Junior Doctor's contracts petition
Discussion
sidicks said:
That's a real annual increase, not a nominal one, isn't it?
And population growth is below 1% p.a....
Increase in funding (inc infl) is 0.9% while population growth is 0.8%, IIRC from kingsfund. That tells very little without taking into account, for example, that population is getting older. You know about pensions so you'll know about that. Or fatter. Or increase in drugs costs. So much so that Circle has pulled out of Hitchinsbrooke (spelling?) and according to ceo one of the main reasons was 'unprecedented, 30% increase in demands on A&E'. And population growth is below 1% p.a....
Sway said:
We're also ignoring failure demand - which runs at around 40% of A&E demand, and is potentially significantly higher across the whole system, due to the lack of systems integration partially due to excessive focus on staff's personal specialisation and a lack of communication and structured management of connected issues...
As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
Are you actually saying that, if there was no resistance to change, you think that savings between 30-50% are achievable, 'for immensely greater outcome as defined by the customers'?As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
sidicks said:
Dixy said:
And how much of any of this has what to do with the Junior Doctors contract?
According to certain people, the JD dispute is evidence of the Tory plans to privatise the NHS...How about this then:
http://order-order.com/2016/04/26/junior-doctors-i...
Guido said:
...Struggling on their not undeserved triple average earnings...
JDs are on triple average earnings? Guido knows their target audience quite well, after a comment on fruitcake's support for homeopathy;
Guido comments said:
the Queens physician, Doctor Peter Fisher has called for more homeopathy on the NHS see www.telegraph.co.uk
i have benefited from homeopathy treatment,
i have also suffered awful secondary effects from a GPs prescription for antibiotics ,but a fuller understanding of homeopathy will do no one harm .
i have benefited from homeopathy treatment,
i have also suffered awful secondary effects from a GPs prescription for antibiotics ,but a fuller understanding of homeopathy will do no one harm .
Fantastic article in FT (no paywall) by Tim Harford.
http://www.ft.com/cms/s/2/2e43b3e8-01c7-11e6-ac98-...
http://www.ft.com/cms/s/2/2e43b3e8-01c7-11e6-ac98-...
jjlynn27 said:
Sway said:
We're also ignoring failure demand - which runs at around 40% of A&E demand, and is potentially significantly higher across the whole system, due to the lack of systems integration partially due to excessive focus on staff's personal specialisation and a lack of communication and structured management of connected issues...
As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
Are you actually saying that, if there was no resistance to change, you think that savings between 30-50% are achievable, 'for immensely greater outcome as defined by the customers'?As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
After all, those and higher benefits have been experienced in equally complex industries...
To add, it's not just resistance to change but also the politicising of the NHS that means I don't believe the real reforms we should be striving for will ever be achieved...
As an really verifiable example - much has been said of the difficulty in attracting emergency care specialists. Do a quick Google for "failure demand in the NHS" and you'll see several links explaining 40 odd % of A&E demand is due to failure demand. Would we have an issue if we only needed to serve 60% of current volumes?
As an really verifiable example - much has been said of the difficulty in attracting emergency care specialists. Do a quick Google for "failure demand in the NHS" and you'll see several links explaining 40 odd % of A&E demand is due to failure demand. Would we have an issue if we only needed to serve 60% of current volumes?
sidicks said:
e21Mark said:
How did you determine it was evidence free?
Because you provided no evidence.HTH
fblm said:
e21Mark said:
...
In fact privatisation has soared by 500% in the last year.
...
In fact privatisation has soared by 500% in the last year.
...
Big scary number! Let me guess they leased a CT scanner this year instead of buying one. Got a link to this "fact"? I'd have thought it was front page of every paper but strangely I can't find it.
e21Mark said:
sidicks said:
e21Mark said:
How did you determine it was evidence free?
Because you provided no evidence.HTH
fblm said:
e21Mark said:
...
In fact privatisation has soared by 500% in the last year.
...
In fact privatisation has soared by 500% in the last year.
...
Big scary number! Let me guess they leased a CT scanner this year instead of buying one. Got a link to this "fact"? I'd have thought it was front page of every paper but strangely I can't find it.
That was your claim wasn't it?
I might have missed something but what exactly is your field Sway? This thread has twisted and turned, been hijacked by Adam and tried to be kepte on track by 968. I don't think anyone who actually works in the NHS has said there are not savings to be made. There are, but plucking figures of 30- 50% out of thin air is impossible to substantiate especially with better out comes.
Reducing A&E demand is a great idea, but the reality of an aging population, increased population , difficulty getting to see a GP, more violence, drink issues, more obese and a generation of people who do not know the difference between a cold and some serious illness, means that will never be reduced unless money is pumped in elsewhere.
This could be in health promotions in schools, all people first aid trained, child care classes in schools again, gym memberships to get obese fitter. Gym classes for the old for mobility, stopping health tourists, the list goes on and on but none of these are the fault of Dr's.
Could money be better spent, yes, could we cut out wasteful spending, yes, would the NHS improve if politics were taken out and a cross party approach was agreed and stuck with a most definite yes.
The key to this dispute is a SOS who is hell bent on getting his way. Ignoring all the problems we can all see, his answer is to destroy the moral of the staff, blame Dr's for all the woes and refuse to discuss any further any issues.
In his latest speech he said he said he was willing to discuss their legitimate concerns, but not the imposition of the contract, even though that to them is a legitimate concern as it covers so much. So that's it in his mind no point talking.
Where it goes from here who knows but without talking sensibly and allowing those who he employed to negotiate to do just that freely, without his veto being used there is no end in sight.
Reducing A&E demand is a great idea, but the reality of an aging population, increased population , difficulty getting to see a GP, more violence, drink issues, more obese and a generation of people who do not know the difference between a cold and some serious illness, means that will never be reduced unless money is pumped in elsewhere.
This could be in health promotions in schools, all people first aid trained, child care classes in schools again, gym memberships to get obese fitter. Gym classes for the old for mobility, stopping health tourists, the list goes on and on but none of these are the fault of Dr's.
Could money be better spent, yes, could we cut out wasteful spending, yes, would the NHS improve if politics were taken out and a cross party approach was agreed and stuck with a most definite yes.
The key to this dispute is a SOS who is hell bent on getting his way. Ignoring all the problems we can all see, his answer is to destroy the moral of the staff, blame Dr's for all the woes and refuse to discuss any further any issues.
In his latest speech he said he said he was willing to discuss their legitimate concerns, but not the imposition of the contract, even though that to them is a legitimate concern as it covers so much. So that's it in his mind no point talking.
Where it goes from here who knows but without talking sensibly and allowing those who he employed to negotiate to do just that freely, without his veto being used there is no end in sight.
Sway said:
jjlynn27 said:
Sway said:
We're also ignoring failure demand - which runs at around 40% of A&E demand, and is potentially significantly higher across the whole system, due to the lack of systems integration partially due to excessive focus on staff's personal specialisation and a lack of communication and structured management of connected issues...
As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
Are you actually saying that, if there was no resistance to change, you think that savings between 30-50% are achievable, 'for immensely greater outcome as defined by the customers'?As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
After all, those and higher benefits have been experienced in equally complex industries...
It was shown, from few different sources, that in term of spend p/c, UK is nowhere near the top, while being very efficient. People might disagree on where it's important to spend money (I personally think that we should spend more money on better outcomes for cancer patients, for personal reasons). I also don't doubt that there is waste that should be eradicated.
Imagine what you could do with 'paradigm change' in less-efficient countries, unless you think resistance to change is ingrained in any health system around the world.
All that in the same post where you are dismissing the fact that no-one else is doing things differently regardless of funding system. You are not inventing graphene here, all those systems are being around for a while.
Experiences that you have with your wife's treatment are clouding your judgement, quite severely, imo.
Sway said:
I also stated that your assertion was evidence free, and after you asked showed my reasoning for why I think a claim that there's been a five fold increase of privatisation had occurred this year...
That was your claim wasn't it?
Sorry, I missed that. That was your claim wasn't it?
The figures I quoted came from research by NHS Support Federation.
e21Mark said:
Taken from recent article by Paul Evans. (NHS Support Federation)
Seriously? I guess you forgot to mention the 50% drop the previous year? Furthermore thats 3.5bn of multi year contracts in 2015 compared to an annual budget of what £120bn? Without knowing the duration of those contracts, you can't even say if the actual annual % of budget even went up or down! Nor how many were renewals of previous contracts. Desperate stuff. I suppose some people fall for the big scary headline numbers though. In any event in my singular experience of the NHS it was not fit for purpose, it's hard to see how privatising a few tiny bits of it can be so bad.Edited by anonymous-user on Friday 29th April 17:36
I'm a business improvement (lean six sigma) consultant - I now run my own consultancy with a few fellow consultants working for me.
I've worked in industries as diverse as farming, automotive, aerospace, electronics, financial services, and more.
My friends/peers, who I would say are significantly better than me, are the ones who've diagnosed and come up with those figures and told me them. None are household names, but within the field they are well known and respected with staggering lists of achievements.
To take your A&E comments - none of those relate to failure demand. I've given precious posts regarding my other half's experiences over the last 15 years.
To summarise them, and to give you an idea of what I mean by failure demand, she's on average seen a GP/specialist/A&E/etc. twice a week for the last 15 years. So even lowballing that's a thousand interactions/treatments/etc. none have had an effect, yet the cost must be staggering.
I mentioned earlier that recently, entirely by chance, she got referred by her local GP to a different type of specialist at the local Nuffield. He has already proved to her he can fix her properly for two operations and 18 months of rehab. That's in three appointments, plus a CT scan.
All because every single one of the people she's dealt with for the last 15 years have either ignored her as a hypochondriac, or seen a label regarding a genetic condition she's diagnosed with, and assumed that it cannot be fixed - the actual issue is much more straightforward, and as said for the first time in over a decade she has a hope of a meaningful and relatively pain free life. Just for clarity, she's 32, and this writing off has significantly limited her quality of life - probably permanently in some other ways.
I've worked in industries as diverse as farming, automotive, aerospace, electronics, financial services, and more.
My friends/peers, who I would say are significantly better than me, are the ones who've diagnosed and come up with those figures and told me them. None are household names, but within the field they are well known and respected with staggering lists of achievements.
To take your A&E comments - none of those relate to failure demand. I've given precious posts regarding my other half's experiences over the last 15 years.
To summarise them, and to give you an idea of what I mean by failure demand, she's on average seen a GP/specialist/A&E/etc. twice a week for the last 15 years. So even lowballing that's a thousand interactions/treatments/etc. none have had an effect, yet the cost must be staggering.
I mentioned earlier that recently, entirely by chance, she got referred by her local GP to a different type of specialist at the local Nuffield. He has already proved to her he can fix her properly for two operations and 18 months of rehab. That's in three appointments, plus a CT scan.
All because every single one of the people she's dealt with for the last 15 years have either ignored her as a hypochondriac, or seen a label regarding a genetic condition she's diagnosed with, and assumed that it cannot be fixed - the actual issue is much more straightforward, and as said for the first time in over a decade she has a hope of a meaningful and relatively pain free life. Just for clarity, she's 32, and this writing off has significantly limited her quality of life - probably permanently in some other ways.
I understand where you are coming from with your wife. The issue is definitely how well the GP takes on board an issue and deal with it.
My MIL had a history of depression, she complained of pains which were put down to a mental problem. After seeing another Dr she had cancer and died 6 months later.
My wife had leg swelling and saw three different Drs before it was found what the issue was by process of elimination. The problem with the NHS is it is not joined up and if it is not what one specialist you see can cure, you go to the back of the queue for the next and so on. When it is private they pass you on quickly. It took less then a month to see three consultants and the last one had the answer.
You could say the first two failed, but in reality they did not, they were part of the process and I cannot see how you could cut them out or see it as a failure.
I don't have the answer but I still feel Dr's are not the biggest issue in the NHS and many consultants over the years have been paid to find out what needs to be changed and little does, it would appear.
My MIL had a history of depression, she complained of pains which were put down to a mental problem. After seeing another Dr she had cancer and died 6 months later.
My wife had leg swelling and saw three different Drs before it was found what the issue was by process of elimination. The problem with the NHS is it is not joined up and if it is not what one specialist you see can cure, you go to the back of the queue for the next and so on. When it is private they pass you on quickly. It took less then a month to see three consultants and the last one had the answer.
You could say the first two failed, but in reality they did not, they were part of the process and I cannot see how you could cut them out or see it as a failure.
I don't have the answer but I still feel Dr's are not the biggest issue in the NHS and many consultants over the years have been paid to find out what needs to be changed and little does, it would appear.
Edited by spaximus on Friday 29th April 19:11
jjlynn27 said:
If you came to a meeting and said 'I can provide 30-50 saving while delivering significantly better service' you'd be, quite rightly imo, laughed out of the room.
It was shown, from few different sources, that in term of spend p/c, UK is nowhere near the top, while being very efficient. People might disagree on where it's important to spend money (I personally think that we should spend more money on better outcomes for cancer patients, for personal reasons). I also don't doubt that there is waste that should be eradicated.
Imagine what you could do with 'paradigm change' in less-efficient countries, unless you think resistance to change is ingrained in any health system around the world.
All that in the same post where you are dismissing the fact that no-one else is doing things differently regardless of funding system. You are not inventing graphene here, all those systems are being around for a while.
Experiences that you have with your wife's treatment are clouding your judgement, quite severely, imo.
Every industry I've worked in, I've been told is 'different', every company I've worked in it's 'different' from its competitors. Yet I or my predecessors have manaaged those sorts of figures over time. I do acknowledge I'm lucky though, McKinsey and Co state 96% of cultural business transformations fall - with 87% being due to a lack of staff or management engagement. My run rate exceeds that by quite a bit, hence the luck. It was shown, from few different sources, that in term of spend p/c, UK is nowhere near the top, while being very efficient. People might disagree on where it's important to spend money (I personally think that we should spend more money on better outcomes for cancer patients, for personal reasons). I also don't doubt that there is waste that should be eradicated.
Imagine what you could do with 'paradigm change' in less-efficient countries, unless you think resistance to change is ingrained in any health system around the world.
All that in the same post where you are dismissing the fact that no-one else is doing things differently regardless of funding system. You are not inventing graphene here, all those systems are being around for a while.
Experiences that you have with your wife's treatment are clouding your judgement, quite severely, imo.
As for being laughed out, my source are friends and peers who are being paid a fair chunk by Whitehall or specific NHS Trusts. Due to the lack of engagement and understanding, they're clever enough to not bother presenting the future state they know through analysis could be achieved - it's not good practice to suggest the client is the problem... Hence why I'm not daft enough to accept the massive day rates I've been offered to join them, I'm far happier taking less from customers who are willing to drive real change.
I know my other half is an outlier, but the cost of a thousand interactions/treatments versus about 30 (so we're currently told, assuming the plan goes as expected and she puts the effort in). Even if she's in the 0.5%, eliminating that would have a meaningful effect on both the mean demand and mean cost per capita... Oh, and to get back on topic, the resource requirements to serve that demand.
spaximus said:
The problem with the NHS is it is not joined up
This has been a problem for my step-son who is currently in ITU at the Royal London. He has a history of heart problems (including surgery as an infant and again at 2 years) which was managed by the team at The Brook Hospital, but because he has been admitted with an abscess on his brain, the lack of knowledge and input has meant treatment has stalled, for fear of complications relating to his medical history. The amount of 'trust politics' that have come into play, whilst he is literally clinging to life, is quite shocking and various departments feel as if they are almost hindering one another instead of helping.spaximus said:
I understand where you are coming from with your wife. The issue is definitely how well the GP takes on board an issue and deal with it.
My MIL had a history of depression, she complained of pains which were put down to a mental problem. After seeing another Dr she had cancer and died 6 months later.
My wife had leg swelling and saw three different Drs before it was found what the issue was by process of elimination. The problem with the NHS is it is not joined up and if it is not what one specialist you see can cure, you go to the back of the queue for the next and so on. When it is private they pass you on quickly. It took less then a month to see three consultants and the last one had the answer.
You could say the first two failed, but in reality they did not, they were part of the process and I cannot see how you could cut them out or see it as a failure.
I don't have the answer but I still feel Dr's are the biggest issue in the NHS and many consultants over the years have been paid to find out what needs to be changed and little does, it would appear.
In this instance, is not just GPS, but 'specialists' - yet the Nuffield guy spotted the issue in the ten seconds it took for her to walk from door to seat - it's that obvious if you know what you're looking for, which is suggest various osteopaths and physios should do. My MIL had a history of depression, she complained of pains which were put down to a mental problem. After seeing another Dr she had cancer and died 6 months later.
My wife had leg swelling and saw three different Drs before it was found what the issue was by process of elimination. The problem with the NHS is it is not joined up and if it is not what one specialist you see can cure, you go to the back of the queue for the next and so on. When it is private they pass you on quickly. It took less then a month to see three consultants and the last one had the answer.
You could say the first two failed, but in reality they did not, they were part of the process and I cannot see how you could cut them out or see it as a failure.
I don't have the answer but I still feel Dr's are the biggest issue in the NHS and many consultants over the years have been paid to find out what needs to be changed and little does, it would appear.
As for systems thinking, it's this that the customer measures. When you buy something online, you don't care how long it takes for the order to be processed, or how long it takes to be picked. You care about total lead time from order to receipt. So that's what Amazon measure.
Targets for the wait between appointments are irrelevant, total lead time from first presentation to final discharge is what matters, yet no one in the NHS cares, measures or is held accountable for it.
Add in the problem that customers trust what doctors say and recommend, and it takes a doctor to tell you another doctor was wrong exacerbates the levels of failure demand...
Sway said:
I'm a business improvement (lean six sigma) consultant - I now run my own consultancy with a few fellow consultants working for me.
I've worked in industries as diverse as farming, automotive, aerospace, electronics, financial services, and more.
My friends/peers, who I would say are significantly better than me, are the ones who've diagnosed and come up with those figures and told me them. None are household names, but within the field they are well known and respected with staggering lists of achievements.
To take your A&E comments - none of those relate to failure demand. I've given precious posts regarding my other half's experiences over the last 15 years.
To summarise them, and to give you an idea of what I mean by failure demand, she's on average seen a GP/specialist/A&E/etc. twice a week for the last 15 years. So even lowballing that's a thousand interactions/treatments/etc. none have had an effect, yet the cost must be staggering.
I mentioned earlier that recently, entirely by chance, she got referred by her local GP to a different type of specialist at the local Nuffield. He has already proved to her he can fix her properly for two operations and 18 months of rehab. That's in three appointments, plus a CT scan.
All because every single one of the people she's dealt with for the last 15 years have either ignored her as a hypochondriac, or seen a label regarding a genetic condition she's diagnosed with, and assumed that it cannot be fixed - the actual issue is much more straightforward, and as said for the first time in over a decade she has a hope of a meaningful and relatively pain free life. Just for clarity, she's 32, and this writing off has significantly limited her quality of life - probably permanently in some other ways.
Extraordinary claim require extraordinary evidence. I'm sure that some black belt sig sigmas, think, that they could save that much. For reasons already stated I think that they are way of the mark. Do you not think that if those efficiencies where achievable they wouldn't be utilized either here or anywhere else? Do you allow for the possibility that health systems across the world had management consultants had a look?I've worked in industries as diverse as farming, automotive, aerospace, electronics, financial services, and more.
My friends/peers, who I would say are significantly better than me, are the ones who've diagnosed and come up with those figures and told me them. None are household names, but within the field they are well known and respected with staggering lists of achievements.
To take your A&E comments - none of those relate to failure demand. I've given precious posts regarding my other half's experiences over the last 15 years.
To summarise them, and to give you an idea of what I mean by failure demand, she's on average seen a GP/specialist/A&E/etc. twice a week for the last 15 years. So even lowballing that's a thousand interactions/treatments/etc. none have had an effect, yet the cost must be staggering.
I mentioned earlier that recently, entirely by chance, she got referred by her local GP to a different type of specialist at the local Nuffield. He has already proved to her he can fix her properly for two operations and 18 months of rehab. That's in three appointments, plus a CT scan.
All because every single one of the people she's dealt with for the last 15 years have either ignored her as a hypochondriac, or seen a label regarding a genetic condition she's diagnosed with, and assumed that it cannot be fixed - the actual issue is much more straightforward, and as said for the first time in over a decade she has a hope of a meaningful and relatively pain free life. Just for clarity, she's 32, and this writing off has significantly limited her quality of life - probably permanently in some other ways.
Your example, and I do why it's so important to you, is colouring your judgement.
We'll disagree on what efficiency savings are possible, but it might be a time to return this thread to the topic.
Best wishes to your wife for speedy recovery.
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