost savings and with zero hardship. 

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