Nurses: The NHS is at breaking point
Discussion
I know it's a while ago, but it's indicative of the problem.
http://www.independent.co.uk/news/uk/politics/jere...
SD.
http://www.independent.co.uk/news/uk/politics/jere...
SD.
loafer123 said:
For A&E, the problems seem to be twofold - at the entry point, you have patients wanting instant medical appointments, not wanting to wait for GPs, so the simple answer is to provide that service alongside A&E, so Emergencies go one way and general medical help goes another. Even eminent GPs don't quite get it - the one on Today this morning agreed with the point, but said that the pressure on GPs was just as great as they deal with 8 out of 9 medical appointments. He clearly didn't understand that a movement of 10% of patients from GPs to A&E would be roughly a doubling at A&E.
At the other end, there is clearly a blockage in discharging people due to a lack of social care provision, so we need to build up the Cottage Hospital network again as a halfway house to care at home, thereby releasing capacity within main hospitals.
Confirming your first point:At the other end, there is clearly a blockage in discharging people due to a lack of social care provision, so we need to build up the Cottage Hospital network again as a halfway house to care at home, thereby releasing capacity within main hospitals.
"We estimate that about 30 per cent of attendees to our Emergency Department could have seen a pharmacist or GP instead of coming to the hospital."
http://www.thetelegraphandargus.co.uk/news/1501415...
Edited due to lack of coffee.
Edited by RicksAlfas on Friday 13th January 12:24
RicksAlfas said:
Here's the other problem for A&E departments:
"We estimate that about 30 per cent of attendees to our Emergency Department could have seen a pharmacist or GP instead of coming to the hospital."
http://www.thetelegraphandargus.co.uk/news/1501415...
It would be easier to get an audience with the Prime Minister than an 'appointment' with my GP, unless I am planning on getting ill a fortnight hence."We estimate that about 30 per cent of attendees to our Emergency Department could have seen a pharmacist or GP instead of coming to the hospital."
http://www.thetelegraphandargus.co.uk/news/1501415...
RicksAlfas said:
loafer123 said:
For A&E, the problems seem to be twofold - at the entry point, you have patients wanting instant medical appointments, not wanting to wait for GPs, so the simple answer is to provide that service alongside A&E, so Emergencies go one way and general medical help goes another. Even eminent GPs don't quite get it - the one on Today this morning agreed with the point, but said that the pressure on GPs was just as great as they deal with 8 out of 9 medical appointments. He clearly didn't understand that a movement of 10% of patients from GPs to A&E would be roughly a doubling at A&E.
At the other end, there is clearly a blockage in discharging people due to a lack of social care provision, so we need to build up the Cottage Hospital network again as a halfway house to care at home, thereby releasing capacity within main hospitals.
Here's the other problem for A&E departments:At the other end, there is clearly a blockage in discharging people due to a lack of social care provision, so we need to build up the Cottage Hospital network again as a halfway house to care at home, thereby releasing capacity within main hospitals.
"We estimate that about 30 per cent of attendees to our Emergency Department could have seen a pharmacist or GP instead of coming to the hospital."
http://www.thetelegraphandargus.co.uk/news/1501415...
Therefore we need to provide general non-hospital medical services at the point of need (at hospitals) without appointments, without taking up the resources of the expensive specialist staff struggling to cope in A&E.
I really don't think that money is the problem, it's the management of resources thats the problem.
In my experience, it's the management and managers that are almost universally either crap at their jobs or following policies and procedures that would not be even considered in the real world.
The clinicians seem to know what they are doing, I cannot really judge that as I have no medical experience, but I do have business experience and the NHS organisation stinks.
Just a few examples of my experience of the NHS.
Years ago a coating company I was Sales and Marketing Director for, developed a coating for paper that rendered it 99.9% effective in killing bacteria and viruses on contact. Paper is a brilliant feeding ground for bacteria, it's moist with plenty of food carried within, and for example our research showed us that the average patients admissions slip was handled by 13 people in the first hospital visit. A huge problem for infection/bug transmission. Imagine therefore, if every piece of paper in the NHS acted as a sterile wipe.
Our coated paper killed the bugs. We tried to get it into the NHS but the buyers weren't interested. We even arranged to provide the treated paper at the same cost as the untreated paper. They still weren't interested. Infection control was not part of the buyers remit. Went up the NHS feeding chain, still no interest. We shelved the concept and printed nappies with Disney characters instead.
My father was suffering from dementia and turned into a bed blocker in hopsital for 4 weeks, even though we were paying for a room in a care home (which was locked waiting for him) because the hospital and the care home could not agree on a care plan. He was waiting to be discharged but the admin couldn't be sorted.
As I am of a certain age I was recently invited for a blood test by my local GP so I went along to have my "Tony Hancock moment" carried out by the practice nurse. When there I asked if the PSA ( Prostate Protein) level could be tested and the nurse replied that it wasn't on the list but clicked on the computer screen a couple of times and then went on to take bloods.
A week later I phoned up for the results ( all good, even the liver function suprisingly as beer is an important part of my diet) and asked about the PSA level only to be told that it had not been requested in that batch of tests but I could request one now. Which I did.
So I had to go back , taking up another appointment, to have bloods taken again, to be sent to the same lab and to have a whole new tets carried out, useless, expensive duplication. PSA level was fine btw.
Now I am a great believer that good management cascades downward through an organisation.
So for example who do we have at the top of the NHS trusts in my area, Birmingham.
Well what would a former Home Economics teacher, who got caught fiddling expenses as an MP, and who was sacked by her constintuents see as the logical progression to her career.
Well for Jacqui Smith it was not to become the chairman of just one NHS trust, Birmingham University Hospital NHS Foundation Trust, but also a second The Heart of England NHS Trust, collecting a salary from both.
So she went from baking cakes, to fiddling expenses, to leading organisations with budgets well into the billions of £.
That in microcosm is the problem with the NHS.
And 2600 of these "managers" who fail to manage so spectacularly are paid more than the PM.
No wonder they all say we need to shovel more money into this bottomless pit. Wouldn't you in their position.
Cheers,
Tony
In my experience, it's the management and managers that are almost universally either crap at their jobs or following policies and procedures that would not be even considered in the real world.
The clinicians seem to know what they are doing, I cannot really judge that as I have no medical experience, but I do have business experience and the NHS organisation stinks.
Just a few examples of my experience of the NHS.
Years ago a coating company I was Sales and Marketing Director for, developed a coating for paper that rendered it 99.9% effective in killing bacteria and viruses on contact. Paper is a brilliant feeding ground for bacteria, it's moist with plenty of food carried within, and for example our research showed us that the average patients admissions slip was handled by 13 people in the first hospital visit. A huge problem for infection/bug transmission. Imagine therefore, if every piece of paper in the NHS acted as a sterile wipe.
Our coated paper killed the bugs. We tried to get it into the NHS but the buyers weren't interested. We even arranged to provide the treated paper at the same cost as the untreated paper. They still weren't interested. Infection control was not part of the buyers remit. Went up the NHS feeding chain, still no interest. We shelved the concept and printed nappies with Disney characters instead.
My father was suffering from dementia and turned into a bed blocker in hopsital for 4 weeks, even though we were paying for a room in a care home (which was locked waiting for him) because the hospital and the care home could not agree on a care plan. He was waiting to be discharged but the admin couldn't be sorted.
As I am of a certain age I was recently invited for a blood test by my local GP so I went along to have my "Tony Hancock moment" carried out by the practice nurse. When there I asked if the PSA ( Prostate Protein) level could be tested and the nurse replied that it wasn't on the list but clicked on the computer screen a couple of times and then went on to take bloods.
A week later I phoned up for the results ( all good, even the liver function suprisingly as beer is an important part of my diet) and asked about the PSA level only to be told that it had not been requested in that batch of tests but I could request one now. Which I did.
So I had to go back , taking up another appointment, to have bloods taken again, to be sent to the same lab and to have a whole new tets carried out, useless, expensive duplication. PSA level was fine btw.
Now I am a great believer that good management cascades downward through an organisation.
So for example who do we have at the top of the NHS trusts in my area, Birmingham.
Well what would a former Home Economics teacher, who got caught fiddling expenses as an MP, and who was sacked by her constintuents see as the logical progression to her career.
Well for Jacqui Smith it was not to become the chairman of just one NHS trust, Birmingham University Hospital NHS Foundation Trust, but also a second The Heart of England NHS Trust, collecting a salary from both.
So she went from baking cakes, to fiddling expenses, to leading organisations with budgets well into the billions of £.
That in microcosm is the problem with the NHS.
And 2600 of these "managers" who fail to manage so spectacularly are paid more than the PM.
No wonder they all say we need to shovel more money into this bottomless pit. Wouldn't you in their position.
Cheers,
Tony
edh said:
Good, I'm glad we agree we can afford "decent" healthcare and it is sustainable. That's not where we're heading though.
Subjective. My point stands in that I believe we can have decent healthcare without increasing the NHS budget. We just need to spend the existing budget more appropriately.edh said:
Governments make choices - this one has chosen to slash local govt funding (blame your local council when services collapse, not us..) As forecast, the effects on social care are now hitting the NHS.
Given the current deficit of £40bn, I'm keen to understand which other services you'd be happy to cut to balance the books...Tony427 said:
I really don't think that money is the problem, it's the management of resources thats the problem...
Superb post.My personal experiences with the NHS tend to echo yours. I've had three operations on my shoulder after a very big downhill mountain bike crash in the French Alps. First op was in France - excellent. Second in UK at Cannock, also excellent. Third also in UK at Stafford, excellent again, but I was over an hour waiting, needlessly - as in although it was an op under GA, I was mowing the lawns within an hour of returning home - blocking a bed, because they had not organised discharge meds.
On interim visits to see the consultant, physios or to have scans and x-rays, I was constantly struck by a paradox; the frontline people and those on receptions were, generally, flat-out, working hard, but there were hordes of their colleagues visibly loafing around, busy doing nothing, every NHS hospital I visited. The most basic time and movement study would reveal a lot.
alfie2244 said:
Digga said:
Lucas CAV said:
What management changes would you make?
Talking to people I know who work in the NHS (as in, actually do a job on the frontline), get rid of a few. I am told, a good number would not be missed and, moreover, would actually increase efficiency by the lack of their meddling.Pan Pan Pan said:
I was always surprised by how many people working in the NHS were morbidly obese, and smoked like chimnies. perhaps they believed that when it comes to paying for their health life choices, they were already in the best place?
My mate was visiting his sister in New Cross Hospital in Wolverhampton and remarked that he'd overtaken, on foot, a nurse through one of the long corridors in the building who barely seemed capable of perambulating about the job, due to her heft.
edh said:
hyphen said:
edh said:
This is nonsense.
1. We have more people in work (being productive and paying tax) in this country than ever before (and a larger population) - why can't we fund heathcare for them?
1. We have more people in work (being productive and paying tax) in this country than ever before (and a larger population) - why can't we fund heathcare for them?
People being in work doesn't automatically mean they are net contributors financially.
Low wage earner probably paying more in rents than in tax, and we don't tax the rentier economy enough.
On the left there are those moaning about privatisation or lack of funding.
On the right there are those who moan about immigration or 'left wing waste' (diversity costs, hippie treatments etc)
Neither side wants to admit to a simple fact - we are trying to keep very ill people alive for longer than before. It's a societal problem.
On the right there are those who moan about immigration or 'left wing waste' (diversity costs, hippie treatments etc)
Neither side wants to admit to a simple fact - we are trying to keep very ill people alive for longer than before. It's a societal problem.
Joey Ramone said:
fatandwheezing said:
That means every employee costs on average about £23 per day, plus this also covers all the facilities drugs and stuff. Sounds like a bargain to me.
NopeNHS costs £106 billion per year, which is just under £300 million per day.
I don't know what that does to your employee costs exactly but I'm guessing you're looking at... a lot.
Tony427 said:
I really don't think that money is the problem, it's the management of resources thats the problem.
<snip>
No wonder they all say we need to shovel more money into this bottomless pit. Wouldn't you in their position.
Cheers,
Tony
I love posts like this. I do. <snip>
No wonder they all say we need to shovel more money into this bottomless pit. Wouldn't you in their position.
Cheers,
Tony
On one hand, you have research after research, by people who know what they are doing, saying that NHS is one of the most efficient health systems in the world. On the other hand, you have Tony, who knows better, and NHS is 'bottomless pit'.
There are some overpaid managers in NHS, just like there are some overpaid people in any organization (>50 people) you care to mention.
To characterize the whole of NHS as bottomless pit because of that is stupid.
sidicks said:
edh said:
Good, I'm glad we agree we can afford "decent" healthcare and it is sustainable. That's not where we're heading though.
Subjective. My point stands in that I believe we can have decent healthcare without increasing the NHS budget. We just need to spend the existing budget more appropriately.sidicks said:
edh said:
Governments make choices - this one has chosen to slash local govt funding (blame your local council when services collapse, not us..) As forecast, the effects on social care are now hitting the NHS.
Given the current deficit of £40bn, I'm keen to understand which other services you'd be happy to cut to balance the books...NHS management is an interesting one - too many, to few..? I see poor management in pretty much every large organisation I've ever encountered. NHS isn't unique, but could do much better. Gerry Robinson did an excellent TV prog on it a few years back.
Sheepshanks said:
dvs_dave said:
I don't know why they don't introduce flat visit fees. For example:
Doctors Office visit: £20
Specialist visit: £30
A&E visit: £75
OAP's, under 18's and registered disabled: No charge
Up to an annual maximum of £250, or 0.5% of your annual income. Whichever is higher.
The poor/idle can claim any charges back as a credit on whatever benefits they're already receiving.
Would take a massive load off the system overnight and free it up for people genuinely in need.
It'd be a "tax on the sick".Doctors Office visit: £20
Specialist visit: £30
A&E visit: £75
OAP's, under 18's and registered disabled: No charge
Up to an annual maximum of £250, or 0.5% of your annual income. Whichever is higher.
The poor/idle can claim any charges back as a credit on whatever benefits they're already receiving.
Would take a massive load off the system overnight and free it up for people genuinely in need.
As I noted above, likelihood is that very few people would be eligible to pay.
edh said:
Lots of choices, on tax, expenditure, and deficit size.. I think I've set out my views many times before. LVT for starters, end to numerous tax reliefs, stop HS2, Trident, Hinkley Point & other grandiose / vanity projects, can free schools, stop private profit extraction from public (monopoly) services (rail, utilities, and now NHS), lots to go at. Then spend capital monies on projects that have a decent multiplier effect & short term returns..
NHS management is an interesting one - too many, to few..? I see poor management in pretty much every large organisation I've ever encountered. NHS isn't unique, but could do much better. Gerry Robinson did an excellent TV prog on it a few years back.
To summarise - someone else can pay (a lot) more tax?NHS management is an interesting one - too many, to few..? I see poor management in pretty much every large organisation I've ever encountered. NHS isn't unique, but could do much better. Gerry Robinson did an excellent TV prog on it a few years back.
sidicks said:
edh said:
Lots of choices, on tax, expenditure, and deficit size.. I think I've set out my views many times before. LVT for starters, end to numerous tax reliefs, stop HS2, Trident, Hinkley Point & other grandiose / vanity projects, can free schools, stop private profit extraction from public (monopoly) services (rail, utilities, and now NHS), lots to go at. Then spend capital monies on projects that have a decent multiplier effect & short term returns..
NHS management is an interesting one - too many, to few..? I see poor management in pretty much every large organisation I've ever encountered. NHS isn't unique, but could do much better. Gerry Robinson did an excellent TV prog on it a few years back.
To summarise - someone else can pay (a lot) more tax?NHS management is an interesting one - too many, to few..? I see poor management in pretty much every large organisation I've ever encountered. NHS isn't unique, but could do much better. Gerry Robinson did an excellent TV prog on it a few years back.
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