Just another £1.2 Billion to fix the NHS?
Poll: Just another £1.2 Billion to fix the NHS?
Total Members Polled: 237
Discussion
"The causes of poor quality care are complex, but there is no doubt that a lack of clinical leadership literally costs lives. The disillusion that I and my friends feel is widespread, if not endemic, in the UK."
My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
mrpurple said:
"The causes of poor quality care are complex, but there is no doubt that a lack of clinical leadership literally costs lives. The disillusion that I and my friends feel is widespread, if not endemic, in the UK."
My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
So chucking any amount of money at the problem won't make any difference. It's leadership thats required.My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
anonymous said:
[redacted]
Of all the comments I hear from my OH these 2 feature more than any others.From my own experience in construction being a brilliant bricklayer doesn't mean you will be the best person to start a contracting business, taking on projects, employing others and negotiating contracts etc etc.
I've worked in the NHS since the late 80s. In admin. Not very high up the ladder - I've been through so many reorganisations. Each of which costs huge amounts of money (in order to "save" money, har har). In recent years we've had millions spent on consultants coming in to work for months and years on end in order to improve our IT provision (we don't pay enough in the NHS to get decent calibre people, is the thinking). And often when these people leave, can anyone find the work they did or the charts they drew up? Or the reports they wrote? No. Some has no doubt been useful - we're more "21st century" now but so much money wasted on consultants who baffle with bulls
t and then leave. Or the branding department we had, which spent god knows how much on new logos and posters in order to improve our image. Most of that has now gone too.
And its true to say Labour introduced far more bureaucracy than there ever was before. While I don't necessarily agree that consultants should be allowed the power they had before, they should have a far better idea of how to run a hospital than an accountant and should be involved in the process.
HEE (Health Education England) IS currently reorganising itself and cutting posts at the top, in order to save some on bureaucracy. No need for quite so many directors of finance etc when operating nationally. There are far stronger financial controls on spending now than 2 years ago. But this is after years and years of money wasted. The damage is quite possibly done.
Next year there will be a new government. No doubt a new structure NHS will follow - they seem to be every few years as people leave and new people arrive with their idea on how the NHS should be run - rehashing older ideas without knowing. Perhaps with some continuity, less money would be spent on reorganising every few years.
t and then leave. Or the branding department we had, which spent god knows how much on new logos and posters in order to improve our image. Most of that has now gone too.And its true to say Labour introduced far more bureaucracy than there ever was before. While I don't necessarily agree that consultants should be allowed the power they had before, they should have a far better idea of how to run a hospital than an accountant and should be involved in the process.
HEE (Health Education England) IS currently reorganising itself and cutting posts at the top, in order to save some on bureaucracy. No need for quite so many directors of finance etc when operating nationally. There are far stronger financial controls on spending now than 2 years ago. But this is after years and years of money wasted. The damage is quite possibly done.
Next year there will be a new government. No doubt a new structure NHS will follow - they seem to be every few years as people leave and new people arrive with their idea on how the NHS should be run - rehashing older ideas without knowing. Perhaps with some continuity, less money would be spent on reorganising every few years.
GT03ROB said:
mrpurple said:
"The causes of poor quality care are complex, but there is no doubt that a lack of clinical leadership literally costs lives. The disillusion that I and my friends feel is widespread, if not endemic, in the UK."
My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
So chucking any amount of money at the problem won't make any difference. It's leadership thats required.My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
Not sure I am best qualified to comment as mine are only 3rd party but linked issues such as bedblocking need to be addressed as well....so it is a complex issue and not just about money or leadership.
It's only going to increase as fewer and fewer people are willing or able to look after their own parents.Sway said:
CamMoreRon said:
CoolC said:
To me the only way is to have a cull of middle management and start running to service in a controlled way. <snip>
Maybe I haven't been paying enough attention, but has anybody actually determined how much "bureaucracy" can be cut without suffering a complete management breakdown? <snip>As an example of failure demand, I recently had both my washing machine and central heating boiler repaired. The boiler chap turned up, diagnosed the problem incorrectly, ordered the wrong part (even for his diagnosis). So the lead time to actually fix things increased to nearly three weeks, and four visits to my house.
My washing machine was very different. <snip>
Secondly, the crippling factor for many NHS Trusts are the PFI costs - I'm sure there was a recent article that showed the average NHS Trust is spending a significant percentage of it's budget paying those loans off, when in many cases the need for the stuff paid for by those loans is very questionable...
I do understand your point, though.. early and correct diagnosis is critical in reducing the cost and duration of treatment, but are the failures in that area specifically down to a management problem? I strongly doubt it.
Regarding PFI.. what can we do about it? I mean.. if I were PM (and it's a bloody good job I'm not) I would cancel all PFI contracts and stick my fingers up at anybody who complains they're losing out. I wouldn't have a bad word to say about any politician who proposed the same.
Of course there are fundamental differences, but the processes used to diagnose 'faults' are very similar (understand symptoms, test, related complications, plan, fix).
The principles of how this process operates are applied to washing machines, cars, houses or people are all fundamentally the same. The difference as you say is the complexity and knowledge involved, the equipment and skills needed, the integration of different functions.
That integration is fundamentally not there in the NHS, nor is appropriate application of effective triage/treatment planning. The individual delivery and care tends to be very effective. Yet because of a lack of integration and correctly applied diagnosis, the number of unnecessary repeat visits is very high (an extensive analysis using the techniques I use, applied by cross discipline clinical specialists found that approximately 30% of the treatments delivered were avoidable. On top of that there's the ability to improve efficiency in the delivery of each stage.
A quick Google of 'failure demand in the NHS' provide a lot of very compelling arguments supporting this.
One example is the rate of admission from A&E when nearing the '4 hour limit'. As departments are increasingly strictly measured against this four hour wait window, all that's happened is that it is 'better' for the A&E department to admit someone who has been waiting for 3 1/2 hours, than 'waste' time understanding the issue and treating it...
The principles of how this process operates are applied to washing machines, cars, houses or people are all fundamentally the same. The difference as you say is the complexity and knowledge involved, the equipment and skills needed, the integration of different functions.
That integration is fundamentally not there in the NHS, nor is appropriate application of effective triage/treatment planning. The individual delivery and care tends to be very effective. Yet because of a lack of integration and correctly applied diagnosis, the number of unnecessary repeat visits is very high (an extensive analysis using the techniques I use, applied by cross discipline clinical specialists found that approximately 30% of the treatments delivered were avoidable. On top of that there's the ability to improve efficiency in the delivery of each stage.
A quick Google of 'failure demand in the NHS' provide a lot of very compelling arguments supporting this.
One example is the rate of admission from A&E when nearing the '4 hour limit'. As departments are increasingly strictly measured against this four hour wait window, all that's happened is that it is 'better' for the A&E department to admit someone who has been waiting for 3 1/2 hours, than 'waste' time understanding the issue and treating it...
CamMoreRon said:
Regarding PFI.. what can we do about it? I mean.. if I were PM (and it's a bloody good job I'm not) I would cancel all PFI contracts and stick my fingers up at anybody who complains they're losing out. I wouldn't have a bad word to say about any politician who proposed the same.
It is one of the greatest scandals of the New Labour years that PFI was used on projects that it was never designed or intended for. PFI was (I think) originally an Australian idea that the Conservatives had imported for use on a few projects. Essentially it was designed for large scale infrastructure projects that generate revenue from their use, and that revenue is used to pay off the finance that was put up by the markets to build and maintain that infrastructure. So good examples of the correct use of PFI would be toll bridges, toll roads etc. What PFI was NEVER designed for was to be used to pay for general government expenditure on things like schools, hospitals etc. This is because there is no user generated revenue, and payments are thus required to be funded entirely from taxation (local and national) . Guess what Mr Brown used PFI for?
Why did Mr Brown do this? Basically so he could keep the "borrowing" off the books. The legacy of this approach has been apocalyptic in many cases. - the more so because many PFI contracts were so badly negotiated by the Public sector.
Can we just tear them up? Sadly not - the impact on the markets would horrible. However I do think that the Government should be insisting on renegotiating the contracts in many cases.
Fairly uniquely to Britain access to healthcare to all, regardless of means, has taken on the meaning that the state must provide this. But the two do not mean the same thing.
A state run insurance scheme could pay for treatment to be met by a mixture of not for profit and private doctors and hospitals.
The man in the street has some knowledge of the American system so that is the comparison used to the NHS. A better comparison would be with the many European systems that combine universal access with an insurance based model.
With the current structure tens of billions extra will be needed to provide a basic level of provision in the years to come and one that will still fall far short of the best healthcare systems in Europe.
£1.2 billion is gesture politics that will make virtually no difference.
A state run insurance scheme could pay for treatment to be met by a mixture of not for profit and private doctors and hospitals.
The man in the street has some knowledge of the American system so that is the comparison used to the NHS. A better comparison would be with the many European systems that combine universal access with an insurance based model.
With the current structure tens of billions extra will be needed to provide a basic level of provision in the years to come and one that will still fall far short of the best healthcare systems in Europe.
£1.2 billion is gesture politics that will make virtually no difference.
mrpurple said:
GT03ROB said:
mrpurple said:
"The causes of poor quality care are complex, but there is no doubt that a lack of clinical leadership literally costs lives. The disillusion that I and my friends feel is widespread, if not endemic, in the UK."
My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
So chucking any amount of money at the problem won't make any difference. It's leadership thats required.My OH retired from a senior nursing position earlier this year after 40 years in the NHS...she didn't really want to retire but was so disillusioned (stressed) she took the opportunity to get out, other senior, capable nursing colleagues of hers don't have this option but many that did have taken it also.
Since retiring she has had literally hundreds of calls / emails to go back to work in various senior NHS linked roles. For obvious reasons I can't go into details but she finally agreed to take on an interim role sorting out some operating theatre management issues in a major hospital.
"thank god we now have somebody that has actually been in an operating theatre before" - was the predominant comment from virtually every member of the team, consultants, anesthetists, nurses and backup staff.
I don't know the answers but I do know that within the NHS disillusion is widespread, if not endemic, in the UK and those that can get out are, and in doing so a huge swathe wealth of knowledge and experience is being lost....I doubt £1.2Bn will replace it.
JagLover said:
.
A state run insurance scheme could pay for treatment to be met by a mixture of not for profit and private doctors and hospitals.
The man in the street has some knowledge of the American system so that is the comparison used to the NHS. A better comparison would be with the many European systems that combine universal access with an insurance based model.
I agree completely. A link for those interested in other European systems.A state run insurance scheme could pay for treatment to be met by a mixture of not for profit and private doctors and hospitals.
The man in the street has some knowledge of the American system so that is the comparison used to the NHS. A better comparison would be with the many European systems that combine universal access with an insurance based model.
http://www.civitas.org.uk/nhs/health_systems.php
Health expenditure per head in the UK is commensurate with most EU countries but the out turns are far worst.
CamMoreRon said:
anonymous said:
[redacted]
I assume it's because these people are dying, and as (generally) social creatures it isn't really acceptable to walk them in to the middle of the woods and let nature do its work.Let me explain. There are many DM stories under the headlines "NHS refuses cancer saving drugs". When you look at closely at the truth. The drugs beside being very very expensive, often £ thousands per treatment do not cure cancer they merely keep the patient alive for a few weeks.
So the question is how much can a state health service afford to spend keeping some one alive for a few weeks. Often with a low quality of life.
CamMoreRon said:
I assume it's because these people are dying, and as (generally) social creatures it isn't really acceptable to walk them in to the middle of the woods and let nature do its work.
Multiple studies have shown that patients entering hospice care live at the least as long as those still having treatment for the same life ending condition.I imagine the last few months of life for those in the hospice are far more pleasant as well.
CamMoreRon said:
anonymous said:
[redacted]
I assume it's because these people are dying, and as (generally) social creatures it isn't really acceptable to walk them in to the middle of the woods and let nature do its work.An elderly person goes into a typical NHS hospital for something fairly minor (let's say they had a fall and bumped their head), but thanks to a complete lack of joined up government they can't be discharged if they don't have adequate care when they get home. They're a little dizzy, so the consultant thinks they're best not at home alone, given they're in their 90s.
So they become 'bed blockers'.
They know they're in the way, taking up resources, but their kids live miles away, work full time and they don't have the money for a full-time carer.
They don't need much in the way of medical care, so they see a nurse occasionally if they need some medication and a domestic three times a day who brings food they often can't eat (no one thought to bring their dentures in), who speaks only rudimentary English (not enough Brits want to work the unsociable hours for little more than dole money) and has no idea of the physical or dietary needs of the patient.
Yeah, living the dream there, living the dream.....
Mark Benson said:
Is the current situation any different?
An elderly person goes into a typical NHS hospital for something fairly minor (let's say they had a fall and bumped their head), but thanks to a complete lack of joined up government they can't be discharged if they don't have adequate care when they get home. They're a little dizzy, so the consultant thinks they're best not at home alone, given they're in their 90s.
So they become 'bed blockers'.
They know they're in the way, taking up resources, but their kids live miles away, work full time and they don't have the money for a full-time carer.
They don't need much in the way of medical care, so they see a nurse occasionally if they need some medication and a domestic three times a day who brings food they often can't eat (no one thought to bring their dentures in), who speaks only rudimentary English (not enough Brits want to work the unsociable hours for little more than dole money) and has no idea of the physical or dietary needs of the patient.
Yeah, living the dream there, living the dream.....
Ok, but turn that argument on its head for a second: the elderly person with a bump to the head is sent home because the consultant believes 97% (arbitrary number) of those with minor dizziness have no further complications. However, they get a haematoma later that evening and die. The NHS subsequently get their balls sued off. This is all hypothetical, of course, but these things have happened in the past and the NHS have had multiple sets of balls (and other body parts) sued off for malpractice, so you can understand (I hope) how a certain level of bureaucracy would have developed over the years, and how patients who could very well go home are forced to stay in for observation - just in case. An elderly person goes into a typical NHS hospital for something fairly minor (let's say they had a fall and bumped their head), but thanks to a complete lack of joined up government they can't be discharged if they don't have adequate care when they get home. They're a little dizzy, so the consultant thinks they're best not at home alone, given they're in their 90s.
So they become 'bed blockers'.
They know they're in the way, taking up resources, but their kids live miles away, work full time and they don't have the money for a full-time carer.
They don't need much in the way of medical care, so they see a nurse occasionally if they need some medication and a domestic three times a day who brings food they often can't eat (no one thought to bring their dentures in), who speaks only rudimentary English (not enough Brits want to work the unsociable hours for little more than dole money) and has no idea of the physical or dietary needs of the patient.
Yeah, living the dream there, living the dream.....
anonymous said:
[redacted]
I do *sort of* agree with you, but the reason "we" do these things is because some people demand it. Some people demand the best possible care & attention when they or a loved one are dying.. it's just the nature of people. I have always said that if I knew I was going to die I would just suck it up and deal with it; I wouldn't want any intervention to prolong my suffering. But that's a selfish idea based on my own thoughts, and may well not be how I would respond if it were actually happening to me! I could completely about-turn on that whole way of thinking and decide I wanted to try absolutely anything on offer that could give me a chance of clawing to life a little longer. Just step outside your own head for a minute and consider that..
CamMoreRon said:
Mark Benson said:
Is the current situation any different?
An elderly person goes into a typical NHS hospital for something fairly minor (let's say they had a fall and bumped their head), but thanks to a complete lack of joined up government they can't be discharged if they don't have adequate care when they get home. They're a little dizzy, so the consultant thinks they're best not at home alone, given they're in their 90s.
So they become 'bed blockers'.
They know they're in the way, taking up resources, but their kids live miles away, work full time and they don't have the money for a full-time carer.
They don't need much in the way of medical care, so they see a nurse occasionally if they need some medication and a domestic three times a day who brings food they often can't eat (no one thought to bring their dentures in), who speaks only rudimentary English (not enough Brits want to work the unsociable hours for little more than dole money) and has no idea of the physical or dietary needs of the patient.
Yeah, living the dream there, living the dream.....
Ok, but turn that argument on its head for a second: the elderly person with a bump to the head is sent home because the consultant believes 97% (arbitrary number) of those with minor dizziness have no further complications. However, they get a haematoma later that evening and die. The NHS subsequently get their balls sued off. This is all hypothetical, of course, but these things have happened in the past and the NHS have had multiple sets of balls (and other body parts) sued off for malpractice, so you can understand (I hope) how a certain level of bureaucracy would have developed over the years, and how patients who could very well go home are forced to stay in for observation - just in case. An elderly person goes into a typical NHS hospital for something fairly minor (let's say they had a fall and bumped their head), but thanks to a complete lack of joined up government they can't be discharged if they don't have adequate care when they get home. They're a little dizzy, so the consultant thinks they're best not at home alone, given they're in their 90s.
So they become 'bed blockers'.
They know they're in the way, taking up resources, but their kids live miles away, work full time and they don't have the money for a full-time carer.
They don't need much in the way of medical care, so they see a nurse occasionally if they need some medication and a domestic three times a day who brings food they often can't eat (no one thought to bring their dentures in), who speaks only rudimentary English (not enough Brits want to work the unsociable hours for little more than dole money) and has no idea of the physical or dietary needs of the patient.
Yeah, living the dream there, living the dream.....
One of the few Labour policies I agree with in principle is the combining of NHS and Social care to streamline just this kind of situation. Hospitals for sick people, social care for recovering/vulnerable people. Problem is it'll be so smothered in bureaucracy it'll end up a bigger mess than what we have now.
As an aside, you can't sue the NHS just because someone dies after a stay in a hospital - there has to be a degree of negligence or malpractice - your situation shows neither.
CamMoreRon said:
PRTVR said:
The NHS is a strange beast, the waste of money is monumental, no body cares, my wife works for them and tells me about it all the time, recently my wife had to go for some training,she was sent with some others, about six of them 50 miles away, all on travel allowance, when my wife asked could the trainer not come to them, she was told no they do not do it that way, on the coarse there was nothing that could not have been fitted in to a boot of a car, this is just a small example of a larger problem.
But this would happen (and does) with any private organisation! For example, I recently had to go (primarily as a PR thing) to the very south of Germany to speak with a customer. I was flown to Zurich, where I rented a car, and went for a drive through beautiful southern Germany to a small alpine village. Of course, all of this was paid for by the company I work for.I know you weren't suggesting that a private NHS would be any different, but I think it's important to note how the private sector "wastes" their money in very similar ways. I don't think anyone would bat an eyelid if I went for a 50 mile jaunt.. I could probably go for one this afternoon if I wanted to.
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