Just another £1.2 Billion to fix the NHS?
Poll: Just another £1.2 Billion to fix the NHS?
Total Members Polled: 237
Discussion
Mark Benson said:
It's far, far more complicated than that (it always is).
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.
Oh I'm sure it is! But I don't think much or any of the bureaucracy in the NHS introduced by Teams Red or Blue has been down to just wanting to create jobs for the sake of it. I bet if you were to boil everything down, then every new job was a reaction to some new standard, new legislation, new reaction to a law suit or public outrage. I'm all for removing some of that bureaucracy, but it requires some constraints to be lifted (from the public perhaps even more so than the government) otherwise I have little doubt that the whole thing will collapse under the weight.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.
I would say an elderly person who reported dizziness after a head injury being sent home to subsequently die was negligent, but that's just my opinion. (And I'm sure that sentiment would also be shared with their family)
the amount of money Agencies can charge for locum nurses, those locuming will take the work either way if they need it, and rates are so big those who are content with their career level (and want to get off the treadmill) are better off locuming than,anything else, which is stupid.
when Gordon Brown upped NICs from 10-11% wasn't that to save the NHS?
when Gordon Brown upped NICs from 10-11% wasn't that to save the NHS?
Croutons said:
the amount of money Agencies can charge for locum nurses, those locuming will take the work either way if they need it, and rates are so big those who are content with their career level (and want to get off the treadmill) are better off locuming than,anything else, which is stupid.
Not just nurses.Some lateral thinking....Is it that now the UK's Inter/National Health Service has been just that, International, that these problems have become all enveloping rendering the organ unsustainable?
Took my son to A&E after a fall from his bike two years ago. I suspected he had broken his collar bone. Despite the attractive A&E receptionist assuring us and others waiting that someone will come soon, and various Hospital staff coming and going nearby laughing and joking whilst carrying cups of tea and coffee, even the receptionist disappeared after four hours and still nothing doing. Despite still in some pain, now into the small hours and still no service or staff of any kind, I drove him home and attended the local surgery first thing next morning. We were not first to arrive and the queue at the door arranged appointments for that day. Later, my son was eventually seen at the hospital and broken bone confirmed.
Why is it like that now ? Something to prove ? It did not used to be like that. It really did not and I do not need to put on the rose tinted to remember that.
Took my son to A&E after a fall from his bike two years ago. I suspected he had broken his collar bone. Despite the attractive A&E receptionist assuring us and others waiting that someone will come soon, and various Hospital staff coming and going nearby laughing and joking whilst carrying cups of tea and coffee, even the receptionist disappeared after four hours and still nothing doing. Despite still in some pain, now into the small hours and still no service or staff of any kind, I drove him home and attended the local surgery first thing next morning. We were not first to arrive and the queue at the door arranged appointments for that day. Later, my son was eventually seen at the hospital and broken bone confirmed.
Why is it like that now ? Something to prove ? It did not used to be like that. It really did not and I do not need to put on the rose tinted to remember that.
turbobloke said:
The number of managers in the NHS rose at double the rate of doctors and nurses under Labour. Throwing other people's money around and generating taxpayer subsidised jobs is all they know.
You fail to mention this was published in the Daily Mail. I challenge you to find any source for the "official statistics showing" 274,000 managers figure. This was described as an excoriating attach on NHS managers by a consultant surgeon who said:
Today, according to official statistics, there are 274,000 managers supporting doctors and nurses. They outnumber consultants nearly seven to one. 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.
The author is undoubtably a skilled GI surgeon. There are a range of testimonies on his website from happy patients. -You can avail yourself of his services here: http://nicholasboyle.com/for-referrers/self-payers... Some might point at a conflict of interest.
Try reading this instead.
http://flipchartfairytales.wordpress.com/2014/01/1...
Edited by captainzep on Wednesday 19th November 17:07
captainzep said:
turbobloke said:
The number of managers in the NHS rose at double the rate of doctors and nurses under Labour. Throwing other people's money around and generating taxpayer subsidised jobs is all they know.
You fail to mention this was published in the Daily Mail. I challenge you to find any source for the "official statistics showing" 274,000 managers figure. This was described as an excoriating attach on NHS managers by a consultant surgeon who said:
Today, according to official statistics, there are 274,000 managers supporting doctors and nurses. They outnumber consultants nearly seven to one. 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.
The author is undoubtably a skilled GI surgeon. There are a range of testimonies on his website from happy patients. -You can avail yourself of his services here: http://nicholasboyle.com/for-referrers/self-payers... -I can't think of any reason why he would want to appear in a popular newspaper like the Mail. Certainly not self-promotion.
Try reading this instead.
http://flipchartfairytales.wordpress.com/2014/01/1...
"While the total number of NHS staff increased by around 35 per cent between 1999 and 2009, the number of managers increased by 82 per cent over the same period, from 23,378 to 42,509 (Information Centre 2009)"
http://www.kingsfund.org.uk/projects/general-elect...
CoolC said:
To me the only way is to have a cull of middle management and start running to service in a controlled way. Story after story of waste within the NHS comes out, but nothing ever seems to change.
Surely to run the service of the size and scope of the NHS in a controlled way you'd need a lot of managers?There is a school of thought that the problem with the NHS is it doesn't have enough managers.
captainzep said:
Thanks for posting that! It's nice to have some numbers to dispel the "seventeen thousand managers for every nurse / doctor / consultant" chants.CamMoreRon said:
Thanks for posting that! It's nice to have some numbers to dispel the "seventeen thousand managers for every nurse / doctor / consultant" chants.
Not that I believe the figures but they show:206k nurses (including supervisors and management?)
34 k 'managers'
92k admin
292k support
looks like 2:1 to me
may be thats good by any standards, dunno
steveT350C said:
This might help...
"While the total number of NHS staff increased by around 35 per cent between 1999 and 2009, the number of managers increased by 82 per cent over the same period, from 23,378 to 42,509 (Information Centre 2009)"
http://www.kingsfund.org.uk/projects/general-elect...
The Kings Fund commissioned study of 2011 is seen as the landmark document on NHS management. It concluded the NHS (compared to other public and private sector bodies) was under managed but over administered. "While the total number of NHS staff increased by around 35 per cent between 1999 and 2009, the number of managers increased by 82 per cent over the same period, from 23,378 to 42,509 (Information Centre 2009)"
http://www.kingsfund.org.uk/projects/general-elect...
The increase in numbers in the late 2000's (a fairly uniquely English NHS phenomenon) was a function of strengthening commissioning so more contract managers, commissioners, finance and info analysts. There was also an increase in safety regulation so clinical governance teams popped up to limit clinical inconsistencies and f
k ups with some success. Lastly the birth of the GMS contract led to more people digging into the work of GP practices to oversee the points means prizes culture. The NHS had become far more process and target driven. Some very notable improvements some less so. Behind it all was a Labour Govt pumping money into the system like no tomorrow. There was waste. No doubt. Health funding doubled but numbers of managers didn't. The public have a choice. Bin managers, fine, but be prepared for sections of healthcare to decline and risks increase.
Clinicians moan about non-clinical managers, always have done. -I did. But clinicians tend not to be whole-systems organisational leaders.
The only way that the NHS can be "cured" is fundamental changes to everything. The first should be that an all party commission agrees a long term stratagy that takes it out of the yah boo every 5 years. By doing this we would stop the endless rounds of reorganisations to prove points.
Run it like a business, where value is at the heart of the matter in all things none clinical. I give you and example, my wife needed to go to the new hospital in Southmead Bristol, it is a huge building with an atrium. You log in with a bar code at a machine go to a gate and then wait. Beautiful building if it were an airport but was it suitable for a hospital.
I had to go to the treatment centre again in Bristol but run by Care UK. It is a nice box building on the ring road easy access on an industrial estate. A building fit for purpose, not an excuse for a designer to make it beautiful. Come up with a suitable design and that is the one you build everywhere, when needed no need to reinvent the wheel.
Met by a person, sent to a waiting room, seen on time.
Speaking with the girl doing the tests, they pay more for her than the NHS, look after her better than the NHS, she is not constantly being harassed by the disruptive anti Tory brigade, who constantly bang on about privatisation, conveniently forgetting that every GP is a private company every Dentist is a private company, who are contracted to the NHS.
They get the same money for everything they do as any NHS hospital but they make a profit, because it is run as a business. The upside is efficiency, less management more hands on staff.
On the downside for staff, no final pension, no open ended sick pay for 12 months, no collective negotiations.
Treatment is next, NHS should be for real illness. We need to really be bold and face up to what we want from it. Should sex changes, IVF, cosmetic surgery be done? IMHO, no, yes two cycles, depends. Certainly not for boob jobs unless reconstructive, but after cancer etc then fine. We need to get away from the sad faced pictures in the paper and do what is right not because someone wants a new nose and is depressed.
hand over all the money for care to the NHS not the councils. There is a constant battle between councils and the hospitals. They want to discharge an old person who needs care not medical attention, council drag their feet setting up systems, they have to stay. If all the money was NHS they would have a convalesance home where they could go which needs carers not nurses, but whilst two budgets are working against each other it is no wonder bed blocking is a huge problem.
I understand it from all angles, as my wife is high in the NHS finance world, my daughter is a Doctor but as someone with aged infirm parents and some health issues myself. It is still very good but it could be better, cost less if people fully understood what goes on
Run it like a business, where value is at the heart of the matter in all things none clinical. I give you and example, my wife needed to go to the new hospital in Southmead Bristol, it is a huge building with an atrium. You log in with a bar code at a machine go to a gate and then wait. Beautiful building if it were an airport but was it suitable for a hospital.
I had to go to the treatment centre again in Bristol but run by Care UK. It is a nice box building on the ring road easy access on an industrial estate. A building fit for purpose, not an excuse for a designer to make it beautiful. Come up with a suitable design and that is the one you build everywhere, when needed no need to reinvent the wheel.
Met by a person, sent to a waiting room, seen on time.
Speaking with the girl doing the tests, they pay more for her than the NHS, look after her better than the NHS, she is not constantly being harassed by the disruptive anti Tory brigade, who constantly bang on about privatisation, conveniently forgetting that every GP is a private company every Dentist is a private company, who are contracted to the NHS.
They get the same money for everything they do as any NHS hospital but they make a profit, because it is run as a business. The upside is efficiency, less management more hands on staff.
On the downside for staff, no final pension, no open ended sick pay for 12 months, no collective negotiations.
Treatment is next, NHS should be for real illness. We need to really be bold and face up to what we want from it. Should sex changes, IVF, cosmetic surgery be done? IMHO, no, yes two cycles, depends. Certainly not for boob jobs unless reconstructive, but after cancer etc then fine. We need to get away from the sad faced pictures in the paper and do what is right not because someone wants a new nose and is depressed.
hand over all the money for care to the NHS not the councils. There is a constant battle between councils and the hospitals. They want to discharge an old person who needs care not medical attention, council drag their feet setting up systems, they have to stay. If all the money was NHS they would have a convalesance home where they could go which needs carers not nurses, but whilst two budgets are working against each other it is no wonder bed blocking is a huge problem.
I understand it from all angles, as my wife is high in the NHS finance world, my daughter is a Doctor but as someone with aged infirm parents and some health issues myself. It is still very good but it could be better, cost less if people fully understood what goes on
spaximus said:
The only way that the NHS can be "cured" is fundamental changes to everything. The first should be that an all party commission agrees a long term stratagy that takes it out of the yah boo every 5 years. By doing this we would stop the endless rounds of reorganisations to prove points.
Run it like a business, where value is at the heart of the matter in all things none clinical. I give you and example, my wife needed to go to the new hospital in Southmead Bristol, it is a huge building with an atrium. You log in with a bar code at a machine go to a gate and then wait. Beautiful building if it were an airport but was it suitable for a hospital.
I had to go to the treatment centre again in Bristol but run by Care UK. It is a nice box building on the ring road easy access on an industrial estate. A building fit for purpose, not an excuse for a designer to make it beautiful. Come up with a suitable design and that is the one you build everywhere, when needed no need to reinvent the wheel.
Met by a person, sent to a waiting room, seen on time.
Speaking with the girl doing the tests, they pay more for her than the NHS, look after her better than the NHS, she is not constantly being harassed by the disruptive anti Tory brigade, who constantly bang on about privatisation, conveniently forgetting that every GP is a private company every Dentist is a private company, who are contracted to the NHS.
They get the same money for everything they do as any NHS hospital but they make a profit, because it is run as a business. The upside is efficiency, less management more hands on staff.
On the downside for staff, no final pension, no open ended sick pay for 12 months, no collective negotiations.
Treatment is next, NHS should be for real illness. We need to really be bold and face up to what we want from it. Should sex changes, IVF, cosmetic surgery be done? IMHO, no, yes two cycles, depends. Certainly not for boob jobs unless reconstructive, but after cancer etc then fine. We need to get away from the sad faced pictures in the paper and do what is right not because someone wants a new nose and is depressed.
hand over all the money for care to the NHS not the councils. There is a constant battle between councils and the hospitals. They want to discharge an old person who needs care not medical attention, council drag their feet setting up systems, they have to stay. If all the money was NHS they would have a convalesance home where they could go which needs carers not nurses, but whilst two budgets are working against each other it is no wonder bed blocking is a huge problem.
I understand it from all angles, as my wife is high in the NHS finance world, my daughter is a Doctor but as someone with aged infirm parents and some health issues myself. It is still very good but it could be better, cost less if people fully understood what goes on
You forgot to mention the "Southmead clock"....did my head in trying to tell the time with it...especially when the sun is shining through the atrium roof.Run it like a business, where value is at the heart of the matter in all things none clinical. I give you and example, my wife needed to go to the new hospital in Southmead Bristol, it is a huge building with an atrium. You log in with a bar code at a machine go to a gate and then wait. Beautiful building if it were an airport but was it suitable for a hospital.
I had to go to the treatment centre again in Bristol but run by Care UK. It is a nice box building on the ring road easy access on an industrial estate. A building fit for purpose, not an excuse for a designer to make it beautiful. Come up with a suitable design and that is the one you build everywhere, when needed no need to reinvent the wheel.
Met by a person, sent to a waiting room, seen on time.
Speaking with the girl doing the tests, they pay more for her than the NHS, look after her better than the NHS, she is not constantly being harassed by the disruptive anti Tory brigade, who constantly bang on about privatisation, conveniently forgetting that every GP is a private company every Dentist is a private company, who are contracted to the NHS.
They get the same money for everything they do as any NHS hospital but they make a profit, because it is run as a business. The upside is efficiency, less management more hands on staff.
On the downside for staff, no final pension, no open ended sick pay for 12 months, no collective negotiations.
Treatment is next, NHS should be for real illness. We need to really be bold and face up to what we want from it. Should sex changes, IVF, cosmetic surgery be done? IMHO, no, yes two cycles, depends. Certainly not for boob jobs unless reconstructive, but after cancer etc then fine. We need to get away from the sad faced pictures in the paper and do what is right not because someone wants a new nose and is depressed.
hand over all the money for care to the NHS not the councils. There is a constant battle between councils and the hospitals. They want to discharge an old person who needs care not medical attention, council drag their feet setting up systems, they have to stay. If all the money was NHS they would have a convalesance home where they could go which needs carers not nurses, but whilst two budgets are working against each other it is no wonder bed blocking is a huge problem.
I understand it from all angles, as my wife is high in the NHS finance world, my daughter is a Doctor but as someone with aged infirm parents and some health issues myself. It is still very good but it could be better, cost less if people fully understood what goes on
http://www.itv.com/news/west/2014-06-02/250-000-sp...
Why cant we just allow private hospitals, care homes and surgeries to dispense care and pay them a fixed rate for their time and equipment use? The NHS would be a funding organisation that pays the bill and manages the supply chain for data sharing, final services, R&D and medication.
for 120bn I think NHS can deliver a decent performance, this will also allow collection of revenues from non-british citizens via insurance schemes by private hospitals. All patients will be registered to private GP practices that already have ground up medical data, history and identity of each person who is registered for healthcare services in UK.
for 120bn I think NHS can deliver a decent performance, this will also allow collection of revenues from non-british citizens via insurance schemes by private hospitals. All patients will be registered to private GP practices that already have ground up medical data, history and identity of each person who is registered for healthcare services in UK.
Sway said:
I deliver efficiency benefits to private sector companies (ranging from very familiar names to small businesses, across several different sectors) - a typical programme of work will deliver between 20 and 40% reduction in waste/cost, with improvements in customer satisfaction and staff morale...
I have ex colleagues that are very experienced, working for various NHS Trusts. Their experience is that given the ability to do so, they could reduce costs by half.
One of the largest problems is failure demand - pretty much every single person in the country will have an example where due to ineffective delivery at an early stage, the level of care and treatment required increases massively.
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. When arranging the repair visit, the call centre operative ran through a fairly simple diagnostic question flow. The engineer arrived two days later (same lead time as the boiler repair). He performed a couple of tests using kit I would be very unlikely to have, and pinpointed the fault. I asked him how long it would take to repair. His response was that 'he broadly knew the issue before leaving, had all the parts that could be causing that, and so it'd be fixed in about half an hour'. I assume that the other parts would either be returned to stock or returned to supplier, at minimal cost to the business (or supplier).
There's a few hundred quid difference in business costs to the different approaches, and the customer satisfaction much higher - so much so I've signed up to the warrantee scheme they run for all my appliances. So the first company has lost a customer, the second a regular guaranteed income. Remember, the chaps coming out to do the work onsite are considerably more expensive than the call centre operatives...
Not all of this applies to the NHS, but there are significant parallels that in principle can be applied all across the two differing approaches.
The problem is the ability to actually deliver them.
...
You work in "lean management", I guess? I have ex colleagues that are very experienced, working for various NHS Trusts. Their experience is that given the ability to do so, they could reduce costs by half.
One of the largest problems is failure demand - pretty much every single person in the country will have an example where due to ineffective delivery at an early stage, the level of care and treatment required increases massively.
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. When arranging the repair visit, the call centre operative ran through a fairly simple diagnostic question flow. The engineer arrived two days later (same lead time as the boiler repair). He performed a couple of tests using kit I would be very unlikely to have, and pinpointed the fault. I asked him how long it would take to repair. His response was that 'he broadly knew the issue before leaving, had all the parts that could be causing that, and so it'd be fixed in about half an hour'. I assume that the other parts would either be returned to stock or returned to supplier, at minimal cost to the business (or supplier).
There's a few hundred quid difference in business costs to the different approaches, and the customer satisfaction much higher - so much so I've signed up to the warrantee scheme they run for all my appliances. So the first company has lost a customer, the second a regular guaranteed income. Remember, the chaps coming out to do the work onsite are considerably more expensive than the call centre operatives...
Not all of this applies to the NHS, but there are significant parallels that in principle can be applied all across the two differing approaches.
The problem is the ability to actually deliver them.
...
And, for your next trick, you'll tell us next about the 1:4:16:64 "rule" as regards not getting it right the first/second/third time in terms of efforts needed to get it right the second/third/fourth time...You're mistaken in your post, because ALL of what you said applies to the NHS
. And boy, does it need it!! 
I was a "lean champion" in a recent working life, and I know EXACTLY what you're saying
( & 
).Rapidly developing problem is a shortage of doctors. Many reasons behind that, some government induced. There is an international job market for English speaking doctors, and market forces have taken over. The NHS can't compete and is losing staff abroad, to agencies, to the private sector, all of which offer better pay and/ or conditions. Some departments / Health Boards have 15 - 20% of consultant posts up filled; the service can't hold up much longer as the remaining staff burn out.
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