David Cameron: The NHS is - safe in my hands
Discussion
Sheepshanks said:
BlackLabel said:
The American taxpayer actually pays more, as a % of GDP/per head etc, than we do - and it's significantly more. They have a two tier system and the state funded schemes (medicair and medicaid) are pretty substandard when you consider what they spend on it.
I'm not sure the American model is one we should be aiming to copy.
We have a two tier system here for people who have medical cover through work or are prepared to pay out of their own pocket.I'm not sure the American model is one we should be aiming to copy.
I hate using it, but today took my missus to see a consultant at the local private hospital. We made the appointment yesterday! after being given one 4 months away on the NHS. The consultant runs the NHS clinic too, but of course there we'd be most unlikely to be seen there by him in person.
I also think you are somewhat off the mark with ' most unlikely' to be seen by a consultant in an NHS OP clinic ...
PorkInsider said:
mph1977 said:
proof beyond the chicken little camp throwing figures around that the NHS pension is not affordable ?
Surely affordability depends on how it is being afforded, doesn't it?It's only affordable if there's enough money available to pay. If there isn't it's unaffordable.
Or am I missing the point?
Edited by PorkInsider on Thursday 2nd April 17:11
Whenever I hear the health unions highlighting a "crisis in the NHS", I assume they mean "give us more money".
mph1977 said:
I also think you are somewhat off the mark with ' most unlikely' to be seen by a consultant in an NHS OP clinic ...
Well, as it happens I've used the same clinic myself multiple times for recurring iritis. I have a card which allows me to attend directly without referral. I've never seen a consultant. And it matters not whether I attend using my pass or with an appointment - I'm always there a number of hours, the place is always bedlam (my wife's appointment letter warned her to take food and drink!).
This morning - seen within a few mins of the appointment time and spent 40 mins with the consultant and it felt like he had all the time in the world.
Jasandjules said:
I don't think it is safe in anyone's hands really, they are all a bunch of liars who will say whatever they think people want to hear to get voted in.
The only way the NHS will improve IMHO is when someone takes out half the useless managers who p**s away money and throw away more paying off people who blow the whistle on the waste and incompetence.
this ^ the only prblem with the nhs is it is run by the same types that run the bbc and various socialwork department around th country. sacking 80% of management would be a good start. oh,and if anyone attempts to introduce a similar system to the states here,i will personally kill them The only way the NHS will improve IMHO is when someone takes out half the useless managers who p**s away money and throw away more paying off people who blow the whistle on the waste and incompetence.
i really do not fancy paying 200k plus if i happen to need my appendix out and there are a few minor complications.
steveatesh said:
Sounds heavy, but it is an easy read and clearly identifies management thinking in the form of silos, targets, budget heads etc as being the problem across the public sector. Management thinking of course at the top level in the NHS is the government who design the system and the measures used. "What gets measured gets done" is very true, hence people focus on what they are measured and incentivized on rather than the desired outcome.
NB. not just in the NHS.
That is my own theory on stats. As soon as anything is run to metrics, the first thing a person learns is to 'juke the stats.'NB. not just in the NHS.
The Adam Curtis film, The Trap also looks at this I think.
mph1977 said:
fblm said:
mph1977 said:
anonymous said:
[redacted]
whidh few staff actually recieve a full pension due to career breaks and part time working ... 85 +% of Nurses are female , an awful lot them will not work full time for all 40 years needed... so it suddenly doesn;t seem as generous does it ...
The fact is the NHS pays something like 15% employer contribution yet IIRC the scheme is in deficit to the tune of 200bn quid so the economic value of that pension is obviously far higher than 15%. If you think that 'doesn't seem generous' you must be living in an alternative universe.
fblm said:
mph1977 said:
fblm said:
mph1977 said:
anonymous said:
[redacted]
whidh few staff actually recieve a full pension due to career breaks and part time working ... 85 +% of Nurses are female , an awful lot them will not work full time for all 40 years needed... so it suddenly doesn;t seem as generous does it ...
The fact is the NHS pays something like 15% employer contribution yet IIRC the scheme is in deficit to the tune of 200bn quid so the economic value of that pension is obviously far higher than 15%. If you think that 'doesn't seem generous' you must be living in an alternative universe.
the 200 bn figure is the chicken little figure of the next ?100 years of liability
fblm said:
mph1977 said:
there is no deficit becasue the government has never allowed a fund to accumulated instead preferring a PAYG so it get get it;s hands on the substantial surplus in contributions every year.
Jesus Christ. 
ok whatevermph1977 said:
fblm said:
mph1977 said:
there is no deficit becasue the government has never allowed a fund to accumulated instead preferring a PAYG so it get get it;s hands on the substantial surplus in contributions every year.
Jesus Christ. ok whateverThere's only ever a surplus because there are more people paying in than taking out.
Unless the NHS grows every year, for ever more, there will never ultimately be enough in the pot to pay the pensions of everyone entitled to one.
You can quite easily say that many, many pension schemes are in surplus if you discount future liabilities and just look at the current income v outgoings.
NHS has major issues but I don't believe the ever creeping move towards a fully American style private system is working. So much money is already wasted on the 'internal market' b
ks. Healthcare should be a public service paid for by all to benefit all; not a profit making business.
I think the big issues are:
1) Regardless of the system in place, we simply don't spend enough per head of population compared to other countries.
2) Cuts in social care and welfare just flow through to the NHS as people end up at their GP or in A&E instead.
3) Almost constant top-down reorganisation and political interference. Leave the NHS alone for more than 5 minutes to see what is going on, then listen to doctors at ground level before making changes. Ignore the 'noctors' and managers that have climbed the greasy pole of politics and have an agenda of their own.
4) Fragmentation of services, internal market and crazy levels of bureaucracy. The NHS is a huge employer and massive purchaser. It should be able to dictate terms of purchase (like supermarkets) when it comes to drugs and supplies. However because everything is so fragmented it doesn't work out that way and drug companies set unjustifiable prices. PFI payments cripple hospitals and cost more in the long run. The internal market makes no sense - all services ultimately come out of the taxpayer pocket so why employ an army of admin staff to 'bill' each other?
5) Politicians MUST stop generating unrealistic expectations, especially for GP services. If people want 12 hour access 7 days a week then they should pay extra for it. Promising that everyone can see their (note, not a) GP within 48 hours or at 7pm on a Sunday evening is just ridiculous.
Oh, and IMO the problems have nothing to do with staff pensions or how nurses are trained. You can train a nurse however you want, but if there is only 1 trained nurse to 16 patients then they are going to wait a long time for their medications. HCA are not nurses and can't give meds like painkillers for example.
NHS is absolutely NOT safe in Tory hands.... but not a lot safer in Labour hands either; they rolled out all this PFI nonsense on a massive scale.
ks. Healthcare should be a public service paid for by all to benefit all; not a profit making business. I think the big issues are:
1) Regardless of the system in place, we simply don't spend enough per head of population compared to other countries.
2) Cuts in social care and welfare just flow through to the NHS as people end up at their GP or in A&E instead.
3) Almost constant top-down reorganisation and political interference. Leave the NHS alone for more than 5 minutes to see what is going on, then listen to doctors at ground level before making changes. Ignore the 'noctors' and managers that have climbed the greasy pole of politics and have an agenda of their own.
4) Fragmentation of services, internal market and crazy levels of bureaucracy. The NHS is a huge employer and massive purchaser. It should be able to dictate terms of purchase (like supermarkets) when it comes to drugs and supplies. However because everything is so fragmented it doesn't work out that way and drug companies set unjustifiable prices. PFI payments cripple hospitals and cost more in the long run. The internal market makes no sense - all services ultimately come out of the taxpayer pocket so why employ an army of admin staff to 'bill' each other?
5) Politicians MUST stop generating unrealistic expectations, especially for GP services. If people want 12 hour access 7 days a week then they should pay extra for it. Promising that everyone can see their (note, not a) GP within 48 hours or at 7pm on a Sunday evening is just ridiculous.
Oh, and IMO the problems have nothing to do with staff pensions or how nurses are trained. You can train a nurse however you want, but if there is only 1 trained nurse to 16 patients then they are going to wait a long time for their medications. HCA are not nurses and can't give meds like painkillers for example.
NHS is absolutely NOT safe in Tory hands.... but not a lot safer in Labour hands either; they rolled out all this PFI nonsense on a massive scale.
Edited by VolvoT5 on Friday 3rd April 13:57
VolvoT5 said:
5) Politicians MUST stop generating unrealistic expectations, especially for GP services. If people want 12 hour access 7 days a week then they should pay extra for it. Promising that everyone can see their (note, not a) GP within 48 hours or at 7pm on a Sunday evening is just ridiculous.
VolvoT5 said:
NHS has major issues but I don't believe the ever creeping move towards a fully American style private system is working. So much money is already wasted on the 'internal market' bks. Healthcare should be a public service paid for by all to benefit all; not a profit making business.
I think the big issues are:
1) Regardless of the system in place, we simply don't spend enough per head of population compared to other countries.
because , although money is wasted in mangement left right and centre the NHS doesn't waste money on micro level transactional / supplies accounting ... it doesn't matter to the system if i sue six pices of gauze and two packets of sutures or 5 pieces of gauze and manage to eek out one packet of suture material ... ks. Healthcare should be a public service paid for by all to benefit all; not a profit making business. I think the big issues are:
1) Regardless of the system in place, we simply don't spend enough per head of population compared to other countries.
you can monitor it on a macro level and there are some things where wasteage in supplies etc is an issue ( some is systems and some is human factors - one of the systems ones is care home residents have to have their own personal supply of relatively infrequently used 'as required ' meds but that is how the community prescribing system works - in hospital you can hold stock at a unit level and draw a dose from stock when it;s needed ...
The NHS negotiates in big bulk - they might turn round to 3M or Smith and nephew and say we want 10 million of those a year , and deliver them to NHS Supply Chain 26 pallets a time ... rather than each hospital / clinic / ambulance service buying a few thousand / few tens of thousands a year and wanting them delivered as and when to the local sites ...
VolvoT5 said:
2) Cuts in social care and welfare just flow through to the NHS as people end up at their GP or in A&E instead.
well they do if the people in LAs choose to cut service while buying new computers, pot plants and nice coffee and driving round in theur unneeded lease cars - the ranks of politicla commissars put in place 1997 -2010 still persist in LAs and the NHSVolvoT5 said:
3) Almost constant top-down reorganisation and political interference. Leave the NHS alone for more than 5 minutes to see what is going on, then listen to doctors at ground level before making changes. Ignore the 'noctors' and managers that have climbed the greasy pole of politics and have an agenda of their own.
the problem is that no one has had the testicular fortitude to deal with a couple of issues 1. peter principle management and a reluctance to use the extant capability and disciplinary processes against managers
2. the ranks of political commissars imposed 1007 - 2010
3. the lack of clinical currency in many Nursing and AHP senior managers ( very few 'Noctors' as you disparagingly call Masters and Doctorate prepared Higher level practicing Health care Professionals are in management as you make a choice at band 6 level whether to become a specilist clinician or whether to give up on clinicial competency and become a (mis)manager)
4. buggin's turn attitude towards promotion and develoipment at bands 5 -7 for Nurses and AHPs
VolvoT5 said:
4) Fragmentation of services, internal market and crazy levels of bureaucracy. The NHS is a huge employer and massive purchaser. It should be able to dictate terms of purchase (like supermarkets) when it comes to drugs and supplies. However because everything is so fragmented it doesn't work out that way and drug companies set unjustifiable prices.
you are incorrect there, the drug companies set the prices based on what they can charge and recieve from fragmented services eslewhere in the world ... the nHS does very well as it stands on what it pays for things VolvoT5 said:
PFI payments cripple hospitals and cost more in the long run.
only becasue you can't 'save' through neglect , much of the hype coming fro mthe left aobut PFI is based in deliberately misunderstanding that it;s not just buying and putting something up you pay for it;s 25 + years of itbeing kept in or near to 'as installed' condition VolvoT5 said:
The internal market makes no sense - all services ultimately come out of the taxpayer pocket so why employ an army of admin staff to 'bill' each other?
money follows patients now in the old days hospitals etc got an arbitrary lump of money to provide their service , now they get money based on activty unfortunately it's interfered with by politicians
VolvoT5 said:
5) Politicians MUST stop generating unrealistic expectations, especially for GP services. If people want 12 hour access 7 days a week then they should pay extra for it. Promising that everyone can see their (note, not a) GP within 48 hours or at 7pm on a Sunday evening is just ridiculous.
I don't think anyone has promised people can see 'their' GP ( as in the Performer upon whose list they appear) but what is being talked about is GP Practices being more than a 9-5 mondy to friday service - some of which you can and will achieve by the simple expedient of staggering the working days of staff all ready in post.
never been convinced by the 48 hour thing either, GP services could be 'front loaded' if the contract encouraged this where triage consultations ( face to face and/or by phone ) were offered in a prompt timeframe with a suitably skilled HCP ( could be a GP, could a GP reg or FOundation doc on GP attahcment could be a Nurse or Paramedic practitioner ) and if a ' proper ' appointment is needed it can be offered with the most appropriate Practitioner in a sensible time frame
VolvoT5 said:
Oh, and IMO the problems have nothing to do with staff pensions or how nurses are trained. You can train a nurse however you want, but if there is only 1 trained nurse to 16 patients then they are going to wait a long time for their medications. HCA are not nurses and can't give meds like painkillers for example.
the problem is the staff side organisations ( one in particualr but another not to close behind deliberately colludes in confusing the public on not explaning the difference between Nurses , Midwifes and the HCPC professions and the assistant grades - because a lot of their NHS based income comes fro mthe assistant grades - historically HCAs couldn;t join the RCN so they had to join COHSE > Unison - they can now if they are managed by Nurses) the ambulance service has no union of it;s own and there's a mixed bag of ex cohse Unison services ex Nupe Unison services , GMB / Unite etc etc VolvoT5 said:
NHS is absolutely NOT safe in Tory hands.... but not a lot safer in Labour hands either; they rolled out all this PFI nonsense on a massive scale.
PFI makes sense if the contract is well written and you don;t swallow some of the bullsEdited by VolvoT5 on Friday 3rd April 13:57
t put around by Unison etcmph1977 said:
PFI makes sense if the contract is well written and you don;t swallow some of the bullst put around by Unison etc
How many are well written.... My local hospital has huge PFI 'debts'. I just don't understand how it can be efficient to borrow money from the private sector and be tied in to long and expensive contracts for maintenance and so on...... not when the government can borrow extremely cheaply directly. t put around by Unison etcStaff side organisations to blame for nursing issues? No I can't buy that one. We need legal limits for the number of patients a nurse is expected to care for and people need to be educated on how the role of nursing has changed (more complex, more patients, more unwell, nurses now to many jobs doctors used to do, etc). It suits the managers to not have anybody be able to tell the difference between a nurse/HCA/Midwife/OT/etc, because it looks like the ward is staffed at a safe level when in reality it is not.
David Cameron said:
"People need to be able to see their GP at a time that suits them and their family. That's why we will ensure everyone can see a GP seven days a week by 2020"
Two examples of unrealistic expectations being generated by a politicians and there is no medical evidence base behind either of these targets as far as I can tell, just populism to gain votes. Where are all these additional GPs going to come from and where is the incentive to be a GP when they are considered lowest of the low in the medical profession? Without sufficient funding for more doctors (plus the associated costs of opening surgeries at weekends) all that will happen is appointments that were done over 5 days will become spread out thinly over 7. Access will still be crap because there is no spare capacity.
All the goodwill in the NHS has gone. Years of abuse by managers, politicians and patients has seen to that. Now if we want decent healthcare it needs funding properly.
VolvoT5 said:
<snip>
Staff side organisations to blame for nursing issues? No I can't buy that one. We need legal limits for the number of patients a nurse is expected to care for and people need to be educated on how the role of nursing has changed (more complex, more patients, more unwell, nurses now to many jobs doctors used to do, etc). It suits the managers to not have anybody be able to tell the difference between a nurse/HCA/Midwife/OT/etc, because it looks like the ward is staffed at a safe level when in reality it is not.
It also suits certain unions comrade ... Staff side organisations to blame for nursing issues? No I can't buy that one. We need legal limits for the number of patients a nurse is expected to care for and people need to be educated on how the role of nursing has changed (more complex, more patients, more unwell, nurses now to many jobs doctors used to do, etc). It suits the managers to not have anybody be able to tell the difference between a nurse/HCA/Midwife/OT/etc, because it looks like the ward is staffed at a safe level when in reality it is not.
Prior to the RCN accpeting HCA members HCAs really only had one choice and that was Unison , along with all the other sundry staff groups that Unison attempts to attract
the RCN was percieved as having a snobbish attitude towards HCAs as 'not good enough' and is percieved by those who are left leaning to be insufficiently radical as it's not suffused with Labour rheotric
yes there are RNs who are unison members (often for party political reasons) but trying to get a staff side consensus on differentiating between RNs and HCAs is going to be hard in that set up and management have encouraged it to allow their own attempt to muddy the waters.
Snozzwangler said:
Halb said:
Halb said:
mph1977 said:
the US model is one not to copy compared to the models in place in mainland Western Europe or Aus
What would be the best model? Worldwide?
certainly not the model the left want for the NHS
a single payer free at the point of clinical need is needed for at least the following
- accidents and trauma
- medical emergencies
- surgical emergencies
- maternity and neonatal services
- paediatrics
- life limiting illnesses and diseases
there is a strong argument for extending this to a large variety of chronic conditions where going untreated means that people will become an unnecessary burden on family and the state
there is a lot less of argument for funding things which are solely 'quality of life' and there needs to be debate over the nature and extent of any contribution from the NHS for these services on welfare / psychological benefit grounds ...
there is no real reason that the state should own or manage providers as long as there is an effective inspection and governance assurance regime... pricing has to be set realistically
there are strong arguments for the ability to purchase services on a 'power by the hour' basis to accomodate variability in demand and /or extremes of demand
there needs to be debate over the acceptability of top-up payment etc rather than the all or nothing approach... however this shouldn;t be used to short cut things - which is why ther all or nothing rule (or penalties for changing to the NHS were brought in )
Edited by mph1977 on Friday 3rd April 21:05
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